Archived: Ryefield Court

Ryefield Court is a residential care home providing personal care to people aged 65 and over. The home can accommodate up to 60 people in one adapted building over three floors, each of which have separate adapted facilities. The second floor specialises in providing care to people living with dementia. At the time of the inspection there were 48 people living at the home.

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

People received excellent person-centred care and were supported to have choice and control. Care plans were highly personalised and recorded people’s preferences in detail, so staff knew how to respond to people’s needs. Staff were innovative in how they met people’s needs and we saw examples of bespoke care. In addition to making sure people’s individual needs were being consistently met, the provider implemented programmes that benefited the whole service, such as the falls prevention strategy, which could then be tailored to each person’s individual needs.

There were various group activities on offer and people could choose to engage in activities that were meaningful to them. There were also activities tailored to people’s individual needs and preferences. People were supported to maintain links with family and friends and the provider was able to accommodate family and friends visiting in either communal areas or more private rooms. We observed staff were responsive to people's needs throughout the day.

There was a complaints procedure in place and the provider responded to complaints appropriately.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. There were also systems in place to identify and manage risks. Medicines were managed and administered safely.

Safe recruitment procedures were in place and there were enough staff to meet people’s needs. The provider followed safe infection prevention and control procedures and provided staff with relevant training to help protect people from the risk of infection. Safe recruitment procedures were in place and there were enough staff to meet people’s needs.

Supervisions, appraisals and competency testing provided staff with the support they required to undertake their jobs effectively and safely. People's needs were regularly assessed to ensure these could be 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. People were involved in making decisions about their day to day care and their opinions were listened to and valued. Independence was promoted. People and their relatives confirmed people were cared for by competent staff who knew the needs of the people they cared for.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. People using the service and staff reported the registered manager was approachable and promoted an open work environment. Clear leadership contributed to people and staff being positive about the management of the home and feeling valued and respected.

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

Rating at last inspection

The last rating for this service was requires improvement (published 21 August 2020). The provider completed an action plan after that inspection to show what they would do and by when to improve. In September 2020, we completed a targeted inspection and found improvements had been made and the provider was no longer in breach of the regulations. At this inspection we found that improvements had been embedded and the rating of the service has changed to good.

Why we inspected

This was a planned inspection based on the previous rating and to check that the provider has been making consistent improvements at the service.

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.

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.

Ryefield Court is a residential care home providing personal care to people aged 65 and over. The home can accommodate up to 60 people in one adapted building over three floors, each of which have separate adapted facilities. The second floor specialises in providing care to people living with dementia. At the time of the inspection there were 49 people living at the home.

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

During the inspection we found the provider had systems in place to identify and manage risks. Medicines were managed safely, and staff followed appropriate infection control practices to prevent cross infection. The provider had made changes to the environment to make it more dementia friendly.

People received person-centred care and care plans were personalised and recorded people’s preferences, so staff knew how to respond to people’s needs effectively. Relatives told us they were involved in planning people’s care. We observed interactions between staff and service users that was kind and caring.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people.

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 21 August 2020) and there were multiple 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 undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12 (Safe care and treatment) and17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ryefield Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information we may inspect.

Ryefield Court is a residential care home providing personal care to people aged 65 and over. The home can accommodate up to 60 people in one adapted building over three floors, each of which have separate adapted facilities. The second floor specialises in providing care to people living with dementia. At the time of the inspection there were 51 people living at the home.

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

During the inspection we found records were not always contemporaneous, which may have resulted in staff not having the most up to date information on people’s needs and how to care for them. We also saw examples of medicines not being managed safely which included instructions for administration that were not clear and opening dates not recorded. The home environment was not always safe or dementia friendly. We observed examples of care that were not person centred which meant people were not always being cared for in a way that met their individual needs.

We also recommended the provider ensure there are a range of activities that meet the needs of all people using the service.

Notwithstanding some of our findings and observations, relatives consistently told us people were cared for by kind and supportive staff who knew the needs of the people they cared for well. People were involved in making decisions about their day to day care and their opinions were listened to.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were in place. Staff followed appropriate infection control practices to prevent cross infection.

Supervisions, appraisals and competency testing provided staff with the support they required to undertake their jobs effectively and safely. People's needs were regularly assessed to ensure these could be met. People were supported to maintain healthy lives and access healthcare services appropriately. People were also 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.

Care plans were personalised and recorded people’s preferences, so staff knew how to respond to people’s needs. There were various activities on offer and families were welcomed to the home. There was a complaints procedure in place and the provider responded to complaints appropriately.

People using the service and staff reported the registered manager was approachable and all stakeholders said the home was well led.

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

Rating at last inspection

The last rating for this service was requires improvement (published 17 January 2019) and there were three 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 enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care, person centred care, premises and equipment and good governance 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.

Ryefield Court is a ‘care home’. People in care homes receive accommodation and nursing or 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. In the case of Ryefield Court, no nursing care is provided. The home can accommodate up to 60 people in one adapted building over three floors which are run as separate units, each of which have separate adapted facilities. The unit on the second floor specialises in providing care to people living with dementia.

The registered manager who was in post at the last inspection had left and at the time of this inspection, there had been a new registered manager in post for two months. ‘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.’

During the inspection we found some aspects of medicines management were not always carried out safely. The provider introduced plans to address the areas that required improvement when we pointed these out to them.

The provider’s arrangements around the control and spread of infection were not always effective. We identified several issues which fell short of good practice.

People did not always receive person centred care that met their needs. A few people were woken up early in the morning when there were no indications that this met their needs, wishes or preferences.

