Ridgeway Nursing Home

Ridgeway Nursing Home is a residential care home providing personal and nursing care to up to 37 people. The service provides support to older people, including those with dementia. At the time of our inspection there were 26 people using the service. The home accommodates people over 3 floors, with 2 being used at the time of inspection. There are communal spaces and quiet areas for people to use. People have access to a secure outdoor space.

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

The registered manager had worked hard to make significant improvements at the service and demonstrated a commitment to continuous learning. Robust governance systems were in place to ensure the registered manager had effective oversight of the service. Where areas for improvement were identified, these were discussed with relevant staff and acted on. There was a warm and welcoming atmosphere within the service and staff put people first. Feedback was encouraged and acted on and people, relatives and staff had different opportunities to share their views. Staff worked collaboratively with a range of professionals, which helped people to achieve good outcomes.

Staff were safely recruited. There were enough staff to meet people’s physical and emotional needs. Staff were able to support people safely because they had clear and up to date guidance on how to do so. People received their medicines as prescribed from kind and patient nurses who followed best practice medicine administration guidance. The service was clean and well-maintained. People were protected from the risk of abuse. Records relating to accidents and incidents at the service were recorded and reviewed regularly, so lessons could be learned when things went wrong.

Staff were suitably trained to carry out their roles. An online training platform was used which helped the registered manager oversee training compliance within the service and support staff to complete courses when training was due. The service worked well as a team, and with other organisations to provide joined up care for people. Where referrals to healthcare professionals were required, these were done in a timely manner and recommendations were followed. People liked the food at the service and had plenty to eat and drink.

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 received person-centred care, and staff knew people well. People had opportunities to get involved in activities and celebrate a range of events. There was a complaints policy in place which people knew about and complaints which had been raised were dealt with in line with this policy. Staff understood how to support people at the end of their 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 19 October 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance, safe recruitment and staff training. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had systems in place to manage an outbreak of COVID-19. Staff were trained and followed safe infection prevention and control procedures, including the safe wearing and disposal of PPE and regularly sanitising their hands. Where staff required individual risk assessments for their personal safety, we saw these had been completed and mitigation measures were in place.

The provider had ensured sufficient stocks of personal protective equipment (PPE) was available to staff. PPE stations were placed outside rooms where people were isolating and, in several locations, to support staff to access when it was required.

The service was clean and regular cleaning of high touch areas had been introduced. Best practice guidance was maintained in relation to infection prevention and control.

Staff participated in the testing and vaccination programme. People had been supported to participate in the COVID-19 testing programme and vaccination programme. People's individual risks in relation to COVID-19 had been assessed. Care plans had been developed that provided staff with guidance about people's care and support needs.

About the service

Ridgeway Nursing Home is a care home in Belper, Derbyshire, providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service is registered to support up to 37 people.

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

A new manager had been appointed since the last inspection. Although governance systems had improved, further improvements were required to make these effective. People, relatives and staff all spoke highly of the new manager and felt improvements were ongoing. The manager had been in post for seven weeks before the inspection, they were working towards an improvement plan.

Staff training required further improvement to ensure this met with Regulations. Staff had completed more training since the last inspection but there were still some areas where training had not been provided.

Staff were not always safely recruited. One staff member had not been subject to pre-employment checks before they were employed, however, all care staff were safely recruited. There were enough staff on duty to meet people’s needs and respond to them in a timely way.

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.

Risks to people’s safety were assessed and minimised. Staff knew people well and understood how to keep them safe from avoidable harm. Records relating to the assessment of risk were in the process of being updated. The number of accidents and incidents of behaviours that challenge had reduced significantly.

Staff were kind and caring and treated people with respect. There was a variety of activities available. People were encouraged to eat and drink things they enjoyed. The manager had re-designed areas of the home, these were now light, spacious and free from clutter.

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 inadequate (published 20 May 2021). Multiple breaches of regulations were found.

This service has been in Special Measures since 3 March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as 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 inspection based on the previous rating.

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

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

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.

