Ritson Lodge

Ritson Lodge is a care home providing personal and nursing care to 34 older people at the time of inspection. The service can support up to 60 people.

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

A new management team had been in place since early 2022. The management team had put an improvement and development plan in place, and we found significant improvements had already been made. This included acting upon areas for improvement identified at previous inspections. However, further improvement was still needed with regards to the management and administration of medicines.

Medicines were stored safely within the home however there were five occasions where one person received an out of date medicine. Some of the equipment to administer medicines was not suitable. Medicines were administered in a timely manner and in a way that respected people’s preferences. One person’s care plan for end of life care was not up to date and did not guide staff on choosing the appropriate dose of analgesic, should it be required. We have made recommendations about how the service can make improvements in these areas.

Care planning and risk assessment was clear, concise and provided enough information for staff to care for people. This had been updated when people’s needs had changed.

The service was clean and there were appropriate procedures in place to minimise the risk of the transmission of COVID19.

The new management team had acted upon areas for improvement identified at previous inspections, as well as areas for improvement identified through the providers own quality assurance system. The new management team had robust systems to manage and monitor the quality of the service and took action where required to ensure people received a consistently good service.

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’ (29 January 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This inspection was planned to assess progress with shortfalls identified at our previous inspection on 11 November 2021.

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.

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.

Ritson Lodge is a residential care home providing personal and nursing care to up to 60 people. At the time of the inspection there were 44 people living in the home, some of whom were living with dementia. It is a purpose-built care home consisting of three separate wings; Seabreeze (nursing care), Seashore (residential) and Memory Lane (dementia care), each of which has separate adapted facilities.

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

Risks in relation to people's care were not always assessed or sufficiently detailed to ensure people were cared for in a safe way. There was not always accurate guidance in place for staff about how to manage or reduce risk.

We could not be assured that people received their topical medicines, such as creams, as recording systems showed gaps in application. Some documentation was confusing in relation to covert administrations of medicines. Some information had not been updated.

Staff were observed to be kind and caring. However, there were not always enough staff to meet people's needs in a timely way, engage with people meaningfully or provide individualised care and support. Staff had not always received appropriate supervision that ensured good practice within the service. Staff were recruited safely.

The majority of people we spoke with told us that they liked living at Ritson Lodge. However, several told us that they would like more time spent with staff.

There were governance systems in place to monitor the quality and safety of the service, however, these had not always been wholly effective. The providers lack of oversight meant previously evidenced standards and regulatory compliance had not been maintained.

The new regional director had completed an audit prior to our inspection which identified issues that needed addressing in the home, some of which were reflective of our findings.

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 9 August 2019).

Why we inspected

We received concerns in relation to staffing levels and the quality of care people were receiving. 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 changed from Good to Requires Improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full

report.

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. Please see the safe and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of the regulations in relation to safe care and treatment, staffing and governance.

Please see the action we have told the provider to take at the end of this report.

We issued the provider with a Warning Notice, notifying them that they were failing to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and a

timescale by which they were required to become compliant.

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 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.

Ritson Lodge is a residential care home providing personal and nursing care to up to 60 people aged 65 and over. At the time of the inspection there were 30 people, some were living with dementia. It is a purpose- built care home consisting of three separate wings; Seabreeze (nursing care), Seashore (residential) and Memory Lane (dementia care), each of which has separate adapted facilities.

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

Since our last inspection, there was now clear leadership and stability in the home. A registered manager was in post and had acted to address the previous shortfalls. This involved making improvements to governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including with their medicines. Under their leadership there had been an overhaul of people’s care records and supporting documentation. This was ongoing to address inconsistencies with language. Improvements had been made in the home to ensure people received safe quality care. These need to be sustained, maintained and fully embedded into the culture of the home.

Feedback from people, relatives, staff and professionals was positive about the registered manager and the direction they were taking the home. Improved governance and oversight arrangements were in place, including quality assurance and risk management systems with clear accountability.

