Ranvilles Nursing & Residential Care Home

Ranvilles Nursing and Residential Care Home is a residential care home providing personal and nursing care to up to 53 people. The service provides support to older people who may be living with dementia or a mental health condition. At the time of our inspection there were 43 people using the service. The home accommodated people in one adapted building.

People’s experience of using this service and what we found

We were assured people were protected against risks associated with infectious disease.

The care people received was based on the relevant national standards and legal requirements. The home had been adapted appropriately to meet people’s changing needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s care and support met their needs, including communication needs, and reflected their preferences. There was a wide range of appropriate leisure activities available to people.

The service was well-led. There had been further improvements since our last inspection, and improvements we saw at that time had been sustained and embedded.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 November 2019).

At our last inspection we found one breach of the regulations in relation to people receiving care which reflected their needs and preferences. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve. The provider kept us informed of progress by sending us a monthly report, and by participating in quality monitoring meetings organised by the local NHS organisation during the COVID-19 pandemic.

At this inspection we found improvements had been made and the provider was now meeting this regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 October 2019. A breach of legal requirements was found in relation to care and treatment.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions effective, responsive and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ranvilles Nursing and Residential Care Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ranvilles Nursing & Residential Care Home provides personal and nursing care for up to 53 older people who may be living with dementia or other mental health needs. At the time of our visit there were 31 people living in the home, many of them with complex needs. The home accommodated people in one adapted building.

People’s experience of using this service and what we found

People received care and support that was safe. The provider had improved how they identified and managed risks to people’s health and wellbeing, including the risk of abuse or avoidable harm. The provider had improved how they learned from accidents and incidents to keep people safe. There were enough suitably skilled staff deployed to support people safely. There were effective recruitment processes in place to make sure staff employed were suitable to work in the care sector. Processes to manage medicines safely and reduce the risk of infection remained good.

People received care and support that was largely effective and based on thorough assessments. Staff received training to deliver effective care according to people’s needs and preferences. The provider worked with other agencies to deliver consistent and effective care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We identified further improvements were needed in how the provider responded to authorisations to deprive people of their liberty and meeting current best practice guidance around dementia-friendly environments.

There were caring and kind relationships and interactions between people and their care workers and other staff. These were based on compassion and understanding of people’s needs. The provider worked to respect and promote people’s privacy, dignity and independence, and encouraged people to be involved in their care.

People’s care and support did not always meet their needs and reflect their preferences. People’s care plans, including end of life care plans, were still task-focused rather than person-centred. The provider was aware of best practice guidance with respect to meeting people’s communication needs. There were some imaginative activities tailored for people living with dementia, but more activities relevant to people’s interests, hobbies and cultural background were needed.

The provider had made improvements to their individual governance and quality assurance processes. However, these were not yet joined up to form a continuous, effective overall governance and quality system, and there was no overall service improvement plan. The provider worked in cooperation with others and had processes in place to engage with people who used the service, relatives and staff.

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

Rating at last inspection and update

The last rating for this service was inadequate (report published 24 May 2019). We found breaches of six regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We required the provider to audit the service every month and report to us the outcome of each audit. At this inspection we found improvements had been made, and the overall rating is still requires improvement. There was one continuing breach of regulation. The provider was no longer in breach of the other five regulations.

This service has been in special measures since 24 May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to people’s care and support meeting their needs and reflecting their preferences.

Please see the action we have told the provider to take at the end of this report.

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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

People’s experience of using this service:

• People were at a significant risk of avoidable harm. Risks to people were not fully assessed and measures were not sufficiently put in place to mitigate risks to people.

• The culture of the service was task focused and staff did not always recognise poor practice. For example, incorrect manual handling practice. We observed some poor manual handling practice during the inspection that put people at risk.

• People in the service displayed a significant number of physically aggressive behaviours. There were a high number of unexplained incidents including bruises. Accidents and incidents were not always recorded and notified to the appropriate organisations such as the local authority. Accidents and incidents were not fully investigated and analysed to prevent future occurrences.

• We received mixed feedback about how open and transparent the service was.

• A staff feedback survey demonstrated concerns about a lack of teamwork. Feedback from staff and relatives was not appropriately acted upon. We have made recommendations about this.

