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 n

The inspection was undertaken on 28 and 29 June 2017 and was unannounced.

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 37 people lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, conservatory and dining room.

The provider did not have a registered manager in place. 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. A new manager had commenced their employment on 21 June 2017.

Our last inspection took place on 22 and 23 August 2016 where we found the provider was in breach of two regulations. 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 to enhance their welfare.

At this inspection we found staffing arrangements were being managed more positively and responses to people’s needs did not significantly impact upon their welfare as at our previous inspection. Although legal requirements had been met in these areas further work was needed to ensure improvements were consistent in how staffing arrangements and care centred on people was responded to so this did not impact upon people’s preferences and individual needs.

People told us they felt safe in the home and staff showed an awareness of how to recognise and report potential abuse so actions could be taken to reduce risks of people being harmed. However, people were not supported by staff to reduce the risks of avoidable accidents when using wheelchairs and in making sure potential environmental hazards had been reduced in a timely manner.

People were confident staff supported them to take their medicines when they needed these so risks to their safety and health was reduced. Where people required time specific medicines staff had prioritised these in line with people’s prescribed health needs.

Staff reflected their skills and knowledge to meet people’s needs in effective ways. The provider had arrangements in place to equip staff with the induction, training and support they required in order to carry out their caring roles. Staff were provided with support during one to one meetings but staff expressed how there were some behaviours within the staff team which required managing as these had impacted upon staff morale.

Staff assisted people with their choices and decisions. There were improved arrangements in place which supported people who lacked the mental capacity to make specific decisions which reflected only people with the legal authority to do so were involved in best interests decisions. Staff had the basic knowledge to inform their practices so people were not restricted unlawfully and staff had knowledge of these so they were able to support people’s safety and meet their needs.

People mostly enjoyed the food which was prepared and cooked. However, for some people there were occasions when they felt unable to eat their meals and enjoy these due to how these were cooked. The former management team had been made aware of this aspect of people’s meal experiences which required improving but no action had been taken to remedy this.

People were supported by the arrangements in place to monitor and identify when people did not eat and or drink sufficient amounts to meet their needs. Healthcare professionals were consulted so staff had the best possible advice and guidance in order to support people to remain healthy and well.

Staff’s caring approaches did not consistently supp

The inspection took place on 22 and 23 August 2016 and was unannounced.

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 38 people lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, conservatory and dining room.

Since our previous inspection a new manager had come into post in October 2015. The manager had said they would make an application to register with us but at the time of this inspection the application had not been made to us. However, at the time of this inspection the provider was recruiting to ensure they were fulfilling their legal responsibility in having a manager who was registered with the Care Quality Commission. 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.

We found the provider needed to make improvements to ensure people’s needs were effectively met and they were safe. We saw staffing arrangements did not ensure people’s individual needs were met in a timely way which significantly compromised people’s wellbeing and safety. Staff believed they did not have time to spend with people to promote good care.

People’s medicines were stored securely and made available to people as prescribed. Although, we were concerned about two people who did not receive one of their particular medicines at the right time. For one person this had impacted on their emotional wellbeing and health needs.

People had different reasons for feeling safe whilst living at the home which included feeling secure and having staff ‘on hand’ so they could request support. Staff showed a good understanding of how to recognise abuse and how to report if concerns were raised. Staff were aware of how to minimise risks to people’s safety. We saw they used specialist equipment to ensure people’s needs were met and the risks of injuries were reduced.

There were staff recruitment and selection processes in place to make sure the providers recruitment arrangements did not compromise people’s safety. Improvements were being made to ensure all staff had the opportunity of receiving regular training and one to one meetings to support them in their roles. We saw staff did not always apply their knowledge into their daily practices and staff felt unsupported due to the inconsistency in staffing arrangements.

People were asked before support was provided and their wishes were respected. We saw people were given choice about day to day decisions such as what they would like to wear and where they would like to sit. However, there were inconsistencies in assessing people's ability to make their own decisions. Where decisions had been made on people's behalf the records did not always reflect whether best interest decisions were made by people who had the authority to do this.