Ridgeway Nursing Home is a care home in Belper, Derbyshire, providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service is registered to support up to 37 people.

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

Safeguarding procedures were not fully embedded, and the provider did not always respond to concerns of abuse. Information about risks to people’s safety were not always clear and were not shared with staff. Safe recruitment practices were not in place when agency staff were employed.

The registered manager did not operate governance systems effectively and the provider had failed to identify this. The system in place for the provider to maintain their oversight did not check the information provided and at times, information was misleading and incorrect. Openness and transparency continued to be lacking and legal requirements were not always met.

People were not supported to have maximum choice and control of their lives and staff were not guided to support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider did not always ensure they complied with the law for depriving people of their liberty when they lacked the ability to make this decision. The provider had not ensured staff were always provided with the training they needed to carry out their role effectively.

People’s privacy, dignity and confidentiality were not always respected. Staff offered people choices during day to day interactions, but documentation did not demonstrate people, or their relatives were involved in decisions about their care.

The provider had failed to ensure people were empowered to express their wishes for the end of their lives if they chose to. The provider did not always ensure people’s communication needs were met.

Although infection prevention and control procedures had improved since the last inspection, further improvement was still required. Medicines were safely managed. People were supported to eat and drink enough. Staff were kind, caring, patient and compassionate towards people. Staff knew people well and developed close relationships. People were supported to take part in activities they enjoyed.

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 inadequate (published 3 March 2021). Multiple breaches of regulations were found.

This service has been in Special Measures since 3 March 2021. During this inspection we found that not enough improvements had been made. Therefore, this service remains in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 monitor the service and 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 in relation to safety, safeguarding people from abuse, staff training, governance, recruitment and meeting legal requirements at this inspection. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Ridgeway Nursing Home is a care home in Belper, Derbyshire, providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service is registered to support up to 37 people.

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

The home was not supported by a manager during the inspection. The registered manager and nominated individual were off work due to illness, the provider had not arranged for a person with the required skill or experience to cover this role. The provider had not implemented nationally recognised guidance or shared guidance with staff. There was no system to identify, capture or manage organisational risk. There was poor communication and collaboration with external stakeholders.

We were not assured the provider had guided staff to work within government guidelines for COVID-19 to protect people from the virus. The provider had not kept records to demonstrate the building was a safe environment. Risks to people’s safety were not always assessed, reviewed or updated. The provider did not recognise or respond appropriately to abuse or allegations of abuse. Staff were not always supported to complete training.

Staff were kind and caring and relative’s spoke highly of them. There were enough staff on duty and we saw staff treated people with kindness and compassion.

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 18 December 2019).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We received concerns in relation to infection prevention and control procedures. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ridgeway Nursing Home 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 monitor the service and 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 in relation to safety, safeguarding people from abuse, staff training, governance and meeting legal requirements at this inspection.

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

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 key questions it will no longer be in special measures.

Ridgeway Nursing Home is a residential care home providing personal and nursing care to people aged 65 and over. The service can support up to 37 people and at the time of the inspection 30 people were being supported. Care is provided on two floors, with bedrooms on each floor and communal areas on the ground floor.

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

The service provided continued to be safe. There were systems in place to safeguard people from abuse. Staff assessed risks to people and monitored these to keep people protected from harm. People received their medicines as prescribed. There were enough staff to support people and the provider recruited and trained staff as required. Good infection prevention and control practices were in place to protect people.

The care given was effective. People's needs and expected outcomes were assessed and regularly reviewed. People were supported by staff who had relevant training, skills and experience to care for them. People had access to sufficient food and drink throughout the day. Staff worked with other health and social care professionals to achieve good outcomes for people's health and wellbeing. The premises were designed to meet the needs of people using the service.

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.

The staff were kind and caring and people had supportive and meaningful relationships with staff. People's independence was promoted, and staff responded promptly to any discomfort and understood people's needs.

The staff continued to be responsive. People had detailed care plans that promoted independence. Staff identified people's information and communication needs by assessing them. People were encouraged to participate in meaningful activities and access the community to avoid social isolation. People and relatives knew how to make a complaint and felt confident they would be listened to. People received compassionate end of life care and staff were trained to enable this.

