Ridgeway Lodge Care Home

Ridgeway Lodge is a residential care home providing personal and nursing care to up to 61 people. The service provides support primarily to older people, some of whom are living with dementia. At the time of our inspection there were 42 people using the service.

People’s experience of using this service and what we found

Since the last inspection improvements had been made to all areas of previous concern, particularly in relation to the poor quality of dementia care.

There were consistently enough staff to meet people's needs. More permanent staff had been recruited and staff were getting to know people and their needs well.

People living with dementia who may show behaviour indicating distress were appropriately and safely supported. Improvements were found in care records including assessments of risk and support plans setting out how to provide safe and personalised care. Processes to learn lessons and for these to be shared with the staff team had been implemented. Incident recording and reporting processes continued to be embedded into practice.

People received person-centred care. Improvements were found in the planning and delivery of person-centred care, particularly for people living with dementia and those who may show behaviour indicating distress. The management team were embedding good practice at all levels so people and their needs were better understood by staff. People were supported to spend time in the way they preferred and doing things they enjoyed.

The provider acknowledged the failings found at the last inspection. A new registered manager started soon afterwards and worked with the provider and staff team to identify, implement and embed improvements in all areas. The registered manager was well regarded. They worked openly and transparently and welcomed the inspection process. They were committed to driving continuous improvements and embedding an open and learning culture in the service.

People were cared for safely and protected from the risk of abuse. People were supported with their medicines and good infection control practices were in place.

People's needs were assessed, monitored and reviewed. Care plans included consideration of people's individual needs under the Equality Act 2010. Since the last inspection staff had received refresher and additional training to upskill their knowledge and practice. Competency checks took place to strengthen this further.

People were supported with their nutrition and hydration needs. Improvements were found in the dining experience since the last inspection, which we observed to be relaxed and enjoyable. People were supported to promptly access health care services when needed.

People received support from caring staff. Staff enjoyed working in the service, valued people as individuals and had positive relationships with people and their relatives. People were treated with respect. Staff maintained people's dignity and privacy. Consent was sought before care was delivered.

People and their relatives knew how to make a complaint, and felt they could raise any issues with the registered manager. Staff felt able to raise concerns if they needed to.

Quality assurance systems were effective. A range of meetings took place with people, relatives and staff. Staff were supported through one to one supervisions, competency checks and team meetings. The management team had an open door policy to encourage staff, people and their relatives to talk to them about anything.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 22 December 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this inspection to review the breaches of regulation found at the last inspection.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ridgeway Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ridgeway Lodge is a care home providing personal care up to 61 people. The service provides support to adults with long term conditions, most people were living with some form of dementia. At the time of our inspection there were 52 people using the service.

People’s experience of using this service and what we found

We found there were issues with how the registered manager, the provider, and staff supported people who lived with dementia and who expressed forms of distress. Staff training, knowledge and skills in this area was limited. People did not have meaningful reviews of their care to try and find solutions to this distress. There was a lack of dementia expertise to promote a safe and personalised care experience for people.

There was a lack of stimulation and access to the safe spaces outside, in the grounds of the home, for people living with dementia. Risks associated with dementia were not always explored and captured in risk assessments and care plans, to promote the individuals and others safety and mental well-being.

When people needed sensor equipment to reduce the risks of falls, this equipment was not always working or positioned correctly.

There were shortages of staff at night and poor processes to guide staff about what to do if there was reduced staffing, because of staff sickness for example. When evening shifts operated with less staff managers did not investigate these situations to look at what went wrong.

Staff did not have effective training and competency checks in place. Key training such as dementia training was not embedded into staff practice.

People’s social experience living at the home was not always personalised to reflect their current interests and previous interests. Staff did not routinely chat and spend time with people, their interactions were task focused. Some people commented on how they had got to know the staff but they also said they had had to work at these relationships. For people who could not do this, some people felt they had a more distant relationship with staff.

Managers and the provider did not always investigate events when there was a need to, in order to see what had happened and learn lessons from these. Audits and reviews into people’s social experiences at the home were limited.

People spoke with confidence about feeling safe at the home. One person told us, “Yes, I feel safe, I say that because I feel that we are well looked after.” Another person told us, “Do I feel safe? Yes I do."

People’s relatives were less confident. One person’s relative said, “On the whole [name of relative] is safe, but they [staff] don’t always follow [name of relative’s] care plan.” Another person’s relative told us, “Yes and no. Up until recently I would have said yes. There are moments when they are short staffed, and [name of relative] may not get enough attention.”

