Archived: Ridgewood

Ridgewood Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Ridgewood is a detached house in a residential area of Camborne. It has two floors and 12 individual rooms. Refurbishment work was underway on the first day of the inspection. This was to improve kitchen, communal bathing and en suite facilities. On completion of the work the service will have 5 rooms with en suite facilities. There were bathing facilities on each floor. A wet room had been added to a bathroom as well as a separate shower facility in another bathroom. There was a lounge and separate conservatory. A previous quiet lounge had been converted to a kitchen preparation area as well as a main kitchen used to cook meals. There was a rear garden area.

A manager was in post, and had applied to be registered with the Care Quality Commission. The manager was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 19 October 2017. In October 2017 we found governance systems were not effective and did not demonstrate clear oversight of the service. Incident reporting was not always happening when it should. For example, there was no evidence of how an incident might have occurred and action to prevent it occurring again. Medicine systems were not being managed effectively. A cream had not been dated when opened to ensure staff knew when the cream would remain effective to use. There were three gaps in administration records for when the cream was applied. Stock control was not always accurate. We made a recommendation for the service to improve the medicine audit system. People’s risks were not always being managed effectively because assessment for a person living at the service had not been completed. The staffing rota was not an accurate record which could be relied upon. Staffing levels supported people to have choices in activities during the week. However, during weekends this could be limited because of staffing levels in the service.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the previous inspection the Nominated Person [A person who has overall responsibility for supervising the management of the regulated activity] had changed. They had introduced new recording and management systems and reviewed all operational systems for the governance of the service. This had been carried out with the manager who had experience of working at a senior level. New governance systems had been put in place including reporting of accidents and incidents. Audit systems relating to accidents and incidents were in place so the manager could identify any patterns or trends to mitigate the possibility of it occurring again.

Medicine administration systems had been reviewed. Weekly auditing processes meant any omissions and stock control issues were being identified and managed more effectively. Staff understood the importance of dating creams when opening them and records to record the application was being maintained.

Risk assessments included details of identifying the risk to the person and how this was going to be managed. Risk assessments were in place for people living at Ridgewood. People’s individual care needs had been assessed for risks related to aspects of daily living and these were reviewed regularly.

Staffing levels had been reviewed and changes to shift patterns meant there was more flexibility in how the service was staffed. There were sufficient numbers of staff deployed to meet people’s needs. This meant people were supported to take part in activities when they wanted to.

The service learned from accidents and incidents. An additional night staff post had been put in place following a review after an incident. It was identified that one member of staff had found it difficult to alert an on-call staff member due to the presenting situation. By creating an additional post, it meant accidents and incidents could be responded to more effectively.

People told us that they felt safe with the support they received from staff at Ridgewood. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they should take if they suspected abuse.

Staff records showed the recruitment process was robust and staff had been safely recruited. Training was up to date, and the staff team were supported through supervision and appraisal sessions.

The care service was established before the development of the CQC policy, 'Registering the Right Support' and other current best practice guidance. This guidance includes the promotion of values including choice, independence and inclusion. The service was working with people with learning disabilities that used the service to support them to live as ordinary a life as any citizen. For example, people’s bedrooms offered space and privacy. There was access to activities both at the service and in the community.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. Where restrictions were in place to keep people safe the best interest process had been followed to check restrictions were necessary, proportionate and the least restrictive practice.

The service was undergoing a refurbishment programme to improve the environment.

There were effective quality assurance systems in place. People, staff and relatives had opportunities to make suggestions about how the service could be improved. Staff described the management team as approachable and supportive.

Ridgewood provides accommodation and personal care for up to twelve people who have a learning disability, mental health needs and maybe also on the autistic spectrum. During this inspection nine people were living at the service.

The service is situated close to the centre of Camborne. People living at Ridgewood were mobile and did not require mobility aids to support movement around the service. People using the service were supported to use community facilities either independently or with staff support.

The registered manager who was also the nominated individual (Person with legal responsibility for the service) had recently left the service. There is a requirement to register a manager with the Care Quality Commission (CQC), in order to meet a condition of the services registration. 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. The service was currently being managed by the owner who was also taking the position of acting manager of the service supported by a deputy manager. Throughout this report the owner will be referred to as the acting manager.

Governance systems were not effective and did not demonstrate clear oversight of the service. Incident reporting was not always happening when it should. For example there was no evidence of how an incident might have occurred and action to prevent it occurring again.

Medicine systems were not being managed effectively. A cream had not been dated when opened to ensure staff knew when the cream would remain effective to use. There were three gaps in administration records for when the cream was applied. Stock control was not always accurate. We have made a recommendation for the service to improve the medicine audit system.

People’s risks were not always being managed effectively because assessment for a person living at the service had not been completed.

The staffing rota did not identify staff roles with no indication of who was senior for each shift. The staffing rota was not an accurate record which could be relied upon.

Staffing levels supported people to have choices in activities during the week. However during weekends this could be limited because of staffing levels in the service.

The service was clean and of a domestic nature, which was suitable for the people who used the service. People’s rooms were personalised and decorated to a satisfactory standard. Health and safety checks were being carried out by the manger and maintenance staff.

People had their healthcare needs met and there were examples of how people's health needs had been effectively responded to. People were treated with dignity and respect and independence was promoted wherever possible.

The service had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff understood the importance of people consenting to support and encouraged choice making where possible. They understood the importance of enabling people to make their own decisions wherever possible and seeking the involvement of appropriate people when making decisions to provide care in a person's best interests.

People were protected from the risk of poor nutrition and staff were aware of people's nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People and relatives knew how to raise any complaints they had and were confident staff would take action if this happened.

We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three people who lived at the home. One person told us "I am happy here". We were invited into three bedrooms and people told us they were comfortable.

The kitchen remained open throughout the day and people were able to walk freely around the home.

The records we reviewed documented individuals choices and preferences.

During our inspection we spoke with two people who lived at Ridgewood and two relatives. People told us 'I quite enjoy it here' and 'I'm happy'. A relative said, 'X is well looked after and safe'.

We saw people did not have keys to their lockable bedroom doors and there was no documentation to show they had been asked about this. People were not always able to move about the home freely and without restriction due to the kitchen door being locked.

Staff told us they felt supported and one person said: 'We are a team'.

We saw people were comfortable with each other and with staff at Ridgewood.

Care plans and associated documentation were detailed, informative and directed and guided staff of the action they needed to take in order to meet people's assessed care needs. People's records were personalised, detailed and provided clear information about the person's needs, wishes and abilities.

We saw people's wishes were respected. We observed people moving around the home without restriction.

We found people's privacy, dignity and independence were respected and people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse.

People were protected from the risk of infection although appropriate guidance had not been followed.

We found the service could not demonstrate that staff had received appropriate professional development because accurate records were not maintained.