The inspection took place on 8 August 2018 and was unannounced. This meant the provider and staff did not know we would be coming. We previously inspected Risedale Rest Home Limited in May 2017, at which time the service was in breach of regulations 9 (person-centred care), 12 (safe care and treatment), 17 (well-led) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the previous inspection we rated the service as requires improvement. At this inspection, whilst there had been some improvements, the service remained requires improvement.
We found risk assessments were not managed appropriately, care plans were not person-centred, staffing levels were too low, training had lapsed, premises were not adequately maintained or cleaned and that there was a lack of management oversight.
Risedale Rest Home 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.
Risedale Rest Home accommodates a maximum of 17 people across two floors. Nursing care is not provided. There were eight people using the service at the time of our inspection, some of whom were living with dementia.
The service did not have a registered manager in place at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager had applied to be registered with CQC and was registered as the manager after the inspection.
At this inspection we found the manager had made a range of improvements and addressed the majority of the areas where the service was previously in breach of the regulations.
We found there were still improvements required with regard to the planning of staffing levels, which were not always adequate to meet people’s needs. Staffing levels were determined by a dependency tool which was not effective. We have made a recommendation about this.
People’s social needs, for example activities and hobbies, could not always be supported because of the lack of appropriate staffing levels. On at least one day a week, the manager was required to assist the one member of care staff on duty. Care staff also had to complete cleaning duties as the provider had not ensured adequate levels of staffing cover in this regard.
Activities provision was not effective. There was no activities co-ordinator and the manager did the bulk of activities planning. Staff helped people with individual activities or played games with people, but none of this was planned in line with people’s preferences. The provider had not ensured there was sufficient staffing in place to provide person-centred care. Subsequent to the inspection the provider confirmed they were seeking the help of a volunteer to help deliver activities.
There had been significant improvements in terms of cleanliness since our last inspection, with evidence of recent refurbishment and more planned. Infection control training had been delivered to staff and all visitors and people who used the service agreed the service was cleaner.
Medicines administration practices had improved and were now safe. Protocols for ‘when required’ were not yet in place.
Risk assessments were in place and described the factors which may put people at risk of harm, and what staff needed to do to minimise these risks. Documentation regarding risks, along with all aspects of care planning, were under review and would benefit from more detailed, person-centred information. Staff knowledge regarding how to keep people safe was good.
All staff were aware of their safeguarding responsibilities and the manager had done some work to ensure this was well understood.
Training and support for staff had improved since the last inspection. A range of mandatory and additional training had either been delivered or planned, whilst staff confirmed they now received supervision meetings. They told us they were now well supported.
Training was monitored via a training matrix, which did not always prove effective as it did not contain information regarding online courses staff had completed. The manager was aware of this and planned a new matrix.
People received a range of meal options and the mealtime experience we observed was a pleasant one. People’s individual tastes and preferences were well catered for.
People were supported to have maximum choice and control of their lives in the least restrictive way possible. Staff had received training in the Mental Capacity Act (2005).
There were adequate bathing and toileting facilities. Some refurbishment work had been undertaken, mostly downstairs in communal areas. Further work was required upstairs to renovate one bathroom and refurbish remaining bedrooms.
Staff knowledge of people’s needs was good and there were well documented interactions with external healthcare professionals.
People who used the service, their relatives and external professionals gave consistently strong feedback about how staff care for people who used the service.
There had been no complaints since our last inspection. The manager ensured the complaints process had been reviewed to ensure it was accessible and understood by people who used the service.
The manager demonstrated a keen desire to continue improving the service. Staff we spoke with and people who used the service confirmed they had taken a proactive, ‘hands-on’ approach to making improvements. All confirmed they had involved staff and people in planning and making improvements.
The culture was one focussed on caring for people in a dignified way, in a homely environment. The impact the manager had been able to make had been limited by the lack of resources at their disposal, most significantly staffing levels. The manager had done well to make a range of improvements but needed more supernumerary time to make further improvements, rather than having to provide cover for when there was only one care assistant on duty.
We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.