Abbey Ravenscroft Park Nursing Home

Abbey Ravenscroft Park Nursing Home is a 'care home'. The accommodation is purpose-adapted with passenger lift access to all three residential floors, each of which have separate adapted facilities. People in this care home receive accommodation along with nursing and 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. At the time of this inspection there were 53 people living in the service.

People’s experience of using this service and what we found.

Relatives told us that people were safe and received good care and support.

Recruitment processes had been improved and procedures were now safe.

Risks identified with people’s health, medical and care needs had been assessed and documented with clear guidance on how to minimise the identified risk to keep people safe.

People received their medicines safely and as prescribed.

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed. There were enough staff to meet people's needs.

The home was clean and odour free. There were increased infection control measures in response to the coronavirus outbreak. The provider reacted appropriately to keep people safe.

Staff received the training and support to carry out their role effectively. Care staff told us that they felt that the management team was very supportive especially during the recent months of the pandemic.

Relatives confirmed that they received regular updates and feedback about their relatives. However, some healthcare professionals did comment that communication between them and the home could be improved.

There was a positive culture throughout the service which focused on providing care that was personalised. The management team used a variety of methods to assess and monitor the quality of the service. They were aware of their regulatory responsibilities associated with their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

More information is in the full report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (report published July 2018).

Why we inspected

We carried out a focused inspection of this service on 16 September 2020 to check that the provider had made improvements required in relation to recruitment and infection control. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Ravenscroft Park Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

The service has a registered manager, which 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 service is registered to provide accommodation for up to 67 people, although records informed us the maximum practical occupancy was 64. There were 52 people using the service at the start of this inspection. The service specialises in dementia care and is operated by a regional care provider.

This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led.

At our last inspection of this service, in September 2017, we found two breaches of legal requirements. These were in respect of safe care and treatment, and safeguarding people using the service from abuse. The service was rated 'Requires Improvement.' The provider completed an action plan to show what they would do and by when to improve the rating of key questions of 'Is it Safe?' and 'Is it Well-Led?' to at least ‘Good.’

At this inspection, we found the necessary improvements had been made. Systems, processes and practices were now safeguarding people from abuse. The service was also now ensuring people received medicines as prescribed. The service’s overall rating from this current inspection has therefore improved to ‘Good.’ However, the rating for ‘Is it Safe?’ remains ‘Requires Improvement.’ This is because we identified some concerns about staff recruitment processes, maintaining sufficient staffing levels in practice, and upholding infection control standards. Whilst the provider sent us a comprehensive written response to address these matters shortly after our visits, we could not be assured that these matters would have been identified without our involvement. We have recommended the provider seek and implement best practice guidance on staff recruitment checks.

People using the service spoke positively about it, describing it as ‘very nice’ and ‘excellent’ for example. Everyone said they would recommend it to friends and family. People’s relatives and representatives provided similarly positive feedback. There was particular praise about supporting people with health-related matters.

We found the whole service worked in co-operation with other organisations to deliver effective care and support. This helped ensure that people’s health care needs were well attended to, for example, for skin integrity, swallowing concerns, and with helping people to reduce aggressive behaviours. People were supported to eat and drink enough and maintain a balanced diet.

The service made sure staff had the skills, knowledge and experience to deliver effective care and support. Staff were committed to people’s care, and treated people with kindness, respect and compassion.

The service supported people to maintain relationships that mattered to them. People’s visitors, relatives and representatives were welcomed into the service, and kept updated where appropriate.

People were supported to express their views and make decisions about their care and support. Their independence was promoted, and their privacy and dignity was respected including for end-of-life care.

People's needs were holistically assessed to help ensure the service could meet their specific needs. These were kept under review, to help ensure people received a responsive service.

The service provided a range of activities that aimed to reflect people’s preferences.

Attention was paid to providing a safe service, both in terms of the premises and equipment, and in respect of people’s individual abilities and needs. Accident and incidents were kept under review, to aim to minimise risks of reoccurrence.

The service listened and responded to people’s concerns and complaints, and used this to improve the quality of care. Systems at the service generally enabled sustainability and supported continuous learning and improvement.

The feedback of some staff indicated weaknesses in the service’s working culture. The provider sent us an action plan shortly after our visits, that aimed to address this. Nonetheless, the provider, management team and staff upheld a clear vision and credible strategy to deliver the good quality care and support that people and their representatives told us of and which we found.