• Staff were not consistently caring and people were not always treated with dignity and respect.

• The provider was not person-centred. People’s diverse needs were not always respected and met.

• The provider was not providing care in accordance with the Mental Capacity Act (2005).

• Staff training was out of date and staff did not always have the skills and expertise required to provide safe care and support.

• The service met the characteristics of inadequate in most areas.

Rating at last inspection: The service was last rated Good, published in December 2017.

Why we inspected: This inspection was brought forward due to information of concern.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: Following the inspection we took urgent action to ensure the provider improved the safety in the service. We informed the local authority and clinical commissioning group (CCG) of our concerns.

The overall rating for this registered provider is 'Inadequate' and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

The home is registered to provide accommodation and nursing and personal care for up to 53 older people who live with advanced dementia or mental health conditions. Accommodation is arranged over two floors with access to all areas by stairs and lift. At the time of our inspection 46 people lived at the home.

A registered manager was in post. 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.

Staff had a good understanding of how to protect people from the risk of infection and policies and procedures were in place for the management of infection control. However, some flooring in the home required replacement as it was difficult to maintain this hygienically.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse, discrimination and harassment and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff deployed to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. Incidents and accidents were clearly documented and investigated. Actions and learning were identified from these and shared with all staff.

Medicines were administered, stored and ordered in a safe and effective way.

People were encouraged and supported to make decisions about their care and welfare. Where people were not able to consent to their care, staff followed legislation designed to protect people’s rights and freedom.

People received nutritious meals in line with their needs and preferences, in an environment which provided a calm and relaxing dining experience for them. Those who required specific dietary requirements for a health, cultural or religious need were supported to manage these.

Staff were calm, kind and gentle in their interactions with people and supported them to remain independent whilst maintaining their safety and welfare. People’s privacy and dignity was maintained and staff were caring and compassionate as they supported people. Staff knew people in the home very well and involved them and their relatives in the planning of their care.

Care plans were person centred and reflected people’s physical, mental, emotional and social needs. The home worked with a multidisciplinary team of health and social care professionals to ensure people’s individual needs were met.

The registered manager promoted an open and honest culture for working which was fair and supportive to all staff. Staff felt supported in their roles and provided care in a manner that was in keeping with the provider’s philosophy of care. People and their relatives spoke highly of the registered manager and all their staff team.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

At our last inspection in October 2016, we rated the service as overall Good although improvements were required in the well led domain with regards to audits and record keeping. At this inspection we rated the service as Good in all domains and audits and record keeping had improved.

A registered manager was in post. 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.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Whilst processes to check the suitability of staff to work with people were in place, records were not always fully informed with this information. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered, and ordered in a safe and effective way.

Staff had a good awareness of people’s needs and the risks associated with these. Risk assessments were in place to identify the risks associated with people’s individual needs; however sometimes care plans did not reflect these needs clearly.

External health and social care professionals were involved in the care of people and care plans reflected this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received nutritious meals in line with their needs and preferences.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and were person centred. Staff were caring and compassionate and knew people in the home very well.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The service had an effective leadership structure in place which provided good support, guidance and stability for people, staff and their relatives. However records of management actions and information were not always kept. We have made a recommendation about this. People, their relatives and staff knew the registered manager and spoke of their clear visibility and support in the service.

We spent time with people who use the service in the lounge / dining area observing the support people received during and after their meal. We saw that not all of the staff were respectful or aware of people's needs. Whilst people were not seen to be unhappy or distressed, staff did not always respond in a timely manner to meet people's needs. We saw that two people did not receive support or fluids when they clearly indicated they wanted or needed it.

Staff told us that they felt they did a good job. Comments included 'We are a good team, we work together well'. 'We have everything we need to be able to care for people living here at Ranvilles'. This was supported by the care plans which detailed the support that nursing and care staff were to give people. Although care staff could tell us what support they would offer to people not all the staff we observed, did so safely or in a timely way. Other documents which supported the care plans to show what care had been given were not always completed for example wound care and records of prescribed lotions and creams.

This report relates to an inspection carried out in February 2013. There has been a delay in the publication of this report due to a complaint made by the provider regarding the inspection, which we have investigated and was not substantiated.