Archived: Ringway Mews Care Home

Updated 29 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 1, 2 and 3 June 2016 and was unannounced. The inspection team consisted of one adult social care inspector and an expert-by-experience on the first day of the 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. The expert had experience of services for older people. The second day of the inspection was carried out by two adult social care inspectors One adult social care inspector returned on the third day of the inspection.

Before our visit we asked the provider to complete a Provider Inspection Return (PIR) form and this was returned to us. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We also reviewed the information we held about the service including notifications the provider had sent to us. We contacted the local Healthwatch organisation and the local authority’s commissioning team, the NHS nursing home service, Manchester Clinical Commissioning Group (CCG) and Manchester City Council’s safeguarding and infection control teams to obtain their views about the service. Some feedback we received raised concerns about staff being unable to meet the wide range of needs of the people supported on one unit (Halifax Unit) when the unit manager was not working. The other organisations we contacted did not express any current concerns about the service provided at Ringway Mews Nursing Home.

During the inspection we carried out observations in each of the four units in the service, including over the lunchtime period. We spoke with 28 people who used the service, eight visiting relatives, and two visiting health professionals. We also spoke with the manager, the clinical lead, two unit managers, five registered nurses, 16 members of care staff, an activity coordinator, a Bupa Clinical Development Manager who visits Ringway Mews each week, the deputy chef, two housekeepers and two laundry assistants.

We looked at the care records for 15 people who used the service and the medication records for 27 people. We also looked at a range of records relating to how the service was managed; these included five staff personnel files, staff training records, quality assurance systems and policies and procedures.

Updated 29 June 2016

This inspection took place on 1, 2 and 3 June 2016 and was unannounced.

Ringway Mews Nursing Home was last inspected in July 2014 when we identified five breaches of the regulations we reviewed; these related to the safe management of medicines, care assessments not being fully completed or regularly reviewed, the keeping of contemporaneous records, the storing of confidential information and having effective quality audit systems in place for the service.

Following the inspection in July 2014 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. Part of this inspection was undertaken to check whether the required improvements had been made. We found improvements had been made.

Ringway Mews Nursing Home is owned by BUPA Care Homes. The service consists of four 30 bedded units; Lancaster, Shackleton, Anson and Halifax. Each unit specialises in either nursing or residential care. Each unit has a lounge, dining area, a conservatory, a smoke room and a kitchenette. All bedrooms are single with no en-suite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

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. They were supported by a clinical lead for the service.

People told us they felt safe in the service and had no concerns about the care and support they received. They told us staff were always kind and caring. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the unit managers, clinical lead and registered manager would act on any concerns raised.

We noted improvements had been made in the management of medicines. Guidance for the use of ‘as required’ medicines and thickeners were in place. One unit did not use the same monitoring tool to ensure the medicine administration records were fully completed. This was implemented after the inspection. Topical cream charts were not in place for staff to record when they had applied any topical creams. Body maps were not used on one unit. We have made a recommendation about the use of topical cream charts and body maps.

A process was in place to recruit suitable staff. Care staff received the induction, training and supervision they required to be able to deliver effective care. We saw that the staff were very busy during key times of the day such as when people were getting up and at meal times. Most people told us there were sufficient staff on duty to support people in a timely manner. The night staff on one unit thought more staff were required, especially when supporting people to go to bed at night.

All areas of the home were clean. There was a malodour on one unit at the entrance to the lounge area. The registered manager told us a carpet cleaner would be purchased to regularly clean the carpet in this area. Procedures were in place to prevent and control the spread of infection; however they had not prevented the malodour on one unit. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks of the fire systems and equipment were completed.

People and their relatives told us they received the care they needed. Care records we reviewed showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We found three people had additional support needs that were not covered in the standard care plans. These had not been recorded in an additional care plan. Care records on three units had been regularly reviewed to help ensure they accurately reflected people’s needs. However on one unit the monthly reviews had not always been completed.

Systems were in place to help ensure people’s health and nutritional needs were met. Records were in place for the care provided, for example when people were re-positioned and for people’s food and fluid intake. Records we reviewed showed that staff were proactive in contacting relevant health professionals to ensure people received the care and treatment they required.

We found people’s records were securely stored in locked cabinets in the office in each unit. Other confidential information was stored securely.

People we spoke with told us that the staff at Ringway Mews were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs of people who used the service.

An end of life champion had been identified for each unit who had received training in end of life care. They advised the staff team when supporting people at the end of their lives. We saw some people had made advanced decisions about what they wanted at the end of their life.

We found the service was working within the principles of the Mental Capacity Act (2005). People’s capacity was assessed and best interest decisions recorded where appropriate.

A programme of activities was in place to help promote the well-being of people who used the service. This included monthly trips out, for example to Knowsley safari park and Blackpool.

Staff told us they enjoyed working in the service and received good support from the registered manager and clinical lead. Regular staff meetings took place and staff said they were able to make suggestions and raise any concerns they had at the meetings.

There were effective systems in place to investigate and respond to any complaints received by the service. All the people we spoke with told us they would feel confident to raise any concerns they might have with the unit managers or registered manager.

We noted there were a number of quality audits in the service completed by the Bupa area manager and clinical lead; these included medicines, care records and the environment. Action plans were completed following the audits. The audits had identified some of the issues found during this inspection; however the required actions to correct them had not been completed. The audits had not identified other issues we found; for example the need for additional care plans for some people.

Monthly statistics were compiled for monitoring purposes on a range of areas; for example nutrition, safeguarding referrals and hospital admissions. This meant any trends or patterns of behaviour could be identified and action taken when necessary to keep people safe.

During this inspection we found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because additional care plans were not in place for some people’s identified needs and the audits completed by the service had not identified the issues found during this inspection or issues that had been identified had not been actioned. You can see what action we told the provider to take at the back of the full version of the report.