The Ruddington

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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 felt safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, timely action was taken to investigate and safeguard people from potential risk. The Deprivation of Liberty Safeguards (DoLS) is a procedure prescribed in law. It is used when it is necessary to deprive a person of their liberty (human rights), to keep them safe from harm. Staff did not always have a good understanding of DoLs. We saw some people had not had up to date referrals when their liberty was being deprived. People’s safety was managed well. Managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. The environment was managed safely, with procedures in place to ensure the home was well maintained. The care home was not well signposted, which could cause confusion for visiting professionals. The provider told us they would make changes to the signage in the care home. There were enough staff to support people with their needs. Managers reviewed staffing levels regularly to make sure there were always enough suitably skilled and experienced staff on duty. Staff received relevant training to meet the range of people’s needs at the service. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service.

This service scored 38 (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 Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

One person had a Deprivation of Liberty Safeguard (DoLs) in place. This authorised restrictions of the person’s rights in another of the provider’s care homes. The person had then moved to The Ruddington; but another Deprivation of Liberty referral had not been made for this new accommodation. This meant the person’s human rights were unlawfully deprived as the restrictions were related to a different location. The provider advised that a new referral would be made. There was a DoLs policy in place. However, we found this policy did not result in effective referrals to the Local Authority. There were policies and processes in place to identify if people were at risk of abuse. There had been no allegations of abuse since the home had become registered with the CQC. There was a safeguarding policy in place and staff had received training on how to respond to allegations of abuse.

Staff had received Deprivation of Liberty Safeguards (DoLs) training, but had poor knowledge of DoLs and how to support people’s human rights. We were therefore not assured that this training was effective. Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns was not being responded to. A staff member told us, “I would raise any concerns with my manager and if it was not dealt with I would go to safeguarding myself." A manager explained their process on how they ensure staff have good knowledge and understanding about safeguarding. They told us, “All staff go through a full induction and training. Safeguarding training is completed by external trainers and its face to face. If needed, its sometimes online if staff can't attend the face-to-face training straight away. Me and [manager] also complete face to face training to ensure staff are aware of what to do.”

People felt they were safe from abuse. One person said, “I feel very safe. The building is secure, people are nice and they don’t come bothering me”

People were seen to have a positive relationship with the staff team. We did not have any concerns about abuse within the home.

Staff understood people's needs and how best to support them. For example, staff understood what equipment a person would need to mobilise safely. One staff member said, "People who need aids, I make sure they have them. I make sure they have the right footwear. If there are any objects in people’s way, I would move them out the way." The kitchen staff had a good knowledge of who could be at risk of choking and how to prepare altered texture diets to reduce this risk. Staff understood how to respond in the event of a fire. One staff member said, “I would check where the fire is and make sure everyone is away from the fire. One staff member will call 999.” The management team told us they had a clear process on how risks are managed. A manager told us, “Risk assessments are changed when and as needed, and if staff report any concerns. We have a daily meeting with all staff and discuss if there are any risks. All staff can raise any observations they have seen or concerns of people not being themselves. We then report and record that and action it."

We saw staff were quick to respond to people’s needs. For example, if a person stood up; staff offered to support the person to leave the room safely.

Care plans provided guidance on how to best support people's needs and risks. For example, one person was at risk of choking. Staff had clear guidance on how to alter their diet and what to do if the person did choke on their food. Staff kept clear records on how they had supported people and at what time. This allowed changes in a person’s needs to be identified and improvements made to their planned care. Staff used nationally standardised tools to assess the level of risk. They used these tools to then guide safe care. For example, staff assessed the risk of a person developing a pressure injury by using a ‘Braden Scale.’ When this tool calculated the level of risk; staff put in place suitable equipment and support to reduce the risk of skin damage for the person.

People felt staff supported them to stay safe. One person described that the call bells meant that if they needed urgent support, staff could respond quickly.

Staff knew how to monitor the safety of the environment, and where to report any maintenance concerns too. Staff were confident that the building was well maintained to keep people safe. A staff member said, "The building is safe, there is always two [maintenance] staff from 7am-6pm checking the building." The management team described a clear process for monitoring the safety of the environment. A manager said, “We have maintenance staff and currently working - 8-6pm generally 7 days a week. Another maintenance staff member started today. We also have external contractors we have contracts with, who come in to complete the building checks.”

The home was clean and there were suitable, well-maintained facilities for people to use.

Two people used rooms owned by the care home next door. However, their care was provided by staff at The Ruddington. These bedrooms were not covered by the scope of the CQC registration. The Ruddington building was on a site with another care home. Both care homes were owned by the same provider, and the buildings were attached. The Ruddington was not well signposted, to allow visiting professionals to understand which care home they were in. A visiting professional explained it had not been made clear to them that they were in a different care home. This poor signposting could impact professionals (like an ambulance crew) arriving at the correct location and effectively supporting a person. The provider told us that they would make changes to the signage at the care home. People were kept safe from legionella. The water had been tested, and processes were in place to prevent the waterborne bacteria from building up in the system. There was clear guidance for staff on how to maintain equipment and use equipment appropriately. For example, staff had guidance on how to set a specialised pressure relieving mattress setting for the person’s skin integrity. Routine building checks had been completed, for example Gas servicing, Portable Appliance Testing and lift servicing had been done.

People told us the home was well maintained, and the maintenance team were quick to fix things if needed.

People told us there were enough staff to support them. They explained that emergency call bells were responded to quickly.

We saw there were enough staff to respond to people.

Staff told us there was enough staff. A staff member said, “I think we do have enough staff, there is 12 residents, and we have 2 staff and one senior staff member. Most people on the ground floor are independent.” Staff felt they had been appropriately trained to do their role. Staff told us, “Every day or every month I have training. I feel I have had the right training to do my job." "No, I don’t need any other training. They [management] give us more than enough training." Management told us they felt the staffing levels were safe, as they use a dependency tool to determine staffing levels.

Processes were in place to assess people’s care needs and calculate how many staff were needed to support the people living at The Ruddington. Rota’s showed us that these staffing levels were then arranged. We saw staff had received training to complete their roles. Skilled staff were deployed around the care home. Staff were recruited safely, for example having references from previous employers to ensure they were good character.

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.