Archived: Ryehill Country Lodge

Ryehill Country Lodge is a residential care home providing personal care to up to 24 people aged 65 and over, some of whom may be living with dementia. 19 people were using the service at the time of our inspection.

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

People benefitted from improvements made to the provider’s monitoring and oversight of the quality and safety of the service.

We found the home to be warm and welcoming and we received positive feedback from relatives about the care their family members had received.

Staff had supported people to remain in contact with their relatives during the COVID 19 pandemic and activities had been arranged within the home to reduce the risk of isolation, including celebrating cultural events.

People received their medicines on time and as prescribed and improvements had been made to the management of people’s creams. Where appropriate, people were supported to administer their own medicines.

Staff kept people safe from the risk of abuse and managed risks to people’s health and welfare.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 October 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 and 23 September 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance systems. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the Key Questions Safe and Well-led. 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 changed from requires improvement to good. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ryehill Country Lodge 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Ryehill Country Lodge is a residential care home providing personal to 23 people living with dementia and aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

Governance systems were not effective. Systems in place did not identify areas requiring improvement we found at this inspection.

People’s prescribed medicines were not always stored safely. Records were not always completed in line with the provider’s policy.

We made a recommendation regarding the storage and record keeping of medication.

Activities were carried out by staff which meant these opportunities were limited.

We made a recommendation regarding activities.

Improvements had been made to the environment to ensure it was safe for people. Refurbishment work had been carried out in the main communal areas. Further work was required with regards to the cleanliness of the service. People told us they felt safe, and there was adequate staff to meet their needs.

Staff received induction, training and supervision to support them in their roles. People were given choices of meals, and they were happy with the food available. People’s health care needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were kind and caring and respected people’s privacy and dignity. People were encouraged to make daily living choices.

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 requires improvement (published 02 October 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12. At this inspection not, enough improvement had been made/ sustained, and the provider was still in breach of regulation 17.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to governance systems at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ryehill Country Lodge 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.

The service provides accommodation and care for a maximum 24 older people and up to four people attending day services each day. There were 22 people living at the service and one person attending day services at the time of the inspection.

The service had a manager who had registered with the Care Quality Commission. 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.

At our previous inspection in December 2015, this service was rated good overall. This is the first time the service has been rated requires improvement.

Notifications relating to safeguarding incidents had not always been made to the local safeguarding authority, or CQC as required by law. We reviewed the service's safeguarding records and found there were incidents of safeguarding which we should have been notified of.

Parts of the environment were not always safe. The laundry area was accessible to people and we found this contained substances which would be hazardous to people if ingested. There was no evidence that the fire alarm and detection system had been serviced by a competent person since December 2014. An upstairs toilet was dirty around the bottom, and a metal pedal bin had mould around the base. A landing window contained bird faeces on the sill.

The registered manager was able to demonstrate they had an understanding of Deprivation of Liberty Safeguards (DoLS) and the Court of Protection. However, we found that Mental Capacity Act (2005) guidelines were not always followed. We have made a recommendation about this.

The quality assurance system in place was not always effective. Checks carried out failed to identify and mitigate risks to people regarding infection control practices and the safety and maintenance of the premises. The system had failed to identify the MCA had not been applied consistently. The registered manager began to address some of the concerns we raised during the inspection.

People told us they felt safe living at the home and that they would tell someone if they were worried about anything. Staff were able to demonstrate they knew the different types of abuse and how to report any safeguarding concerns and had access to training on how to safeguard people from abuse.

Risks to people had been identified and recorded in their care plans. Where people presented with behaviours that placed others and themselves at risk of harm, staff knew how to support them.

Recruitment practices were robust to ensure the suitability of people who worked in the service. There were sufficient numbers of suitably skilled and experienced staff positioned across the service to meet the needs of people and keep them safe.

Medicines were managed safely and staff had appropriate training.

We saw that staff completed an induction process and had regular training to equip them with the skills and knowledge to meet people's needs.

People's nutritional and hydration needs were assessed and planned for. People enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day. People’s comments were positive about the provision of food and drink.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. The guidance contained in some care plans was not always sufficiently detailed on how staff were to support people during times of distress.

The approach to care planning for people was person centred and their care plans took account of the person's views and preferences about how their care was to be provided.

People were offered a variety of different activities to be involved in, and people told us they were well cared for. People were treated with dignity and respect and we observed staff communicated with people and gave encouragement.

People were supported to access healthcare services when they needed to, including their GP and dieticians. Electronic records were maintained for people, describing the contact and input from external healthcare professionals.

A complaints procedure was in place and complaints were addressed appropriately.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the report.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. One person said, " Staff look after my medicines, I prefer it that way."

People were protected from unsafe or unsuitable equipment. We saw that people used equipment they had been assessed and risk assessed for and we saw that staff were skilled in using equipment.

There were enough qualified, skilled and experienced staff to meet peoples' needs. Staff were satisfied with their shifts and said they liked coming to work. They covered each others' absences and had sufficient support from their seniors and manager.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare

of people using the service and others. Audits and surveys were used to obtain peoples' views, but the main quality monitor was the manager's discussions with people and relatives and daily observation of peoples' demeanour and the care they received.