Archived: Ravenscroft

Ravenscroft 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.

Ravenscroft provides accommodation for a maximum of seven people who have a learning impairment or associated condition. At the time of inspection seven people were living at the service accommodated in two adjoining bungalows.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities who use the service can live as ordinary a life as any citizen.

At our last inspection in April 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Some people were unable to tell us about the service because of their complex needs. People appeared content and relaxed with the staff who supported them. Other people told us they were satisfied with the service provided by staff. Staff knew the people they were supporting well and there were enough staff on duty to provide individual care to people.

Detailed records accurately reflected the care provided by staff. People’s privacy and dignity were maintained. Staff understood the needs of people and care plans and associated documentation were clear and person-centred. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines safely. We have made a recommendation about medicines management. People received a varied diet.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff received other appropriate training and they were supervised and supported. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

People were encouraged and supported to go out and engage with the local community and maintain relationships that were important to them. They 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.

People and staff spoke well of the registered manager, they said the management team were approachable. There were effective systems to enable people to raise complaints, and to assess and monitor the quality of the service. The provider undertook a range of audits to check on the quality of care provided.

Further information is in the detailed findings below.

Ravenscroft is a purpose built care home that provided care for up to seven people with learning disabilities. The home is a purpose built bungalow and comprises three separate units.

The registered manager had been in post since the home opened 20 years ago. 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.

At the time of the inspection seven people lived at the home and we met all of the people who used the service. They told us that they were very happy with the service and found it met their needs.

We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle.

People who used the service required staff to provide support to manage their day-to-day care needs; to develop impulse control; as well as to manage their behaviour and reactions to their emotional experiences. We found that the registered manager had taken appropriate steps to ensure staff provided consistent responses and took appropriate action when people’s needs changed, which had ensured staff could continue to meet the individual’s needs.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

People were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

There were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities.

Staff had also received training around safeguarding vulnerable adults and clearly understood how to implement these procedures. We observed that staff consistently maintained people’s privacy and dignity. We found that staff treated people with respect and compassion.

Staff had also received training around the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. The staff we spoke with fully understood the requirements of the MCA and were ensuring that where appropriate this legislation was used.

People and the staff we spoke with told us that there were enough staff on duty. We found there were sufficient staff on duty to meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered manager had an effective system in place for dealing with people’s concerns and complaints. People felt confident that staff would respond to any concerns they raised and would take action to deal with any issues.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety, relevant infection control procedures were followed by the staff at the home. We found that action was taken to minimise known risks.

The registered manager had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service.

Training records held by the registered manager, were now accurate and up to date and showed when certain training had been completed, needed to be refreshed and when future training had been arranged.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. Relatives' comments included, 'He is well looked after and cared for. It's a nice place and it's safe; that's what counts, and 'I do consider she's safe and well-looked after there. I have no worries or concerns about her safety.'

People were cared for in an environment that was clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. The building was clean, secure and other appropriate measures were in place to ensure the security of the premises. One relative told us, "The girls are very good with her. They look after her very well and the accommodation is good; I couldn't complain at all.' A senior support worker commented, 'It's very clean and tidy here. The girls (staff) are very good with the cleaning and senior staff do walk-rounds to check the cleanliness of the home."

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. Staff had received appropriate professional development, appraisal and supervision. A relative told us, 'There are always lots of staff on and they have very good staff.'

However, we found that staff training was not up to date and the provider did not always monitor training requirements appropriately. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff and training arrangements.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. All the relatives spoken with talked highly of the level of care provided by staff. One relative commented, "He gets good care and is well-looked after there.' Another relative told us, 'He gets good care; it's the best thing that's ever happened to him, going to Ravenscroft.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed every six months to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

People and their relatives were consulted about the service people received and the environment in which they lived. Meetings for people and their relatives were regularly held. This demonstrated that the provider took account of the views of people using the service and their relatives.

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives. One relative commented, 'There's plenty for him to do. They take him out and about all of the time. He is always busy and he has a good social life; he's never in.'

The provider had a written complaints policy and procedure, which detailed the process that should be followed in the event of a complaint. People and their relatives knew how to make a complaint if they were unhappy. We saw that no complaints had been received by the service within the last four years and the service had received five compliments within the last 12 months.

Is the service well-led?

The service had a registered manager in post. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. One relative told us, 'Glynis (registered manager) and the deputy are nice people and they are very approachable.' Another relative commented, 'The manager's good; I'm very happy and satisfied with the service.'

We used a number of methods to help us understand the experiences of people who used the service. These included observing care, speaking with people who used the service, reviewing comments and surveys and speaking with staff. Those who were able to communicate with us said they felt safe and were treated with respect ' no complaints were received from people who used the service.

We saw there was a good rapport between people who used the service and staff, who attended to people's needs promptly and in an unhurried way. We spoke to staff, who were knowledgeable about people's care needs and what they should do to support them.

We checked patient records and saw before people received care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We confirmed staff received training and support to deliver care and treatment safely to patients.

There were systems in place to identify, assess and manage risks to the health, safety and welfare of people used the service and others.

We observed the care given to the people who used the service present at the home on the day of our visit.

We saw that people who used the service and their relatives had commented upon the care that had been provided. They said they were 'happy how the home is run, can't see how it can be improved', 'excellent care given', 'staff are friendly, always a welcome for everyone' and 'plenty entertainment with lots of visits'.

We also checked on the safety and suitability of the accommodation and environment. We saw the shared areas were clean and tidy and bedrooms were spacious, well decorated and personalised by individual service users.

People spoken to had access to their care plan and we were told that any changes in their care had been discussed with them and their family members. We saw that contact sheets were kept that recorded all communication with family members.

During our observation we saw people were treated with consideration and respect. We reviewed two care records and saw that people's preferences and care needs had been well documented. Staff were knowledgeable about people's care needs and what they should do to support them.

We saw that there were enough staff to meet people's needs.

People who used the service commented that they knew they had a key worker and that they knew who to talk to if they had a problem. They said that they had 'enough activities to do' and they were 'happy with food and snacks'.

We saw surveys completed by the home, relatives had commented that Ravenscroft 'is a beautiful bungalow, staff friendly, always a welcome for everyone', that there 'is plenty entertainment with visits to the seaside, park, zoo, theatre, pantomime or a walk around the shopping centre' and that 'I would recommend Ravenscroft to everyone; look around and see the happy, contented faces, that is all the recommendation anyone needs'.

These comments were complemented through comments made by staff. They said that there 'is a definite sense of belonging within the home, the role of the individual is challenging, however staff feel they can make decisions affecting the workplace'. Staff spoken to said they 'had a sense of belonging' and that 'all staff get excellent training'.