Ridgemount

Ridgemount is a care home service without nursing which can support up to 66 people. At the time of the inspection 37 people lived in the home, some of whom lived with dementia. The home had four units spread over three floors with lift and stair access. Each unit had separate communal lounge and dining areas as well as kitchenettes. The ground floor also contained a large conservatory where group activities could take place.

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

People told us there were insufficient activities to engage them and some of the activities we observed were not meaningful to the person. Staff told us they did not always have the time to initiate the activities which the provider expected them to manage. Following inspection, the provider told us their wellness coordinator was supporting staff to improve on this. We made a recommendation that the provider supports staff in a way which enables them to provide care for people, as well as being able to deliver activities of people’s choosing.

The provider was part of the local authority’s ‘provider support and intervention’ programme since April 2021, following concerns about risk management and safe care of people. The current leadership team embraced the support offered by the local authority to improve the service, attended all required meetings and submitted regular updates on their improvement plan. Despite this, we found the provider’s audits did not always identify areas for improvement including how records were kept. We made a recommendation that the provider should maintain close oversight of the service until such time as the current improvements are embedded.

People were supported to keep safe. Staff were using personal protective equipment correctly and there were appropriate systems in place for the testing of staff, visitors and people living at the service for the COVID-19 infection. People received their medicines safely and as prescribed.

Staff were knowledgeable about the risks associated with people's care. There were plans in place to protect people in the event of a fire or if the building had to be evacuated. Care plans were personalised in recognition of people’s individual needs and care staff spoke positively about the quality of information they contained.

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 told us staff were kind, caring and respectful towards them. Relatives and visitors were welcomed into the service. People and relatives knew how to raise a complaint and were confident that complaints would be listened to and addressed.

People, relatives and staff said the current leadership of the service was supportive and managers were frequently seen around the home. Staff told us that they were encouraged to report any incidents or matters of concern and to share their views and ideas on the running of the service.

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 good (published 2 September 2019).

Why we inspected

The inspection was prompted due to concerns received about poor monitoring of people’s nutritional intake, reduced social activities for people and a poor staff culture. A decision was made for us to inspect and examine those risks.

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 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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Responsive and Well-Led section of this full report.

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

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.

Ridgemount is a care home service without nursing for up to 66 older people, some who may have dementia. At the time of the inspection 44 people lived here. The home has three floors, with lift and stair access. The ground floor had two units each of which had 14 bedrooms; the first floor had two units each of which had 12 bedrooms; and the third floor had one unit which had 13 bedrooms. Each unit had separate communal lounge and dining areas as well as kitchenettes. The ground floor also contained a large conservatory where group activities could take place.

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

Peoples experience of care and support had improved since our last inspection in 2018. The provider, manager and the staff team had pulled together to review the service and make improvements. As a result, all the concerns we had identified at the last inspection had been addressed. Improvements made included a review of how staff were deployed around the home, improvements in how people’s medicines were managed, and the increased involvement of community-based health care professionals to support staff in meeting people’s needs.

People were supported by staff who kept them safe from harm. They did this by identifying hazards to people’s health and safety and put into place plans to minimise the risk of people coming to harm. Areas assessed included people’s individual support needs, such as risk of falls, choking, or behaviour that may challenge, to environmental risks such as fire, cleanliness, infections and equipment failure. Contingency plans were in place to ensure people received care that met their needs in emergencies, such as if the building had to be evacuated.

Staff understood their roles and responsibilities when it came to protecting people from abuse. They were able to describe the signs of abuse and the action they had to take should it be suspected. The providers safeguarding policies gave guidance on the reporting process which was in accordance with the local authority safeguarding procedures.

People were kept safe because recruitment processes for new staff were robust to ensure they were safe to work with people who may be vulnerable. The deployment of staff ensured that people received the care and support they needed, at the time they needed it. Staff training and supervision was up to date and gave them the skills to meet people’s needs. People received their medicines when they needed them, and as prescribed.

People told us they enjoyed the food, and that there was plenty of choice. Drinks and snacks were always available, and staff ensured that people received support with this when needed.

