Archived: Ridgway House

This was the second comprehensive inspection carried out at Ridgway House.

Ridgway House is registered to provide accommodation and support for 35 older people. On the day of our visit, there were 35 people living in the home, ranging from frail elderly to people living with dementia. At the time of the inspection there were 35 people using the service.

The service has 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 and associated Regulations about how the service is run.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to use the whistleblowing procedure. Risk assessments were centred on the needs of the individual and any potential risks to people had been identified. We saw that risk management plans had been completed to enable them to live as safely and independently as possible. There were sufficient numbers of staff to meet people’s needs and keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe

People had their medicines managed safely, and received their medicines in a way they chose and preferred. The registered manager and staff had given much consideration about how they could support and encourage people to manage their medicines safely.

Staff were well trained and aspects of training were used regularly when planning care and supporting people with their care and support needs. People told us and records confirmed that all of the staff received regular training in mandatory subjects. In addition, we saw that specialist training specific to the needs of people using the service had been completed. This had provided staff with the knowledge and skills to meet people’s needs in an effective and individualised way.

Staff sought people's consent to care and treatment which was in line with current legislation. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

The staff team were passionate about providing a service that placed people and their families at the very heart of their care. We found a progressive, caring and highly positive atmosphere throughout the service and within the delivery of care provided by staff. Without exception, people and relatives praised the staff for their caring, compassionate and professional approach. Everyone we spoke with said that staff went over and beyond what was expected of them and they were like family.

People received care that was responsive to their needs and centred on them as individuals. Their needs were assessed and care plans gave clear guidance on how they were to be supported. Records showed that people and their relatives were involved in the assessment process and review of their care. A wide and varied range of activities was on offer for people to participate in if they wished. The service had an effective complaints procedure in place and we saw appropriate systems for responding to any complaints the service received. Staff were responsive to people’s worries, anxieties and concerns and acted promptly to resolve them.

Systems were in place which continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well. The registered manager took steps to learn from such events and put measures in place which meant lessons were learnt and they were less likely to happen again.

Staff enjoyed working at the service and felt well supported in their roles. They told us the registered manager was an excellent role model and there were systems in place to develop staff and promote reflective practice. There was a culture of openness and inclusion at the service and we found a caring and positive atmosphere amongst the staff team. This was reflected in the way staff supported people and each other. Quality monitoring systems and processes were used robustly to make positive changes, drive future improvement.

During the inspection, we gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Care records we looked at showed that people's food and hydration needs had been assessed, and we found some clear information to assist staff in understanding each person's preferences and support requirements.

Although no one had been assessed as being at risk from malnourishment, we saw that food and fluid charts were being maintained for everyone living in the home, to be clear about how much each person was eating and drinking. Records showed that people's weight was being monitored on a regular basis, and that staff sought help from appropriate external healthcare professionals if any concerns were identified.

The manager, who was new in post, showed us a new form that she planned to introduce from the following week, to assist her with monitoring people's food and fluid intake more closely. She had arranged a meeting on the day of our inspection to explain the new system to staff.

We found that the service had carried out an internal audit which had taken into account staffing levels and staff deployment in the home. This had identified some issues which the manager had already begun to address. We saw that the manager was in the process of recruiting additional staff, and reorganising staff rotas as a priority.

We also learnt that up until now, care staff on the morning shift had been expected to prepare breakfast and morning drinks for people living in the home. The manager told us that from the following week, a dedicated member of the home's catering team would be on duty to cover both these tasks. We spoke with a number of staff who told us this change was very welcome and would allow them to spend more time providing care and support to people living in the home.

Is the service effective?

We observed staff working well together in the best interests of the people living in the home.

Is the service caring?

We observed some positive interactions between staff and people living in the home and it was clear that staff knew people well and how best to meet their needs.

Everyone we observed looked well cared for in terms of their personal appearance. One person we spoke with told us 'I like it here. I wouldn't go anywhere else.'

We noted that people who required assistance with eating and drinking were given this support in a discreet manner. During lunch, we observed some staff sitting at the dining table with people, creating an opportunity for some positive social interaction.

While we were in the home, a postman delivered some mail which included a postcard for someone living in the home. A staff member took the postcard directly to the person and with their permission read it to them, which was received really well. This showed that people were respected, and that staff understood people's right to receive personal correspondence in a timely manner.

Is the service responsive?

We observed people's requests being met in a timely way. For example, one person asked for a hot drink just before lunch and this was provided.

Call bells were answered promptly throughout the inspection.

Is the service well-led?

A new manager had started working at the home on 14 July 2014. She was not yet registered with the Care Quality Commission but had applied to do so.

It was evident from speaking with the manager that she had already identified areas requiring improvement in the home and had begun to address these in a timely manner.

Everyone we spoke with spoke positively about the new manager, and felt that she was having a positive impact on the home. One person said, 'Things are moving in the right direction.' People told us that changes were needed to improve things, but felt that this could be achieved with consistency and clear management oversight.

Overall, we found sufficient evidence during this inspection to show that the provider and manager had taken positive steps to improve the service and ensure the health and well-being of the people living in the home.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe at Ridgway House, they said their choices, privacy and dignity were respected. Suitable risk assessments were in place and addressed areas of specific risk to individuals using the service.

Systems were in place to investigate complaints and concerns. This meant that people benefitted from a service that took on board lessons learnt.

Is the service effective?

People's health and care needs had been fully assessed and detailed care plans were in place. There was evidence of people being involved in assessments of their needs and the planning their care, there was also evidence of people's representatives being involved in decisions about the care provided. Specialist dietary needs were assessed and included in care plans. The plans had been regularly reviewed.

Is the service caring?

People spoke highly of the staff, they told us the staff were patient, polite and worked at their pace and always professional in their approach.

Is the service responsive?

People said they knew how to complain if unhappy with the service.

We looked at records of complaints which confirmed that complaints were thoroughly investigated in line with the companies own complaints policy.

Is the service well-led?

At the time of our inspection there was no registered manager in post. However the manager told us they had submitted their registered manager application to the Care Quality Commission, which was in progress. The areas we found non compliant at our last inspection on 24 May 2013 had been appropriately addressed. There was appropriate quality assurance systems in place. The service was well managed and people received reliable, safe and effective care.

We spoke with the relative of a person that used the service that visited on a regular basis. They told us that they liked the homely atmosphere at the service.

We spoke with two staff members that worked at the service. They told us that they both enjoyed their roles. One staff member told us 'Everybody that works here really does care'.

We found that people needs had been assessed and that care plans had been put in place to ensure that their needs were met. We saw that people looked well and they told us that they were happy with the care they received.

We saw that regular audits of the service were carried out which meant that there was a system in place to identify any concerns with the service. We were concerned that we could not always see evidence that problems had been followed up.

We found concerns about the way that medication at the service was being managed which meant that there were not appropriate arrangements in place to ensure that people were protected from the risks associated with medication.

We had concerns about the staffing levels at the service as people told us that the staff were very good but that they had to wait for staff to respond to them if they called for assistance. This meant that people's needs were not always being met.