Archived: Ringway Mews Care Home

Ringway Mews Nursing Home was last inspected in July 2014 when we identified five breaches of the regulations we reviewed; these related to the safe management of medicines, care assessments not being fully completed or regularly reviewed, the keeping of contemporaneous records, the storing of confidential information and having effective quality audit systems in place for the service.

Following the inspection in July 2014 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. Part of this inspection was undertaken to check whether the required improvements had been made. We found improvements had been made.

Ringway Mews Nursing Home is owned by BUPA Care Homes. The service consists of four 30 bedded units; Lancaster, Shackleton, Anson and Halifax. Each unit specialises in either nursing or residential care. Each unit has a lounge, dining area, a conservatory, a smoke room and a kitchenette. All bedrooms are single with no en-suite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

The service had a registered manager in place. 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. They were supported by a clinical lead for the service.

People told us they felt safe in the service and had no concerns about the care and support they received. They told us staff were always kind and caring. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the unit managers, clinical lead and registered manager would act on any concerns raised.

We noted improvements had been made in the management of medicines. Guidance for the use of ‘as required’ medicines and thickeners were in place. One unit did not use the same monitoring tool to ensure the medicine administration records were fully completed. This was implemented after the inspection. Topical cream charts were not in place for staff to record when they had applied any topical creams. Body maps were not used on one unit. We have made a recommendation about the use of topical cream charts and body maps.

A process was in place to recruit suitable staff. Care staff received the induction, training and supervision they required to be able to deliver effective care. We saw that the staff were very busy during key times of the day such as when people were getting up and at meal times. Most people told us there were sufficient staff on duty to support people in a timely manner. The night staff on one unit thought more staff were required, especially when supporting people to go to bed at night.

All areas of the home were clean. There was a malodour on one unit at the entrance to the lounge area. The registered manager told us a carpet cleaner would be purchased to regularly clean the carpet in this area. Procedures were in place to prevent and control the spread of infection; however they had not prevented the malodour on one unit. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks of the fire systems and equipment were completed.

People and their relatives told us they received the care they needed. Care records we reviewed showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We found three people had additional support needs that were not covered in the standard care plans. These had not been recorded in an additional care plan. Care records on three units had been regularly reviewed to help ensure they accurately reflected people’s needs. However on one unit the monthly reviews had not always been completed.

Systems were in place to help ensure people’s health and nutritional needs were met. Records were in place for the care provided, for example when people were re-positioned and for people’s food and fluid intake. Records we reviewed showed that staff were proactive in contacting relevant health professionals to ensure people received the care and treatment they required.

We found people’s records were securely stored in locked cabinets in the office in each unit. Other confidential information was stored securely.

People we spoke with told us that the staff at Ringway Mews were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs of people who used the service.

An end of life champion had been identified for each unit who had received training in end of life care. They advised the staff team when supporting people at the end of their lives. We saw some people had made advanced decisions about what they wanted at the end of their life.

We found the service was working within the principles of the Mental Capacity Act (2005). People’s capacity was assessed and best interest decisions recorded where appropriate.

A programme of activities was in place to help promote the well-being of people who used the service. This included monthly trips out, for example to Knowsley safari park and Blackpool.

Staff told us they enjoyed working in the service and received good support from the registered manager and clinical lead. Regular staff meetings took place and staff said they were able to make suggestions and raise any concerns they had at the meetings.

There were effective systems in place to investigate and respond to any complaints received by the service. All the people we spoke with told us they would feel confident to raise any concerns they might have with the unit managers or registered manager.

We noted there were a number of quality audits in the service completed by the Bupa area manager and clinical lead; these included medicines, care records and the environment. Action plans were completed following the audits. The audits had identified some of the issues found during this inspection; however the required actions to correct them had not been completed. The audits had not identified other issues we found; for example the need for additional care plans for some people.

Monthly statistics were compiled for monitoring purposes on a range of areas; for example nutrition, safeguarding referrals and hospital admissions. This meant any trends or patterns of behaviour could be identified and action taken when necessary to keep people safe.

During this inspection we found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because additional care plans were not in place for some people’s identified needs and the audits completed by the service had not identified the issues found during this inspection or issues that had been identified had not been actioned. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice. Care plans and our observation of staff provided evidence of good practice in applying the least restrictive options to promote each person's autonomy.

Risks relating to care, treatment, support and the environment had been appropriately assessed and were being managed well to keep people safe from accidental harm.

Care plans provided evidence of good risk management. For example, information in records provided evidence of staff taking prompt action to prevent person from becoming malnourished.

The home's equipment had been subject to servicing and maintenance at regular intervals.

Suitable systems were in place to safeguard people from the risk of abuse. A relative told us "The manager and her team have an open door policy. I could visit in the middle of the night if I chose to and I am confident that any concerns I might have would be managed satisfactorily."

Is the service effective?

A person centred approach had been developed in one of the four houses on site at Ringway Mews. This meant that staff understood and respected them as individuals and provided their care and support in line with each person's choices and preferences. Action was being taken to guide staff and update care plans to make sure all people living in the home received the same standard of support.

Systems for dealing with complaints, suggestions and compliments made sure that the views of people using the service and their representatives were responded to by making improvements where appropriate.

Is the service caring?

People living in the home were provided with stimulating and interesting activities each day, and care and support was in line with good practice guidelines. This enabled people living with dementia to orientate themselves to their surroundings, maintain meaningful relationships and participate in the home's activities of daily living.

In relation to catering we were concerned that people living in the home were not being adequately supported to maintain their rights and choices in relation to their nutritional needs. The manager provided evidence to demonstrate this had already been identified as an area for improvement and we were reassured to find action had been put in place to improve catering in the home.

The seven relatives we spoke with expressed positive feedback about the care provided to people living in the home. One of the relatives said, "Personal hygiene needs are always met and the environment is well equipped for coping with the needs of people living with dementia."

Is the service responsive?

People living in the home had their needs assessed and their care plans told us how staff would provide care and support to meet their needs. Care plans also contained some information about individuals' choices and preferences.

The people we spoke with during our visit made positive comments about the way the service was provided. They said they were listened to and consulted about the way the service was provided. A relative said, "Yes we know about the complaints procedure, but we have never had to make a formal complaint. We did have concerns about X's clothes going missing in the laundry and they needed their fingernails cutting. However, after speaking to staff, both issues were dealt with immediately."

Is the service well-led?

Robust systems were in place to monitor, audit and review the quality of the service provided in Ringway Mews. The management team took a positive approach in responding to feedback from people who used the service and their representatives. We saw evidence of the action being taken to learn from incidents and feedback and identify where improvements should be made.

The staff we spoke with described the manager as fair, approachable and firm. One member of staff said, "The manager is fair, but focussed on retaining a quality team of staff. Things have improved since she came here." Several staff told us there had been a lot of improvements since the manager had been in post.

For this inspection visit we were supported by an Expert by Experience (ex-by-ex). This is a person who has personal experience of using or caring for someone who has used this type of care service.

We found that people were generally satisfied with the quality of care and support provided.

Comments from people who used the service included:

'I am a satisfied customer.'

And:

'It's lovely. A special place.'

Relatives told us:

'My (relatives) level of care is acceptable as long as I am here to sort out the niggles.'

And:

'We'cannot visit every day, but (my relative) appears to be cared for.'

We found people's needs were effectively met because the service cooperated with health professionals. We saw various systems in place to check the quality of the services provided.

At the previous inspection on 18 September 2012 we found that care staff did not always treat people who used the service with dignity and respect. At this inspection visit we saw schemes to improve the way staff related to people had been introduced and the effectiveness of these initiatives were being monitored.