Old Raven House

Old Raven House is a residential care home. It provides personal care and accommodation for up to 36 older people. There were 33 people living at the service at the time of inspection, some of whom were living with dementia.

People’s experience of using this service:

The home had undergone a change in ownership since our last inspection. There had been changes to the provider, management structure and the systems to monitor quality and safety. This had contributed towards improvements in how staff assessed and monitored risks associated with people’s health and medical conditions.

The registered manager fostered a positive atmosphere and was practically involved in the day to day running of the service. They had a good understanding of their role and responsibilities.

People told us they were happy with the care they received at Old Raven House. There was a homely atmosphere at the service, where people felt comfortable with staff and in their surroundings.

Staff understood people’s needs and were motivated in their role. They treated people with dignity, respect and were patient when they offered support. There were enough staff in place, who had received appropriate training and support in their role.

People’s care reflected their individual needs. This included their preferred daily routines and preferences. They were supported to remain active and take part in a variety of activities on site.

People’s needs were assessed to ensure they received appropriate support with their nutrition, hydration, medicines and healthcare. Risks associated with the environment were safely managed and the home was clean and hygienic.

Some aspects of the homes décor and decoration required refreshing and updating. There were plans in progress to prioritise where this was most needed.

The provider had processes in place to gain appropriate consent to care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The provider had safeguarding policies and procedures in place, which helped to reduce the risk of people suffering abuse or coming to avoidable harm. There were appropriate systems in place to gain feedback and respond to complaints.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (published 5 December 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Old Raven House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Old Raven House accommodates up to 36 older people in one adapted building. There were 35 people at the service at the time of inspection, some of whom were living with dementia.

The service had a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons.' Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection was prompted by the notification of concerns raised by health and social care professionals, regarding the management of pressure ulcers. This meant that people’s care, treatment and support had not always been provided in a safe way. At our inspection we found the registered manager and staff had implemented training and guidance from professionals to make the required improvements. People were now receiving appropriate care to ensure pressure ulcers were prevented or managed safely. However, more time was required to demonstrate that these improvements had become embedded across the service and were sustainable.

Prior to our inspection healthcare professionals had also raised concerns regarding techniques used by staff to support one person to move safely. Since these concerns were raised, healthcare professionals had provided staff with relevant training and guidance, tailored to support this person's individual needs. Staff were now supporting the person to move safely in accordance with their care plan. However, the provider required more time to demonstrate improvements had become embedded and sustained.

At our last inspection we rated the service good, though found that that the provider was not always working within the principles of the Mental Capacity Act (2005). At this inspection we found that the required improvements had been made. The registered manager had established an effective process for making decisions in people’s best interests, when they did not have the capacity to do so for themselves. . Staff supported people to make as many decisions as possible and protected their human rights. The registered manager had a clear understanding of consent, mental capacity and Deprivation of Liberty Safeguards legislation and guidance, which they followed.

Previously, governance and oversight of processes for monitoring and improving the quality and safety of the service had not always been reliable and effective, for example, the provider had not identified the concerns raised by healthcare professionals regarding pressure ulcers. At this inspection professionals consistently made positive comments regarding the registered manager’s determination to put things right and improve this aspect of the service. Professionals praised the registered manager and the team leaders’ openness, for listening to and following their advice and guidance. However, the provider needed more time to demonstrate new governance processes had become embedded, were sustained and effective.

People were protected from avoidable harm, neglect, and discrimination by staff who understood their responsibilities to safeguard people from abuse. When required the registered manager completed thorough investigations in partnership with local safeguarding bodies.

Staff were aware of people who were at risk of choking or falling and how to support them safely to mitigate these risks. Staff underwent appropriate training to support people to manage their medicines safely and had their competency to do so regularly assessed.

The provider applied thorough recruitment procedures to ensure staff were suitable to support people living with dementia. The registered manager completed rotas which ensured that enough suitably qualified staff, with the right skills, were deployed to provide care and support to meet people’s needs safely.

The premises were kept clean and hygienic by staff who understood their role in relation to infection control and hygiene. Staff followed current national guidance to ensure people were protected from the risk of infections.

The provider had enabled staff to develop and maintain the necessary skills and knowledge to meet people’s needs effectively. People were supported to eat and drink enough to meet their nutritional needs.

Staff supported people to maintain their health and ensured they were referred promptly to their GP whenever their needs changed.

