The Raikes Residential Home is registered to provide residential care for up to 31 people. Most of the people who use the service are older people, some of whom live with dementia. The home is situated just outside the village of Silsden. Accommodation is provided in single rooms on the ground and first floors. Two passenger lifts provide access to the first floor. On the day of inspection 30 people were living at the home.

This inspection took place on 7 September 2017 and was unannounced. At the last inspection on 9 May 2016 we rated the service ‘Requires Improvement’ overall and identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On this inspection we found this regulation had been met and no further breaches of regulation were found.

There was 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.

The home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and kept them as safe as possible. People told us they felt safe because the staff were caring and because the registered manager listened to them and acted quickly if they raised concerns.

There were enough staff on duty to meet people’s needs and staff had undertaken training relevant to their roles. Staff told us there were clear lines of communication and accountability within the home and staff meetings were held to keep them up to date with any changes in policies and procedures or anything that might affect people’s care and treatment.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

People told us they enjoyed the food and we saw people’s weights were monitored to ensure they had sufficient to eat and drink.

We saw the complaints policy had been made available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

The care plans in place were person centred and identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists.

We found medication policies and procedures were in place and staff responsible for administering medicines received appropriate training.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required.

The inspection took place on 9 May 2016 and was unannounced.

We last inspected this service in March 2014 and found it was meeting all of the regulations inspected at that time.

The Raikes Residential Home is registered to provide residential care for up to 31 people. Most of the people who use the service are older people, some of whom live with dementia. On the day of our inspection 31 people lived at the home. The home is situated just outside the village of Silsden. Accommodation is provided in single rooms on the ground and first floors. Two passenger lifts provide access to the first floor.

At the time of this inspection the manager was not registered with the Commission. However, following our inspection they submitted an application to become the 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.

People we spoke with told us they felt safe and did not raise any concerns about the way they were treated. Staff were aware of action they would take to keep people safe such as in the event of an emergency or if they were concerned someone was at risk of abuse. We found safeguarding concerns were being referred to the local safeguarding team but the Commission was not always being notified about them.

We found some care records were not complete and did not always demonstrate that risk had been mitigated. The manager was in the process of updating all care records to ensure they were sufficiently detailed and contained person centred information.

Overall risks to people’s health, safety and welfare were identified and action taken to manage the risk. However, care records did not always fully reflect the risk reduction strategies staff followed.

Our observations, discussions with people and review of records led us to conclude there were sufficient staff to meet people’s needs.

Overall we concluded there were processes in place to make sure people’s medicines were managed safely. However, some improvements were needed to ensure a consistent approach. We recommend the provider reviews and revises their protocols for ‘as required’ medicines to ensure they are developed in line with current guidance and provide clear guidance for when people should be provided with these medicines.

We concluded the manager was taking appropriate action to implement an effective system of staff training but there was still work to be done in this area.

We found the premises to be clean, tidy, appropriately furnished and homely. Some window restrictors needed to be replaced to ensure they met current guidance. Following our inspection the manager arranged for this work to be completed.

People told us the food was good and our observations showed people received sufficient food and drinks. However, care records did not always evidence nutritional risk had been effectively managed, especially in relation to people’s fluid intake.

People provided positive feedback about the standard of care provided and told us staff were kind and caring. We saw staff knew people well and used this knowledge to provide care which met people’s individual needs. Staff treated people with respect and dignity and offered support in a kind and sensitive way.

Staff supported people to see other health care professionals so they could maintain good health and we saw examples where staff had made referrals where they were concerned about someone’s health and wellbeing. The advice provided by health care professionals was not always reflected within care records.

Assessments and applications had been made to ensure the rights of people with limited mental capacity were protected in line with the legal framework of the Deprivation of Liberty Safeguards

We found there were some new processes in place that ensured appropriate infection control standards were maintained including detailed cleaning schedules and a new audit. We also found the environment had been newly decorated, old commodes had been replaced and there were newly introduced wall mounted soap and paper towel dispensers for staff to use.

We briefly spoke with one person who used the service during the inspection and they appeared comfortably and cheerful. We noted their bedroom was clean and tidy and their commode was also clean.

We found staff openly discussed the care and support they provided with people who used the service and asked for consent where necessary. We found staff were respectful and supported people in a caring and professional way. We also found care plans were easy to follow and it was clear what people's risks were and what support staff needed to offer in order to meet people's needs.

We found the majority of the environment of the home was visibly clean but attention to detail was lacking with some equipment and high surfaces. We also found hand washing and drying facilities for staff were not easily accessible and washing of commode pans was conducted in the laundry room.

We found staff were supported in their role and offered the necessary training that ensured they had the right knowledge and skills. We also found there was a suitable complaints process and people who used the service had the complaints process discussed with them during admission to the home.

We spoke with four people who used the service, one person said "I get on well with the girls and wouldn't want to move from the home." They also said the food was good and they had a laugh. Another person said they were very happy at the home and had no complaints. Another person who used the service said they were “comfortable and happy".

We spoke with five out of the 27 people who live at the service, they told us that they were happy and comfortable living at The Raikes Residential Home and that they got the care and support they need.

People we spoke with told us they received care that was appropriate to their needs. One person told us “Staff are good, I can do what I want, they look after me here.”

People told us their individual needs were met. One person told us “I can get up and go to bed when I like here”.

Visitors told us they were involved in making decisions about their relatives care and treatment. They also said they were kept informed of any changes in their relatives needs. One person told us "Its as good here as it gets, staff seem to care.”

Staff we spoke with told us they felt supported and had the knowledge and skills to support people who lived at the home. One staff member said “Nice to think I’ve made a difference, we make a difference”.