Www.cqc.Org.uk Sites Default Files Media Reports 1-112591905 Ravensworth Care Home Limited INS1-597702190 Scheduled 05-07-2013

| Inspection Report | Ravensworth Care Home Limited | July 2013 www.cqc.org.uk 1

Inspection Report

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Ravensworth Care Home Limited

Markham Road, Duckmanton, Chesterfield, S44 5HP

Tel: 01246823114

Date of Inspection: 23 May 2013 Date of Publication: July 2013

We inspected the following standards as part of a routine inspection. This is what we found:

Consent to care and treatment Met this standard

Care and welfare of people who use services Met this standard

Management of medicines Met this standard

Supporting workers Met this standard

Assessing and monitoring the quality of service provision

Met this standard


Details about this location

Registered Provider Mr & Mrs F Renshaw

Registered Manager Miss Maxine Spray

Overview of the service

Ravensworth Care Home provides accommodation and personal care for up to 26 older people, some of whom havedementia. The home is located in the village of Duckmantonnear Chesterfield in Derbyshire.

Type of service Care home service without nursing

Regulated activity Accommodation for persons who require nursing or personalcare


Contents

When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

More information about the provider 4

Our judgements for each standard inspected:

Consent to care and treatment 6

Care and welfare of people who use services 8

Management of medicines 10

Supporting workers 12

Assessing and monitoring the quality of service provision 14

About CQC Inspections 16

How we define our judgements 17

Glossary of terms we use in this report 19

Contact us 21


Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 23 May 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. We talked with commissioners of services.

What people told us and what we found

At our visit there were 26 people accommodated. We spoke with four staff and three people and one relative about their care and looked at five people's care and medicines records.People told us they were happy with their care and meals provided and one person told ushow they were consulted about these. We found that people experienced care, treatment and support that met their needs and protected their rights. One person told us, "Anyone would be happy here, it's better that the best." Another said, "I have made a lot of good friends here and the staff are wonderful."We were not able to hold discussions with many people because of their conditions, such as dementia. We observed staff interacting and supporting people and found staff were supported to deliver care and treatment that was safe and appropriate to people's needs and rights. Where people could not make decisions for themselves, we found the correct procedures were being used to obtain consent for their care. We also found that people were protected by the provider's arrangements to regularly assess and monitor the quality of service they received and to manage potential risks to people's health, safety and welfare.This included for their medicines.

You can see our judgements on the front page of this report.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.


There is a glossary at the back of this report which has definitions for words and phrases we use in the report.


Our judgements for each standard inspected

Consent to care and treatment Met this standard

Before people are given any examination, care, treatment or support, they should be asked if they agree to it

Our judgement

The provider was meeting this standard.

Consent was consistently obtained to people's care.Where people could not make decisions for themselves, the correct procedures were usedto obtain consent for their care.

Reasons for our judgement

At our last inspection of this service we found that consent to people's care was not consistently obtained and that where people could not make decisions for themselves, the correct procedures were not always used to obtain consent for their care. At this visit we found that action had been taken to ensure that consent was consistently and correctly obtained.

At our visit we found that one person was subject to Deprivation of Liberty Safeguards (DoLS), which was formally authorised by the recognised body concerned with these. DoLS are part of the Mental Capacity Act 2005. They aim to make sure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The safeguard should ensure that a care home or hospital only deprives someone of their liberty in a safe, correct way. It is only done in the person's best interests and where there is no other way to look after them.

Another person had made changes to an advanced decision they had previously made about their care and treatment for in the event of them needing emergency resuscitation due to collapse. Records to support their decision were provided. This is important if a decision was required, about whether the home's staff or emergency services attending a person at the home should attempt to resuscitate them in the event of an emergency.

We spoke with the manager and one staff member responsible for gaining and reviewing consent from people for their care and treatment. We asked them about the arrangements for determining how people's consent to this was being obtained and looked at five people's care records. All of the care plans we looked at included evidence that people were consulted about their care with regard to some of their preferred daily living routines and choices. One person had signed their agreement to their care plan. However, four people could not always consent to their care because of their dementia. Staff were able to describe how they assessed each person's capacity to make decisions about their care


and their care records accounted for the types of decisions they were able to make and where decisions were to be made in their best interests. They also provided details of consultation with other people, such as relatives where required.

We saw it was recorded where any person had a legally appointed person to make decisions for them. This included the decisions they were authorised to make. This meant that the right person would be contacted if a decision needed to be made on behalf of someone receiving care at Ravensworth Care Home.

We found that staff responsible for gaining and reviewing consent from people about their care and treatment had a basic understanding of the Mental Capacity Act 2005 (MCA). The MCA is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. All of the staff, except one new starter, told us they had completed training in the MCA and training records we lookedat reflect this.


Care and welfare of people who use services Met this standard

People should get safe and appropriate care that meets their needs and supports their rights

Our judgement


People experienced care, treatment and support that met their needs and protected their rights.


