We carried out a review of the data available to us about Welcome House - Ruby Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Welcome House - Ruby Lodge, you can give feedback on this service.
Welcome House – Ruby Lodge is a residential care home providing support and personal care to up to 17 people. The service provides support to people living with mental health conditions, such as, paranoid schizophrenia and bipolar affective disorder. At the time of our inspection there were 13 people using the service.
People’s experience of using this service and what we found
People told us they felt safe and would speak with the registered manager or staff if they had any concerns. We observed people were relaxed and spoke openly with staff and the registered manager. One person told us, “I am good yeah. I can talk to [registered manager] if I wasn’t.” Staff understood their responsibilities to safeguard people from the risk of abuse and knew how to report concerns.
People's needs were assessed; risks relating to their mental and physical health were frequently reviewed and care records updated following changes or professional advice. Accidents and incidents were analysed, patterns were identified and investigated to lessen the risk of reoccurrence. Risks were mitigated as staff knew people well, detailed documentation guided staff to support people to recognise when they may experience a relapse in their mental health. People told us they felt settled and supported by staff.
People were supported by enough staff who were suitably trained and skilled to meet their needs. Staff administered medicines to people safely and encouraged people to follow professional advice. One person told us, “I have lost some weight, I have stopped eating cakes, sugar, sweets and chocolates. I am really trying. My psychiatrist said to lose weight, my medication makes me put on weight.”
People were protected from the risks of COVID-19 and other infections. Staff wore appropriate personal protective equipment (PPE) and followed the provider’s infection prevention and control policy. People told us they were able to go out and see friends and family or they were welcomed to go into the service for visits.
People knew the registered manager and staff well; most had worked at the service for many years. The registered manager told us about a positive outcome following a person’s mental health relapse. They said, “The way you communicate with your clients is important, they listen, and they open up. Our good relationship helped [person] recover.”
People were empowered to make decisions and were asked for their opinions on the service. House meetings, keyworker meetings and informal discussions were held for people to express their views. People and staff told us they felt able to approach the registered manager with ideas. One person told us, “We all get our say about things here, like what we eat and how we want things done.” A staff member said, “The service users are treated well, they are given respect and choices. Anything they want, staff do what they can to make sure they have independence.”
People were appropriately referred where professional advice was needed. The registered manager and staff worked closely with professionals to improve people’s care, safety and well-being. One health care professional told us, “I have never had any issues with the service, all of the staff have been approachable and happy to help. They provide the support we ask them to provide. It seems calm and clean, never had any issues.”
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 CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 9 February 2022). 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 12 and 17.
Why we inspected
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 which contain those requirements.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Welcome House – Ruby Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Welcome House - Ruby Lodge is a residential care home providing personal care to 11 people with mental health needs. The service can support up to 17 people in one adapted building.
People’s experience of using this service and what we found
People were engaged in activities at the home and those we spoke to said that they were happy living there. We spoke to one person participating in an art activity, she told us, "I like living here", another told us "it's okay, I like chatting with the others".
People were able to personalise their rooms. One person was keen to show us their room, they told us, "I love my room, I am able to play music and put up posters".
Risk to people’s health, safety and welfare were not consistently assessed, identified and monitored. Records were inconsistent and varied in the level of detail provided to guide staff to keep people safe.
Actions to safeguard people were not always followed. Internal procedures were not always followed by staff and risk assessments were not always updated following an incident.
People’s care plans were not always person centred and contained inconsistencies. These could lead to people’s needs not being met and increased risk of harm.
We recommend the provider seeks advice and guidance from a reputable source about person-centred care planning and equality characteristics.
Medicines were safely managed and administered. Medicine administration records were correct, and audits took place to highlight any errors.
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.
Infection Prevention and Control policies and procedures were being followed. The premises looked clean and tidy and we were assured that the service had controls in place to minimise the risks posed by COVID-19.
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 31 July 2019] 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 not enough improvement had been made and the provider was still in breach of regulations.
The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
We received concerns in relation to the management of risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has remained the same. 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 COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements in safe and well-led. Please see the full report for more details.
You can read the report from our previous comprehensive inspection, by selecting the ‘all reports’ link for Welcome House Ruby Lodge on our website at www.cqc.org.uk.
