CQC report explained · a nursing home
What the CQC found at Ramsey Step Down and Care Centre
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments and care plans were not always completed on arrival or updated when people’s needs changed. The home had enough staff on the inspection day, but did not have a formal system to show that staffing levels and skills matched people’s needs.
- Effective?
- Requires improvement
- Staff were skilled and people received support with rehabilitation, food and healthcare. However, care plans lacked detail and the home did not have adequate systems for assessing and reviewing mental capacity and best interest decisions.
- Caring?
- Good
- People and relatives described a caring atmosphere. Inspectors observed kind, respectful care, involvement in decisions and support for independence.
- Responsive?
- Good
- Care was personalised and adapted to people’s preferences and changing needs. People were supported with activities, relationships, rehabilitation and end of life care, although some relatives were unsure how to make a formal complaint.
- Well-led?
- Requires improvement
- Quality checks did not identify important gaps in care plans, emergency evacuation information, consent records and clinical oversight. The provider had a positive culture and worked well with partners, but its governance systems were not effective enough.
What inspectors found, January 2023
Ramsey Step Down and Care Centre was rated Requires Improvement; care was kind and responsive, but risk records, consent checks and management systems were not reliable enough.
This was the home’s first inspection. It was unannounced and took place on 16, 17 and 25 August 2022. Inspectors spoke with people, relatives, staff and health professionals. They reviewed care and medicines records, staff files and management records.
The home provided nursing and personal care for up to 37 people, with 26 people living there during the inspection. Inspectors found caring and responsive support. People were treated with kindness, involved in decisions and supported with activities, rehabilitation, food and end of life care.
However, care plans and risk assessments did not contain enough detail or always reflect changing needs. The home also lacked effective oversight of clinical care, staffing levels, consent decisions and quality checks. The overall rating and the ratings for Safe, Effective and Well-led were Requires Improvement. Caring and Responsive were rated Good.
Kind and respectful care
People were treated with compassion and dignity. Staff knew people’s preferences and helped them feel safe and included.
“People were treated with kindness and compassion in their day-to-day care and support.” from the report
Good personal outcomes
People were supported to regain skills, stay active and, where suitable, return home. Relatives and professionals described improvements in mobility, eating, confidence and wellbeing.
“Despite the concerns described above, we found people achieved good outcomes at the service.” from the report
Effective partnership working
The home worked with professionals such as physiotherapists, speech and language therapists and hospice staff. Staff advocated for people to receive healthcare support.
“The service was supported well by varied healthcare professionals such as Speech and Language Therapists (SALT), physio and the local hospice.” from the report
Activities and engagement
People were encouraged to take part in activities, trips, gardening and special events. Staff sought professional advice to improve stimulation.
“Staff had sought advice from a health professional about how to develop stimulating activities.” from the report
Incomplete risk information
seriousRisk assessments were not always recorded when people arrived. Care plans did not always explain how to manage conditions or reflect changing needs, including changes to food and feeding arrangements.
“Assessments of people's needs, and risk had not been recorded for people on their arrival at the service.” from the report
Consent and capacity checks
seriousThe home did not have adequate systems to assess and review decisions for people who lacked capacity. This created a risk of unlawful care or restrictions.
“Lack of a full understanding and oversight of capacity assessments put people at risk of unlawful support and restriction.” from the report
Weak management checks
seriousAudits did not identify important gaps in care plans, emergency evacuation plans, staffing oversight or clinical leadership. The provider could not show that governance systems were working effectively.
“The provider's quality assurance and governance arrangements were not effective.” from the report
Medicines guidance
needs fixingMedicine care plans did not give enough information about purposes and side effects. There were initially no protocols for medicines given as needed, and timely supply of some medicines remained a concern.
“Care plans did not provide enough information and guidance for staff about prescribed medicines on their purpose and any signs to be aware of in relation to side effects.” from the report
Formal complaints process
minorSome relatives were unsure how to raise a formal concern, although informal concerns were generally dealt with well.
“Two relatives told us they were not sure how to raise formal concerns, though they felt able to approach senior staff.” from the report
- 01How have you updated care plans and risk assessments so they reflect each person’s current and changing needs?
- 02How do you check that staffing numbers, nursing cover and staff skills match the needs of people living here?
- 03How are mental capacity assessments and best interest decisions recorded and reviewed?
- 04What action has been taken following the Regulation 17 Warning Notice, and can you explain the progress on the action plan?
- 05How can relatives raise a formal complaint, and who will respond to it?
This was the first unannounced comprehensive inspection of the newly registered home and assessed all five key questions. This explanation was written from the published report of 19 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Ramsey Step Down and Care Centre
Each visit the CQC has published, newest first, back to the day the home was registered.
- January 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Ramsey Step Down and Care Centre →
- January 2021
Registered with the Care Quality Commission on 4 January 2021.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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