The service continued to be well-led. All staff shared the positive culture and vision to support people's health and wellbeing. Staff were clear what their individual and team responsibilities were. The registered manager understood their duty of candour and responsibilities of registration with us. People, their relatives and visiting health and social care professionals were invited to provide feedback which was used to drive improvement. Regular audits took place to measure the success of the service and to continue to develop it. The provider was transparent, open and collaborative with external agencies.

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 17 May 2017).

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 5 and 10 April 2017 and was unannounced on the first day.

Ridgeway Nursing Home is located in a rural setting, close to the town of Belper and provides nursing and personal care for up to 37 older people, including people who have dementia. On the day of our inspection there were 32 people using the service.

A registered manager was not in post, although there was a manager who had applied to become the 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.

The providers arrangements for medicines administration, recording and storage was safe. People were supported to have their medicines when they needed. They were also supported to maintain good health and were helped to have access to appropriate healthcare professionals and services. Guidance from healthcare professionals was followed to ensure people’s needs were met.

Staff understood the need to include people with decision-making; staff considered people’s capacity and followed the key principles of the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed; people were supported to have choice and control over their life and staff supported them in the least restrictive manner. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff had been provided training so they were able to meet people’s needs and provide them with safe and effective care. New staff participated in a period of training and shadowing more experienced staff as part of their induction.

Staff supported people to have sufficient to eat and drink; when necessary, people were assisted with their meals and special diets were catered for. People’s individual needs were assessed and care plans were developed and reviewed. People’s dignity and privacy was respected; staff were kind, caring and compassionate.

A complaints procedure was displayed; people and relatives knew they could complain if they felt it was necessary. Staff felt supported by the management team; support and supervision was provided to staff. Audits were carried out to ensure people received safe and effective care.

Ridgeway nursing home provides care for up to 37 people. On the day of our inspection there were 29 people using the service.

A registered manager was not in post, as the previous registered manager had left the service the day before the inspection. However an acting manager had recently been appointed and was present throughout the day. 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 the last inspection on 6 and 13 October 2015, we found that improvements we had required the provider to make, following our previous inspection in December 2014, had not been made. Consequently there were breaches in the regulations for person-centred care, safe care and treatment, good governance, premises and equipment, dignity and respect, the need for consent and staffing.

In all we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service was ‘Inadequate’ and the service was therefore placed in ‘Special measures’. At this inspection we found significant improvements had been made, particularly regarding risk management. However there were still areas, including person-centred care, premises and equipment and good governance, that we considered required further improvement. This inspection found there was enough improvements to take the provider out of special measures.

Staff followed the provider’s policies and procedures to help ensure people’s safety. Staff told us they had completed training in safe working practices and we saw they put this training into practice. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were involved in making decisions about their care. They were asked about their choices and individual preferences and these were reflected in the personalised care and support they received.

People were protected by thorough recruitment procedures and appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who were employed.

Medicines were stored and administered safely by staff who had received appropriate training.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) training to make sure they knew how to protect people’s rights. The manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates.

Systems to monitor the quality of the service Identified issues for improvement and these were resolved in a timely manner. There was a formal complaints process. The provider recognised that not all people could raise formal complaints and their feedback was sought through regular involvement with their keyworker. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

We found that people living at the home were treated with respect and dignity. Staff ensured that people were supported to make choices in all areas of their care. One relative we spoke with told 'he gets to choose when he gets up and when he goes to bed'.

We found that the systems for managing medicines did not ensure that people were protected from the risks associated with poor medicines management.

We found that the providers systems for monitoring quality and assessing risks to the health and welfare of people using the service were not always effective and in some instances were not in place.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. However, inconsistencies in the provision of staff training and supervision did not ensure that all staff were properly trained, supervised and appraised. In addition, the provider did not have recruitment and selection processes which would ensure that people were suitably qualified, skilled, experienced and fit to work in social care.