Ridgecourt Residential Care Home

We found the following examples of good practice.

There were sufficient supplies of personal protective equipment and staff were supported to follow current UK Government guidance.

Consideration had been given to creative ways of minimising the spread of infection should an outbreak occur. For example, disposable hoist slings were purchased in readiness, and disposable medication pots were used instead of reusable pots.

One member of staff was appointed as infection prevention and control champion. They attended external training and then disseminated this to the staff team.

Staff worked flexibly to ensure all roles were covered, including care and management staff performing cleaning tasks where necessary. We observed that the premises was clean, tidy and odour free.

Visiting arrangements were assessed on an individual basis and took account of the person’s individual needs and the visitors’ personal circumstances. Visits were supported both inside and outside of the service, and essential caregivers were supporting people where appropriate.

A family member told us, “staff have been brilliant.” They had been supported to visit their loved one throughout the pandemic, progressing from window visits to regular indoor visits with the precautions of lateral flow tests and masks as the guidance allowed it. Communication with families in relation to visiting arrangements had been good.

People’s experience of using this service:

• People, relatives and healthcare professionals spoke very highly of the home. People said they felt safe and well cared for. People’s preferences were respected and staff were sensitive and attentive to people’s needs.

• Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well.

• People, relatives, staff and healthcare professionals said the home was well managed. One relative described the home as “The best in the west country.”

• There were sufficient numbers of staff employed to ensure people’s needs were met. However, some people thought the staffing at night should be increased from the one waking and one sleeping-in member of staff currently on duty: the registered manager said they would review this with the provider.

• Recruitment practices were safe and staff received the training and support they required for their role.

• Risks associated with people’s healthcare needs were assessed and managed well. However, the actions being taken to reduce risks were not always recorded in people’s care records. Staff were aware of their responsibilities to safeguard people.

• People and their relatives were involved in making decisions about their care. Care plans still required some improvement to reflect level of knowledge held by the staff about people’s needs and their preferences. The operations manager said the soon to be implemented electronic care planning system would address this.

• People received their medicines safely and as prescribed. Medicine management practices were safe.

• The home was spacious and well furnished. The environment was safe and equipment regularly serviced to ensure it remained in safe working order.

• Consideration was given to providing a variety of social activities for people to enjoy. However, some people said they would like to see more planned activities and the registered manager said they would review this.

• A new quality assurance system to assess, monitor and improve the quality and safety of the home was being developed and introduced.

The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

Rating at last inspection: requires improvement (March 2018).

Why we inspected: This inspection was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Ridgecourt Residential Care Home provides personal care for up to 17 older people some of whom were living with dementia: 15 people were living at the home at the time of the inspection. The home does not provide nursing care, people receive nursing care through the local community health teams. The home also has a detached supported living accommodation unit for up to five people. Personal care packages delivered by Ridgecourt Residential Care Home, or other homecare providers, can be arranged for people living in this unit as required. None of the three people living in the supported living accommodation unit at the time of our inspection were receiving personal care.

This inspection took place on 27 and 28 November 2017. The first day of the inspection was unannounced. One adult social care inspector and an expert-by-experience undertook this inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care home. The expert-by-experience for this inspection had experience in the care and support of people living with dementia.

The home was previously inspected in May 2015 was rated ‘Good’. At this inspection we found improvements were required to the systems used to record and monitor the home to ensure people received safe, effective and responsive care.

The home had 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 2008 and associated Regulations about how the service is run.

Improved recording of the information obtained in relation to new staff member’s employment history was required to ensure the suitability of staff to work at the home. The home had obtained disclosure and barring check (police checks), proof of identify and references for newly employed staff. However, for two of the four recently recruited staff, the home could not demonstrate they had recorded a full employment history or information about why the staff members had left their previous care positions. The registered manager was aware of some of this information but they had not recorded it. Following the inspection, the provider and registered manager confirmed full employment histories had been obtained.

People received their medicines as prescribed to promote good health. People’s medicines were reviewed regularly by the local pharmacist as well as the GP. However, staff had not received up to date training in the safe administration of medicines and no records were kept of assessments to monitor staff members' competency to administer medicines safely. Records of the administration of protective skin creams were not being maintained. Following the inspection, the provider and registered manager confirmed staff had received training in the safe administration of medicines and had their competency assessed.

People, staff and the registered manager told us that more staff were required to meet people’s needs. One person told us, “They could do with a few more staff. It often appears they have too much to do.” While staff agreed people’s care needs were being met they felt they had little time to spend with people in conversation. We reviewed the staffing arrangements with the provider who felt there were enough staff employed to meet people’s needs. They said they used a dependency tool to help them assess the home’s requirements. Following the inspection, the provider undertook a review of people’s care needs and their staffing requirements. They provided us with a copy of the tool, which indicated there were more staff provided than the tool indicated were necessary to meet people’s needs. We have asked the provider to seek feedback from people and staff about the availability of staff and how the staff are managed on each shift.

