What life is like for people using this service:

The overall rating for this service 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.

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.

People were at risk of harm as fire safety procedures and checks were not effective and the maintenance of fire doors did not keep people safe from the risks of fire.

People were at risk as the infection prevention and control systems were not effective and did not reflect best practice.

Staff members did not always follow safe practice when supporting people with their medicines.

People’s individual preferences were not prompted when supporting them with meals and food options.

The physical environment did not contain appropriate signage to help people orientate themselves to their surroundings.

People’s individual protected characteristics were not clearly identified.

People’s privacy was not always respected.

People’s individual communication needs had not been assessed in line with best practice.

The provider did not have effective systems in place to monitor the quality of the service they provided or to drive improvements where needed.

People had care and support plans which gave staff members the information that they needed to provide care but staff members did not routinely read them.

People felt that the activities that were available were limited and that at times they felt unstimulated.

People did not always receive timely support when showing signs of anxiety or distressed.

Staff members had access to training and felt supported in their role. New staff members completed a structured introduction to their role.

People were referred to additional healthcare services when it was required.

The provider had systems in place to respond to complaints or compliments from people or visitors.

Rating at last inspection: Good (Last report published 17 September 2016). Following significant concerns regarding people’s safety the current rating is ‘inadequate’ overall.

About the service:

Ravensmere Rest Home is registered to provide accommodation and personal care for up to a maximum of 24 people who have a diagnosed mental health condition or who may be living with dementia. Ravensmere does not provide nursing care. At this inspection 18 people were living there.

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Enforcement.

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

Follow up:

We will monitor Ravensmere Rest Home and re-inspect as part of our published inspection programme timetable. In addition, we will receive regular updates from the provider on the progress they are making in addressing the concerns we have raised with them.

The Inspection took place on the 24 August 2016.

Ravensmere Rest Home provides accommodation and personal care without nursing for up to 22 persons some of whom may be living with dementia. At the time of our inspection 22 people were living at the service.

The service had a registered manager. 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had made appropriate DoLS referrals.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, community psychiatric nurse and dementia nurse specialist.

Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People knew how to make a complaint; complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The registered manager carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements.

As part of our planning two inspectors visited the service prior to this inspection taking place. This was in response to a concern raised. This visit took place on 31 March 2014 and the information gathered at that visit has been considered as part of this inspection which took place on 10 April 2014 with two further inspectors.

Some of the people who lived at Ravensmere Rest Home had complex needs but some were able to speak with us. We spoke with five of the 23 people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who lived in the home and with staff. We also spoke with four staff members, the manager and provider and two relatives. We looked at five people's care records. Other records viewed included staff recruitment and training records, staff rotas, health and safety checks, medication records and satisfaction questionnaires completed by the people who used the service, their relatives and staff.

We considered our inspection findings to answer questions we always ask; Is

the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that appropriate processes were in place with regard to medication and its administration, so that people could be confident they were protected from the unsafe use and management of medicines.

Appropriate checks were undertaken before staff began employment at Ravensmere Rest Home.

The service was safe. We saw records which showed that the health and safety in the service was regularly checked and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "The staff are very polite and friendly.” Additionally two relatives said: “We have complete peace of mind and no concerns whatsoever.”

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect. One person who commented on a recent quality survey questionnaire said: “I love the staff’s calm approach when caring for the residents. Nothing is too much trouble and any problems are quickly dealt with in a calm and caring way.”

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People's choices were taken in to account and listened to.

People who used the service were generally provided with the opportunity to participate in activities which interested them. Two people who commented on a recent quality survey questionnaire said they would welcome the opportunity to have a more structured activity programme.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People can therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system which was to be further developed, and records seen by us showed that identified shortfalls were addressed promptly.