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.
Welcome House- Ruby Lodge is a residential care home providing personal care to 13 people with mental health needs at the time of the inspection. Some people had additional needs including dementia, sensory impairment, and a learning or physical disability. The service can support up to 17 people.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
People could not be assured there were enough staff available at the times they needed them. This was because staff rotas did not reflect people’s assessed needs.
Although people had been supported appropriately when incidents had taken place, CQC had not been notified off all important events, in line with legislation. This is necessary so CQC can be assured that when significant things happen, people’s health, safety and welfare is maintained.
Quality assurance systems had improved since the last inspection in identifying any shortfalls in the service. However, daily checks had not identified that there was no lock on a shower room door. Also, there was a continuous beeping noise in the dining room which people said was irritating, whilst they were eating their lunch. This was because action had not been taken in a timely manner to change the battery to the fireguard on the dining room door.
People’s safety had improved since the last inspection because risks were now identified and managed. People felt safe and staff knew how to identify, report and respond to safeguarding concerns.
People 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 understood people’s health, social and personal care needs. Partnerships had been developed with a range of health care professionals. People received their medicines when they were needed.
People were supported by a small team of staff who knew them well. Staff understood the importance to people’s well-being of developing trusting relationships and treating people with dignity and kindness.
People said they could choose how to spend their time. Staff encouraged people to attend local support groups and activities and to take responsibility for household tasks. People had performed plays to which they had invited their friends, family members and supporting professionals.
The views of people, relatives and professionals were regularly sought. Feedback was positive. People said they could make choices, felt listened to, come and go as they pleased.
Staff felt well supported, that they had the knowledge and skills to perform their roles and worked well as a team.
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 7 August 2018) 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 we found although these regulations had been met, the provider was in breach of two different regulations.
This is the second time the service has been rated Requires Improvement.
Why we inspected
This was a planned inspection based on the previous rating.
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.
We carried out an unannounced comprehensive inspection of this service on 3 October 2017. After that inspection we received concerns in relation to how people were supported to manage their finances and that there was a controlling culture at the service. As a result, we undertook an unannounced focused inspection of Welcome House – Ruby Lodge. We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe. At this inspection the service was rated as it requires improvement in safe and well-led, therefore the overall rating for the service is now requires improvement. This report only covers our findings in relation to these two domains. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Welcome House -Ruby Lodge on our website at www.cqc.org.uk.
Welcome House – Ruby 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.
Ruby Lodge is registered to provide accommodation and personal care for up to 17 people with mental health needs who do not require nursing care. People who lived at the service needed support with managing their mental health needs. They needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, 13 people lived in the service. On the whole people could make their own decisions about how they lived their lives.
There was a registered manager working at the service. 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 registered manager had oversight about what was happening at the service on a day to day basis, however in certain areas they lacked knowledge and awareness. People were not fully protected from harm and abuse. The registered manager had not followed safeguarding protocols. Incidents had occurred when people had been abusive towards each other. The registered manager had not reported or discussed potential safeguarding incidences with the local safeguarding authority. Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like police or safeguarding incidences. The registered manager had not informed CQC of important events that occurred at the service, in line with current legislation. Clear staff disciplinary procedures had been adhered to when they identified unsafe practice.
The staff culture at the service did not fully take into account the rights of the people. People reported some staff being not being respectful.
Some potential risks to people were identified like eating safely and when people had behaviours that could be challenging. Full guidance on how to safely manage risks was not always available. Some people smoked, there was a generic risk assessment which outlined how to prevent the risk of fires related to smoking but there were no individual, personalised risk assessments in place. Some people presented an increased risk of harming themselves or others due the fact they carried lighters on their person. There had been incidences when staff and people had been placed at risk because of this. Action had not been taken to reduce the risk. Some environmental risks had not been identified there was a risk of people being scalded as the hot water was over the recommended safety temperature. Some windows were not restricted to prevent people opening them widely.
Accidents and incidents were recorded but were not analysed to identify if there were any patterns or if lessons could be learned to support people more effectively.
On the whole staff were recruited safely. The provider had policies and procedures in place for when new staff were recruited. Most of the relevant safety checks had been completed before staff started work. However, gaps in employment had not been fully explored when staff were interviewed. This is an area for improvement.