People were treated with kindness, respect and compassion. Staff demonstrated an understanding of people’s individual needs and how to meet them. People’s privacy and dignity was consistently respected, and their independence promoted. They were encouraged and enabled by staff to pursue their hobbies and participate in activities of their choice.

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. People had access to healthcare services to maintain their health.

Risks to people’s health, safety and welfare were managed well. Staff were aware of risks to people’s safety and how to respond appropriately through safeguarding processes. We have made a recommendation in the management of people’s medicines.

Staff received training, support and supervision to care for people safely. The environment met the needs of the people who lived there, and the home was clean and hygienic throughout

The registered manager and the provider’s senior management team have actively engaged with CQC; sharing information including progress updates and ongoing developments at Ritson Lodge since the last inspection.

Rating at the last inspection and update

The last rating for this service was inadequate (published 29 December 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. We met with the provider in January 2019 to discuss their action plan and progress to date.

The service has been in special measures since 29 December 2018. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within that time frame. During this inspection we were encouraged by the progress the registered manager supported by the provider had made within the home to improve the safety and quality of care provided. Ritson Lodge is no longer rated as inadequate overall or in any of the key questions and is therefore now out of special measures.

During this inspection the provider demonstrated that improvements had been made. The service is no longer rated inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Ritson Lodge provides care and support for up to 60 people who live with dementia and have nursing or residential care needs. At the time of the inspection, there were 49 people using the service. People were accommodated across three separate units in the home: Seabreeze (nursing care), Seashore (residential care) and Memory Lane (dementia care).

At our last inspection 31 October 2017, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. There were concerns over staffing level arrangements and the service was not consistently well-led. We rated the service 'Requires Improvement' overall. We told the provider to submit an action plan of how they intended to address the concerns we raised. At this inspection 31 October 2018, we found the provider had not made satisfactory improvements to ensure that they were consistently delivering a quality safe service and that standards of care had deteriorated.

During September and October 2018, we received several whistleblowing concerns, safeguarding concerns and other information of concern about the service. We therefore brought this scheduled inspection forward, so that we could check that people were receiving safe care. At this inspection we found people’s health, safety and well-being was being compromised in multiple areas and identified significant concerns regarding the management and leadership of the service due to ineffective governance and oversight arrangements. People were being put at risk of harm due to unsafe management of medicines, poor record keeping and ineffective risk management. We have rated this service overall inadequate.

We found the home was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One of these regulations is a continued breach from the last inspection 31 October 2017. You can see what action we told the provider to take at the back of the full version of the report.

Since the last inspection there had been several changes of manager. The registered manager of Ritson Lodge was no longer employed by the provider nor was the provider’s operations manager, who had been brought in as their replacement. A third manager has been appointed and they are in the process of registering with CQC. 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.

There were ineffective governance oversight arrangements in the service. The provider had not made the improvements expected since the last inspection, as a result people did not consistently receive safe care and remained at risk of harm. Systems in place to monitor the quality and safety of the service provided were not robust enough for the service to independently identify shortfalls and mitigate risk.

Risks to people’s health, safety and welfare were not managed effectively, placing them at significant risk. People’s care records were not always person centred and accurate. They lacked information to guide staff in how to meet their needs safely and effectively.

Systems for the safe management of medicines and safeguarding people from abuse were not robust. The service was not consistently working within the principles of the Mental Capacity Act 2005.

Although staff were caring in their approach, people were not consistently supported in a way that upheld their dignity and respected their privacy. Activities did not always meet the individual and specialist needs of all people.

There were sufficient numbers of staff to meet people’s needs who had been recruited safely. However, the deployment and organisation was not wholly effective at times. Improvements to support staff through supervision and training were ongoing.

There was a complaints procedure in place and people and relatives knew how to voice their concerns.

The environment met the needs of the people who lived there. Systems were in place to protect people from the risk infection.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Ritson Lodge provides accommodation, nursing and personal care for up to 60 people, some of whom were living with dementia. At the time of our inspection, there were 50 people living in the service.

