The Ridings Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last inspection we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect. The service was in continued breach of legal regulation in relation to how people were not supported in a person-centred way. There was not always evidence people’s consent had been sought before decisions were made on their behalf. This was not in line with the Mental Capacity Act (MCA 2005) guidelines and was a continued breach of legal regulation regarding how consent was sought. We did see examples of good care during our visits; however this was not consistent to all care we observed.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who could speak to us spoke positively about the staff team. One told us, “The staff are good, they are polite when they speak to me.” Another said, “The staff are all nice.” Relatives we spoke with also described the staff team as ‘kind’. One relative told us, “The staff are very kind and caring.” Another said, “[The staff] are very very kind to [my loved one].”

Staff told us about ways in which they supported people with kindness and care. They spoke fondly of some of the people they supported. They described ways in which they preserved people’s dignity and privacy. Staff also spoke positively about each other as a team. The registered manager spoke about how proud they were of all the hard work the staff had done to improve the standard of care provided to people.

Not all people living at the service were able to speak to us about their experiences of care. For these people we used a structured observational tool to assess whether they received kind and compassionate care and were treated with dignity. We saw some examples of people being treated in an undignified way. One person was given a medical test and had the results of it announced to them at the dinner table in front of others, they were not offered the option of doing this privately. Staff spoke about people as being ‘assists’ or ‘prompts’, this reduced people down to aspects of their care needs and was not a respectful way to speak about them. We also saw care records which did not use respectful or dignified language about people and in some instances seemed to be written from the standpoint of staff convenience rather than people’s needs and wishes. Although we saw improvements overall in the care provided to people since our last inspection, there remained areas which needed further improvement.

People we spoke with told us staff mostly treated them as individuals and knew their specific needs. One person told us, “Nobody bothers me if I don’t want to be bothered.” Another person told us about the interests they had and were supported to pursue by staff. One person said, “I go to bed when I want to.”

Staff told us they knew more about the individual needs of some people than others. They explained historically they had worked with the same people for a long time and felt they knew about their needs and wishes well. They now moved around the home and worked at times with most of the people who lived there and would therefore know less about people they had worked with less. Staff told us they could access people’s care records for guidance on their needs and preferences. Some staff told us about people’s particular likes and dislikes. For example 1 staff member explained a person who was living with dementia would often decline a drink, but if they asked again after 10 minutes, they would often say they did want a drink.

We saw a mixed picture regarding the treatment of people as individuals. We saw examples of people being supported to go out for a cigarette and being asked about whether they wanted to participate in particular activities. We also saw people being given meals without being offered options. For example some people were only offered blackcurrant squash as a cold drink option with their meal; this failed to consider not everyone may like or want this option. Some people were given a selection of vegetables with their meals but were not asked about which vegetables they liked or wanted. When asked people told us they did not like broccoli and had therefore not eaten it. People who required soft diets were not always offered extra portions of their meal, but people who did not require soft diets were offered extra portions. The menus on people’s tables did not reflect the actual food offered. The print on the menus was small and italic; 1 person commented they could not read the print or understand the layout. People living with dementia were not offered plated options of their meals, even when 1 person was visibly struggling to decide. Adaptions had not been made to support people living with dementia and help them make choices about their meals. There was little evidence of how people’s individual interests and wishes had been considered in the provision of activities in some cases. We saw 1 person’s care records indicated they would not participate in any activities, but records showed this was not always the case. There was no evidence of a conversation with the person to learn about how they might like to spend their time. We saw many people being cared for in their rooms, either exclusively or for most of the time. Records showed these people were left without activities and engagement for many hours each day.

Care plans contained more personalised information about people than they had at our previous inspection to help staff understand their needs better. However this did not always translate into more personalised care. Records could not always evidence any meaningful attempt to engage 1 person for months prior to our assessment. Processes to ensure people’s specific interests were catered to wherever possible had not been consistently successful. Processes to ensure people’s specific needs, likes and dislikes were catered for at mealtimes had not always resulted in people being offered food and drink they liked and wanted. They had also failed to ensure staff communicated people’s choices in a way which helped people living with dementia to make personal choices The management team told us there were extra portions of pre-prepared meals available for those who needed soft diets, but staff had failed to utilise these. The management team also said they would look into the design of menus to see if they could be produced with larger print, in an easy to follow layout and accurately reflect the food choices.

