Ramsey Step Down and Care Centre

Updated 19 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of five inspectors and an Expert by Experience who made phone calls to people’s family and representatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Ramsey Step Down and Care Centre is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ramsey Step Down and Care Centre is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with six people who used the service about their experience of the care provided. We spoke with the registered manager, the general manager, the administrator, the clinical lead, two nurses, the chef and five care staff. We met with four family members and three external professionals who were visiting the service.

We reviewed five people's care records and medication administration records. We looked at three staff files. We also looked at a variety of records relating to the management of the service and quality assurance arrangements.

After the visit to the service

We had phone contact with eight family members for feedback about the service. We had email contact with six staff. We continued to seek clarification from the provider to validate evidence found and to gain assurances about some of the concerns we found during our visit to the service. We had email or phone contact with five professionals who had contact with the service.

Updated 19 January 2023

Ramsey Step Down and Care Centre is a residential care home providing personal and nursing care for up to 37 people. The service was originally set up to support hospital discharges during the COVID-19 pandemic. It continues to provide a step down service for patients discharged from hospital and requiring continuing nursing care. Some people chose to remain at the service beyond their planned short stay, while other people were receiving end of life care. At the time of our inspection there were 26 people using the service.

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.