The maintenance manager had developed a strategy to adapt lighting, signage and decoration to meet the needs of people using the service.

People's independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff respected people’s human rights by treating them with dignity, valuing their privacy and individuality. People experienced good continuity of care from staff who were kind and compassionate. People were relaxed in the presence of staff who invested time to develop meaningful relationships with them.

People were supported to participate in stimulating activities of their choice, which had a positive impact on their well-being. People were supported by staff to maintain special relationships with friends and relatives to protect them from the risks associated with social isolation.

Opportunities were available for people and their families to regularly contribute to the development of the service and to help drive improvement.

People were effectively supported at the end of their life to experience a comfortable, dignified and pain-free death.

The management team had created a transparent culture within the home, where staff ideas and views were discussed and taken seriously, which made them feel their contributions were valued.

Old Raven House (to be referred to as the home throughout this report) is a home which provides residential care for up to 36 people who have a range of needs, including diabetes, people living with sensory conditions such as hearing and slight loss as well as people living with dementia. At the time of the inspection 36 people were using the service.

The home comprises of a period property with a purpose built extension with front and rear gardens which offers seating areas for people, relatives, visitors and staff to enjoy. The garden also contains hutches for two rabbits and two guinea pigs which are used in animal therapy sessions.

On the ground floor the home has living accommodation with communal areas including lounges, dining rooms, a conservatory and a sun lounge which faces to the front of the house. On the ground floor there is a kitchenette area where people, relatives, staff and visitors can make hot and cold drinks. The ground floor also has a hairdressing business and salon which is also available for use by members of the public. The first floor is accessible by one main staircase which has an operational stair lift. The first floor comprises of living accommodation. Communal bathrooms and accessible toilets are available on both floors.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in place did not always support this practice. It had not always been clearly documented that where people lacked the capacity to make specific decisions for themselves that actions taken on their behalf were always in their best interests. Immediate action was taken following the inspection to ensure these decisions were documented fully. Staff sought people's consent before delivering their care and support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. The registered manager showed an understanding of what constituted a deprivation of a person's liberty by the correct submission of relevant applications to ensure people were not deprived of their liberty without legal authority.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. People's safety was promoted because risks that may cause them harm had been identified and guidance provided to staff to help them manage these appropriately for people.

People were supported by sufficient numbers of staff to meet their needs. The provider was able to adapt their staffing levels appropriately when required in order to meet changes in people’s needs.

Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.

People received their medicines safely; senior staff were responsible for managing medicines and had received the appropriate training to enable them to complete their role safely. Medicines were stored, administered, disposed of and documented appropriately.

Contingency plans were in place to ensure the safe delivery of people's care in the event of adverse situations such as a fire or flood which may result in the loss of their living accommodation. These were accessible to staff and emergency personnel such as the fire service, if required to ensure people received continuity of care in the event of an on-going adverse situation which meant the home was uninhabitable.

People were supported by staff who received appropriate training enabling them to meet people’s individual needs. Staff received regular supervision to ensure they were supported in their role.

People were supported to eat and drink safely whilst maintaining their dignity and independence. We saw that people were able to choose their meals and were offered alternative meal choices where required. People's food and drink preferences were documented in their care plans and were understood by staff. People were supported to eat and drink enough to maintain a balanced diet.

People’s health needs were met as the staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

People told us that care was delivered by kind and caring staff who sought to meet their needs and ensure they were happy. We saw that people had friendly and relaxed relationships with staff who would stop and speak with them as they moved around the home.

Care plans and risk assessments contained detailed information to assist staff to provide care in a manner that respected each person's individual requirements and promoted their dignity. People were encouraged and supported by staff to make choices about their care including how they spent their day in the home.

People’s care plans and risk assessments were reviewed monthly or sooner when required to ensure they remained accurate to enable staff to effectively meet people’s needs.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way.

The provider’s values were communicated to staff. Staff understood these and relatives told us these standards were evidenced in the way care was delivered.

The registered manager and staff promoted a culture which focused on being open, honest and inclusive, empowering people to share their care experiences. The registered manager provided strong positive leadership and fulfilled the requirements which would be associated with their role as a registered manager.

The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe. Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. People were assisted by staff who were encouraged to raise concerns with the registered manager.

The quality of the service provided was reviewed regularly by means of effective quality control audits. These were completed to identify areas where the quality of the service provided could be improved. We could see action had been taken to address where any shortfalls in the service provision had been identified.

