The Ridings Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

At our last inspection the service was in breach of legal regulation in relation to people’s safe care and treatment. At this inspection we found improvements in how safeguarding concerns, incidents and accidents were investigated and analysed. There was evidence of lessons being learned from when things had gone wrong. These were shared with the wider staff team and used to help mitigate future risk. The home was clean, uncluttered and well maintained. People were supported to take their medicines safely. Recruitment and induction processes helped ensure staff were suitable and competent in their roles. People and their loved ones told us they felt staffing levels were appropriate. A couple of staff told us at busy times they felt more staff were needed in a particular area of the home, other staff said they felt staffing levels were adequate. These improvements meant the service was no longer in breach of regulations regarding people’s safe care and treatment.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. People and their loved ones told us they had not had cause to raise any concerns or complaints but knew how to do so if needed. One person told us, “I would not hesitate to raise any concerns.” A relative said, “The manager is approachable if I had any concerns, I would speak directly with [them].” Staff we spoke with knew people’s needs well. Most carers we spoke with continued to work across all areas of the home but told us they were used to this way of working and felt they had got to know people’s needs and risks well. Staff were able to tell us about ways in which lessons learned had been introduced to improve people’s safety. The management team had introduced a folder containing a brief summary of when things had gone wrong and how to avoid future similar risks. It contained for example an incident in which a person’s shoes were found to be ill fitting. The person was at risk of falls and new better fitting footwear was obtained. Staff were guided to check when helping people put on their shoes that they fitted well to reduce the risk of trips and falls.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Care plans showed evidence people had been consulted and involved in their development. Relatives told us they were involved in regular reviews of people’s care. Systems were in place to ensure people received a safe transfer of care if they were admitted to hospital, or upon their return from hospital. There were good working arrangements in place between the service and the local GP surgery. This ensured people received timely health care. Systems to guide staff with regard to when emergency services would be needed in the event of a fall had been improved. We saw people who had unwitnessed falls or head injuries consistently had guidance sought from emergency services.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People and their loved ones told us they felt safe and protected from harm. One person told us, “When I am in bed they check in on me.” Staff told us about how they would identify safeguarding concerns. They knew what action to take if they had any safeguarding concerns. The management team shared safeguarding concerns with other appropriate agencies. This transparency ensured others from outside the service would review possible risks to people’s safety and wellbeing. We saw people being supported safely for example to move around the home with assistive equipment. We saw improvements in the investigation of safeguarding concerns. Root cause analysis was completed to better understand when things had gone wrong and how to prevent future risk of avoidable harm. People were supported appropriately for example following a fall, to make sure they received the safe and timely care they needed.

At our last inspection we found staff did not fully understand why some people were subject to Deprivation of Liberty Safeguards (DoLS) and what that meant for people. This is the legal framework to protect the rights of people who do not have the mental capacity to make decisions about their own care and treatment. At this inspection we found that now staff we spoke with had a good understanding of DoLS. This meant people’s rights were understood and protected. People and their loved ones told us they enjoyed being able to visit when they wanted to. One person said, “Visitors can come and go whenever they like.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. In an attempt to reduce the number of falls in shared areas of the home, the management team asked staff to ensure they monitored lounges when they were being used. During our visits we saw 1 person had been left unattended in a lounge and was walking around without their mobility aid. A passing staff member did notice and acted to ensure the person was accompanied to the dining room safely. A couple of staff told us sometimes when it was busy it was difficult to support and monitor people in the shared areas in 1 particular part of the home. In this area the numbers of falls people were having were much higher. People were more able to move around independently in this area, but many needed support and could be unsteady at times. We spoke with the management team about how the risks were managed in this area. They told us about changes they had made to reduce risks to people. For example at night a carer was asked to remain in the hallway so that they could be alerted quickly to people getting up or coming out of their rooms. The management team told us staff were guided to let them know if there were times when they were particularly busy, as additional staff could be made available if needed at busy times. Most staff we spoke with told us they thought staffing levels were safe. They felt risk of falls had been reduced since staff were monitoring the lounges.

