The Ridings Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question inadequate and found breaches of regulations in relation to safeguarding and protecting people from neglect and abuse. We found safeguarding concerns were not being raised with other agencies as needed and were not being recorded, monitored or investigated effectively. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was a risk that people could be harmed. We saw safeguarding concerns were shared with other agencies as needed, which meant the service was no longer in breach of regulation 13 protecting people from abuse and improper treatment. However the circumstances of safeguarding concerns, for example falls and incidents between people living at the home, were not always investigated. When concerns were investigated, investigations were not robust and effective. Additionally there was little evidence to show what learning had been gained and how this would help protect people from future risk. This left people at risk of avoidable harm and was a continued breach of regulation 12 safe care and treatment. We saw improvements in the cleanliness and maintenance of the home. Aside from a concern regarding rescue medicines for epilepsy, people were supported to manage their medicines safely.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they knew how to raise concerns but they had not had any to raise recently. They told us they felt confident if they had concerns they would be listened to. One person said, “[The registered manager] is approachable and I can tell her if there is anything wrong.” Relatives told us they knew how to make a complaint or raise a concern.

Some staff we spoke with knew the people they were supporting well. However others told us they did not know people well as they had not worked with them very much. The registered manager explained staff were expected to work across the 4 areas of the home occupied and had been doing so for 9 months. Staff told us this rotation meant they might not work with the same people for many weeks. This meant there was a risk staff might not be aware of risks to people. For example, our expert by experience asked a staff member if a person they were supporting was hard of hearing, the staff member said they did not think so, but records showed the person was hard of hearing and needed people to speak up to enable them to hear. Staff told us they felt confident to report any concerns they had to the registered manager.

The service did not always have a proactive and positive culture of safety based on openness. They did not always investigate concerns about safety. Lessons were not always learnt to continually identify and embed good practice. For example, when a person fell and was noted to have old slippers which needed replacing, there was no evidence the management team investigated how the slippers had become so worn without staff noticing, or evidence the wider risk from old and worn footwear to others in the home was considered. Complaints were logged but when one was reviewed, there was little evidence to show how the complaint had been investigated and the response to the relative had not addressed a key concern effectively.

Relatives told us they were involved in regular reviews of their loved one’s care. There was some evidence people had contributed to the development of their care plans.

The management team were not clear during the assessment, about when staff should seek emergency medical support in the event of someone sustaining a head injury. Nursing staff were able to tell us about how they would safely transfer someone’s care to a hospital setting and re-admit them back into the home. The management team told us they had a good working relationship with the local GP surgery and the community mental health team. We also saw evidence of this during our visit and in people’s care records.

Improvements had been made to people’s hospital passports to make them more reflective of people’s individual needs. Systems to ensure effective communication between services were improved but some problems remained. For example there was confusion amongst the management team about the procedure for responding to head injuries, with regard to at what point emergency services would need to be called. When we highlighted this, clarification was provided and shared with the staff team.

People told us they felt safe living at The Ridings Care Home. One person, who was commenting upon the improvements made to the home in the past year told us, “I feel safe here, it’s changed now and I don’t worry about anything.” Another said, “I’m in safe hands.” Relatives told us they felt their loved ones were safe. One described how staff supported their loved one using a hoist and made sure this was done safely.

Staff could tell us about the key signs of safeguarding concerns and knew what action to take if they had any concerns. The management team ensured safeguarding concerns were shared with other appropriate agencies, such as the local authority safeguarding team.

At our previous inspection we saw examples of unsafe care. At this assessment we did not see any unsafe conduct by staff, or people in situations which were not safe for them. The registered manager explained some people who had been living at the service had been assessed and they had decided they could not safely meet their needs. These people had been supported to move on to services which could better meet their needs.

