Archived: Ryland View Care Home

Updated 7 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 12 and 13 September 2017. The inspection was conducted by four inspectors, a pharmacy inspector, a specialist advisor and two experts by experience [one on each day of the inspection]. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Experts by Experience involved in this inspection had experience of caring for an older relative who used regulated services including care homes with nursing. A Specialist Advisor is a person who has specialist skills, knowledge and clinical experience in an area of practice relevant to the service being inspected; they are deployed by the Care Quality Commission to support the inspection process. The Specialist Advisor involved in this inspection was a registered nurse with specialist knowledge and skills of nursing people with general and dementia care needs.

We looked at the information that we hold about the service prior to visiting the location. This included notifications from the provider about deaths, incidents and safeguarding alerts which they are required to send us by law. Following our inspection and before the completion of our report we shared concerns with the provider that were raised with us by a whistle-blower. Whistle-blowing is the term used when someone who works in or for an organisation raises a concern about malpractice or wrongdoing; staff should be supported to raise their concerns within the organisation without fear of reprisal.

A Provider Information Return [PIR] request had not been sent to the provider prior to the inspection and therefore was not available to inform the inspection plans. A PIR is a pre-inspection questionnaire that we send to providers to help us to plan our inspection. It asks providers to give us some key information about the service, what the service does well and any improvements they plan to make.

We contacted the local authority and commissioning services to request their views about the service provided to people at the home, and also consulted Healthwatch. Healthwatch is the independent consumer champion created to listen and gather the public and patient's experiences of using local health and social care services.

We spoke with 19 people who lived at the home and 14 relatives. We also spoke with 14 members of care and nursing staff, a regional director, five unit managers, the head chef and the head of activities. Some of the people living at the home had complex care needs and were unable to tell us about the service they received. We used a tool called the Short Observational Framework for Inspection (SOFI) on Bloomfield, Palethorpe, Haines and Heronville units coupled with general observations across all the units of the home. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We reviewed the care records of 25 people and examined the medicine administration processes for 21 people and any associated records in detail. We looked at training records for staff and four staff files to review recruitment and supervision processes. We also looked at records which supported the provider to monitor the quality and management of the service, including accidents and incident records, compliments, complaints, infection control audits and quality monitoring reports.

Updated 7 December 2017

This inspection took place on 12 and 13 September 2017 and was an unannounced inspection.

Ryland View Care Home was previously registered under the provider name of BUPA Care Homes (CFH Care Limited) up until February 2017. We were notified in December 2016 that the provider intended to simplify its structure and applied for all of its registered locations across the UK, (which at that time were registered across 13 different legal entities) to transfer over to just two legal entities. This meant that Ryland View Care Home became newly registered under the provider name Bupa Care Homes Limited in February 2017. Therefore, this was the provider's first inspection at this location since newly registering with us in February 2017. The inspection history for the location under the previous provider was used to inform the planning of this inspection because there had been no other changes at the location; the registered manager and the running of the service had remained consistent.

Our last comprehensive inspection of this location took place in January 2016; the service was rated as Good. The report from this inspection is available in the full history of inspection reports, which can be found in the previous provider's archived records for this location on our website at www.cqc.org.uk.

Ryland View Care Home provides accommodation and nursing care for up to 144 people. At the time of our inspection, there were 144 people living at the home. Care was provided within five units. Bloomfield and Heronville units provided care to people who lived with dementia, whilst Palethorpe unit provided care to younger adults who lived with a physical disability. Haines unit provided care to people who lived with conditions and frailty relating to old age. Manby unit facilitated intermediate and step down support and care for people for a short duration of time; some people on this unit had been discharged from hospital and required short term support to regain their health and/or mobility.

There was a registered manager [RM] 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. On the day of our inspection the RM was not available so we were supported by the acting manager in the RMs absence [also a unit manager] and the Regional Director.

Medicines administered to people in food or drink or via a tube to their stomach did not have all of the necessary safeguards and guidance for staff in place. Some medicines used for pain relief had been administered beyond their expiry date. Medicines administration records clearly demonstrated that people were receiving their medicines at the times they needed them.

Risks to people in relation to the support they required to maintain their health had been assessed; however these had not been consistently monitored on all units in relation to the equipment in use for supporting and maintaining skin health.

People felt safe living at the home because staff supported them well with their health care needs. The provider ensured enough staff were on duty to ensure their needs were met in a timely manner and reviewed staffing levels on a daily basis. The provider operated safe recruitment practices, ensuring the necessary pre-employment checks were carried out.

The provider had identified some staff as ‘safeguarding champions’ who had received advanced training in this area to act as an additional source of support and information for other staff. The provider operated clear processes and had a policy in relation to the reporting and learning from incidents. Staff understood how they should respond to a range of potential emergencies.

The oversight and application of the Mental Capacity Act [MCA] and Deprivation of Liberties Safeguards [DoLS] was in need of review at the home. Staff understanding of DoLS was variable. Staff established consent from people before providing care.

Resuscitation issues were discussed with people or their representative and the appropriate documentation was completed. The staff team were well trained and the provider ensured staff were supported in keeping their knowledge and skills updated. New staff were provided with a structured induction. People were provided with choices of food and drink that met their needs and preferences. People were supported to access all the health care support they needed in order to maintain their wellbeing.

People’s right to privacy was protected and they were treated with dignity and respect. Staff demonstrated they were kind and compassionate when meeting people’s needs. People and/or their representatives were involved in the planning of their care wherever possible.

Communication within the service was effective and staff used a variety of methods of communication to establish people’s requests and ensure their understanding. A broad range of activities were available and events took place that people enjoyed and engaged in.

Regular meetings and discussions took place to review and respond accordingly to people’s changing needs. Clear information about the service, the facilities, and how to complain was made available to people. Complaints received were fully investigated and responded to.

Peoples’ feedback was actively sought, encouraged and acted upon. People were overwhelmingly positive about the service they received. Staff were clear about the leadership structure within the home and were fully involved and updated in relation to its development.

Audits were carried out about every aspect of the service to identify how it could improve and monitor its effectiveness; however we found some deficits that these quality checks had not identified. When the need for improvement was identified, remedial action was taken to improve the quality of the service. A variety of regular staff and senior management meetings took place to share and review updates about the service.