Care plans were not always person centred and detailed, to address how people’s needs were to be met. For example, the care plans to support people with their elimination care needs did not make clear how these needs would be met.

The provider’s quality assurance systems and governance arrangements were not always effective because they had not identified the shortfalls we identified at this inspection, so they could make the necessary improvements and protect people from the risk of receiving unsafe and inappropriate care. Once we pointed out the shortfalls, the provider started to address these promptly.

Whilst the home provided a warm, clean, well maintained and inviting environment for people, the unit for people with dementia did not always support their orientation and independence because of a lack of signage, the use of colour and features. We have made a recommendation to the provider about this.

The provider had recruitment processes which were not always adhered to robustly. The registered manager stated they would make sure that these were adhered to as required.

The provider had policies and procedures in place to protect people from abuse. Staff we spoke with had received training and knew how to respond to safeguarding concerns.

Staff had up to date training, supervision and annual appraisals to develop the necessary skills to support people using the service.

People's dietary and health needs had been assessed and recorded so any dietary or nutritional needs could be met. People were supported to maintain healthier lives and access healthcare services appropriately.

The provider worked within the principles of the Mental Capacity Act (2005). People were generally supported to have choice and control over their day to day decisions.

Before coming to the service, the provider undertook an assessment to determine if the service could meet the person’s needs.

There was a complaints procedure in place and the provider responded to complaints as per their procedure.

People using the service and staff told us the registered manager was available and listened to them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 14 March 2017 and was unannounced.

This was the first inspection of the service since it was registered in July 2016.

Ryefield Court is a care home for up to 60 older people in the London Borough of Hillingdon. The home caters for some people who may be living with the experience of dementia. At the time of the inspection 24 people were living at the service. Some of these people were there for short stay care. The service is run by Ryefield Court Care Limited, which is part of the Berkley Care Group, a national privately run organisation. The organisation had five care homes at the time of the inspection, with plans to open a sixth home in 2017.

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 and associated Regulations about how the service is run.

The service was exceptionally caring and people were supported to feel special. The leadership of the home and the staff worked in a natural and well-coordinated way to focus their attention on each person. Every interaction we observed showed how the staff treated people as individuals and appeared happy and confident in the way they supported them. In addition, people living at the service and their visitors reported this was always the case. People shared stories with us and the registered manager told us about examples where staff had gone the extra mile to give someone the care and support they needed. In these examples we saw how the staff considered the holistic needs of each person, thinking about their emotional wellbeing as well as their physical needs.

People's needs were met in an exceptionally person centred way. They were supported to plan their own care and to pursue the life they wanted to live. The staff showed empathy and understanding around the challenges people felt when they moved into a care home and tried to support people to ease this. Examples of this were supporting people with hobbies and interests and helping people to feel more confident and able to accept help and support.

The service was closely linked with the local community. Vulnerable and older local community members were invited to the home to take part in activities, share meals and socialise with people. This service was free of charge and people were offered transport to and from the home. This initiative was supported by Age UK and allowed some of the more vulnerable members of the local community to have access to support and services, including hot meals, which they may not otherwise have had. In addition the people living at the service enjoyed this aspect of the service, as local community members volunteered, socialised and spent time with them.

The arrangements for social activities and entertainment were innovative and reflected people's preferences and needs. The provider arranged for regular unique and interesting visiting entertainers. People enjoyed this. People also had access to community activities, including regular trips to places of interest and the theatre. The spa room offered treatments each day and people had unlimited access to the cinema room to watch films or sporting events. The provider had access to satellite films and sporting events and was a member of social media film clubs.

The provider had designed an all-inclusive luxury service. This meant that the environment, furniture and furnishings were all very good quality. The provider had a policy that any damaged items would be immediately replaced. The environment included additional communal features which people were able to use whenever they wanted, free of charge. For example, there was a cinema, which people could use to watch films or sporting events with their friends and families, a spa where people using the service and their visitors could receive treatments and a bar/bistro area where food and drinks were served throughout the day. People were extremely positive about the service and the environment. The all-inclusive nature allowed for them and their families to have unlimited access to the services at the home. They told us they appreciated this and enjoyed the way in which the service was run. The registered manager told us that allowing families and friends to have access to the same services as people who lived at the home had resulted in visitors staying longer and as a result this was better for the wellbeing of the people who they were caring for.

The quality of the food at the service was exceptional with all meals freshly prepared from food which was delivered daily. People were able to make choices about what they ate when they were served. There was a good variety of set choices, but people were also able to ask for something different and eat at different times of the day to set meals and this was accommodated.

The service was well-led. The registered manager operated an open door policy, telling us, ''We never turn people away if they want to talk with us.'' People who lived at the service, staff and visitors confirmed this telling us the registered manager was approachable and valued them. There were comprehensive systems for monitoring the quality of the service and the provider was striving for continuous improvement based on feedback from their stakeholders.

People were cared for in a safe way. There were procedures designed to protect them from abuse. Risks to their personal safety and within the environment had been assessed. There were enough staff and there had been checks on their suitability whilst they were being recruited. Medicines were managed in a safe way. The staff worked with other healthcare professionals to make sure people's health needs were monitored and met. People felt that their complaints were appropriately responded to and felt confident speaking with the registered manager, staff and provider about any concerns.

The staff were appropriately trained and supported. They had regular training and commented that this was useful. They had the information they needed to carry out their duties and they told us they felt well supported by the registered manager and senior staff.

The provider acted in accordance with the requirements of the Mental Capacity Act 2005. They had assessed people's capacity, obtained consent for care and taken appropriate action where people lacked capacity to ensure care was delivered in their best interests.