Some people we spoke with told us about ways in which they were supported to be independent. One person told us staff were encouraging them to walk more often to help build strength and independent mobility. Some people told us they made choices about how they spent their time, and what time they got up in the morning and went to bed.

Staff told us about the ways in which they sought consent from people before offering support. However they did not all understand mental capacity, Deprivation of Liberty Safeguards (DoLS) and what these meant for people. Staff could not tell us who, amongst the people they were supporting, had a DoLS in place. They were not always sure for example about who could not decide for themselves to remain living at The Ridings Care Home and who could make the decision to leave if they wanted to. Staff told us they had received training in mental capacity. The training did not seem to have enabled all staff to fully understand choice and consent.

We mainly saw staff seeking consent from people before providing care. We did see 1 person having food put into their mouth without obtaining consent to do so. The person was given no choice about what type of food they were eating and just had the food placed into their mouth without any discussion to tell them what the food actually was. We saw guidance for staff was not in line with the Mental Capacity Act (MCA) 2005. People had capacity assessments, but they were not decision specific. Capacity assessments were often about a variety of different decisions related to their life at The Ridings Care Home. This implied people either had or lacked capacity generally and did not always clearly identify what aspects of daily life people could make decisions about. For example 1 person’s capacity assessment stated because of a medical condition, they could not make decisions for themselves. However in discussion with the person it was clear they could make decisions about many aspects of their daily life. We also saw 1 person had CCTV installed in their bedroom. The registered manager explained the family of the person had requested this as a result of a previous safeguarding concern. However there was no evidence to demonstrate the person subject to CCTV in their bedroom had been meaningfully consulted with about this decision, or that their wishes beliefs and preferences had been considered. In response to our concerns the use of CCTV in a person's bedroom was reviewed and no longer used.

At our last inspection we found people’s capacity had not always been assessed and decisions were being made on their behalf in some cases inappropriately. At this assessment we found people had capacity assessments, but they did not consider people’s capacity in relation to specific decisions. For example a person may not be able to decide whether they should live in a care home (a complex decision with significant long term impact) but they may be able to decide what they want to eat, what clothes they want to wear, or how they want to spend their time. Care records did not provide staff with guidance about when they may need to support people to make decisions in their best interests. Records regarding whether next of kin had power of attorney to make certain decisions upon their behalf were not always accurate. In one case we found a relative had been recorded as having power of attorney to make decisions about their loved one’s health and wellbeing; however, no proof of this had been sought and no proof was available during our assessment. The management team did not fully understand capacity assessments needed to be decision specific. People were left at risk of having decisions made inappropriately upon their behalf.

People told us staff supported them with their immediate needs. They told us they did not have to wait long if they pressed the call bell. They told us they were supported to remain comfortable and address any needs they had.

Staff told us about how they checked on the needs of people who could not use the call bell to ask for assistance. They explained the electronic system they used prompted them to check on these people through the day. They also explained for some people they would check and record people’s activity on an hourly basis if needed.

Staff did not always respond to people’s urgent needs in the moment. We saw some examples of people not receiving the most appropriate care when urgent support was needed. For example there was confusion around what action should be taken if people sustained a head injury. When we highlighted this, the provider updated their process guidance for staff. We saw one instance of a staff member misinterpreting a person’s condition and failing to respond appropriately. This person was not harmed by this failure but was exposed to significant risk. When this was highlighted to the provider, they arranged training for staff and changed and improved the guidance for staff to mitigate the future risk of this happening again.

Most of the staff told us they felt supported by the management team. Staff told us the process of change in the last year had been challenging but felt it had resulted in better care and a better living environment for people. Some staff told us historically some of the management team had not been effective and the new managers were more effective. Some staff told us they had been supported by the registered manager with personal matters which had enabled them to work flexibly at times of difficulty. This meant they were able to provide a better standard of care to people as they were not working when they felt less able to support people well.

We saw staff were supported with regular supervisions and appraisals.