At our last inspection of this home we found that people did not always experience care and support that met their needs and protected their welfare and safety. This was becausecare and treatment was not always planned in a way that ensured their health, safety and welfare needs would be met. We also found that people were placed at unnecessary risk from some environmental hazards that we found. Following that inspection the provider told us what they were going to do to ensure people's needs would be met safely.

At this inspection we found that people's needs were properly assessed and that their careand treatment was planned and delivered in a way that ensured their health, safety and welfare. We also saw that action had been taken by the provider to remove the environmental risks we had previously identified. These included ensuring the correct use of a bathroom and reviewing their storage arrangements and means of escape for people from the first floor in the event of an emergency.

At our visit we looked at five people's care records and spoke with three people and one person's relative about the care provided. People said they were happy with their care and meals provided and one person told us about how staff involved them in their care plan. One person said, "Anyone would be happy here, it's better than the best." Another said, "I have made a lot of good friends here and the staff are wonderful." We also saw that activities were regularly organised, which people could choose to join.

We found that people had a range of health conditions and disabilities, which potentially placed their health and welfare at risk. We saw their general medical, nursing and health needs were recorded in their care files and that a recognised approach was used to assess and review known risks to people's health and welfare. People's written care plansincluded how those conditions affected them, such as in relation to their dementia, mobility, risks of falling, nutrition, pain, continence, medicines and risk of pressure ulcers (skin sores). We also saw that people's nursing and personal care records were regularly reviewed to make sure they were up to date. They were personalised and accounted for any required input from outside health and social professionals. This meant that people were protected from any risks associated with these and their individual health needs werebeing met.


We found that we were not able to hold discussions with many people because of their dementia. However we observed staff interacting with and supporting some of those people. We saw that staff delivered care and support to people in an inclusive, safe and supportive manner. This included, support and assistance with people's physical needs, such as their eating and drinking, medicines and mobility needs and their dementia care needs. Staff ensured people's privacy and dignity and we saw they interacted appropriately with people in a way that respected and recognised their reality.

Staff told us about one person with dementia who sometimes presented with behaviours that they found difficult. We looked at the person's written care plans and saw they described the required care interventions and key information about their condition. They assisted staff to understand the person's behaviour and to meet their dementia care needs. They included agreement, advice and support from relevant outside health professionals concerned with that person's care. This meant their care reflected relevant advice and guidance and took account of their diverse needs.

We found there were arrangements in place for dealing with foreseeable emergencies. This included procedures for responding to and dealing with accidents, incidents and emergencies, such as in the event of a fire or the collapse, fall or the sudden illness of any person living at Ravensworth. We also saw there were arrangements to alert and inform staff of national safety and risk alert notices.


Management of medicines Met this standard

People should be given the medicines they need when they need them, and in a safe way

Our judgement


People were fully protected against the risks associated with unsafe medicines practice because the provider had appropriate arrangements in place to manage medicines.


We looked at the arrangements for the storage of people's medicines in the home and for the management and administration of five people medicines. We found these supported their safe management and administration.

We found that information about people's medicines, including in their recorded needs assessments and care plans, were sufficiently detailed to ensure that people would receive individualised care that met their needs and for their medicines to be administered safely. For two people this included where they were prescribed a medication that may begiven in variable doses. Records identified the correct arrangements for these, including where staff needed to monitor for any adverse reactions to them and the action that must be taken if a dose was missed for any reason. The staff member who administered their medicines to them at lunch time told us about the arrangements for these, which reflected the instructions in each of their written care plans.

We looked at five people's medicines administration record (MAR) sheets and saw that these were properly completed. Written plans were in place which supported staff in their decisions where medicines were prescribed to be given when required by the person, rather than at regular intervals. We saw that one person administered their own inhaler when they needed this, which was detailed in their written care plan. Discussions with staff told us they regularly checked with the person about how and when they did this. However, the provider should note that there was no recorded risk assessment of their ability to do this.

We saw that appropriate storage was provided for people's medicines. These included medicines that were kept by the home on people's behalf, in a locked room with suitable type cupboards and a medicines refrigerator. Locked medication trolleys, used to circulatemedicines around the home to people, were stored safely in this locked room when not in use.

We saw medication being administered safely by a staff member at the home and found that staff had access to a suitable medicines reference book and other relevant informationabout people's medicines. This was important as it provided staff with information about


the types of medicines they were administering to each person, their effects, any substances should that should not be taken with some types of medicines and what to do if a dose was missed or too much accidentally taken. We also found that training and appropriate policies and procedures were provided to support staff in their management and administration of medicines.


Supporting workers Met this standard

Staff should be properly trained and supervised, and have the chance to develop and improve their skills

Our judgement


People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.


At our last inspection visit we found although appropriate training was provided, that staff were not fully supported to ensure the provision of safe and appropriate care. This was because the arrangements for their supervision and appraisal were not adequate. Following that inspection the provider told us what action they were going to take to rectify this.

