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Archived: Ringway Mews Care Home Requires improvement

The provider of this service changed - see new profile

Reports


Inspection carried out on 1 June 2016

During a routine inspection

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 u

Inspection carried out on 21 and 22 July 2015

During a routine inspection

Ringway Mews currently comprises of four units, Lancaster, Halifax, Anson and Shakleton, each accommodated up to 30 people. The service provides accommodation for people who require nursing or personal care and for those people who live with dementia. Each unit has their own designated staff team. There is a general manager in overall charge of Ringway Mews and each unit has a designated unit leader. The units are single storey buildings and set in their own grounds. Accommodation on each unit comprises of a large dining room /lounge and all bedrooms are single occupancy. There is ample car parking space and public bus services run nearby.

The service was last inspected in May 2014. All areas we assessed at that time were judged to be meeting the regulations at that time.

This was an unannounced inspection carried out on the 21 and 22 July 2015. At the time of our inspection there were 118 people living at the service.

The manager is registered with the Care Quality Commission. 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.’

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

People’s care records did not contain sufficient information to guide staff on the care and support they required. We found no evidence to show that people and/or their relatives were involved and consulted about the development of their care plans. Confidential information in respect of people’s care was not securely maintained.

We found the provider did not always adequately assess risks. This was in relation to people’s health and well-being.

We found the system for managing medicines was not as safe as it should have been. The provider did not ensure the proper and safe management of medicines.

Systems were in place to assess and monitor the quality of the service provided but they were not robust enough to identify the issues of concern we found during the inspection.

Systems were in place to safeguard people from abuse. However during the inspection we were made aware of issues, which had not been brought to the registered manager’s attention. We have made a recommendation that all staff are reminded of their responsibilities when allegations are made to them so people are kept safe.

The provider had requested authorisation in all instances where people were potentially being deprived of their liberty. However we have made a recommendation that principles of the Mental Capacity Act 2005 are consistently applied so that valid consent is sought, acting in accordance with people’s wishes.

A programme of refurbishment was being completed throughout the service to enhance the standard of accommodation and facilities provided for people.

A safe system of staff recruitment was in place. This helps to protect people from being cared for by unsuitable staff.

We saw how the staff worked in cooperation with other health and social care professionals to help ensure that people received appropriate care and treatment.

Checks were made to the premises, servicing of equipment and fire safety. Staff told us there was enough equipment available to promote people’s safety, comfort and independence.

Sufficient numbers of staff were employed, who received on-going training and support to meet the medication, physical and emotional needs of people living at Ringway Mews.

During our visit we saw examples of staff treating people with respect and dignity. People living at the home and their visitors were complimentary about the staff and the care and support they provided.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met.

Inspection carried out on 22, 23 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice. Care plans and our observation of staff provided evidence of good practice in applying the least restrictive options to promote each person's autonomy.

Risks relating to care, treatment, support and the environment had been appropriately assessed and were being managed well to keep people safe from accidental harm.

Care plans provided evidence of good risk management. For example, information in records provided evidence of staff taking prompt action to prevent person from becoming malnourished.

The home's equipment had been subject to servicing and maintenance at regular intervals.

Suitable systems were in place to safeguard people from the risk of abuse. A relative told us "The manager and her team have an open door policy. I could visit in the middle of the night if I chose to and I am confident that any concerns I might have would be managed satisfactorily."

Is the service effective?

A person centred approach had been developed in one of the four houses on site at Ringway Mews. This meant that staff understood and respected them as individuals and provided their care and support in line with each person's choices and preferences. Action was being taken to guide staff and update care plans to make sure all people living in the home received the same standard of support.

Systems for dealing with complaints, suggestions and compliments made sure that the views of people using the service and their representatives were responded to by making improvements where appropriate.

Is the service caring?

People living in the home were provided with stimulating and interesting activities each day, and care and support was in line with good practice guidelines. This enabled people living with dementia to orientate themselves to their surroundings, maintain meaningful relationships and participate in the home's activities of daily living.

In relation to catering we were concerned that people living in the home were not being adequately supported to maintain their rights and choices in relation to their nutritional needs. The manager provided evidence to demonstrate this had already been identified as an area for improvement and we were reassured to find action had been put in place to improve catering in the home.

The seven relatives we spoke with expressed positive feedback about the care provided to people living in the home. One of the relatives said, "Personal hygiene needs are always met and the environment is well equipped for coping with the needs of people living with dementia."

