An inspection of this home was carried out in December 2017, the provider was rated Requires Improvement and was in breach of regulation 12, Care and treatment, 17, Good governance and 18, Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan to tell us what action they would take to improve the service and to comply with the regulations. After the publication of this report in February 2018, in March 2018, conditions were imposed on the provider’s registration because of the continued breach of regulations.

At this inspection in January 2019, we found the provider had not taken measures to comply with the regulations or the terms and conditions of their registration.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

This inspection was unannounced and took place on 24 January 2019.

Ravenswood Care Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ravenswood Care Home accommodates 55 older people some of whom were living with dementia. On the day of our inspection 35 people were living in the home. The home is situated on two floors and was accessible to people who used a wheelchair.

The home had a registered manager who was present on the day of our inspection visit. 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.

The management of medicines continued to be unsafe and people did not always receive their medicines in line with their prescription. People were at risk of potential abuse because safeguarding protocols were not followed to safeguard them.

Where accidents had occurred, lessons were not learned and measures were not taken to reduce the risk of them happening again. People were not assisted to access treatment and this placed their health at risk. Staff were not always available to support people in a timely manner and this meant some people were left in discomfort.

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This inspection took place on 4, 5 and 6 December 2017 and was unannounced. This was a comprehensive ratings inspection. Ravenswood Care Home is a residential home for up to 55 older people. There were 39 people living at the service at the time of the inspection. People who used the service were older people and may have had physical and/or mental health needs.

At the last inspection on 31 July and 1 August 2017, we asked the provider to take action to make improvements to meet regulations 9, 10, 11, 12, 13, 14, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had made some improvements so they were no longer in breach of Regulations 9, 10, 11, 13, 14, 16 and 19. They were in continued breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

There was no registered manager in post. There was a manager in post; however they had not undertaken the registration application 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The number of staff had improved since our last inspection. However people did not always have their needs met in a timely way as staff were not always deployed effectively. This meant people could not always be treated with compassion due to a delay in them getting support.

Medicines were not always stored and administered as prescribed and there were gaps in the recording regarding medicines.

Risks to people’s health and wellbeing were not always assessed and planned for, such as agitation, health conditions and following falls, leaving people at risk.

The provider did not have effective systems in place to ensure people received the care and support they needed. The provider did not always take action to make required changes when incidents occurred.

Staff understood their safeguarding responsibilities and appropriate referrals had been made. However, one incident had been documented by staff but had not been reported by management.

Decision-specific mental capacity assessments needed to be put into place and best interest decisions clearly recorded.

Staff training had improved although further improvements were required. We have made a recommendation about staff continuing to receive updated training so all training is up to date and that staff understand what the MCA means for people they support.

The home had improved in appearance but further improvements could be made to ensure it was dementia friendly.

Care plans were not always updated following a change in people’s needs so staff did not always have up to date guidance.

Plans for when people were coming towards the end of their life had been considered. We have made a recommendation that the service consistently reviews and records people’s wishes in relation to their end of life support preferences.

More activities were now available for people, although it was felt more time for staff to engage with people would be beneficial.

An Equality and Diversity Policy was in place, however people had not always been given the option to discuss their sexuality, if those chose to.

Infection control measures were in place and the home was clean with no malod

This inspection took place on 31July 2017 and the 1 August 2017 and was unannounced. This was a comprehensive ratings inspection. Ravenswood Care Home is a residential home for up to 55 older people. There were 46 people living at the service at the time of the inspection. People who used the service were older people and may have had physical and/or mental health needs.

At the last inspection on 22 February 2017, we asked the provider to take action to make improvements to meet regulations 10, 12, 13, 17 and18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of Care Quality Commission (Registration) Regulations 2009. At this inspection we found the provider had not made the required improvements and there had been further deterioration in the quality of the care people received.

There was no registered manager in post. There was a manager in post; however they had not undertaken the registration application 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.

During this inspection we identified nine breaches of the Health and Social Care Act 2008. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore remains 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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 did not always have their needs met, because there was not enough staff to meet people’s needs. Where people were at risk, staff did not understand how to manage the risks to keep people safe. People did not always receive their medicines safely. Medicines were not always available to people. People were not protected from the risk of abuse. Staff did not always identify potential abuse, which meant incidents were not investigated and reported to the local safeguarding authority.

People received support from staff that did not have the knowledge to support people safely. We found not all staff understood how to provide some aspects of people’s care. People were not always supported in a way that protected them from unlawful r

The inspection took place on 22 February and 24 March 2017and was unannounced. Ravenswood Care Home is a residential home for up to 55 older people. There were 52 people living at the service at the time of the inspection. People who used the service were older people and may have had physical and/or mental health needs.

At our previous inspection in October 2016, we found there were concerns about staffing levels and there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It was also identified that audits were not always being carried out. We asked the provider to tell us how they were going to make the required improvements.

There was a Registered Manager 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.

At this inspection we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One of these breaches was an on-going breach identified in the last inspection in relation to staffing levels. There was also a breach a breach of Care Quality Commission (Registration) Regulations 2009.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

There were not always enough staff available to keep people safe and meet people’s needs. Communal areas were often left unattended which left people at risk of harm to their health, safety and wellbeing.

