Archived: Ranyard at Dowe House

Is the service safe?

There were care plans and risk assessments in place for people. However, the care plans did not always reflect people's current needs and how to manage risks to people's health. Staff had not also always implemented these plans.

Medicines were not always safely managed. We found unexplained gaps on the medicines administration records (MAR). People did not always have their prescribed medicines available to take. This could put people at risk as out of date medicines or medicines not fit for use could be administered.

Staffing levels were not always suitable and sufficient to meet the needs of the people who used the service. Staff we spoke with told us about the pressure and demands of the job due to shortage of staff. Relatives we spoke with told us that at times it appeared that the home was short staffed.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is the service effective?

Care need assessments were carried out and care was planned for individuals. However, these did not always reflect people's needs fully and were not followed by staff. There was an activities coordinator who planned and coordinated activities for people. Relatives and other health and social care professionals were involved planning and delivering people's care.

Is the service caring?

People told us that staff were kind, supportive and caring. Staff did not engage and interact much with people when carrying out activities. People's dignity and privacy were not always respected; we saw an example where staff had left the toilet door open while a person was using the toilet.

Is the service responsive?

The home worked closely with other health professionals such as diabetes nurses, GP and occupational therapist in meeting the needs of people effectively. We saw recommendations from professionals, for example, dietary requirements and pressure sore care, but these were not always implemented.

People's care plans and risk assessments were not always reviewed to reflect the current care needs of the person.

Is the service well led?

The home had a registered manager who also managed another home.

The views of people and their representatives were not always sought and followed up. There was no action plan to address feedbacks following the quality surveys conducted in November 2013.

Staff morale was low and staff told us that the management at Ranyard at Dowe did not always listen to them or addressed their concerns. Team meetings were not held regularly. Staff supervisions or appraisals were not conducted regularly in line with the organisation's procedure. Records for staff, people who used the service and administration of the home were not up to date and accurate.

We spoke with four people using the service, relatives, care staff on duty and the manager. People using the service praised the care they received, the manager and carers. One person told us, 'They look after me well". We observed that people were treated with care and consideration and with dignity and respect.

Records were not always suitably maintained or fit for purpose.

At a previous inspection in November 2012 we found there was a lack of supervision, appraisal for staff. At this inspection we found these issues had been addressed.

People we spoke with during our inspection liked the home. One person said, 'The staff are lovely". Another person said, "They do everything for me". People using the service and a family member described the staff as "friendly, helpful, kind, hardworking". However, some relatives of people using the service were not happy about the way people with dementia were treated.

During our visit we saw that staff engaged with people about how they wanted to be helped. People had assessments of their personal care and support needs. However, during our inspection we found that potential risks to people using the service, such as the risk of a fall were not always correctly identified in their care plans.

Staff were attentive to people's needs and asked them how they preferred to be helped. Care was provided to people in a timely way. A person we spoke with said, 'they know how to look after me here'.

New measures had been introduced to promote people's rights, independence and choice. The activities programme had been refreshed and people had been invited to meetings and social events to give their views on the care and activities provided. There was evidence in recent care plan review records that people's social and personal needs and choices were discussed.

We found that the completeness of staff records had improved, which provided assurance that people were being cared for by suitably qualified and experienced staff.

At our previous inspection on 20 November 2012 we found that potential risks to people using the service, such as a risk of falls or developing a pressure ulcer, were not always correctly identified in care records. At this inspection we found that the documenting of potential risks had improved, but some risk assessments and care plans did not accurately reflect people's current care needs or level of risk, which meant there was a possibility that appropriate care, treatment and support was not always provided.

However, although infection control practice had improved, further improvement was needed.

People using the service and a family member described the staff as 'friendly, helpful, kind, hardworking', and "totally caring and dedicated'.

During our visit we saw that staff asked people how they wanted to be helped and protected their dignity. However, personal care and assistance was not always provided in a timely way, and people's independence was not always promoted. There was limited evidence that people had expressed their views and were involved in making decisions about their care and treatment, or that their relatives and representatives were always consulted about their care and treatment.

However, during our inspection we found that potential risks to people using the service, such as the risk of a fall or of developing a skin pressure ulcer, were not always correctly identified in their care plans.

We also found that effective systems were not in place to reduce the risk and spread of infection.

There was limited evidence that all appropriate checks were undertaken before staff began work, and not all staff had completed their mandatory training.