At this inspection we found that a written annual programme for the ongoing supervision and appraisal of all staff was established and had commenced. We also saw that the manager held staff meetings with different staff groups and looked at the minutes of those most recently held.

We spoke with the registered manager and three care staff, including one senior. All felt they received the training, instruction and support they needed to carry out their duties safely and to provide people in the home with the right care and support. Care staff told usabout the arrangements for their learning and development to achieve recognised national qualifications relevant to the care of older people. One person told us about the necessarytraining they had undertaken to enable them to take blood samples from people when required by the person's GP. Two staff told us that supplementary information was provided in people's care plan files about their medical conditions to assist staff to understand these. Records that we looked at reflected what staff told us.

We spoke with one care staff more recently employed in the home about the arrangements for their induction. From those discussions and records we looked at, we found that staff induction arrangements met with national guidance.

Staff said they were provided with contracts of employment and job descriptions and felt confident to raise any concerns they may have about people's safety and welfare, with the manager or senior person on duty. All were familiar with whistle blowing and safeguardingprocedures to follow in the event of any safety or welfare concerns relating to people's care and also any allegation or witnessing of the abuse of a person living at the home. Thelatter included reporting to relevant agencies and authorities outside the home. We saw that a range of policies and procedures, resource files and national guidance were


provided for staff to assist and support them in their duties of care, which were relevant to the types of care provided for at Ravensworth. These included dementia care, infection control and the Mental Capacity Act 2005.


Assessing and monitoring the quality of service provision

Met this standard

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement


The provider had an effective system to regularly assess and monitor the quality of servicethat people received and to identify, assess and manage risks to people's health, safety and welfare.


At our last inspection we found that systems used were not fully effective to regularly assess and monitor the quality of services that people received. This was because not all audit systems were fully introduced, such as for care plans and medicines and not all complaints and concerns were accounted for.

At this inspection we found that audit systems were fully introduced and effectively provided for the regular assessment and ongoing monitoring of the quality of services people received. These included for people's care plans and medicines arrangements. We also saw that people's comments, concerns and complaints were properly accounted for.

We looked at records of some of the most recent audits undertaken by the manager to ensure staff followed their policies and procedures. These included for environmental maintenance and repairs, waste management, medicines, food hygiene and safety, care plans and infection control. We found they identified any actions that need to be taken as a result and who would be responsible for ensuring their completion. Minutes of recent staff meetings that we looked at conveyed this information to staff.

We looked at some of the provider's procedures for the reporting of matters relating to patient care and safety, which staff knew and understood. These included emergency and complaints procedures, medicines errors, recognising and reporting abuse and for falls and serious injuries to people. We found that each of the staff we spoke with was clear about their roles and responsibilities for these and that decisions about people's care, safety and treatment were made by the appropriate staff at the appropriate level.

All staff we spoke with said the registered manager regularly spoke with them aboutpeople's care needs and dependency levels and the arrangements for care delivery and staff workload allocation. Minutes of a recent staff meeting we looked at reflected this.

We looked at how the provider consulted with people or their representatives about their


experiences of their care and saw there were regular opportunities for this. These includedregular care reviews, residents meetings and complaints investigations. We also saw that a recent satisfaction survey had been conducted with people by an independent party acting on behalf of the provider. The survey asked people a range of questions and to ratethe quality of care and service they received. Results showed people were generally satisfied.

We saw where changes were made, which accounted for people's expressed views and any complaints made. Examples of these included approaches to continence management, laundry systems and ensuring the correct use of specialist pressure relieving mattresses and cushions.


About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "governmentstandards".

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.

Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

You can tell us about your experience of this provider on our website.


How we define our judgements

The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action.We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete.

Enforcement action taken

If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range ofactions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecutinga manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.


How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact people who use the service experienced poor care that had an impact ontheir health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly.

Moderate impact people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly.

Major impact people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.


Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant numberof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe theessential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are:

Respecting and involving people who use services - Outcome 1 (Regulation 17)

Consent to care and treatment - Outcome 2 (Regulation 18)

Care and welfare of people who use services - Outcome 4 (Regulation 9)

Meeting Nutritional Needs - Outcome 5 (Regulation 14)

Cooperating with other providers - Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse - Outcome 7 (Regulation 11)

Cleanliness and infection control - Outcome 8 (Regulation 12)

Management of medicines - Outcome 9 (Regulation 13)

Safety and suitability of premises - Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment - Outcome 11 (Regulation 16)

Requirements relating to workers - Outcome 12 (Regulation 21)

Staffing - Outcome 13 (Regulation 22)

Supporting Staff - Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10)

Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.


Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled inspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.


Contact us

Phone: 03000 616161

Email: [email protected]

Write to us at:

Care Quality CommissionCitygateGallowgateNewcastle upon TyneNE1 4PA

Website: www.cqc.org.uk

Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with thetitle and date of publication of the document specified.

Documents

Www.cqc.Org.uk Sites Default Files Media Reports 1-112591905 Ravensworth Care Home Limited INS1-597702190 Scheduled 05-07-2013