Ridgemount

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• 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

People received safe care and support from staff who understood their needs and followed healthcare guidance from professionals. Staff knew how to safely support people around their individual risks and how to protect people from abuse and neglect. Staff received appropriate training and were recruited safely. The provider ensured there were enough well-trained staff to provide support to people in a timely and safe way. The home environment was safe, clean and met people's needs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People spoken with said they felt safe at the home and with the staff who supported them. People were protected from the risk of abuse and neglect and felt safe in the service. One person told us, “Yes I do, they know what I need.” Another told us, “More or less, but I like to try to do as much as I can for myself, I am very slow and careful.”

Staff were aware of their responsibilities to keep people safe. Safeguarding training provided to all staff and records showed good compliance of this training. Staff demonstrated a good understanding of safeguarding triggers, awareness of types of abuse and how to report potential abuse. One member of staff told us, “If we have a concern, no matter who it is regarding, friends, family, or staff, we will alert management. We can make a direct safeguarding concern to the LA team. Others said, “I would report it or whistle blow. I can’t keep a secret if someone is hurt,” and “I would go straight to the manager or deputy manager with any concerns. Feedback from healthcare professionals included, “Learning from incidents is an area discussed at our safety huddles with the home and they do engage and are seen to be making changes. The actions we have requested to take place can however take some time in being completed,” and “We have commenced regular safety huddles with the residential home, which they are engaging with well.”

Staff supported people in a kind and sensitive way when they became distressed. They did this in a calm and discreet manner, which enabled people to re-engage with activities and their environment with minimal distress to themselves.

The provider had clear systems and processes in place to safeguard people and to support staff to raise any concerns. Staff received appropriate safeguarding training. There were clear safeguarding and whistleblowing policies in place. All incidents and accidents were reported, recorded and reviewed by the management. The management team took action to protect people and worked with the local authority to investigate any concerns and monitored the level of concerns and any trends. There were no ongoing safeguarding enquiries at the time of this assessment.

People were involved in discussions around their care and support needs, this included discussing any risks and how to minimise these. People felt their independence was supported and were encouraged to take positive risks and told us staff supported them to manage their risks in a safe way. One person told us they had an arrangement with staff about how to minimise the incidence of other people entering their room uninvited, which worked very effectively for them. Whilst this was beneficial to the person and what they wanted, and staff we spoke with understood the terms of the agreement, there was no formal assessment or written guidance to record the agreed action. We have considered this in the well-led section of this report. One person told us how the equipment they used was well maintained for their safety, “I wear a buzzer around my neck and my walking frame is in good condition.” They also told us the general home environment was clean and well maintained, “Yes it’s well kept and the toilets are nice and clean. Staff change my bed linen every week.” A family member told us, “There’s a sensor mat shoved under the bed in the day when she’s not in and then it is placed back in position at night.” We saw evidence that family members were engaged in Best Interest decision making, and were told, “Yes, we have been asked to attend these meetings as [person] is unable to take many decisions. If the situation ever arose, we would be very clear about challenging any decisions we did not agree with.”

Staff had regular handovers and staff meetings to enable robust information sharing, especially regarding risks. Staff were able to describe people’s risks and how they were managed. One said, ”The more you try to stop [service user] the more aggressive they may become, so we back off and follow. They just like to get up and wander and we can’t stop them, as long as they are safe.” Another told us, “If I see a change for example a mobility problem I will tell a team leader and they will do an assessment.” Healthcare professionals told us, “We do feel that staff follow our advice and are constantly on the phone regarding patient concerns.” However, they also told us there were occasions when they thought staff were not always able to meet the needs of people with certain healthcare risks, for example, unstable diabetes. We addressed these comments with the area manager who told us the provider’s diabetes management policy which refers to nutrition, medication, skin and nail care and risk assessments are transferred into the person’s care plan, which we saw. The policy also includes the signs and symptoms of hyperglycaemia and hypoglycaemia. They confirmed that the current arrangement is that district nurses visit daily to administer insulin and do blood sugar levels checks. Staff we spoke with understood the care needs associated with management of additional risks for people with diabetes. Staff knew their responsibilities around consent and Mental Capacity Act 2005 (MCA 2005). Staff told us, “We always assume people have capacity and we support them to make informed decisions.

