Ribble View

Ribble View is a nursing home providing accommodation and personal care for up to 30 people. The service provides nursing care to adults with multiple complex health needs and physical disabilities. At the time of our inspection there were 26 people using the service. The accommodation is provided over 3 floors, each floor has a dining room and communal spaces.

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

This was a targeted inspection that considered how choking risks to people were assessed and their safety monitored and managed, so they are supported to stay safe. We also checked if people’s freedom was being respected and were lessons learned and improvements made when things go wrong.

Based on our inspection of these aspects of safe care we saw records with clear risk management strategies in place and staff were fully aware of people's risks and how to manage them. Some processes and systems of communications used in the home could be improved to ensure more effective sharing of information.

There was a balancing of people’s choices and the management of risk taking. Details in some records could be clearer but did not affect the care and management of choking risks. Staff were very knowledgeable about people’s individual clinical presentations and how to manage them. The registered manager told us they were aware from recent learning that more communication with external professionals would be beneficial.

We have made a recommendation about enhancing the detailing in records to ensure absolute clarity and to promote more dialogue in communications both in the home and with external professionals.

Where accidents and incidents had occurred, actions had been taken to prevent them from reoccurring. There were systems and processes used in the home and by the registered manager and provider to ensure lessons learned were shared.

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. Staff were very knowledgeable about people’s rights to make their own choices including those that may be considered unwise.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 2 September 2022).

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 choking. This inspection examined those risks.

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

Recommendations

We have made a recommendation about enhancing the detailing in records to ensure absolute clarity and to promote more dialogue in communications both in the home and with external professionals.

Follow up

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

Ribble View is a nursing home providing accommodation and personal care for up to 30 people. The service provides support to adults with multiple health needs, people living with a brain injury, people with mental health needs and people with physical disabilities. At the time of our inspection there were 18 people using the service.

The building has three floors which are all kept secure with key code locks. The middle floor is not yet in use although the service has begun to take referrals for people to move in.

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

People were kept safe from the risk of abuse and relatives said people were well cared for. A relative said, “I turn up unannounced, so I know (my relative) is safe.” Staff had good knowledge about people’s needs and people benefitted from a positive and caring atmosphere. One person said, “I love it here” and a relative said, “I can’t fault the staff, they are great.”

People were protected as the management team used safe recruitment processes. We have made a recommendation about the storage of some medicines.

People benefitted from an effective management team that were committed to improving the service. The registered manager used different ways to talk to people and staff and encouraged people to provide feedback. Staff enjoyed working at the service and were enthusiastic about their roles.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/or who are autistic.

The environment itself was a nursing home which could limit opportunities for independence. However, staff valued and upheld people’s dignity and privacy. Staff took the time to find out what was important to people and supported them to take part in their interests and hobbies.

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 8 August 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Ribble View is a nursing home providing accommodation and personal care for up to 30 adults. There were nine people living at the service at the time of the inspection. Some of the people lived with mental health, complex neurological conditions and required support with their physical needs.

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

People and their relatives told us they felt safe and protected from the risk of abuse and avoidable harm by staff who understood how to recognise, respond and report concerns. The registered manager had improved their systems to ensure they only admitted people whose needs they could safely meet. Risk assessments were in place to monitor and minimise the potential risk of avoidable harm to people during the delivery of their care. This was a significant improvement. People were safely supported to receive their medicines as prescribed. People were supported by staff who had been safely recruited. Staff had received training and guidance in the prevention and control of infections including COVID-19.

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. People's care and support had been planned in partnership with them, their specialist professionals and their relatives where possible. Staff had received training that was suitable to meet the needs of people in the home and the induction and support of new staff had improved. People’s experiences of care had been enhanced by a staff team with varied specialist clinical backgrounds including physiotherapists, positive behaviour support and occupational therapists. Staff supported people in line with national and best practice guidance.

People and their relatives shared positive comments about the caring nature of the staff team. They said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld.