There were quality assurance systems in place. There were regular audits carried out
by the registered manager and operations manager, this included reviewing and updating care plans, audits, health and safety checks, but these audits and checks had not identified the shortfalls found at the inspection.
Emergency plans were in place so if an emergency happened, like a fire, staff knew what to do. There were regular fire drills. People had personal evacuation emergency plans (PEEPS) that contained all the information to explain what individual support people needed to leave the building safely.
People were encouraged and supported to help keep the service clean. The service was clean and there were procedures in place to protect people from infection.
On the whole medicines were managed safely and people were supported to take their medicines as prescribed by their doctors. Some people needed creams applying to their skin to keep it healthy. There were no body maps to identify where the creams needed to be applied to make sure they were applied consistently to the right area. The staff said they would address this immediately.
The registered manager had formally sought feedback from people, their relatives and other stakeholders about the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. There were regular meetings with the staff and people. Staff and people told us that the service was well led and that the registered manager was supportive and approachable and sometimes worked alongside the staff.
Services are required to prominently display their CQC performance rating. The rating was displayed in the entrance hall of the service and on the providers website.
This is the first time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.
Ruby Lodge is registered to provide accommodation and personal care for up to 17 people with mental health needs who do not require nursing care. The people who lived at the service lived with mental health disorders and needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, 15 people lived in the service. They were fairly independent and required minimal support.
At the last Care Quality Commission (CQC) inspection on 05 October 2015, the service was rated Good in all domains and overall.
At this inspection we found the service remained Good.
People continued to be safe at Welcome House - Ruby Lodge. People continued to be protected against the risk of abuse. People felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for.
Medicines were managed safely and people received them as prescribed.
There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.
Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.
People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.
Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.
The registered manager ensured the complaints procedure was made available to people to enable them to make a complaint if they needed to.
The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.
Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.
Further information is in the detailed findings below.
We inspected this home on 6 October 2015. This was an unannounced inspection.
Ruby Lodge is registered to provide accommodation and personal care for up to 17 people with mental health needs who do not require nursing care. The people who used the service lived with mental health disorders and needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, 13 people who lived in the home were fairly independent, hence requiring minimal support.
There was a registered manager at the home. 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 protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.
The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as mental health, and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.
There were sufficient numbers of staff to meet people’s needs. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.
Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.
Safe medicines management processes were in place and people received their medicines as prescribed.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.
Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.
People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.
Staff were aware of signs and symptoms that a person’s mental health may be deteriorating and how this impacted on the risks associated with the person’s behaviour. People were supported as appropriate to maintain their physical and mental health.
Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.
The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the Commission.
We spoke with three people who used the service, one said 'staff treat me with respect', another said 'staff treat me well, I get lots of choices and I know about my care plan'.
We looked at care plan files for people who used the service and saw that individual risk assessments were in place. We saw that mental health assessments were up to date and that Community Psychiatric Nurses (CPN's) were involved in peoples care.
People who lived at Ruby Lodge were encouraged to be as independent as possible through their care plans and support; they did their own cleaning and helped to maintain the overall cleanliness of the communal areas of Ruby Lodge. We saw that the areas of the home we viewed were clean and tidy.
We found that the registered manager had a range of risk assessments in place including but not limited to, slips, trips and falls, an up to date fire risk assessment, environmental risk assessments and assessments covering the control of substances hazardous to health. (COSHH).
We found that the registered manager used a range of methods to collect feedback from people who used the service, their representative or relatives and that these had been responded to.
There were effective recruitment and selection processes in place.
People told us that they "enjoyed living at the home" and that staff were "very friendly and approachable". One person told us that the food was "lovely" and there was always "plenty of it".
The manager and staff at Ruby Lodge understood the needs of each service user and were very well informed about each of the service users.
There was a robust complaints procedure in place and people felt able to raise concerns with the manager and staff members. There was a copy of the complaints procedure available to the service users and this was in an easy-to-read format.
Overall, the home was clean and tidy but the home did not have a system in place to prevent, detect and control the contamination of the homes water supply system with legionella bacteria. This posed a risk to the people using the service and also to those working at Ruby Lodge and we have asked the Provider to address this in a timely manner.