There were good links with outside agencies to ensure that people received joined up care and support, such as if they had to go into hospital. Regular access to GP’s and other health care professionals was also in place to keep people healthy or give them support if they became unwell.

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 supported by kind and caring staff, who had the time to build positive relationships with them. Staff enjoyed their jobs and treated people with dignity and respect. People’s right to complain if they were unhappy was understood and supported by staff. Comments and feedback were sought out and used to make improvements.

Peoples preferences and support needs were recorded in comprehensive care plans. Staff knew people as individuals and gave care and support in accordance with the care plans. People had access to a wide range of activities to keep them from being bored, as well as to keep them fit and healthy.

The quality assurance processes within the home were now effective at picking up on areas that needed to improve and making the necessary changes to give people a better standard of care.

The manager, staff and provider were keen to drive continuous improvement that had a positive impact on people's lives.

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 8 August 2018) 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

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.

This inspection took place on 18 May 2018 and was unannounced.

Ridgemount 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. Ridgemount is a care home service without nursing for up to 66 older people, some who may have dementia. At the time of our inspection 55 people lived here.

There was not 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 is the third inspection in a row where Ridgemount has not had a registered manager in post. A manager was in post after our last inspection, but they left the service before completing the registration process with CQC.

During this inspection we found that the lack of a registered manager had impacted on the staffs ability to maintain a good rating across the five key questions. The management arrangements to cover the lack of a registered manager had not been effective at supporting the staff to maintain a good rating. A long serving member of staff had just been promoted to manager within the home, and they had begun the application process to become registered with CQC. The manager was at the home during the time of our inspection.

People’s safety could not always be assured. We identified three issues during our inspection when we asked ‘Is the service safe?’ Risks of harm that had been identified were not always well managed to ensure people were kept safe. We identified that improvements were required in how staff managed people’s medicines. Staff deployment around the home on the day of our inspection meant that there were times during the day where numbers of available staff fell below the minimum specified by the provider.

Where complaints and comments had been received the staff had not always responded or recorded how things would be corrected. People knew how to make a complaint.

People’s access to activities had been impacted by the loss of two activities coordinators. The provision of activities was under review by the manager to ensure people did things that were meaningful and of interest to them. One replacement activities coordinator was going through the induction process and the manager said they were still recruiting for a second.

Staff received an induction when they started at the home and ongoing training, tailored to the needs of the people they supported. However staff did not always put into practice what they had learned.

People’s experience of accessing relevant healthcare professionals to maintain good health was inconsistent. Some people were referred to specialists in good time, however other people had not been referred by staff as quickly as they could have been.

The provider had not always completed an appropriate assessment of people’s ability to make specific decisions for themselves. We made a recommendation that the recording of where best interest’s decisions had been made for people could be improved. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People told us they found the staff to be kind and caring and respected them. However, some felt that because staff moved around the building from shift to shift they weren’t able to build relationships with them. We observed some interactions which showed a lack of attentiveness by staff to people’s needs. We also saw some good interactions by staff, such as holding people’s hands and giving comfort when they were upset. People were involved in their day to day care decisions. Processes to support people at the end of their lives needed to be improved.

People and staff were involved in improving the service, but this was not always used to make improvements. The management liaised with outside agencies to review and make improvements to the service.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff understood their duty should they suspect abuse was taking place. There was an ongoing safeguarding investigation at the time of our inspection and the provider was working with the local authority safeguarding team.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building.

The home was clean and staff practiced good infection control measures. This included washing their hands, hygienic cleaning of the environment and equipment and correct use of personal protective equipment.

Before people moved into the home, their needs were assessed to ensure staff could provide the care and support they needed. Adaptations had been made to the home to meet people’s individual needs. These included large open communal areas and bathrooms to suit individual requirements.

People told us they enjoyed the food. They received a balanced diet and they were encouraged to keep hydrated. People had enough to eat and drink, and specialist diets either through medical requirements, or personal choices were provided.

During the inspection we have identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was not 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.

A new manager had been recruited to become the registered manager and was due to start at the home within a few weeks of this inspection. Senior management support was available at the home while the recruitment process was underway.