Ritson Lodge accommodates up to 60 people across three separate units; Seabreeze (nursing care) Seashore (residential care) and Spindrift (memory lane).

Ritson Lodge 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.

There was 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.

At our last inspection on 20 May 2015, we rated the service as Good.

During this inspection we found that the quality assurance and auditing mechanisms did not identify concerns we found during the inspection. Concerns regarding staffing levels had not been addressed promptly by the provider to ensure people were receiving responsive care. Some relatives told us that communication needed to improve between them and the management team. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, for good governance. You can see what action we told the provider to take at the back of the full version of the report.

The culture in the service was welcoming, friendly, and person-centred. The management team presented as open and transparent throughout the inspection, seeking feedback to improve the care provision.

People did not always receive the time and attention they needed to fully meet their needs. At times staff were unable to respond to people as quickly as they would like or perform their role effectively. This impacted on staff's ability to provide care which was consistently dignified and respectful.

Appropriate arrangements were in place to ensure people's medicines were obtained, stored and administered safely. Documentation relating to ‘as required’ and variable dose medicines were not always clear and accurate.

Activity provision was delivered by two activity co-ordinators within the service. However, some feedback suggested that this did not always meet the individual needs of people, and we have asked the service to review this to ensure it is effective.

People were referred to other health care professionals to maintain their health and well-being in a timely manner.

Staff interacted with people in a kind and caring manner. Staff were patient with people, and skilled in using different methods of communication which reassured people.

The service was meeting the requirements of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS). Staff understood the need to obtain consent when providing care. 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 were able to recognise abuse and knew how to report concerns if they suspected a person was being abused. Systems were in place to discuss potential safeguarding issues so they were escalated appropriately.

There was a complaints procedure available in the service for people and relatives to raise concerns.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People told us that the staff working at Ritson Lodge were kind and treated them with respect. However, they told us that they sometimes had to wait for help because the staff were busy. They and their relatives said that there were not always enough staff working in the home to provide people with the care and support they required, when they needed it. Improvements were needed to ensure that there were sufficient numbers of staff on duty to meet the needs of people living at the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

The environment was seen to be safe, clean and hygienic in all areas. Infection control procedures were robust and people were protected from the risk of cross infection. We found that people had received their medication when they needed it and that the provider had monitored the medication administered to people.

People received the care and support they needed. However, some people’s care planning records were incomplete and were not all up to date. The information and guidance that some contained put people at risk of receiving inappropriate and unsafe care and support. Improvements were required to ensure that accurate records were held. A compliance action has been set for this and the provider must tell us how they plan to improve.

The service was meeting the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). There was a process in place in relation to DoLS and policies and procedures were held by the provider. There was a plan in place to ensure that all staff had been trained and knew when a DoLS application was needed. The manager knew how to submit a DoLS application to ensure that people who could not make decisions for themselves were protected.

Is the service effective?

People’s health and care needs were assessed by staff but had not been reviewed with them or their family member. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person told us. “This is a nice home and the staff will do anything to help you.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that the staff were sometimes busy but did not rush them. Our observations confirmed this. A visitor told us. “I am happy with the care given to my family member. The members of staff are polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed but not all had been recently reviewed. The care and support provided was adjusted to meet the needs of each person. Improvements were being made to ensure that any change in care and support was recorded in the person’s plans of care. A record was held of people’s preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People did not have access to a range of planned daily activities because the staff were too busy to provide them. The manager showed us that improvements would be made when the new activities co-ordinator was in post.

Is the service well led?

Staff we spoke with had an understanding of the ethos of the home and quality assurance processes were in place. Relatives told us that they had been asked for their feedback on the service their family member received. Visitors and staff said that they had recently felt listened to when they had made a suggestion or raised their concerns. People told us that the new manager was approachable.

