Archived: Ravenstone

Updated 16 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 29 November 2018 and was unannounced.

The inspection team consisted of one inspector, an inspection manager, specialist advisor who was knowledgeable and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience was of older people and dementia care.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form the provider completes to give some key information about the service, what the service does well and improvements they plan to make. The provider returned the PIR and action plans we took this into account when we made the judgements in this report.

We considered the action plan we requested from the provider in response to the five breaches in regulations identified at the last inspection. We also looked at the statutory notifications the provider had sent us. A statutory notification is information about important events which the provider is required to send to us by law.

We sought information from the local authority and the clinical commissioning group to obtain their views about the quality of care provided at the home. The local authority and the clinical commissioning group have responsibilities for funding care and monitoring the quality of this. In addition, we contacted Healthwatch who are an independent consumer champion who promote the views and experiences of people who use health and social care.

We spoke with 10 people who lived at the home and four relatives about their care experiences. In addition, we spent time with people looking at how staff provided care to help us better understand their experiences of the care they received.

We also talked with the registered manager, deputy manager and regional manager. Additionally, we spoke with four members of the care staff team, one nurse, the housekeeper, maintenance person and activities co-ordinator. Following our inspection visit we spoke with a nurse practitioner by telephone. The advanced nurse practitioner regularly supports people with their healthcare needs and agreed for their views to be included in this report.

We looked at three people’s care records to look at their specific needs and associated monitoring charts. We checked how medicines were managed and looked at 34 people’s medicine administration records. In addition, we looked at how the provider and management team monitored the quality of the service to assure themselves people received a safe, effective quality service.

Following our inspection visit the registered manager sent us further information. This included a summary of surveys completed by people who lived at the home, relatives and staff, and risk assessments they had completed.

Updated 16 January 2019

The inspection was undertaken on 29 November 2018 and was unannounced.

Ravenstone is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The provider of Ravenstone is registered to provide accommodation and nursing care for up to 43 people who have nursing needs. At the time of this inspection 36 people lived at the home.

The provider had a registered manager in place who supported this 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.

Our last inspection took place on 28 and 29 June 201, we rated the service as 'Requires Improvement’. We identified five breaches of the regulations. These included the provider had not make sure risks to people from avoidable harm was reduced. The staffing arrangements did not reduce risks of people care needs being met in a safe and timely way. Staff did not respond to people's needs in a way which promoted care was centred on their needs and their dignity was respected to enhance their welfare. The provider did not effectively use their quality checks to bring about improvements in a timely way so people lived at a home where high-quality care was promoted.

As a result of the inspection, we asked the provider to send us a report explaining the actions they were going to take to improve the service.

At this inspection we found the registered provider’s oversight and quality checks were more effective. These were used to drive through improvements to support people’s needs in a timely way and safely, with people at the heart of all their care. The provider had now met legal requirements in these areas although further improvements required.

People’s medicines were available to them as prescribed however the management of medicines needed strengthening to ensure risks to people continued to be reduced. Risks to people's safety from avoidable harm and injury in relation to some electrical items had not been assessed so actions to minimise identified risks completed. Staff practices in infection prevention and control was not effective in all areas of the home environment so the spread of infections continued to be reduced.

People’s needs were responded to and met without any unreasonable delays which was an improvement made since our last inspection. Staff were knowledgeable about the subject of abuse and what actions to take if they had concerns. The provider had systems in place to support staff in reporting accidents and incidents. The management and staff team used learning from accidents and incidents to inform their caring practices and continually improve.

Staff were supported to maintain and improve their skills through ongoing training and support from the registered manager and deputy manager. Checks were completed before staff started to work at the home to ensure they were of good character and safe to work with people living at the home.

People’s individual needs were assessed when they came to live at the home and regularly reviewed. Staff worked well together to meet people’s varied needs and where people would benefit from equipment this was provided. People were referred to healthcare professionals when needed and staff followed the guidance shared with them.

People were encouraged and supported to eat a nutritional diet which met their needs and recognised their choices. Risks to people's nutritional health had been assessed and when weight loss was identified, people were not offered extra calories in their meals or as snacks. Drinks were offered to people and support was given when needed including people having their drinks left within their reach.

People’s needs were met by the adaptation, design and decoration of the home environment which had improved since our last inspection to provide colour and contrast with interesting things for people to see.

The provider had made improvements following our previous inspection to ensure people's rights under the Mental Capacity Act were understood and promoted by staff and management.

People had built caring relationships with staff who consistently respected their dignity. Staff knew people well and this had positive benefits of promoting personalised care. Care plans had been developed with people's involvement and accurately reflected their individual needs. People enjoyed the varied things to do for fun and interest so people did not feel socially isolated. The changes in staffing arrangements and culture had supported people in always receiving personalised care which was an improvement achieved since our last inspection.

People who lived at the home and relatives were supported in raising their concerns and complaints. shared concerns with staff and the registered manager. When concerns and complaints had been raised these were effectively responded and resolved to people's satisfaction.

People who lived at the home, relatives and staff were able to offer their views on the care provided through meetings and surveys. The provider and registered manager listened to their concerns and worked to resolve them.

The provider and registered manager had further improved the systems in place, since our last inspection so these were more effective in keeping checks on standards, develop the service and make improvements. During this inspection the registered manager took an open and responsive approach to the issues identified so action was taken to resolve these.

You can see what action we told the provider to take at the back of the full version of this report.