Plans were not always in place to support people if they became agitated. Staff were also not trained to support people effectively who were experiencing periods of agitation.

Plans were also not in place for people who needed support with their skin integrity and we could not be sure that people were receiving the level of support required to look after their pressure sores.

Risk assessments and detailed plans were not always in place to prevent people from falling and if people had fallen, action was not always taken to support people from falling again and some people had continued to experience falls.

We could not be sure that people were receiving their topical medicines as prescribed. Some risks to peop

This inspection was completed on 11 October 2016 and was unannounced. Ravenswood Care Home provides personal care and accommodation for up to 55 older people, some of whom may be living with dementia. At the time of the inspection 52 people were using the service. The service had a registered manager in post. 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.

People were at risk of not getting the support they required in a timely manner as at times, there were insufficient staff to meet their needs. We found that, at times, people had to wait to have their care and support needs met and that staff were unable to spend quality time with people.

People gave us mixed reviews about the activities available to them in the service, and expressed wishes to be able to access the community more often.

Quality assurance audits were not always undertaken effectively to identify any trends in incidents.

People were referred to relevant health professionals when they needed it and were supported to maintain a healthy diet. People’s medicines were stored and administered safely by trained staff.

People were provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and were provided with support when required to ensure their nutritional needs were met. People's health was monitored and access to healthcare professionals was arranged when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

People knew how to complain and told us they were confident issues would be addressed. People and their relatives were encouraged to give feedback on the care provided. The registered manager and provider responded to feedback and changes were made to improve the quality of the service provided.

Staff knew what to do if they suspected a person had been abused. The manager reported incidents of suspected abuse to the local authority for further investigation.

Safe recruitment procedures were followed to ensure that new prospective staff were fit to work with people.

The registered manager understood the conditions of registration with us. We saw that systems were in place to monitor quality of the service; however some incidents were not being assessed for trends to identify areas for improvement. People at the service felt the registered manager was approachable.

At the last inspection of December 2013 we asked the provider to take action to make improvements in relation to care and welfare and risk assessment and this action has been completed’.

This inspection was completed on 14 October 2014 and was unannounced.

Ravenswood Care Home provides personal care and accommodation for up to 55 older people, some of whom may be living with dementia. The service had a registered manager in post. 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 and associated Regulations about how the service is run.

Staff were clear about the actions they should take if they had suspicions that people were not safe. They confirmed they had received training in safeguarding people from abuse, but did not always demonstrate knowledge of how to report it.

Assessments were completed when people were at risk of harm and action was taken to reduce any identified risk.

A robust recruitment process was in place to ensure only people suitable to work in care were employed.

People received their medication when they needed it. We have made recommendations about the management of some medicines to ensure the arrangements were safe.

New staff completed a thorough induction programme before they started to work and received training that was necessary for them to do their job. Regular reviews of staff competence and the quality of care they provided were carried out.

Staff were aware of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). Referrals were made for people who may have their liberty restricted. The provider ensured that people’s rights were respected, but we recommend that staff knowledge of consent and capacity issues on a day to day basis is improved.

People were provided with a well-balanced diet. However, the mealtime experience should be reviewed so that people can enjoy their meal in a more pleasurable way and a review of people’s food preference and the quality of food provided would help to ensure people’s overall satisfaction.

People were treated with dignity and respect. Staff were patient, caring and compassionate. They demonstrated an understanding of people’s needs. Relatives confirmed they had no concerns about staff attitudes, but observations showed that some staff engagement was not always positive or considerate.

People were involved in the assessment and planning of their care whenever possible. Where this is not possible, representatives were involved.

An activities coordinator had responsibility of planning the recreational and occupational events on the home. Recreational activities were available, but we have recommended that the provider seeks further guidance about activities that are suitable for people living with dementia.

Complaints and concerns regarding the service were dealt with appropriately. The provider demonstrated that they considered any complaints they received to assist in any improvements to the service for people.

There was a registered manager and staff told us they felt well supported by the manager and the management team. Relatives confirmed the registered manager was approachable and responded quickly if they raised any concerns of issues with her.

The registered manager informed us of any significant incidents that occurred in the home; this included accidents, and had good systems in place to monitor the quality of care being delivered.

The provider had plans for improving the quality of the service it provided and for the benefit of people living at the home.

There were 51 people in the home on the day of our inspection some people had a diagnosis of dementia.

We spoke with two relatives during our inspection and reviewed 16 comment cards.

People were treated as individuals and care was provided with dignity, respect and compassion. A relative told us, “There is a wonderful caring atmosphere here where you feel your family member is safe and secure”.

We saw that staff did not always seek specialist advice and support to maintain people’s physical and mental health with the urgency required to keep people safe.

Staff had received training in the care of people with dementia. Staff we spoke with were able to explain the different types of dementia and knew the needs of the people they cared for well.

Staff felt well supported by the manager. A member of staff told us, “It’s much better here since X started”.

A relative told us, “During the last 12 months the care has improved greatly. The staff spend more time with people. I also receive feedback from the staff about my family member”.

The registered manager had put effective systems in place to monitor the quality of service and make improvements when necessary.