We inspected Ravensworth Care Home on 22 May 2017. This was an unannounced inspection. The service is registered to provide accommodation and nursing care for up to 30 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 28 people living at the service.

At our last inspection on 6 November 2015 the service was found to be fully compliant and was rated good in all areas.

A registered manager was in post and present on the day of the 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.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. They were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

We inspected Ravensworth Care Home on 22 May 2017. This was an unannounced inspection. The service is registered to provide accommodation and nursing care for up to 30 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 28 people living at the service.

At our last inspection on 6 November 2015 the service was found to be fully compliant and was rated good in all areas.

A registered manager was in post and present on the day of the 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.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. They were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

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 us how 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.

We spoke to people at Ravensworth, their families and staff about care at the home. People were generally happy with their care, and we saw that staff were respectful and sensitive to people's needs when providing support. One person's relative told us, "The staff are great. They are kind to Mum and get her singing and dancing."

We found that although people and their families were informed and consulted, consent was not always being sought for people's care, including if they were not able to consent for themselves.

We saw appropriate direct care being given to people, and that care plans were adequately detailed and personalised at the time they were written. We found that not all plans were up to date, however, and also that information was not always included to make staff aware of possible risks. We also found some hazards in the home that could result in accidents.

We saw that staff were trained in relevant areas and that they were supported by the manager in team meetings. We found that although staff told us they could approach the manager during their working hours, staff were not supported with regular supervision meetings.

We saw that effective infection control systems had been introduced at Ravensworth, and that the home was clean and hygienic. We found that other monitoring systems were not fully adequate to ensure the quality and safety of care delivered at Ravensworth.

At our visit three people said they were not provided with a copy of the service guide, but each felt that their family advocate acting on their behalf may have been given this on their admission to the home. They said they enjoyed regular contacts with their families and two people told us about activities that were regularly organised. One person we spoke with was not able to access key service information due to its format and because of their given sight difficulties

Information people gave, told us that in many ways their rights were promoted to ensure they were suitably informed and involved in making decisions about their care and daily lives in the home. Although this also told us that some were not best informed or supported to maintain their independence and dignity in accordance with their disability needs.

All three people told us they were comfortable in the home and expressed overall satisfaction with the care and support they received. One person told us, ‘I made the right decision coming here, I get all the care and help I need from staff.’

Two people described satisfactory arrangements for their access to outside health and social care professionals. All said they had agreed for the home to retain and administer their medicines on their behalf. One person told us, ‘I really praise the work staff do.’ They are very good and if you are not well, they get the doctor so I don’t have to worry.’

Two people confirmed they felt safe in the home. They expressed confidence in raising any concerns they may have with staff and that these would be dealt with. All said that staff, were usually available when they needed them and indicated that they listened and acted on what they said. One person told us, ‘The staff, they always come when I want them for anything, even though they are busy.’

All said they were satisfied with their own rooms, including the cleanliness of these and also with the laundry service provided for their personal clothing and bedding.

All gave examples about some of the ways they were consulted with for the care and services they received. They included regular group meetings and periodic satisfaction surveys with them or their advocates.