4 October 2022
During a routine inspection
Ravensmere Rest Home is a residential care home providing personal care to 9 at the time of the
inspection. The service can support up to 24 people living with dementia, mental health conditions and learning disability.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
Right Support:
The provider failed to have safe and robust systems in place when incidents and accidents occurred, and these were not reported which placed people at serious risk of harm.
Risk management was poor. Staff were not provided with enough clear guidance to
support people safely.
There were limited opportunities for choice, control and independence. There was no activity schedule or plan and opportunities to access the community or to pursue individual interests or hobbies.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity to make decisions, the provider failed to put in place documents to support decision making.
Right Care:
Care was not always person-centred or designed to promote people's dignity, privacy and human rights.
Staff did not always understand how to protect people from poor care and abuse. The provider often delayed or cancelled visits from other agencies.
Not all staff were appropriately skilled to meet people’s needs and keep them safe.
Right Culture:
People were supported by staff who did not understand best practice in relation to people with a learning disability and/or autistic people.
There were indicators of a closed culture. Staff did not ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. The routines within the service were not always personalised to individual people.
The provider failed to develop effective governance and quality assurance system to assess the quality and safety of the support people received. The provider failed to acknowledge the concerns consistently identified during inspections which meant improvements were not made to improve the care people received.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update the last rating for this service was inadequate (published 23 December 2021). At this inspection we found the provider remained in breach of regulations.
At our last inspection we recommended the provider reviews best practice guidance on creating a supportive environment for people living with dementia. At this inspection we found the provider had not acted on this recommendation or made any improvements.
Why we inspected
The inspection was prompted in part due to a safeguarding and continued concerns received about people living at Ravensmere Rest Home not having access to professionals and stakeholders involved in their care. The provider was continuing to not allow professionals and stakeholders to access the service to carry out their statutory obligations to ensure people’s safety and wellbeing. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment, safeguarding, mental capacity, staff training and person-centred care.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.