This inspection was unannounced and took place on 19 July 2018.

Ravenscourt Nursing Home 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.

At our last inspection on 24 May 2016 the service was rated ‘Good’. At this inspection on 19 July 2018, we found the service remained ‘Good’.

Ravenscourt Nursing Home accommodates 70 people in one adapted building. Ravenscourt Nursing Home accommodates people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing nursing care to people living with dementia. The second unit specialises in providing nursing care to older people. At the time of our inspection, 68 people lived in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the home is run.

At our last inspection, we found the provider was in breach of the regulation to notify the CQC of serious incidents, safeguarding alerts or Deprivation of Liberty Safeguard (DoLS) authorisations. At this inspection, the provider was now compliant and was sending the CQC the relevant notifications without delay.

People received safe care. Risks to people were identified and there was guidance in place for staff to minimise these risks and safeguard them from abuse. People were supported by staff who had received training to provide a safe and effective service.

Systems were in place to ensure medicines were administered safely and when needed.

Equipment in the service was maintained and serviced regularly. People lived in an environment that was safe and suitable for their needs.

Any accidents or incidents were investigated and recorded and lessons were learnt to reduce any reoccurrence.

There were sufficient numbers of staff available to support people. Recruitment processes were safe, which ensured that staff were suitable to work with people who needed support.

People were supported to have choice and remain as independent as possible. The service was compliant with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. People and relatives were involved in decisions about their care.

People’s nutritional needs were met and the provider was developing new menus to better suit people's preferences and tastes. Staff worked with health and social care professionals, such as GPs, to ensure that people remained healthy and well.

People continued to receive care and support that was responsive to their needs. They were supported by caring staff who treated them with respect. Their privacy and dignity were maintained.

We saw that staff supported people patiently and were attentive to their needs.

People were able to engage in activities and social events that they enjoyed. They were able to provide feedback and make suggestions about what they wanted from the service.

Since the last inspection, a new registered manager had been appointed to manage the service. They ensured the quality of the service was monitored regularly and effectively.

The inspection was unannounced and took place on 24 May 2016. The service was meeting legal requirements at our last inspection in September 2014.

Ravenscourt Nursing Home provides care to 70 people some of whom may be living with dementia. On the day of our visit there were 61 people living at the service.

There was a registered manager in place. 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.

The premises and some equipment were not always safe or properly maintained. We spoke to the registered manager about this and were told repairs would commence by the end of June 2016.

We found that although some incidents had been reported to the local authority, the registered manager had not informed the Care Quality Commission as required by law of some incidents that had resulted in harm.

People told us they felt safe and secure at Ravenscourt and felt there were enough staff to support them. We found staff had attended safeguarding training and were aware of how to recognise and report any type of abuse in order to protect people from harm.

Risks to the environment were kept up to date. However we found that moving and handling and falls risks assessments were not always updated particularly for people who had been living at the service for a period of two or more years. In addition mental capacity assessments were not always evident except in instances where covert medicine was used.

We found short falls in staff understanding of the Mental Capacity Act 2005. Although they were aware of the some of the people requiring a Deprivation of Liberty Safeguards authorisation they were unsure about the process to be followed. We spoke to the registered manager and deputy who showed us evidence that appropriate steps had been taken to ensure that people were only deprived of their liberty when it was in their best interests to do so. We recommended that more advice and training from a reputable source be sought to expand staff knowledge base.

Staff were aware of the procedures to follow in an emergency. There was a colour coded system at the nurse’s station to ensure staff knew at a glance the best method to evacuate people to areas of safety in the event of a fire.

Medicines were stored and handled safely by staff who received regular training and updates relating to medicines management.

People were supported to eat a balanced diet that met their needs. Staff including the chefs were aware of people on different types of diets. For people on enteral (feeding via a tube going into the stomach) feed appropriate guidance and direction and speech and language advice was followed to ensure people received their nutritional support safely.

People were treated with dignity and respect and their privacy was promoted. Staff addressed people by their preferred names and responded to calls in a timely and appropriate manner.

People and their relatives described staff as caring and compassionate. We observed staff being sensitive to people’s needs. Staff had attended relevant training and were supported by annual appraisal and regular supervision. Appropriate recruitment checks were completed to ensure staff were suitable to work in a health and social environment.