We also saw assistive technology being used around the home to help staff know for example, when a person who may not call for help when it was needed, had got out of bed. This would enable staff to respond quickly and potentially prevent a fall. When speaking to the nursing team and looking at the process for responding to unwitnessed falls and head injuries, we identified some confusion. The nursing team were not clear about which clinical tools they should use in the event of an unwitnessed fall or head injury. There was guidance about monitoring people after a fall, but the guidance did not detail what should be monitored. No one had been harmed as a result of this confusion. The provider changed the guidance to make it clearer for the nursing team and senior carers. Staff told us about ways in which they communicated with people who had individual communication needs, for example people who could not communicate easily verbally. Staff described ways in which they knew when a person was distressed or communicated other needs. Staff knew about people’s specific needs around eating and drinking to make sure they could enjoy meals and snacks safely. Staff understood distress was a form of communication and responded with patience and kindness when we saw a person become upset. Care plans also guided staff to understand stress as a way of expressing a need. We saw people were supported to take risks in a balanced way. We noted that the risk management of medicated creams which could be flammable could benefit from further steps to reduce risk for people who smoked. We discussed this with the provider who agreed to discuss this with the people effected.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People and their loved ones told us they enjoyed the home environment and felt it was managed safely. Staff knew what action to take in the event of a fire emergency. Systems were in place to monitor and maintain a clutter free and safe environment. In one part of the home people had access to a kitchenette. Risks had been carefully considered to make sure this environment was safe for people to use. We saw evidence of regular checks to ensure equipment and technology around the home was well maintained.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Recruitment systems were in place to make sure staff were suitably experienced and competent. At our last inspection, we found a lack of evidence of competency checks for some staff. Additional checks had now been introduced. Staff told us they received training to ensure they maintained the right skills and knowledge for their roles. The management team ensured the staff team kept up to date with their ongoing training. This meant people were supported by staff with up to date knowledge and skills to provide effective care. Most people and their loved ones told us they thought the staff had the right skills to do the job well. One relative told us, “The staff are very good at their jobs and have the right skills.” One person told us they did not think there were enough staff, because they did not have time to sit down for a chat. There was a full time vacancy for an activity coordinator. The rest of the people we spoke with and their loved ones told us they thought there were enough staff to support them safely. One person said, There are definitely enough staff during the day. You may see different faces, but they are all familiar.” One relative told us, “I’ve never had concerns about the staffing.”

The provider assessed and managed the risk of infection effectively. People and their loved ones told us the home was kept clean and well maintained. One person told us, “My room is always kept clean.” We saw staff working hard to keep the home clean and tidy. Staff told us they were supported with adequate supplies of personal protective equipment (PPE). We saw staff wearing the correct PPE for the care tasks they were performing. Staff supported people to maintain their personal hygiene well. For example we saw people being supported to wash their hands before and after their meals. Regular checks were made to ensure the home remained clean and well maintained.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. We saw people being supported to take their medicines safely and appropriately. Care plans guided staff as to how people wanted to be supported to take their medicines. We found 2 discrepancies when checking medicines stocks and records. We told the management team. An investigation was commenced into how an inaccuracy in a stock count had not been identified. No one was harmed as a result of the errors we noted. The provider explained there had been some problems with the electronic system used to record medicines and there were plans to move to a new system provider. Audits of medicines management were done every 3 weeks, and for each person when they were ‘resident of the day.’ In response to our findings the provider completed a detailed medicines audit which was normally carried out annually. This provided the management team with assurance that aside from a small number of minor issues, people were being supported safely to take their medicines. At our last assessment we identified concerns about staff being able to access and use rescue medicines quickly in the event of someone having a seizure. Changes had been made to how and where these medicines were stored and training had been given. Staff had demonstrated they could access rescue medicines quickly and knew how to use them if needed. Staff had access to clear guidance on how and when to use ‘as needed’ medicines. Records were kept to ensure people were supported to use medicated creams as they were prescribed.