Improvements were necessary to the records relating to managing risks to people’s safety and welfare as well as to the ease of obtaining information in the care plans. We looked at the care plans for three people with varying healthcare needs. The care plan format used by the home was of a booklet type divided into four sections and it was not easy to identify people’s care needs and how staff should provide support. One person’s care plan and risk assessments were out of date. The other two care plans did not fully describe people’s support needs and how staff should manage risks.

People were protected from the risk of abuse. Staff had received training in safeguarding adults and had been provided with written information about their responsibilities to report suspected abuse. People told us they felt safe and protected living at Ridgecourt. One person said, “I feel more than safe living here.” The registered manager told us they visited the home overnight to review people’s care needs at night and to supervise and monitor staff’s performance. Although the registered manager did not keep records of these visits, night staff confirmed these checks took place.

People told us they felt very well cared for by the staff. They said staff knew them well. One person said, “I can’t fault the level or quality of care I get here.” This view was shared by all of the people and relatives we spoke with. However, staff were not being provided with some of the training necessary to understand people’s care needs and they were not supported through formal suppression and appraisals. Staff had not received training in the care of people living with dementia, the management of diabetes or the Mental Capacity Act 2005. Following the inspection, the registered manager confirmed arrangement had been made for staff to receive this training and for supervisions and appraisals to be reintroduced.

The home was working within the principles of the MCA. Records showed assessments of people’s capacity to consent to receive care and support had been undertaken. For those people who were unable to consent to receive support, best interest decisions were recorded and included consultation with relatives and health care professionals, as appropriate. However, the assessments for the use of equipment to mitigate risks to people’s safety some people had not been recorded. For those people whose freedom to leave the home was restricted, applications to the local authority for authorisation of the restriction had been submitted.

People told us they enjoyed the food provided by the home but said they were not provided with a choice of meals. One person said, “I’m not sure how to tell what I’ll be offered to eat, the meals are just served up to me.” During both days of the inspection we observed people being serviced their lunchtime meal. Meals were presented to people fully plated and people were not able to say how much or what they would like to eat. For those people who asked for an alternative meal, this was provided.

The home worked closely with GPs and the community nursing teams and people received good healthcare support. We received very positive feedback from both GP surgeries and the community nurses with regard to people’s care and how the home keeps them up to date with people’s healthcare needs.

People were very positive about the staff; they described them as “lovely” and “very caring”. One person said, “They care about us here and they think about our dignity and privacy.” A relative told us the staff were interested in people. They described how the home had made their relative’s birthday “very special”. The home had also received very positive feedback from people and relatives in the recent questionnaire sent to seek their feedback.

The home arranged various social activities which people told us they enjoyed. One person told us, “There’s a lot to do and you only have to look at the list on the wall to find out what is to happen.” During the inspection we saw people enjoying two group activities organised by external facilitators.

People and relatives told us they thought the home was managed well. One person said, “I see [registered manager] every day, she looks after us well.” However, one person said they felt the registered manager was very busy and required more assistance. The registered manager acknowledged they had not given sufficient time to administrative tasks over the past year and was aware there were areas that required improvement.

The provider visited the home at least once a week to receive a verbal and written report from the registered manager and to discuss people’s well-being and support. They said they kept up to date with best practice in caring and supporting people through care professional journals, CQC website and participating in the Devon Care Kite Mark Forum. This is a forum of local care providers who met regularly to share information and good practice.

The home had not received any complaints since the previous inspection. People told us they felt they could make a complaint or discuss any worries they might have with the staff and registered manager. No-one we spoke with, including relatives and health care professionals, had any concerns over the care and support people received.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made four recommendations for improvement.

You can see what action we told the provider to take at the back of the full version of the report.

People's needs were assessed and their care and treatment was planned and delivered in line with their individual care plan. We saw that prompt and appropriate referrals had been made to GPs and specialist health services as necessary. A GP who visited people at the home told us that Ridgecourt delivered "very good levels of care". People's care and treatment reflected relevant research and guidance. The provider had systems in place to deal with emergencies.

People told us that they felt safe at Ridgecourt. We saw that people were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse and to prevent abuse. For example, care workers and ancillary staff had received appropriate training in the safeguarding of vulnerable adults. The provider had effective recruitment systems in place to ensure that people were suitable to work with vulnerable people.

The provider had effective quality assurance systems in place. People, relatives and staff had opportunities to influence and improve the service. We received very positive feedback on the quality of service. Comments included, "a top notch service".

People who lived at the home told us that their care was good and that they felt safe. Comments included, "The care is amazing, I can't speak highly enough." We saw that the home was clean, warm and well maintained. People that we spoke with told us that they liked the homely touches, such as bird tables and flower filled pots placed outside their windows.

People told us that they were involved in their care, as much as they wanted to be. Relatives of people who lived at the home told us that were involved in decision making too.

People had clear assessments of their individual needs and plans were in place to meet those needs. Visiting health professionals told us that this home provided, "really good, personalised care."

Staff had suitable training and experience to enable them to meet people's needs. They were positive about their work and felt well supported. They were aware of their role and responsibilities in safeguarding of vulnerable adults.

Regular recorded checks were carried out on the safety of the premises and the equipment used.

The home used a variety of quality monitoring methods including surveys, reviewing incidents and the manager making unannounced spot checks.