Is the service responsive?

People living in the home had their needs assessed and their care plans told us how staff would provide care and support to meet their needs. Care plans also contained some information about individuals' choices and preferences.

The people we spoke with during our visit made positive comments about the way the service was provided. They said they were listened to and consulted about the way the service was provided. A relative said, "Yes we know about the complaints procedure, but we have never had to make a formal complaint. We did have concerns about X’s clothes going missing in the laundry and they needed their fingernails cutting. However, after speaking to staff, both issues were dealt with immediately."

Is the service well-led?

Robust systems were in place to monitor, audit and review the quality of the service provided in Ringway Mews. The management team took a positive approach in responding to feedback from people who used the service and their representatives. We saw evidence of the action being taken to learn from incidents and feedback and identify where improvements should be made.

The staff we spoke with described the manager as fair, approachable and firm. One member of staff said, "The manager is fair, but focussed on retaining a quality team of staff. Things have improved since she came here." Several staff told us there had been a lot of improvements since the manager had been in post.

Inspection carried out on 14 May 2013

During a routine inspection

There were four units open at Ringway Mews: Shackleton, Anson, Lancaster and Halifax each unit provided support for up to 30 people. We visited each unit and met approximately 110 people who used the service. On the day of the visit Ringway Mews was being managed by an interim general manager.

For this inspection visit we were supported by an Expert by Experience (ex-by-ex). This is a person who has personal experience of using or caring for someone who has used this type of care service.

We found that people were generally satisfied with the quality of care and support provided.

Comments from people who used the service included:

“I am a satisfied customer.”

And:

“It’s lovely. A special place.”

Relatives told us:

“My (relatives) level of care is acceptable as long as I am here to sort out the niggles.”

And:

“We…cannot visit every day, but (my relative) appears to be cared for.”

We found people’s needs were effectively met because the service cooperated with health professionals. We saw various systems in place to check the quality of the services provided.

At the previous inspection on 18 September 2012 we found that care staff did not always treat people who used the service with dignity and respect. At this inspection visit we saw schemes to improve the way staff related to people had been introduced and the effectiveness of these initiatives were being monitored.

Inspection carried out on 18 September 2012

During a routine inspection

There are four units open at Ringway Mews; Shackleton, Anson, Lancaster and Halifax.

People throughout the service told us that they were overall happy with the service provided.

People using the service on Anson House told us:

“It’s quite good, I can’t say anything wrong about them.”

And

“I like that the place is clean, well organised and there’s plenty of room.”

And a relative told us:

“The service is very good and they seem to know what is wanted. There’s a residents meeting to day which I’m going to.”

People throughout the service commented that the food provided was plentiful, of good quality and enjoyable.

A person using the service on Lancashire House said:

“The chef is very approachable and I’ve recently spoken to him about my food preferences and we’ve more or less agreed my menu and it’s very good.”

People throughout the service told us that they felt safe and health care provision was effective.

A relative visiting on Halifax House told us:

“They’re very quick at getting the doctor and they know (my relative) enough to see there’s problem even though they can’t speak.”

Another relative summed up the experience of receiving support at Ringway Mews and told us:

“I think the service is adequate and sometimes quite good, you’re never happy with it all of the time but on the whole it’s pretty good.”

We were told by two people on different units, Lancashire House and Halifax House, that in their opinion, support with personal hygiene needed to be improved.

Our observations confirmed that in some instances staff did not promote peoples dignity and sense of wellbeing in this respect. This was because we saw that inadequate attention was paid to supporting people to achieve a socially acceptable level of personal hygiene. This problem was observed on different units. We have asked the provider to improve in this area.

Inspection carried out on 17 January 2012

During a routine inspection

People we spoke with told us what it was like living in Ringway Mews and that the staff treated them with respect and maintained their dignity. They also told us that they were kept safe at the home. Comments made included;

“The staff are always around to help you and ask you what you want. They don’t rush you and you can take your time getting dressed and things like that.”

“The staff are brilliant. The nurses and other staff are never off the floor, they are busy all day looking after us.”

“We go to bed whenever we want and we get up when we want.”

“The breakfasts here are really good. You can have porridge, sausage, beans or tomatoes, toast and drinks, nothing is too much trouble.”

Reports under our old system of regulation (including those from before CQC was created)