Ravenlea

Ravenlea 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.

Ravenlea accommodates up to seven people who have learning disabilities or autistic spectrum disorder. Some people had additional health concerns such as epilepsy and diabetes. There were six people living at the service when we inspected.

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had 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 2008 and associated Regulations about how the service is run.

This service was last inspected in September 2017 and we found two breaches of regulations and improvement was required. The breaches concerned not responding promptly to concerns about people’s safety and a failure to notify CQC of events which was legally required. This inspection found required improvement had been made and the previous concerns were addressed.

People's medicines were well managed and stored safely; there was clear guidance for staff on how to support people to take their medicines.

Risks to people were individually assessed and there was comprehensive guidance for staff. People were kept safe from avoidable harm and could raise any concerns with the registered manager.

There was enough suitably trained and safely recruited staff to meet people’s needs. Staff had the right induction, training and on-going support to do their job. People were supported to eat and drink enough to maintain a balanced diet and were given choice with their meals.

People’s needs and rights to equality had been assessed and care plans were kept up to date when needs changed. People were protected from any environmental risks in a clean and well-maintained home. Lessons were learnt from accidents and incidents.

Health and social care professionals were involved in people’s care and support and people accessed the healthcare they needed. Staff worked closely with other organisations to meet people’s individual needs.

People’s needs were met by the facilities provided at Ravenlea. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, the management team ensured there was a culture which promoted treating people with kindness, respect and compassion. Staff were attentive to people. The service had received positive feedback and people were involved in their care as much as possible. Staff protected people’s privacy and dignity and people were encouraged to be as independent as possible. Visitors were made welcome.

Personalised care met people’s needs, care plans were person centred and up to date. Where known, people’s wishes about their end of life care were recorded. People were encouraged to take part in activities they enjoyed. There had not been any complaints but people could raise any concerns they had with the registered manager. The provider sought feedback from people and their relatives which was recorded and reviewed.

People were happy with the management of the service and staff understood the vision and values of the service promoted by the provider and staff. There was a positive, person centred and professional culture. The registered manager had good oversight of the quality and safety of the service, and risks were clearly understood and managed. This was supported by good record keeping, good communication and working in partnership with other health professionals. The management team promoted continuous learning by reviewing audits, feedback and incidents and making changes as a result.

Further information is in the detailed findings below.

Ravenlea provides accommodation and personal care for up to seven people with a learning disability who may have an autism spectrum disorder. At the time of the inspection there were seven people living at Ravenlea, although two of the people were on holiday. In addition a further person visited the service and received day care. The service is a detached house, set in a quiet residential street in Folkestone. Each person has a single room with ensuite bath or shower room, with two bedrooms situated on the ground floor. There is a shared bathroom, kitchen, dining room, laundry and conservatory with doors leading to the garden. The enclosed garden has a paved seating area, lawn and raised beds and borders and is at the back of the house.

The service is required to have a registered manager. 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 and associated Regulations about how the service is run. At the time of this inspection the service had a registered manager, however, they were not present during the inspection. The day to day running of the service was overseen by a Peripatetic Manager, an Operational Director and a Quality Improvement manager.

People were not protected from the risk of abuse because some safeguarding concerns were not reported when they happened. However, staff had received safeguarding training and were aware of how to recognise safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.

Services are legally required to report some incidents to CQC without delay, although retrospective notifications had been made, the service had not informed CQC of significant events in a timely way.

The provider ensured systems were in place to monitor the care at the service was of a good quality, however, some actions to address concerns they had identified required further time to become every day practice.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A robust system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit and appropriate to be working with people. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had the right skills and knowledge to be able to care for, support and meet people’s needs. Staff continued to receive training, competence checks and support to meet the needs of people. There were staff meetings, so they could discuss any issues and share new ideas with their colleagues, to improve people’s care and support.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. Incidents and accidents were monitored to make sure the care provided was safe. Emergency plans were in place and practiced so if an emergency happened, like a fire, the staff and people knew what to do.

The care and support needs of each person were different, and each person’s care plan was individual to them. Care plans, risk assessments and guidance were in place to help staff to support people in an individual way.

People's legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this. Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve positive outcomes for people.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs very well. Feedback we received from people, their relatives and health professionals was positive.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with staff.

People were complimentary about the food and were offered choices around their meals and hydration needs. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy and nutritious diet.

People's feedback was regularly sought and action was taken to implement improvements. Staff told us they felt well supported by the day to day managers, they had a good oversight of the service and were able to assist us in all aspects of our inspection.

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

Ravenlea provides accommodation and personal care for up to seven people with a learning disability who may have an autism spectrum disorder. At the time of the inspection there were seven people living at Ravenlea and one person received day care at the service. There were no vacancies. The service is a detached house, set in a quiet residential street in Folkestone. Each person has a single room with ensuite bath or shower room, with two situated on the ground floor. In addition there is a shared bathroom, kitchen, dining room, laundry and conservatory with doors to the garden. The enclosed garden has a paved seating area, lawn and raised beds and borders and is at the back of the house.

The service is run by a registered manager. 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.

People were not fully protected by the risks associated with their care and support. Most risks had been assessed, but not all and some guidance required review, in order to keep people safe.

Most people got their medicines when they should, but improvements were required to medicine records and guidance to fully protect people.

People and relatives were involved in the planning of people’s care and support. However care plans required review to ensure they reflected all current care and support, and detailed peoples wishes and preferences to ensure safe and consistently support. People told us their independence was encouraged wherever possible, but this was not always fully supported by the care plan.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of the inspection people had their liberty restricted, but one DoLS application had not been submitted. People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

There were audits and checks undertaken to ensure the service ran effectively. However action was not always taken in a timely way to address shortfalls that had been identified. Records were not always available or dated making it difficult to ascertain whether they were current. Feedback was not sought from relatives and other stakeholders to drive improvements.

People were protected by safe recruitment procedures. New staff underwent an induction programme, which included shadowing experienced staff, until staff were confident to work on their own. Staff received training relevant to their role. Staff had opportunities for one to one meetings and team meetings, to enable them to carry out their duties effectively. Some staff had gained qualifications in health and social care. People had their needs met by sufficient numbers of staff. Staff rotas were based on people’s needs and one to one funded hours.

People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach.

People had a varied and healthy diet. People were supported to maintain good health and attend appointments and check-ups. Appropriate referrals were made to health professionals when required. People had a varied programme of interactive and leisure activities that they had chosen and regularly accessed the community.

People did not have any concerns, but felt comfortable in raising issues. Their feedback was gained both informally and formally.

People and staff had access to forums with regional staff where they could discuss any concerns or issues.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

At this inspection we spoke with most of the people who lived at the service, some of the staff and the manager. People who lived at the service told us they were happy with the care and support they received. One person told us 'The staff talk to me about my care and what I like' another person told us 'I enjoy my activities'.

We found that people and their representatives had the opportunity to be involved in making decisions about the care, treatment and support they received. We saw that people's decisions were reflected in their care plans, activities and goals. Where people needed help to make important decisions, we saw that an advocacy service was used.

During our inspection we looked at care plans and other records, we found that people did not always have the opportunity to be involved in discussions about their care and treatment. This meant that some recorded decisions may not continue to meet people's current wishes. We saw that health care plans were in place, people had access to healthcare professionals and appropriate referrals were made.

People told us that they felt safe living at Ravenlea and felt supported by the staff. We found that there were enough staff to meet people's health and welfare needs and records showed that all staff received training in key areas.

Quality checks were in place that helped to ensure that the service was provided within a safe and well maintained premises. There was a clear and accessible complaints procedure for people to follow if they wished to make a complaint.