The Ridings

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.

Follow up

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.

The Ridings is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Ridings accommodates up to 48 people in one purpose-adapted building. There were 41 people living at the service during our 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.

Why the service is rated Good.

The service continued to ensure people were safe. Staff understood potential signs of abuse, were aware of their responsibilities to report any concerns and knew how to do this. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Medicines were stored and administered safely. There were enough appropriately trained staff to meet people's needs. The provider followed appropriate recruitment procedures to ensure they employed staff who were suitable to provide care.

People continued to receive effective care. People were supported by staff who were trained and supported in their roles. People were given choice and provided with support in accordance with the principles of the Mental Capacity Act. People had their nutritional needs met. We observed a lunch time meal and noted people were consuming appetizing food in a relaxed atmosphere.

The service continued to provide a caring service to people. Staff consistently demonstrated kindness and compassion towards people. People and, where appropriate, their relatives were involved in making decisions about the care and support people received. People's choices

and preferences were respected.

The service was outstanding in their responsiveness. The service went the extra mile in providing people with a broad variety of activities to prevent social isolation. The service was extremely responsive to people’s needs and wishes. People and their relatives told us that staff went over and above their call of duty which made a profound difference to people’s lives. People emphasized the fact that they were delighted by the events organised by the service. People using the service and their relatives knew how to raise a concern or make a complaint.

The service continued to be well-led. People, their relatives and staff spoke highly of the management. There were systems in place that monitored the quality of the service, resolved issues and strived for continuous improvement. Staff felt engaged and empowered working at the service.

The Ridings is a residential home providing accommodation for up to 48 people. At the time of our visit there were 42 people living at the service.

The service had a registered manager in place. 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. People and visiting health and social care professionals felt the service was well led and were complimentary about the registered manager and staff team.

At a comprehensive inspection of this service in December 2014 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds with two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were in relation to not always having enough staff on duty and care plans and risk assessments were not being reviewed. The provider sent us an action plan to tell us how they would ensure the service met the legal requirements of the regulations. At this inspection in January 2016 we found improvements had been made. There was enough staff to meet people’s needs. Care plans and risk assessments were reviewed on a monthly basis. We have asked the registered manager to continue to make improvements in the maintenance of peoples care records. This was to ensure any changes to peoples care were reflected in the care plans when the changes happened and not left until the monthly review to be made.

People had been involved in reviewing their care. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Care plans were detailed. Staff followed guidance in care plans and risk assessments to ensure people were safe and their needs were met. Where required, staff involved a range of other professionals in people’s care. Staff were quick to identify and alert other professionals when people’s needs changed.

People felt cared for, valued as individuals and told us staff went out of their way to make them feel they mattered. Staff knew the people they cared for and what was important to them. Staff appreciated peoples unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records. Staff offered support in a way that promoted people’s independence.

People were involved in setting the activity program, enjoyed the many activities on offer and told us there was always something to do.

People were supported to have their nutritional needs met. People were complementary about the food. The menu offered people choice and variety and alternatives were available if people did not want what was on the menu. Mealtimes were flexible according to people’s choice and preference.

People felt supported by competent staff. Staff were motivated to improve the quality of care provided to people and benefitted from regular supervision, team meetings and training to help them meet the needs of the people they were caring for.

Medicines were stored and administered safely.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people these had been legally authorised and people were supported in the least restrictive way.

Everyone we spoke with told us they were involved in their care. One person said 'I like it here, I am able to choose things and live like I wish'. Another person told us, 'I feel respected and listened to'.

Everyone told us they were happy and had no complaints. One person said, "this place is wonderful. The staff are magnificent ". Another person said "everything is very good". Another person told us, 'we never go without'.

Medicines were given safely. We observed a team leader provide a person's prescribed medications at lunch. We saw that the team leader gave the person a drink and observed them take their medication before recording to say it had been taken. The team leader talked to the person and worked at a pace comfortable to that person.

Care workers and other staff were supported appropriately. For example all staff we spoke with told us they felt happy to raise concerns to the home's management. One care worker told us, 'I'm happy to go to the manager; they deal with my concerns pretty quickly'.

We saw minutes of resident meetings which showed us that people were consulted with regards to changes to the service. One care worker told us, 'I attend resident meetings; I helped them raise concerns, like waiting in the dining room after meals'. The home's management had dealt with these concerns.

People who lived at the service told us that they felt safe living at the service. Residents comments included "the staff here do the job to the best of their ability", and "an atmosphere of serenity pervades the whole place." A member of a residents family told us they thought the Ridings provided "a good standard of care." Two visitors to the service raised issues about residents laundry, but, the manager said she intended to review the laundry processes with immediate effect. Residents and visitors told us that they found the service to be approachable and that the service did take prompt action when service improvements were identified.