Care plans were person centred and reflected people’s social, emotional, cultural and physical needs. Activities were based on people’s needs and were a mixture of one to one, group, indoor and outdoor activities. Lots of games were left around for people and staff to use when the activity coordinators were not around.

People told us they could raise a complaint without fear of being victimised. Staff were aware of the complaints procedure and told us that any complaints were usually resolve

A single inspector carried out this inspection. During the inspection we spoke with four people who used the service. We spoke with the registered manager, the Head of Care (senior nurse), three care workers, two registered nurses, an activities co-ordinator and relatives/visitors. We also spoke with a visiting health professional. We reviewed the care records for seven people and reviewed a selection of other records, including audits, staff files, policies and procedures.

Is the service safe?

Risk assessments of people had been documented in their care records together with guidance on action to take to protect people. There was documented evidence that staff had been provided with essential training such as first aid and health and safety to enable them to care for people safely.

Staff received training and guidance regarding the requirements of the Mental Capacity Act (MCA) 2005. The registered manager and the Head of Care demonstrated to us their knowledge of the Deprivation of Liberty Safeguards (DoLS) and the MCA requirements.

Is the service effective?

We spoke with relatives, visitors and people who used the service who all indicated the service was effective and responsive to the needs of people. One person said, "I like it here." One visitor said, "They always seem well cared for when I visit." People's care needs had been assessed with the help of their relatives, representatives and other providers involved in their care. Their choices and preferences were documented and staff we spoke with were aware of these. This enabled staff to respond effectively when caring for people. Care plans had been clearly prepared. These were up to date and were regularly reviewed.

Is the service caring?

We received feedback from people who used the service, which indicated people found the staff caring and kind. We observed the staff treating people with respect and dignity. A relative wrote regarding the care provided, "We would like to thank you for all your care in getting us through a difficult time, you and your staff have been amazing."

Is the service responsive?

The registered manager informed us the provision of services and care was regularly reviewed and if there were problems or suggestions made, they would respond. This included providing special meals for those that required a certain diet or preferred a certain type of food. On the day of the inspection, there was fresh Asian food cooked as one of the meal choices. When we needed information regarding the care provided and the management of the service, this was promptly provided. We spoke with an external health professional who told us that they staff were very responsive to the changing needs of the people who used the service and were good at involving the families in any decisions.

Is the service well-led?

The staff who were present during the inspection were knowledgeable regarding their roles and responsibilities. There were arrangements for monitoring the quality of care provided. All the staff said they had been given good support and felt the management would respond to any concerns. They received plenty of training to do the job. Staff were aware of the policies and procedures in place.

At this inspection we checked compliance in areas identified for improvement during our inspection in March 2012. This was in regard to respecting and involving people who use services and the quality of record keeping. We found that improvements had been made in these areas to achieve compliance. We also checked further outcomes at this inspection to ensure compliance was maintained.

People told us that they liked living at Ravenscourt Nursing Home. They received the help and support they needed from staff who were aware of their needs. We found that people's privacy and dignity were respected and their views were sought in relation to their care. Where people did not have the capacity to consent the provider had acted in accordance with appropriate guidance on consent. We saw that people had been assisted with their personal care and were being supported in accordance with their individual care plan. One person told us "the staff are very nice, they ask you before they do anything."

A relative told us "we came here because the staff are friendly, all had a big smile. There is a pleasant atmosphere here."

We found there were sufficient staff available to assist people when needed. People said they would raise any concerns with the manager or their relative. We also found that the service had improved record keeping by regularly reviewing and maintaining accurate records in respect of people using the service and management of the service.

Relatives said they were happy with the care given and were complimentary about the staff.

We saw people engaged with and enjoying activities with staff and visitors.

Relatives told us that they had not been involved in the recent redecoration of the home but they were pleased with the improvements.

People’s opinions of care ranged from OK to wonderful.

Care plans did not evidence how people were involved in planning their own care and things seemed to happen to and around people. Some people did not get the support they needed at meal times.

Some people said they had no complaints and felt they were treated well by the staff that did their best to meet their needs.

Some people said they thought the home was lovely, clean, tidy and always warm.

Relatives said they had confidence in the staff. People told us that “care workers seemed to know what they were doing” and “absolutely first class, kind and caring”.