Ruth Lodge

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last inspection we rated this key question requires improvement. At this assessment the rating has changed to Inadequate. This meant there were widespread and significant shortfalls in service leadership. There was a closed culture at Ruth Lodge. A closed culture means a poor culture that can lead to harm, which can include human rights breaches such as abuse. Leaders and the culture they created did not assure the delivery of high-quality care. The service was in breach of legal regulation in relations to people not being treated with dignity and respect and governance at the service. There was a lack of robust oversight of the safety and quality of care. Feedback was not obtained from all people, relatives, staff and external professionals to drive improvements. Staff said they felt supported however they were not provided with formal breaks on long shifts and were working multiple shifts in a row. Staff were not reporting concerns to the provider when needed.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a lack of management and provider oversight to ensure RC, RS, RC was being considered in line with the guidance. Leaders and staff failed to ensure autistic people and people with a learning disability were living an ordinary life as any other person. There was a lack of provider oversight to ensure people had access to activities that were important to them. There was no evidence these areas had been audited by leaders with actions taken to make improvements. People were not always treated in a dignified way. Staff told us 1 person was being supported with their personal care in an undignified way with staff cleaning them with a shower whilst on the toilet instead of using toilet paper. We observed the plastic wrapping of 1 person’s mattress had been left on since August 2024 and the person was having to sleep on top of this. Staff were not respectful of a person when we said hello to them and in front of the person told us they could not speak. This could have been said to us quietly and out of earshot of the person. We also observed undignified language being used by staff in people’s care records.

The leaders of Ruth Lodge did not have the skills or knowledge to lead effectively. They had not recognised the closed culture at the service, or the detrimental impact this had on people being supported. Leaders lacked credibility: they had not been open or honest with us, or with key partners. Leaders were not role models to staff, or advocates for people. They lacked knowledge about the issues and challenges at the service, and did not challenge poor or inappropriate practice. Although staff told us leaders were supportive, we found they had failed to ensure staff were working a safe number of hours. We saw from rotas, staff were working 12-hour day shifts, a night shift and a day shift the following day. This risked staff being fatigued and unable to support people in a safe way. Staff and leaders told us during the day shifts, staff were not allocated formal breaks. The provider told us there was no policy around this. We saw from a health and safety audit of October 2024 that ‘staff welfare risk assessments’ needed to be completed yet we found these had not been done. The provider and registered manager told us, “It was just a delay…... There was so many things, I took my eye off the ball.”

Although staff told us they would not hesitate to speak up if needed, we found leaders were not supporting an open culture within the staff team. When we visited staff initially told us they would stay awake during the night shift. It was only when we advised staff the leaders had said this was not the case, they then told us they did go to sleep. Not all staff were open and transparent about using restraint with 1 person during incidents. One member of staff told us they and other staff held a person’s wrists when they were hitting out at staff. However, other staff told us they never restrained the person, and the provider and registered manager told us this had also not been shared with them by staff when asked.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

There were inadequate systems in place to robustly monitor the quality and safety of the care and support people received. There was a complete lack of responsibility by leaders in managing risks to people, and this significantly impacted people’s quality of life and their safety. We saw audits were taking place by the provider however these were not effective in driving improvements. The provider, who was also the registered manager for Ruth Lodge and 2 other of the providers registered locations, was also the manager for other 5 other services. This meant they were unable to have day to day management oversight of Ruth Lodge. There was a lack of audits of staff approach to care, no audits of care plans or care notes and maintenance issues were not addressed in a timely way. The provider told us about complaints that had been made by a relative, however these had not been recorded and there was no evidence of how these had been responded to in relation to any improvements.

The provider failed to work in partnership with external professionals. Whilst there was 1 external professional who felt the communication with the service was positive, there were others who felt this there was a lack of response to areas they identified needed improvement. We saw from a report of a visit from the quality assurance team at the local authority, they made various suggestions for improvements, however these had not all been actioned by the provider. This included gaps in recruitment records, staff not taking breaks on long shifts and the lack of actions being taken after audits had been completed by leaders. We continued for find all of these concerns at this assessment. Not all actions recommended by the Fire Service visits in March 2024 had been actioned. There was a lack of evidence that the provider was updating the local authority of all incidents relating to a person.

Staff and leaders lacked understanding, skills and capability to make improvements happen. There were missed opportunities to reflect and make improvements on care. Leaders told us they had reflective sessions with staff when some incidents occurred however there was no evidence of this. People were not involved in the running of the service and as such were not able to influence positive changes. We were told 1 person was unable to verbally communicate yet no steps had been taken to gain feedback from them using an alternative method of communication. We asked the leaders to send us evidence of surveys with relatives, external providers and staff yet we were not provided with this. This meant they missed opportunities to gain feedback, learn from this and make improvements.