At the last inspection on 17 May 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People were safe living at Ridgemount. Staff understood their roles in keeping people safe and protecting them from abuse. Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

Staff understood any risks involved in people’s care and took action to minimise them. Accidents and incidents were recorded and reviewed to ensure any measures that could prevent a recurrence had been implemented. There were sufficient numbers of staff to meet the needs of the people who live here.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them.

Staff received comprehensive training, regular supervisions and annual appraisals to ensure they could meet and understand the care needs of the people they supported.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met. People’s healthcare needs were monitored and they were supported to obtain treatment if they needed it. People who had ongoing conditions were supported to see specialist healthcare professionals regularly.

Staff treated people with respect and maintained their privacy and dignity. People were supported to maintain relationships with their friends and families. People were encouraged to be independent.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical needs. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs.

The management team provided good leadership for the service. They were experienced in their role and communicated well with people, relatives and staff. Staff felt valued and had access to support and advice from the management if they needed it. Team meetings were used to ensure staff were providing consistent care that reflected best practice.

The provider had effective systems in place to monitor the quality of care and support that people received. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The deputy manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

A person who used the service told us they felt the home was a safe place to live and they were well care for. They told us they had "tested the home twice before making a choice to live there". A relative of a person who used the service told us they felt the home was a safe place and felt confident that their family member received good care safely. They said they could talk to the provider if they felt unhappy regarding anything about the service. Safeguarding procedures were in place and staff understood their role and responsibility regarding safeguarding the people they cared for. We saw safe manual handling procedures being undertaken and saw no negative practices during our visit. We saw staff were recruited according to the home's recruitment policy and had all the required security checks in place. This ensures the welfare of the people they were supporting.

The service was clean and safe and provided people with safe access to all areas of the home.

Is the service effective?

People's health care needs were assessed with them whenever possible and written in a care pan. Arrangements were in place for people to see their GP when necessary to monitor their individual health care needs. People also had effective support to manage their dementia needs. Other support for example the chiropodist, dentist, optician, dietician and a Community Psychiatric Nurse (CPN) or clinician was provided on a regular basis and records were maintained in people's care plan.

Is the service caring?

People who used the service told us the staff were caring and always treated them kindly. We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner. We were told by a relative of a person who used the service that they were reassured by the care their family member received and felt they made "the best choice possible for their relative". We saw people who required help to eat their meals were supported by staff in a sensitive and caring manner. We also saw staff took the time to enable people to be as independent as possible. .

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allow the individual to be as independent as possible. This included the management of falls. We saw that grab rails had been fitted in hallways and in bathrooms to promote mobility and encourage independence safely.

The service also provided entertainment people who used the service to enjoy following a suggestion at a home meeting.

Is the service well led?

The home is managed by the registered business manager with the support of the head of care and team leaders. They have a good understanding of the needs of the people who used the service.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment.

Complaints and accidents were monitored and the provider discussed the management of these in order to reduce the reoccurrence of these.

You can see our judgements on the front page of this report.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Relatives told us they were generally kept informed of events in the home and any significant chances to their family member's care and treatment.

The home was busy with people undertaking a variety of activities. Some people who used the service were going on a trip organised by a voluntary group and were looking forward to it. Some people were having their hair "done" by the visiting hairdresser, others were watching television, reading their daily newspaper, or enjoying the garden.

We saw that staff were polite and professional and addressed people in an appropriate way. People who used the service told us that staff were kind and caring.

Staff felt they had the training and support necessary to undertake their roles and meet peoples assessed needs.

People were very satisfied with the catering arrangements and told us that the food was very good.They said " we can have a choice and have extra if we wish.

We saw the service had quality assurance monitoring processes in place to measure the quality of the service provided. Feedback was acted upon.

We saw several examples where people were supported by staff in an appropriate manner. We also spoke to three relatives who told yus that they felt that the care that people received was "Good".

We found that there were suitable arrangements in respect of the administration of medicines. People told us that they felt "Safe". One person said that 'When it's time for my medication, they knock before entering; when I have guests they ask me if they would like the guests to stay or leave the room whilst I have my medication'.

We found that many of the staff had not received up to date training and supervision which could affect the care and support that was provided.