Ramsey Step Down and Care Centre

People’s experience of using this service and what we found

The registered manager and provider had not put in place effective systems to protect people from risk and ensure they receive good quality care. Improvements were needed to formal systems throughout the service, particularly in the oversight of clinical care and quality checks which had not picked up the concerns we found during our inspection.

Care plans and risk assessments lacked detail and did not provide enough information about people’s current and changing needs to assist the registered manager to plan care and decide on staffing levels. Staff recorded the support they provided; however, the information was not effectively analysed to check for gaps or trends.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support the registered provider to meet their legal requirements when supporting people who lacked capacity to make decisions about their care.

People received their medicines as required, though medicine care plans lacked detail. There were enough safely recruited staff to keep people safe. Systems to safeguard people from abuse were improving, however greater transparency was required during internal investigations and complaint management. The registered manager had measures in place to minimise the risk of infection.

Staff were knowledgeable about people’s needs and provided personalised care. They worked well with other agencies to meet people’s needs in a holistic manner. People had support to eat and drink in line with their preferences and health needs. The registered manager was enhancing the environment to meet the needs of the people living at the service.

There was a positive culture at the service. Care was compassionate and respectful. People and their representatives were positive about the culture of the service and told us people achieved good outcomes.

Staff communicated well with people and their representatives to ensure they were involved in making decisions about care. People were supported to remain active and stimulated. Staff encouraged people to maintain their skills, enabling them to return home where appropriate. People received compassionate care at end of life from a team of committed staff supported by external professionals.

Stakeholders told us Ramsey Step Down and Care Centre provides a strategically important and flexible service which supports hospital discharge at a time of high demand for health and social care services. In 2021, the CQC report, “Enabling innovation and adoption in health and social care: Developing a shared view” highlighted one of the principles of innovation as “Focus on outcomes and impact.” We found the provider reflected this innovative approach and achieved positive impact and outcomes. Following our inspection, the provider responded positively to address the concerns we had raised around risk management and care planning, whilst still retaining a commitment to innovation.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

This service was registered with us on 4 January 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service, which included concerns received about the culture and management. A decision was made for us to carry out the first inspection of the new service and also look into the concerns raised.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to safe care and treatment, need for consent and governance arrangements. Please see the action we have told the provider to take at the end of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.