The Ridings Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection we rated this key question Inadequate. At this assessment the rating has changed to requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. For example there were systems in place to identify and report safeguarding concerns, incidents and accidents to external agencies but processes to check these systems had failed to identify investigations were either not being completed, or when completed were not robust. Quality assurance systems had failed to identify many of the concerns raised by our assessment. These included some problems identified at our last inspection of the service. The service was in continued breach of legal regulation in relation to the governance of the service.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with understood and supported the values and vision of the organisation. Some staff spoke about the improvements they felt this vision had enabled them to achieve. Staff were able to tell us about how they understood people’s human rights and about some of the ways they supported people’s diverse needs. However in practice staff and management did not all have a clear or well developed understanding of people’s rights under the Mental Capacity Act and their associated responsibilities.

Processes ensured staff had a shared vision and values regarding the care and support they delivered. People and relatives had been provided with clear information about how to raise suggestions and concerns about the service. The management team had sought people’s views about how to improve the service, enabling them to contribute to its development. However this process, in combination with people’s involvement in their care plans, had not always ensured care was personalised and put people at the centre of all planning. The provider’s processes and training had not ensured a clear understanding and promotion of people’s right under the Mental Capacity Act 2005.

Staff mostly spoke positively about the support and leadership of the management team. They told us the management team were easy to access when needed. One staff member told us compared to other managers they had worked with, the current manager had a ‘more supportive approach’.

The management team had developed processes which enabled them to work alongside staff teams, maintain visibility and awareness of the culture of the team.

Staff told us they felt confident to speak up if they had any concerns. One staff member told us, “ I have not had any concerns, but if I did have I would report them to the manager.”

There was a whistle blowing policy in place. Staff were informed about this as part of their induction. Staff could access the policy electronically if needed.

A number of staff told us they were supported to work flexibly, which supported their work life balance.

On the whole staff told us the management team took into account their equality, diversity and inclusion and treated them fairly. Some described how they were supported inclusively to maintain cultural practices. The diversity of the workforce to some extent reflected the diversity of the people they supported. The manager told us they would like to recruit more staff who could speak the languages of people whose first language was not English but had been unable to do so.

Staff and management we spoke with told us they were clear about their individual roles and responsibilities as these related to delivering good quality care. However we found in practice this was not always the case. For example systems to monitor the quality and effectiveness of training and its impact upon staff competency had not identified some staff had not completed training to help them recognise and support people with epilepsy. They had also not identified staff who had completed mental capacity training had not all developed a clear understanding of the subject as a result.

The provider’s systems and processes were not operated effectively to enable staff to consistently improve upon the safety and quality of care provided to people. Oversight of the means by which consent and capacity were assessed and sought, had failed to ensure people’s capacity was always assessed in relation to specific decisions. In some cases people were subject to restrictions such as the use of bed rails. However, the mental capacity for people to make a specific decision about the use of bed rails was not evident. Systems to oversee the analysis of incidents and accidents did not always ensure robust analysis. When there had been an investigation, oversight of the process had not identified key learning opportunities had been missed. For example, the ‘falls analysis’ record contained gaps in which no information had been entered. In some cases the actual fall or incident had not been recorded so it was not clear what had actually happened to the person. Without key information, actual incident analysis was difficult to achieve, but quality assurance checks on these records had not identified the issue. Systems to review the safety and effectiveness of people’s clinical care had failed to identify staff were not always following the provider’s head injury policy and procedure. Quality assurance systems had not enabled the management team to identify a lack of guidance for staff around some people’s specific healthcare needs and how this was impacting upon the safety and effectiveness of the care provided. Reviews and observations of the care provided had failed to identify some people who needed full assistance to eat and drink were in some cases having to wait a long time for their meals, and in some cases their meal was going cold. Although the management team were responsive to many of the concerns we raised during the assessment, systems in place had failed to highlight the issues for them to identify and act upon themselves.

People and their relatives told us they received support to access services from other health care professionals as needed, such as their GP, dentist or chiropodist. Some were also supported to access services in the community such as going to the hairdressers or getting their nails done.

Staff and management told us they collaborated with all the relevant professionals, stakeholders and agencies, such as occupational health therapists and community mental health professionals.

Commissioners told us the management and staff team had been working hard to address the concerns raised at our previous inspection. A concern was raised by paramedics regarding staff knowledge of a person and the response they received to a medical need.

Processes were in place to ensure external partners were notified of relevant information. For example, the management team completed CQC notifications, based upon information brought to their attention and had raised safeguarding concerns with the local authority safeguarding team. Improvements had been made to people’s hospital passports to make them more reflective of people’s care needs. This would facilitate a better understanding of how to support them in the event of needing care from another service.

Staff told us they understood how to make improvements to people’s care happen, by, primarily, raising issues and concerns with the management team. However the management team had not driven consistent improvements in the safety of people’s care or minimised possible risks to people.

Systems and processes to support learning and improvement in people’s care were not always effective. We saw 1 example of a minor injury to a person which had not been recorded or discussed initially with the person. Overall staff were recording incidents and accidents, including unexplained injuries. Systems to ensure learning was gained to mitigate future risk were not effective. For example the falls analysis record did not prompt staff to make recommendations, consider lessons learned, or consider how any recommendations would be reviewed for effectiveness. We saw recommendations had been made to reduce 1 person’s risk of falling. They had been written underneath the falls analysis entry. During our visits the recommendations were not being followed. The registered manager was unable to tell us whether this was because the suggestions had been unsuccessful or had simply not been communicated to the wider staff team for them to try. We also saw records of a person having fallen 4 times in 1 night, but there was no evidence the reason for this had been explored to understand better how to mitigate future risk for the person. A lack of internal investigation and analysis meant opportunities to identify gaps or inconsistencies in staff knowledge were missed. This had also led to a failure to identify lack of adherence to policy and procedures and chances to mitigate against known risks were missed. The provider shared an improved method of analysis after the assessment was concluded as part of changes made to address these concerns.