People received health input from a GP or nurse as needed. People received effective care in terms skin management, and the management of their medicines.

People were supported to have choices and some control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 21 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of dementia care and staffing levels. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety management, staffing, person centred care and the leadership of the home at this inspection.

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.

We found the following examples of good practice.

¿ The service was receiving professional visitors to the service with robust infection control procedures in place. Visitors were provided with a designated preparation area on arrival in which they were provided with guidance, personal protective equipment (PPE) and a health screening questionnaire was completed. Each visitor also had their temperatures checked by staff on arrival.

¿ The service had taken steps to alleviate feelings of loneliness or isolation being experienced by people. The service had a ‘Wellbeing Lead’ who was involved in developing activities for people and supporting telephone and video calls to their relatives and friends. The registered manager and deputy manager also told us of other actions the Wellbeing lead had taken to boost morale of people and staff; such a visit by the local fire service on a ‘Clap for Carers’ Thursday and the sharing of uniform/linen bags and small gifts for staff which had been donated by members of the community.

¿ The provider had developed a robust package of policies, procedures and guidance for locations which the registered manager had successfully implemented at the location.

Further information is in the detailed findings below.

Ridgeway Lodge is a care home registered to provide care and support for up to 61 people. The service consists of two floors, with different units accommodating people with specific care needs, such as dementia and residential care. At the time of the inspection, 58 people were living at the service.

People’s experience of using this service and what we found

People, relatives and staff said there were not always enough staff to support people in a timely way. People had not been harmed, but this had a potential to put people at risk because waiting, for example, to go to the toilet or to move, could impact on their dignity, health and welfare. Staff told us they could not give enough time to support people as they wished or respond to them quick enough. This was because they were too busy. Although there was an assessment in place to consider staffing numbers, this did not accurately reflect the needs of people or the actual experience of practical delivery of care.

Improvements were also required in the quality of the information in people’s daily records so that these clearly reflected people’s experiences and their individuality. The provider's quality monitoring processes were not always effective at ensuring that people always received truly person-centred care.

However, people said they received good care and were supported well to meet their needs. They told us staff were kind, caring and provided care in a respectful manner. Relatives were happy with how staff supported their family members.

Potential risks to people’s health and wellbeing had been managed well. People were protected from abuse because staff were trained to identify and report concerns. Staff were recruited safely. People were supported to take their medicines safely. Lessons were learnt from incidents to prevent recurrence. Staff followed set processes to prevent the spread of infections.

Staff had been trained to meet people's needs. The provider reviewed if they needed to do more to support staff to learn new skills and improve on existing ones. People had enough to eat and drink, but more needed to be done to ensure there were enough staff to support people who needed help to eat. This would also improve people’s dining experience. People had access to healthcare services when required, and this helped them to maintain their health and well-being.

Staff were respectful in how they interacted with people and supported them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

There were plans to further improve the amount and quality of activities provided to ensure people were active and not socially isolated. Complaints were followed up and improvements made when required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 28 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing levels and the provider’s quality monitoring systems at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ridgeway Lodge Care Home is a purpose built home for up to 61 older people with a diagnosis of dementia and is registered with the Care Quality Commission as a care home without nursing.

The service has 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. In our previous inspection we had found that people’s medication was not managed in a safe manner. In this inspection we found that this was no longer an issue and the provider had created more robust processes to ensure that people's medicines were managed safely.

There was enough staff available to support people to be safe in the home. In our previous inspection we had found that staff were not effectively deployed around the home to safely meet people's needs. During this inspection we found that this was no longer a concern and there was adequate staff deployed around the home to support people.

Detailed audits were now in place to monitor the management of the service and identify any issues with documentations but we found that the process was still a work in progress.

The provider had robust recruitment processes in place. Staff understood their roles and responsibilities and would seek people's consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people's individual needs.

People were supported by caring and respectful staff who knew them well. Staff were given the opportunity to get to know the people they supported through keyworker roles.

People's needs had been assessed, and care plans took account of their individual, preferences, and choices. Staff supported people to maintain their health and well-being.

Feedback was encouraged from people and the manager acted on the comments received to continually improve the quality of the service. The provider had quality monitoring processes in place to ensure that they were meeting the required standards of care. There was a formal process for handling complaints and concerns which were investigated and resolved in a timely manner.