25 November 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Three inspectors and an Expert by Experience carried out 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 service.
Service and service type
The Ridings is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Ridings is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who work with the service.
During the inspection
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 10 people about their experience of the care provided. We reviewed a range of records. These included five people's care records and multiple medicine administration records with accompanying documentation. We spoke with six members of staff, including the registered manager, the administrator, the activities co-ordinator, two care staff members and an agency staff member.
Following the inspection
We contacted five relatives of people. We liaised with the provider to source additional information.
25 November 2022
About the service
The Ridings is a residential care home providing accommodation for persons who require nursing or personal care. It can accommodate up to 48 people in one purpose-adapted building. The service provides support to older people and people living with dementia. At the time of our inspection there were 32 people using the service.
People’s experience of using this service and what we found
Quality assurance systems were not always effective in identifying gaps in information. Care plans required reviewing so that staff were fully aware of people's preferences as to how they wished to be cared for and supported. We identified gaps in health and safety checks.
We observed there was a lack of interaction between staff and people at times. We saw some staff talking about people in earshot of people.
Medicines were managed safely, and people could be assured they received their medicines at the correct time. However, protocols for medicines administered when required (PRN) needed improvements.
We received mixed but mostly negative feedback about the quality of food.
Governance systems had not always lead to improvements at the service. Feedback was sought, but improvements were still needed on how it was acted on. We received mixed feedback on whether people's and relatives' views were sought and acted on.
The record keeping regarding people involved in the best interest process needed improvement.
People could be assured they were cared for safely as staff knew how to keep people safe and protected them from harm. Staff were recruited safely and there were enough staff to support people.
Staff were supported with regular training, supervision and appraisal. People had access to other health professionals when needed.
People were supported to have maximum choice and control of their lives and staff provided them with care in the least restrictive way possible. The policies and systems in the service promoted this practice. However, people’s choices and preferences were not always met by the service.
Activities were taking place, and we received positive feedback about these. The provider had systems in place to investigate and respond to complaints.
We received positive feedback about the leadership of the registered manager. Staff worked effectively with a wide range of external professionals.
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 good (published 31 May 2018).
Why we inspected
We received concerns in relation to people not having access to emergency services in a timely manner. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
Enforcement and Recommendations
We have identified a breach in relation to good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.
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 will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.