As part of this inspection we spoke with four people who used the service, the manager, a supporting manager and three members of staff. We reviewed records relating to the management of the home which included, five care plans, daily care records, training records, support/supervision records of staff and quality information.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

The four people who used the service told us that they were happy with the care and support provided. Two people told us that they felt safe, and one person said, “I would go straight to the manager if I thought there was a problem."

We looked at five sets of care records. Prior to a recent management change, risk assessments were not always in place, for example to minimise the risk of choking for people with swallowing difficulties. However we were satisfied that measures had been put in place to minimise any risks to people who used the service that ensured they were supported safely. For example, risk assessments were in place to ensure that the environment in which care was provided was safe, that medication was safely administered and that people who needed to be moved with a hoist were transferred safely. We also saw that risks to people’s health and wellbeing through malnutrition, falls or pressure ulcers were assessed and minimised.

Care plans detailed the support required by people and how this was safely delivered but we noted that further improvements were needed to ensure the safety of people who used the service. For example, diabetes care plans to guide staff in safely managing people’s condition.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. The new manager of the service was aware of the procedures and explained a recent occasion where such an application had been considered. We were satisfied that people who used services would only be deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

There were sufficient numbers of trained and competent members of staff employed to provide people with safe and appropriate care as identified in their assessment and care plans.

Is the service effective?

During our inspection we saw that people who used the service were treated with dignity and respect. However, we noted a lack of involvement in day to day matters regarding their care. This was borne out at a meeting held with the new manager a few days prior to our inspection.

Quality assurance measures were in place to identify the quality of the service offered but we found that in past months these had not been effective. A monthly quality visit had identified issues of concern but these were not addressed and merely repeated on subsequent monthly reports

Is the service caring?

We saw that people were cared for in an appropriate manner. However, although records were in place to show that people’s needs had been assessed, we noted that they did not contain sufficient detail and were of variable quality.

During our inspection we spoke with four people who used the service. They said they were happy with the care and treatment they received. One person we spoke with said, "I feel well looked after, staff are very good but on occasions there are not enough staff." We asked whether call bells were answered quickly and whether staff were available when they needed support and they told us that, "It has not really affected me personally but I know others have commented." We asked them about activities that were arranged and they said, "There are things to do some of the time, but there is not enough stimulation of the mind for me." They said they enjoyed reading and had access to newspapers, books and magazines and their own telephone which enabled them to keep in touch with family and friends.

Another person we spoke with said their care was, "Satisfactory." They told us about a film that had been shown that afternoon and said, "It was really interesting, the reminiscence work here is really good."

Is the service responsive?

The five records we looked at showed that people's needs, choices and personal preferences had been assessed and planned for. However, the quality of the assessments was variable and some related to their stay in another service. Records we looked at during our inspection did not provide sufficient detail about the individual person, their likes and dislike, cultural or spiritual needs and social interests. This meant that people’s individual needs were not identified or met.

Is the service well-led?

A new management team had been introduced to the service shortly before our inspection. It was clear that problems from previous management of the service were still impacting on the quality of care provided. However, we saw that an action plan had identified the issues and some of the more urgent actions needed had already been taken

There were monitoring and reviewing systems in place to measure the quality of the care and support provided but these were not always effective. There was no evidence of any analysis of incidents or accidents. We spoke with three members of staff who told us that they had the training and support they needed to safely do their job, which they said they enjoyed.

Records showed that staff had received support and supervision in the past month but this had not been delivered consistently prior to that.

We were satisfied that the changes made to the management team and the new measures being introduced would ensure that the service was managed better in the future

People told about the care they received. One person said, "It’s marvellous, there doesn't seem to be anything we can't have." Another person told us that," I feel safe and well looked after. The staff here treat us very well indeed."

We found that records maintained by the service were up to date, stored securely and readily available although we did see two areas within the care records that required improvement. The provider was made aware of this and agreed to take action immediately.

People who used the service were safe and knew who to speak with if there was a problem, and the staff team had received the required training in safeguarding adults from abuse as well as a range of other relevant training. Recruitment procedures were robust ensuring staff had the values and qualities required to look after the needs of people who used the service.