This report covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the all reports link for this service on our website at www.cqc.org.uk.

Abbey Ravenscroft Park Nursing Home is a nursing home providing accommodation with nursing and personal care for up to 65 people. At the time of our inspection there were 60 people living there.

The service had a registered manager in post. A condition of the registration of the service was to have a registered manager in post at the service. 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.

Staff could identify what abuse looked like and had been on training but we saw one instance where a safeguarding referral was not made to the local authority.

Medicines were not always managed safely. Some medicines were not recorded as administered and records needed updating to reflect current prescriptions and allergy status.

Audits were more robust and frequent, with better oversight of care provided. However, audits for care plans were missing information that showed whether action had been taken.

People told us they felt safe and the home was clean, staff followed infection control procedures and wore gloves and aprons.

Staff told us they felt supported and their skills were being developed. The registered manager was reflective and positive on the improvements that had been made in the service.

We found two breaches of legal requirements in this inspection, and we made one recommendation regarding notifications to us. Further information is in the detailed findings below.

You can see what action we told the provider to take at the back of the full version of the report.

Abbey Ravenscroft Park is a 67 bed nursing home registered to provide accommodation and nursing care to older people. At the time of our inspection there were 61 people living there.

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. There was a registered manager employed at the time of our inspection and they had been registered there for over 17 years.

Staff had a good understanding of safeguarding and knew what abuse might look like and how to report it. However, we found that safeguarding concerns were not always reported to the local authority or investigated.

Where an incident had taken place the home could not show that they had learned how to manage the risk to reduce the chance of the incident reoccurring.

We found the premises unsafe with windows on upper floors not having window restrictors, putting people at risk of falling out and sustaining a serious injury.

Medicines were mostly managed safely, but there was not sufficient oversight of medicines audits and competency testing for staff did not always take place.

The principles of the Mental Capacity Act were being followed and staff had an understanding of seeking consent.

Staff training was robust and regular supervisions were taking place which staff said they found helpful.

People and relatives told us staff were kind and caring, and people’s privacy and dignity were respected.

Care plans were not person centred and some needs were not assessed or reviewed. Staff knew people and their likes and dislikes but this was not reflected in care documentation.

People knew how to complain and felt comfortable doing so but complaints were not always not investigated fully.

Quality assurance was not robust, mistakes were not always picked up and some of the same issues were found in this inspection as in the last.

We had concerns about the management culture in the home and staff and people had heard shouting in the wake of incidents or mistakes.

We found three breaches of regulations at this inspection in relation to premises and equipment, safe care and treatment and a repeated breach in governance relating to quality assurance.

You can see what action we told the provider to take at the back of the full version of the report

The Abbey Ravenscroft Park Nursing Home is registered to provide accommodation, nursing and personal care for up to 67 older people. At the time of the inspection there were 57 people living at the home. The home had 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.

We found improvements in the management of medicines, staff supervision and recording in care plans as required at the previous inspection. However we found a number of new issues which required improvement.

We were concerned to find insufficiently rigorous recruitment systems in place for new staff, to ensure the protection of people living at the home. We also found that staff were not fully trained in the Mental Capacity Act 2005, and people who were unable to make decisions for themselves, were not always sufficiently protected by the procedures specified in this Act. Although quality assurance systems were in place, they were not sufficiently thorough so as to identify and address a number of significant shortfalls that were found during this inspection.

Staff had some knowledge of people’s preferences regarding their care and support needs, but care plans were not always sufficiently personalised to record people’s specific care needs and choices, and risk assessments did not always include clear actions to minimise the risk of harm. Staff were clear about the procedures for reporting abuse.

The home was kept clean and hygienic, and people were provided with a choice of food, and were supported to eat when needed. People had a range of activities available to them, and access to health and social care professionals. When people made complaints they were addressed appropriately.

At this inspection there were three breaches of regulations relating to staff recruitment, mental capacity and quality assurance, and one recommendation relating to care records. You can see what action we told the provider to take at the back of the full version of the report.

An increased number of training sessions were available to staff, who were given protected time to attend sessions to ensure they would meet the home's requirements. Nursing staff had been trained to undertaken supervisions with a group of staff in their unit area, with future plans to ensure that the provider's policy was adhered to.

We saw planned care and treatment for people was not always delivered in order to ensure their safety and welfare. We also found that some staff did not receive appropriate training to work with people who use the service. Since the inspection, the provider has addressed some of the concerns raised.