Safeguarding concerns were shared with the local authority safeguarding team and other appropriate agencies. However safeguarding concerns identified were not always investigated or fully investigated by the management team. This meant opportunities to learn from when things had gone wrong were sometimes missed. For example staff had noted a large bruise on a person who was cared for in their bed. The person was not able to tell staff how they had sustained this injury as they were living with dementia. The GP examined the injury and surmised that staff may have accidentally caused this by the way the person was supported when receiving personal care. Although steps were taken to ensure guidance for staff reinforced the need for gentle contact during direct support, there was no evidence the particular circumstances around this injury were investigated. This meant opportunities to maximise learning and future mitigation of risk were missed.

Some of the people we spoke with told us they felt some staff knew them and their care needs well. One person told us, “They know all about my medical issues.” Another said, “They know me, they know I have [a specific medical condition].” Some relatives we spoke with also told us they thought staff knew about their loved one’s care needs.

We received mixed views from staff about how well they knew people’s care needs and risks. All staff told us if they were not sure they knew where to seek further information or guidance. Two staff told us they were concerned about how well they could communicate with people whose first language was not English. The registered manager told us people had communication folders to assist staff in being able to communicate. One of the staff told us they were using these but still found communication difficult. These staff said they did not feel confident they always knew what these particular people were trying to tell them and there was a risk their needs may not be met. They explained they had seen a staff member who could speak 1 person’s first language, communicating with them well and felt that staff member could much better gauge the person’s needs. Other staff told us they knew these people really well and felt they would be able to tell if they were in pain or distress. For example 1 staff member said, “I spend a lot of time with [the person], I know how he breathes, eats and drinks. I know what is normal for him.”

The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. We saw guidance for staff to support people with epilepsy was not always clear and lacked sufficient detail to help staff understand the specific risks to individuals. An incident had occurred in which a nurse had failed to identify a person with a diagnosis of epilepsy was having a seizure. However following this, guidance for staff had not been improved. A handover document designed to inform staff of key risks for people failed to include a person had a diagnosis of epilepsy. Guidance for staff to support people who had sustained head injuries was not clear. A person had sustained a head injury, and staff had not followed the correct policy and procedure. Although we found no evidence people had been harmed by these oversights, people had been at risk of a poor or inappropriate care from staff.

During our assessment there was confusion regarding what action staff should take in the event of a person sustaining a head injury. The commission issued a letter of intent; this is a formal request to highlight risks to people and prompt immediate action from the provider. Following this clarity for staff on how to support people in the event of a head injury and guidance for supporting people with epilepsy was improved. We saw guidance for staff for 2 people who could become distressed, particularly during personal care, had failed to identify this as a form of communication. Guidance for staff did not highlight aggression or frustration as possible ways of refusing care. Two people’s care plans did not include information about how staff could tell if they were not consenting to care. This put people at risk of having their wishes ignored or not fully understood. After the assessment was concluded, the provider shared evidence showing 1 person's care plan had been updated with guidance for staff to address this concern.

People and relatives told us they felt the environment of the home was managed safely. One relative told us, “Equipment and staff are always available when [my loved one] needs them.” One person said, “We’ve got new lights in the corridor which are brighter.”

Staff told us they felt the presentation of the home was much improved, décor had been updated and it was a nicer environment. Staff also told us they felt confident to respond in the event of a fire emergency and had participated in drills and training. This included night staff who had also had practice fire drills.

During our visits we saw the care environment was much improved. It was uncluttered and well maintained. Fire doors were no longer propped open as they had been during the previous inspection and staff told us they had been prompted to check this regularly.

However, we saw 1 record of an incident in which a person had tripped over a sign on the floor. An accident form had been completed in which recommendations had been made about how staff could prevent a similar accident from occurring in the future. However there was no evidence provided to demonstrate how the registered manager planned to ensure these recommendations would be shared with staff, adhered to, and whether they would be effective over time. Aside from this issue we saw the service detected and controlled most potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People and relatives told us they thought there were enough staff to support them safely and that they had the right skills for the job. One person told us, “Before we had too many inexperienced staff who were looking after very complicated patients. It’s improved now.” Another said, “There’s always enough staff.” A relative told us, “I have no concerns about staffing levels.” One person told us, “[The staff] know what they are doing, I am in safe hands.”