People received person-centred care, which was responsive to their needs. Care records were well written and contained important details about people’s needs. Staff supported people to access the local community. People's individual communication needs had been assessed and staff had tools to assist their interactions with people. The registered manager dealt with people's concerns and complaints appropriately. People received dignified end of life care.

The provider had made significant improvements to the quality monitoring, governance and leadership arrangements which had contributed to driving improvements at the home. People were supported by a collaborative clinical team with varied experience. The provider and staff had worked hard to improve people’s experiences and to address shortfalls found at the last inspection. Comments from relatives included; "Things have changed drastically, my relative now has support 24hrs a day" and, "There is a feeling of knowing the people they look after and there is a sense of family and staff knowing what’s going on if you ask about your relative." The service worked in partnership with a variety of agencies to ensure people received all the support they needed. Staff were positive with how the service was managed and the culture and morale within the staff team had significantly improved.

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 inadequate (published 25 November 2020) and there were multiple 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.

This service has been in Special Measures since 25 November 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on our inspection scheduling.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ribble View is a nursing home providing accommodation and personal care for up to 30 adults. There were 14 people living at the service at the time of the inspection. Some of the people lived with mental health, complex neurological conditions and required support with their physical needs.

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

People told us they felt safe and staff were kind and caring. However, our observations and findings showed that people did not always receive safe care and treatment. People did not always receive their medicines safely to manage their conditions. While safeguarding protocols were in place, they had not always been followed to report falls and to ensure internal safeguarding investigations were robust. Clinical risks to people were assessed however, they had not always been timely reviewed or used to make effective decisions on people’s care. People were not supported by adequate numbers of suitably qualified staff to reduce risks of harm. Infection prevention protocols were in place and we were assured by measures in place, however, staff needed to follow them robustly to prevent and reduce the spread of infections.

People were not always supported by staff who had the right skills and knowledge. Staff did not receive suitable induction and training to meet the specialist needs of people they supported. 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 however this needed to be consistent. People told us staff sought their preferences. Staff supported people to have access to health professionals and specialist support. People were offered a variety of choice on their daily meals.

The registered manager and the registered provider had a governance system in place however, this had not been adequately implemented to promote a person-centred approach and the delivery of safe and high-quality care. Shortfalls were identified but not always resolved in a timely manner. Staff gave mixed responses regarding the culture and management style in the home and there was low morale. The registered provider needed to enhance clinical leadership and clinical oversight to ensure the service could admit people whose needs they can safely meet. Leadership in the home had established community links with local health and social care services.

People and their relatives were involved in designing their care and setting their goals however they were not always involved in the review of their care. Care records were written in a person-centred manner however they did not always accurately reflect people’s current needs. Staff had not received training in supporting people towards the end of their life. We made a recommendation about end of life care. There were arrangements to maintain regular communication between relatives and staff. People and family members knew how to make a complaint and they were confident about complaining should they need to.

People and their relatives were positive about the service and said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. The registered manager worked in partnership with people and their advocates.

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

Rating at last inspection

This service was registered with us on 19/11/2019 and this is the first inspection.

Why we inspected

We received concerns in relation to the management of people’s clinical needs, the deployment of staff and the leadership in the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the registered provider needs to make improvements. Please see the safe, effective and well led sections of this report. The registered provider took immediate action to address the concerns and improve the clinical oversight on the service and the management of medicines.

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 coronavirus and other infection outbreaks effectively.

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 discharge our regulatory enforcement functions required to keep people safe and to hold register providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from preventable harm such as medicines management and clinical risks, safeguarding, responding to changes in people’s needs, deploying suitably qualified staff and poor governance at this inspection. Please see the action we have told the registered provider to take at the end of this report

Follow up

We will request an action plan for the registered provider to understand what they will do to improve the standards of quality and safety. We will work alongside the registered 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the registered provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the registered provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.