People were supported to have a choice of meals from the menu which was being developed further. Improvements were being made to provide people with further opportunities throughout the day to boost their calories if their appetites were poor, such as snacks. More consideration was needed to make sure people had the support they required to eat their meals without any unreasonable delays and it was a sociable occasion for people.

Health and social care professionals were involved in people's care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. However, staffing arrangements and the lack of leadership had impacted upon the time staff invested into providing

This inspection took place on 5 January 2015 and was unannounced.

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 39 people lived at the home.

The manager was appointed in September 2014 and is currently registering with us. 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.

We saw conversations between staff and people who lived at the home were positive in that staff were kind, polite and helpful to people. All the people we spoke with told us they felt their privacy was respected and they felt safe.

People had their prescribed medicines available to them and these were administered by staff who had received the training to do this. The protocols for ‘when required’ medicines were not in place. This meant that staff did not have information available to them to make reference to about these medicines so that people received these medicines in the right way.

Staffing levels did not always promote people’s needs being met in the right way and at the right time. This included making sure people were supported in doing fun and interesting things. This meant they were at risk of social isolation.

Staff were aware of the Mental Capacity Act 2005 (MCA), but lacked understanding of Deprivation of Liberty Safeguards (DoLS). We found the provider had made suitable arrangements to ensure people who lacked capacity received appropriate assessment and training was planned in both the MCA and DoLS to increase staff knowledge.

Care plans, risk assessments and daily records did not always reflect the care people received. Staff were knowledgeable about people’s needs and how to meet those needs. This included supporting people with their meals so that people received nourishing diets and drinks.

Some of the staff we spoke with and records we saw confirmed staff training had been planned. We saw staff did not always apply the knowledge gained from training effectively when carrying out their roles.

People we spoke with told us they knew how to raise any concerns and who they should report any concerns to. The manager investigated and responded to complaints, according to the provider’s complaints policy and procedure.

We found that although further improvements were needed the leadership at the home had been strengthened. The manager had improved people’s opportunities to make suggestions about the service they received. This showed the quality of the service was being focused upon but further action was required for the benefit of people who lived at the home.

Our inspection was unannounced; no one knew we would be visiting. We spoke with three people who lived at the home and one family member to find out their views about the service provided at the home. We also spoke with four staff which included the management team and looked at some records.

People were positive about life at the home. One person said "It is excellent here, like home from home. I feel safe and am extremely happy here.” Another person told us: “I think it is (the care) good” and “Very happy with what goes one here.”

During our inspection we saw that staff helped people to make simple everyday decisions, such as, what they wanted to drink and what they wanted to do. There were some arrangements in place where required, to help people with the bigger decisions so that their best interests were upheld.

We saw that people who lived at the home had their medicines as prescribed at the right time and in the right way. This made sure people’s health needs were effectively met.

The manager had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made where necessary. All the people that we spoke without exception told us that the management team and staff were approachable and for this reason they felt comfortable to complain if they needed to.

Forty-one people lived in the home when we visited. We talked with some of them about their experience of living there on the day of our visit and we spoke with the relatives of others after our visit.

Many of the people we spoke with were happy with the quality of the care provided. They said, ‘’Care a lot better than it was”, ‘’Staff are very good and patient’’ and ‘’Staff are good and meet my needs.’’

Some of the people we spoke with told us that staff treated people with respect and helped them to be as independent as possible. Throughout the day we observed staff supporting people with words of encouragement where needed whilst completing tasks. We also saw that time was taken to pass the time of day through general chat between people who lived in the home and staff. It was evident that staff had a good rapport with people and it became evident that the registered manager and staff knew people’s likes and dislikes.

We observed lunch being served to people during our visit. Staff were seen to offer people choices of where they would like to eat their meal and assistance was provided at people’s own pace. Many of the people who lived in the home and relatives of others who we spoke with told us that they were happy with the meals provided at Ravenstone. They said, ‘’Food is good and have many choices’’ and ‘’Food so much better as more choices now’’.