Staff told us there were enough staff to support people safely. They said efforts were always made to cover staff absence. Staff told us, if needed, agency staff were used to support people. The registered manager said agency staff use had been reduced a lot and bank staff were approached, as well as offering extra hours to the team before agency staff were considered. Staff told us they felt they received suitable induction support and training. For example 1 staff member talked about how recent training around food and nutrition had improved the support they offered to people. The registered manager explained a member of the nursing team had skills and knowledge which enabled them to offer training and guidance to the wider staff team. The registered manager explained some of the members of the activity team had not been available for many weeks, but they had been asking care staff to step in and assist with this role.

During visits we saw generally the staff team were relaxed and conversational and not rushing around with a task based focus. However we did see in one part of the home people were waiting a long time to be supported to eat their meals. A staff member told us they did generally struggle at lunch times because so many of the people they supported needed full assistance to eat and drink. The management team said other staff could be made available to support this area of the home at meals times if they were struggling. There was no evidence the need for ongoing additional support at mealtimes had been identified or discussed.

The service had made sure there were sufficient staff to support people safely. A review of an incident suggested competency checks for staff were not always adequate. An incident had occurred in which a staff member had misinterpreted the symptoms a person was having and had not taken the correct course of action. The person was not harmed as a result of this error. When this incident was investigated, the management team failed to consider what training and guidance was available to the staff to make sure a similar mistake did not happen again. Processes to make sure staff had received training in a medical condition a number of people in the home experienced, had failed to note not all staff had had this training. There was a lack of evidence that staff competency and understanding was checked to ensure they could support people safely with their medical needs and risks. Following our assessment the provider commenced additional training for staff in this area, including the ability for nursing staff to administer appropriate medication when needed. Staff recruitment processes were completed safely. This included Disclosure and Barring Service (DBS) checks, to check the suitability of potential staff for the roles they applied for.

People and relatives told us they we happy with the cleanliness of the home and the support they received with personal hygiene. One relative told us, “[My loved one] is always clean and so is their room.” Another said, “All of the home is clean.”

Staff told us they felt the cleaning regime had improved since our last inspection. One staff member said, “The care home is more clean now.” The registered manager said, “We have come a long way as team, the home is clean now and there is no clutter.”

During our visits we saw the cleanliness of the home was much improved since our last inspection. Shared areas of the home as well as people’s own rooms were clean and tidy. The home was clutter free. Staff wore personal protective equipment (PPE) appropriate to their tasks. People were supported to maintain good hygiene. Staff knew about infection prevention procedures which they followed to protect people from risk.

The service assessed and managed the risk of infection appropriately.

People we spoke with told us they were happy with the support they received to take their medicines. One person said, “They bring me my tablets every day.” One relative described the ways in which the staff supported their loved one to take their medicines when they needed them.

The registered manager explained in the parts of the service where people received nursing care, nurses administered their medicines. In the parts of The Ridings Care Home where people received residential care, they mainly received support to take their medicines by a senior carer who had received additional training to do so. The registered manager confirmed they had not reviewed storage of rescue medicines for people at risk of seizures. They had not reviewed staff's knowledge of where to find rescue medicines and how to use them despite an incident during which staff had not taken appropriate action in a timely way.

We saw people were supported to take their regular medications safely. We did observe 1 person receiving a medical test at the dinner table in front of others. Aside from this, we did not observe any issues with the way in which people were supported to take their medicines. People were supported to use creams in line with the recommendations of the prescriber. Medicines were ordered and stored safely. We found generally people were supported to manage their medicines safely. However, we identified a concern about rescue medicines were being stored in a cupboard inside the locked medicines cabinet, inside the locked medication room. There had been no effort made to test how long it took staff to obtain rescue medicines for people who were prescribed these in the event of an epileptic seizure. A concern about this had been raised by an external health professional, but this had not been investigated. There was also evidence suggesting not all staff knew how to administer rescue medicines. The management team made changes to the storage of and guidance for staff regarding rescue medication in response to a letter of intent issued by the Commission.