About the service:

OSJCT Ridgeway House is a care home for older people, including those living with dementia. 39 people were living in the home at the time of the inspection.

What life is like for people using this service:

Risk assessments and plans to manage the risks people faced were not always kept up to date and some records contained contradictory information. Despite these shortfalls, staff demonstrated a good understanding of people’s needs and the support they needed to stay safe. The registered manager had identified that work was needed to update the records. This will ensure any new staff coming into the service have clear information about the support people needed to stay safe.

People and their relatives were complimentary about the care they received and about the quality of staff.

People were supported make choices and have as much control and independence as possible.

People had been supported to develop care plans that were specific to them. These plans were regularly reviewed with people.

People received caring and compassionate support from kind and committed staff.

Staff respected people’s privacy and dignity.

People received support to take their medicines safely.

People’s rights to make their own decisions were respected. People were supported to choose meals they enjoyed and access the health services they needed.

The registered manager provided good support for staff to be able to do their job effectively.

The provider’s quality assurance processes were effective and resulted in improvements to the service.

More information is in Detailed Findings below.

Rating at last inspection:

Good. Report published 21 September 2016.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

OSJCT Ridgeway House provides accommodation and personal care for up to 43 older people some of who are living with dementia. The home is situated on two levels with two communal lounges and a dining area, with a central kitchen and laundry. At the time of our inspection there were 42 people living there and one person staying short term.

The inspection took place on the 23 and 24 August 2016. The first day of the inspection was unannounced. At our last inspection of OSJCT Ridgeway House in September 2013 we found the provider met the legal requirements in the areas we looked at.

The service did not have a registered manager employed at the home. 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. A new manager had recently been appointed and was in the process of applying to become the registered manager.

People and relatives spoke positively about the care and support they received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly.

People were treated with dignity and their right to privacy was respected. Staff knocked on people’s doors before entering and sought people’s permission before undertaking any care tasks. We found staff had a good understanding of people’s needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection, with people using the service not hesitating to seek assistance where required and sharing jokes with staff.

People spoke positively about the food choices and were supported to have sufficient food and fluids. People were offered a choice at meal times and alternatives were available where people did not want what was on the menu.

People’s medicines were managed safely. Systems in place ensured that people received the medicines as prescribed and at the correct time.

There were systems in place which encouraged people and their relatives to share their views on the service. Complaints were investigated and responded to appropriately. People told us they were regularly consulted about their care and they attended six monthly care review meetings.

Risk assessments were in place to support people to be as independent as possible. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. Staff displayed a good understanding of how to keep people safe from potential harm or abuse and what actions they would take should they suspect abuse had taken place. There were enough staff on duty to meet people’s care and support needs safely.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role. The staff had received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support. Staff attended a range of core training as well as training specific to the needs of people using the service, for example dementia awareness. Staff also received refresher training on a regular basis.

We checked whether the service was working within the principles of the Mental Capacity Act 2005. We found related assessments and decisions had been properly undertaken and the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS).

The provider had quality monitoring systems in place. Accidents and incidents were investigated and discussed with staff to minimise the risks or reoccurrence. The management operated an on call system to enable staff to seek advice in an emergency. This showed leadership advice was present 24 hours a day to manage

People who used the services told us they were happy living in the home and were complimentary of the services provided and of the staff team. They told us they felt safe, cared for and listened to. Comments included, “I made up my own mind to come into the home having talked it over with my daughter”, “food is very good and you always have a choice” and “staff are as good as you get them”.

We looked at people's care plans and supporting documents. We found peoples care plans detailed their needs, and how to meet those needs.

We found the home was clean with no unpleasant odours and had processes in place to promote infection control.

Relatives of people who used the services told us they were happy with the services provided and were kept informed and were listened to.

We found staff were knowledgeable of people’s specific health and personal care needs and had received training to update their skills and knowledge. Staff told us they felt supported by the provider and management team.

The provider had ensured staff received appropriate professional development and support to safeguard and deliver care and support to the people who lived in the home.

We found people and their relatives had opportunities to contribute their views about the quality of the service. The provider had systems for monitoring services provided.

We spoke with six people who lived at Ridgeway House. One person said "couldn't find a better place" another person said "couldn't find fault" and a third person said "I like it here."

People said that the staff were respectful, maintained their dignity and encouraged them to be independent. People told us that they had been asked about the care and support that they needed. They said that the staff gave them all the help and support they needed. They also said that they felt safe in the home.

People told us that there was a residents’ survey and residents’ meetings so that they had the opportunity to comment on the quality of the service and to suggest improvements.

People expressed their appreciation of staff. One person told us “all the girls are lovely” and another “they’re wonderful to me”. A person told us staff were attentive to them. One person said “they do come when I ring the bell, it’s no problem”. The home has put much effort into improving its assessment and care plans and staff we spoke to were aware of how to meet people’s needs. For example, one person’s care plan stated they were always to have their call bell close to hand. We observed this was the case throughout all our visit. We observed staff always called people by their own name and approached them in a calm, supportive manner when they needed assistance.

The home has made many improvements to its environment and use of equipment, to ensure they meet infection control standards, however they are not always following their own policies when caring for people. This could place people at risk of infection. Most records are clear, however a few needed improvement. Some people need more support to meet their hydration needs.

People we spoke to were mainly positive about the home. One person told us that they were happy in the home and that they felt listened to. Another person said that they had agreed with their key worker about how they would be “looked after”. Other comments included “we think it’s great” while another person described the home environment as “lovely”.

However, we observed that some frail people were not supported in a way which met all of their care needs. Attention was needed to availability and cleanliness of some items needed in personal care such as disposable gloves and commode inserts. More emphasis was needed to ensure that people’s dignity was respected in some aspects of care provision such as calling people by their own name, not generic terms of endearment such as “darling” and ensuring that people’s privacy was maintained when hoists were used. Some people felt that the home did not have enough staff to meet people’s needs and some staff felt that this was why assessments and plans for meeting people’s needs were not up-to-date. Not all of the concerns people had raised about their care was fully documented, so it was not clear if people had been appropriately responded to when they raised matters.

People told us that they liked living in the home. One person told us “I’ve never been waited on so much”, another “I do feel safe here, it’s nice to feel safe”, and another “It’s a very nice place to live in I can tell you”. People also told us about how much they liked the staff. One person told us “I can’t say anything bad about the staff, all are kind, helpful and jolly” and another “they’re marvellous girls, lovely”.

We observed that people were well supported by staff. One care worker explained to a person how they were going to help them move using a hoist, making sure that the person understood how they were going to do this and why. We observed a very frail person who spent all or most of their time in bed. They looked comfortable, with clean bedding, night clothes and attractively arranged hair. We observed a person who changed their mind about what they would like to eat when they saw their meal. The care worker went and got the person the other choice of meal for them to look at and decide which they would like.

We observed that frail people who could not change their positions independently were not supported to do so, so risks of pressure ulceration were therefore not reduced. Some peoples’ records were not clear or updated when their needs changed. Such matters had not been identified in the home’s own quality assessments. We observed that the home’s quality audit had also not identified other issues we observed, or were told about, these included, using information from concerns raised by people and safety of specific areas of the home environment.