Ridge House Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to premises and equipment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

The provider did not have effective oversight of the safety of the service. They failed to act when staff raised concerns about the safety of the environment, and provided equipment which did not meet current safety standards. National patient safety alerts and best practice information was not used to support a learning culture at the service. For example, within recent months the provider had supplied the home with metal bed rails that carried a risk of entrapment.

The registered manager shared information openly with other health professionals and supported a learning culture within the staff team.

The registered manager worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Assessments were completed prior to people moving into the service to ensure their needs could be met. Systems were in place to ensure information was shared appropriately with health care professionals when people moved between services.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The provider did not support effective partnership working to ensure safeguarding concerns were appropriately shared and addressed. When the registered manager had appropriately shared safeguarding concerns with healthcare partners, the provider had criticised them for doing so without prior consultation, despite it being their legal responsibility to do so. Meeting minutes documented the provider telling the registered manager, ‘You didn’t ask me, you’ve gone behind my back, this is not the first time’. The minutes also show the provider had their solicitor present, and told the registered manager, “If you put a safeguarding in without context, you are opening yourself up to issues.” This is not in line with best practice, not reporting safeguarding issues promptly may result in harm to people living at the service.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that MCA assessments and DoLS applications had been made where required, and details of any conditions relating to approvals were documents in people’s care plans.

Staff understood how to keep people safe, and people and their relatives told us they felt safe at Ridge House.

The registered manager worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s risks were assessed and regularly reviewed. Staff had completed comprehensive risk assessments for people’s specific health conditions which were based on people’s individual healthcare needs and best practice. People’s care plans supported staff to monitor and manage risks effectively. The registered manager identified where environment issues created additional risks for people, such as trip hazards, and mitigated these appropriately.

The provider did not always detect and control potential risks in the care environment. They did not make sure equipment, facilities and technology supported the delivery of safe care.

The environment was run down, dirty and had bad odour in places. We found safety concerns, broken furniture and poorly maintained areas which impacted on the quality of people’s living environment. There were leaks in the roof which impacted people using the lounge and dining room when it rained. Some equipment and furniture was old, broken and, in some instances unsafe for people and staff. For example, manually adjustable beds were in use along with metal bedrails which are not recommended due to risk of entrapment. The registered manager told us the provider bought the equipment second hand within recent months. One staff member said, “[The beds] aren’t good for our backs, or for the residents themselves, it’s difficult for them with the movement of the bed.” Another staff member said, “A [health professional] told us this bed is from the 1980’s, and they were surprised to see it.”

We saw safety risks such as uncovered radiators which put people at risk of scalds and burns, and wardrobes that were not secured to walls and could potentially fall on people. Patio doors leading to the garden were either not alarmed at all or not switched on, which put people at risk if they left the home and staff were not aware. People’s bedrooms had broken and worn furniture which was unsightly and couldn’t be cleaned properly. We asked one person about their broken wardrobe, they said, “that’s nothing, have you seen the rest of the place?”

Some pieces of equipment were damaged, and not all equipment functioned as it should. For example, the oven had no temperature gauge which meant the cook had to constantly watch food as it cooked. Staff told us they had repeatedly raised concerns about the environment, but the provider had not taken action to address it. The maintenance person told us they worked hard to keep the home safe but had limited budget and resource. One staff member said, “[Provider] doesn’t seem to be putting in any effort anymore. We raised our concerns, but no action is taken. It [water leak] has been like that for over 6 months, we wouldn’t leave our own homes like this, it’s not fair and it definitely impacts on the residents. We have to tell them they can’t go to a certain area in their home, and it’s not right.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Whilst the registered manager ensured staff were well supported and completed online training, there were challenges in ensuring some training courses went ahead. For example, the service improvement plan said a practical moving and handling course had been booked, the update said, ‘The owner cancelled it and said it was too much money. [Provider] was meant to sort another trainer, but this was not completed.’ This meant none of the staff had in date practical moving and handling training.

The registered manager did not receive effective support from the provider, and the provider’s approach impacted the wider staff team’s morale. Staff told us they did not feel well supported by the provider, but they appreciated the registered managers support and leadership. One staff member said, “We are doing our best, but [the provider] needs to spend the money to do the maintenance. Apart from that, it’s a brilliant home.”

There were enough staff to meet people’s needs and staff were recruited safely. One person’s relative said, “It is very well staffed.” A staff member said, “The staffing levels are fine, we have no problem with staff.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The environment meant it was difficult for staff to maintain good infection control practices. Carpets were worn and visibly dirty, walls were stained and the registered manager had purchased washable covers to cover the old and worn armchairs in communal areas. Several bedrooms had bad odours. One person’s relative told us, “There’s an odour problem in [relatives’] room, and an unpleasant odour as you came into the home.”

Worn and broken equipment meant it was not possible for staff to clean to the standard required to prevent the spread of infection. For example, exposed and rusted metal in a bathroom, chipped tables, bed frames, bed rails and porous, unpainted wood on radiator covers. The laundry was not arranged to allow a dirty to clean flow, and staff could not access the handwash sink easily.

Despite the environmental challenges, staff worked hard to keep the home as fresh and clean as possible, including daily carpet cleaning. Personal protective equipment was used appropriately.

Medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Systems were in place to ensure people’s medicines were ordered, stored and administered safely and in line with their personal preferences. Medicines were managed in line with best practice, and we saw people were supported by competent staff. Routine medicine audits were completed to identify any areas for improvement.