One person told us that if they needed extra support or if they needed to see a doctor, staff arranged this quickly. One relative commented that staff ‘’Always let me know if there is a problem”. A person who lived in the home told us that they had seen their social worker to talk about their needs and ensured these continued to be met.

All of the people who lived in the home and the relatives that we spoke with were confident that they could raise concerns if they were not happy with the care being received and that they would be listened to.

We spoke to seven people that lived at the home. They told us that the staff were friendly and polite and that they liked their bedroom. Three people told us they felt they had to wait for staff at certain times.

People we spoke to who were in their bedrooms told us that they had chosen to stay in their rooms. They did sometimes get involved in activities and confirmed they were going out to a Christmas meal arranged by the home. They told us that they had a television, books and newspapers available.

We saw that staff appeared busy and spent time focussed on tasks. They did not also have time to provide social interaction with people who used the service.

We looked at two care plans and we saw that there were gaps in the planning and recording of peoples needs. More details are provided in Outcome 4 later in this report.

Two people that we spoke to were not able to tell us about their care and treatment but told us that the staff were nice and friendly. One person told us that they were happy with the care and we saw that they were able to raise concerns with the manager. We saw that the manager was able to respond to their concerns immediately.

We spoke to one person who was staying at the home for respite care. They were pleased with the way they were being looked after and they told us they did not have to wait for things. They told us that the ‘staff were encouraging’ in their rehabilitation.

The inspection took place on 22 and 23 September 2015 and was unannounced.

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 39 people lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, conservatory and dining room. A registered manager was in post at the time of our 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.

We received mixed views from people about whether there were sufficient staff to consistently meet their needs. We found improvements had been made to make sure staff responded to people’s requests for assistance and helped people to follow their interests. Although, at this inspection there were some people who had to wait to receive support with their personal care needs.

People had their prescribed medicines available to them and staff followed safe medicine practices. This included referring to information which had been developed for people who needed ‘when required’ medicines to make sure they received these safely and in the right way for them. This was an improvement made by the provider since our last inspection. However, we were concerned about one person who did not receive one of their medicines at the right time which was important for them as this could have impacted on their physical abilities.

People told us they were supported to access health and social care services but for two people staff had not followed up the advice provided by the doctor to maintain and promote their health and well-being.

People and their relatives told us that they felt safe. Staff knew how to identify harm and abuse and how to act to protect people from the risk of harm. Staff had received the training they needed to fulfil their roles and felt supported by the registered manager but some staff did not conduct themselves professionally whilst on duty. All new staff had been checked for their suitability to work at the home.

Staff were knowledgeable about people’s needs and how to meet those needs and care records had been improved to reflect the care people received. This included supporting people with their continence needs by making sure the records accurately recorded any aids people required to help staff provide personalised care which consistently met people’s needs.

Staff respected people’s rights to make their own decisions and choices about their care and treatment. People’s permission was sought by staff before they helped them with anything. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well. Where people may have restrictions on their liberty and freedom in order to keep them safe applications had been made to the local authority so that assessments could take place to make sure people were not unlawfully restricted.

People were provided with appropriate food and drink to meet their health needs. People were happy with the food they were provided with and staff helped people to make their own choices so that people’s personal preferences could be met. However, there was an unpleasant smell in the dining room where people were eating their meals which did not enhance people’s dining experience.

Staff were caring and respectful towards people with consideration for people’s individual needs when chatting with people. Staff offered people the opportunity to have fun and interesting things to do. People’s right to private space and time to be alone with their relatives and friends was accepted and respected.

People knew how to make a complaint and felt able to speak with staff or the registered manager about any issues they wanted to raise. People were encouraged to give their views and experiences of the home through meetings but staff were also aware of advocacy services should people need an independent person to speak on their behalf.

People benefited from living in a home where quality checks were completed on different aspects of the service to drive through improvements. The registered manager was open and responsive to making further improvements so that people consistently received good standards of care and treatment.