We considered all the evidence we had gathered under the outcomes we inspected, which related to people's care and welfare, cleanliness and infection control, supporting staff, assessing and monitoring the quality of service provision and records. We used the information to answer five key questions; is the service safe, effective, caring, responsive and well-led.

This is a summary of what we found.

Is the service safe?

People and relatives of people who use the service were complimentary of how the provider maintained people's safety. One person told us 'I feel absolutely safe here.' A survey to gather feedback from people was conducted in May 2014 by the provider. This recorded up to 19 responses from 36 people. We saw respondents agreed that they felt safe.

Evacuation plans were in place to ensure people's safety in the event of a fire at the service. A member of the management team was available on call in case of emergencies outside usual working hours.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to this type of service. The service was safe because requirements in relation to the DoLs had been met.

People were cared for in an environment that was safe, clean and hygienic. People were protected from the risk of infection because protocols based on current Department of Health guidelines were followed.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

However, people were not protected from the risks of unsafe or inappropriate care because staff used unsafe moving and handling practices when providing care and support to people. We found people's medication profile forms in their care plans were not always accurate. They had not been updated when the prescribed medicines had been changed. This meant that there was an increased risk that medicines would not be administered in accordance with the most current prescription. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring steps are taken to ensure people are protected from the risks of unsafe or inappropriate care.

The provider did not have appropriate arrangements in place to manage people's medicines safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring effective processes are in place for the safe management of medicines.

Is the service effective?

The service demonstrated effective practices because people's views and their relatives about the type of care they wanted had been sought and acted upon. On person confirmed their involvement and told us 'Staff asked me what I would like.' We found staff had a good understanding of people's care and specific support needs, for example, in relation to pressure sore prevention.

All six people and relatives we spoke with were complimentary about the care received. One person said 'The staff look after us very well.'

Is the service caring?

People were supported by kind and supportive staff. One relative told us 'Staff have been very supportive. The overall care and atmosphere here is excellent. It feels like a happy family environment.' All interactions we observed between the staff and people were respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed.

The compliments folder we looked at recorded responses from people's relatives. We saw feedback was positive. Relatives rated staff support and care highly.

Is the service responsive?

People's needs were assessed before they were admitted to the service. Records confirmed people's preferences and diverse needs had been recorded. Staff provided examples of care and support being provided in accordance with people's wishes, for example, in relation to meal preferences and personal hygiene.

Overall, we found care was planned and delivered to meet the identified needs for people to ensure theirs and others' safety and welfare.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring care is planned and delivered to meet the needs of all people who use the service.

We saw evidence that the provider responded to feedback from people , their relatives, staff and outcome of service audits in order to improve the service.

Is the service well-led?

We saw people's and relative's feedback was sought through meetings and surveys. The provider was responsive to comments from people, such as improvements to the supper menu and the implementation of a planned refurbishment of the service to meet people's wishes and suggestions.

Audits and checks ensured people's safety and wellbeing was promoted. Where issues were identified, an action plan was formulated. Progress and completion of this was monitored. We saw issues were identified and actions completed appropriately.

People told us they enjoyed the quality of the food and were provided with a choice of meals. Visitor's said when they had visited the home, 'meals always looked healthy and were nicely prepared'. They said in their observation 'there was always enough staff available to help people with their meals'.

We found improvements were needed to ensure the nutritional assessment used by the home was used effectively by staff. This was to ensure records of people's weight were accurate and to minimise individual risks of undernourishment. During our inspection the manager told us of the immediate steps they had taken to minimise risk and to improve accuracy of records that informed nutritional assessments.

There were procedures to protect people from abuse and to minimise the risk of unsuitable staff being employed. We found that staff were knowledgeable of people's specific health and personal care needs and had received training to update their skills and knowledge.

People and their relatives told us they were kept informed, were listened to and given opportunity to give their view of the services provided. Comments included, 'I'm very happy' and 'I've even had my nails done for nothing'.

Observation of care practices during our inspection confirmed people living in the home were receiving effective, safe and appropriate care which was individualised and designed to meet their specific needs. The care provided was carried out with sensitivity and patience. Staff were able to demonstrate to us they knew the people who used the service well and were aware of their care needs.

We observed people being offered choices about their care and support. Staff discussed with them any options and supported them to make an informed decision

People we spoke with said they had not needed to make a complaint and that they were very happy with the service they had received from the home.