We observed staff intervening at times to minimise risk to individuals. For example, on one occasion, a member of staff noticed a service user’s slippers were hanging off their feet which put them at risk of tripping. They immediately asked the service user to sit down in the lounge and they fitted the slippers properly. On another occasion, staff quickly intervened to guide a service user away from a person who became agitated by their approach. This was done with sensitivity and discretion. Call bells were accessible to people and sensor mats were correctly positioned and plugged in.

People were assessed for risks such as skin integrity, falls, moving and handling, nutrition and hydration for example. People’s Positive Behaviour Support plan [PBS] outlined guidelines for staff to manage and monitor people’s behaviours. Risk assessments were in place for people who were at risk of placing themselves in danger from others and there was guidance for staff to follow to minimise risks. However, we found there was conflicting information in some care plans. For example, one person’s medicines care plan stated they did not require ‘as prescribed’ medicines, whereas their emotional support plan stated they did. We confirmed the person received their medicine in accordance with their prescription and therefore, no harm was caused to this person as a result of this conflicting information. We also found that episodes of care were not consistently recorded in people’s charts, including fluid and food intake, hourly checks and frequency of people being repositioned. We checked individual records and there was no evidence of impact on people’s health or skin integrity. We spoke with the deputy manager, who acknowledged some gaps in recording of care. They explained that staff were still becoming familiar with the recently introduced electronic care record system and may have omitted to record each episode of care. We have considered these inconsistencies in the Well Led section of this report.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us there were enough competent staff to provide them with the support they required and they were happy with how staff responded when they needed support. One person told us, “Yes, there probably is enough, but they could do with more help.” Others said, “Agency staff are used if they are short, but they don’t know the residents as well [as the full-time staff].” People told us staff were trained to support them effectively, “I can see they are well trained by the way they their job.”

Staff received the training and support they needed to be able to effectively support people. There were enough staff to support people in a timely way as per their individual needs. Staff told us there were enough carers to look after people safely. One told us, “Normally there are just 2 staff up here, but if [service user] is agitated, they put on one staff extra,” and “On the whole yes, we’ve got enough staff.” Staff told us they received training and said, “Training and induction have been good; I’m still going through my training.” Others said, “Training is done regularly and is done online. Team leaders deliver some training like manual handling, fire safety and infection control.” Staff also told us, “There is a training tracker which is frequently printed out to check and we get email reminders. If we haven’t done all our training, we are told we will be taken off the unit, but I have never had this happen to me.” Staff who administered medicines told us their competencies are checked annually and said, “Meds competencies are done yearly unless there’s a problem and we will then be shadowed and do it [assessment] again. I had my assessment not too long ago and it’s recorded online and on paper. There are different levels, one is with [supplying pharmacist] and one with Anchor.” Some staff seemed unclear about when they received supervision. Some staff told us they had regular supervision, others told us, “Supervision is done as and when, it’s supposed to be done every 6 weeks but it’s not always done. We do group supervisions in handovers but don’t record it on a supervision sheet,” and "We discuss concerns about the residents only, not my stuff. I don't think it is recorded or there is an agenda." However, following the assessment, the provider clarified that the requirement is for supervision to be delivered every 12 weeks.

On the day of the assessment, we observed there were enough staff available to respond to people’s needs. Staff were visible throughout the visits and were seen supporting people who required support during mealtimes, activities and with personal care. Call bells were also observed to be ringing and responded to in a timely manner. Inspectors observed that staff did not appear to be rushed in their work and they had time to sit and chat with people and to engage them in activities. We observed a person have a significant coughing fit during lunchtime which was managed by a family member, with support from staff. However, this episode was not recorded in the daily notes by staff. We raised this with the deputy manager and they submitted evidence the following day of a risk assessment as well as a referral to a speech and language therapist.

Current medicine competency assessment records were not available for inspectors to review on the assessment day and a member of the senior leadership team confirmed that they could not find current competency assessments, despite being of the opinion that they were recently completed. They committed to reassessing medicine competencies for each member of staff who administered medicines. The provider sent evidence to CQC that all staff medicine competency assessments were completed in the days following this assessment. We reviewed the provider’s supervision matrix and noted that whilst staff received supervision, frequency of supervisions was not always in accordance with the provider’s performance management policy. We have considered these points in the Well Led section of this report. Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks were completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. New staff completed a full induction and probationary period. Training for staff included safeguarding, Mental Capacity Act (MCA), medication, fluids and nutrition, first aid and moving and handling.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.