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Inspection carried out on 4 April 2017

During a routine inspection

The inspection took place on 4 and 6 April 2017 and was unannounced on the first day. Ridgeway Residential Home provides personal care for up to 16 people over retirement age who may be living with dementia or may have a physical disability. It does not provide nursing care. At the time of this inspection there were 12 people living at the service.

We last inspected the service on 18 December 2015 and 5 January 2016 when it was rated as Requires Improvement overall. At that inspection, we found four breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to staff recruitment, people’s capacity to give consent, meeting people’s social needs and having effective quality assurance and record-keeping systems. The provider had produced an action plan to ensure improvements were made and sustained. At this inspection, we found that improvements had been made across all four areas with all breaches met.

Since the time of the last inspection, a new registered manager had been appointed. They were present on both days of the inspection. 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.

The registered manager had high aspirations for improving the service, led by example and was supported by a committed provider. A priority had been set of improving quality assurance systems. Feedback was regularly gained from staff, people using the service and family members. Concerns and complaints were investigated promptly and thoroughly, with learning identified and changes implemented.

Everyone we spoke with recognised that the new manager had effected a significant culture change at the service to promote person-centred, rather than task centred care. This was reflected in a positive and welcoming atmosphere, a sense of team commitment and positive energy within the whole staff group.

People using the service and their family members said they felt safe and that staff supported people in a kind, caring and respectful way. Comments included “I think the quality of care here is very good. I have never heard anyone raise their voice.” And “I’m quite impressed with the way they look after people here.”

People were protected from potential abuse and harm by staff who understood how to identify safeguarding concerns and what action to take. Everyone living at the service had risks relating to their care assessed, recorded and measures put in place to mitigate risks. Care plans were regularly reviewed and amended as people’s needs changed. Medicines were well managed and stored safely.

Staff levels had increased significantly since the time of the previous inspection when a recommendation had been made. They were now sufficient to meet people’s needs. The benefit of social activities had been recognised and was now met with the appointment of an activities coordinator and a visiting physiotherapist. People were able to work in the garden utilising accessible raised beds. The garden had won two national awards from the Britain in Bloom organisation.

Staff described a new feeling of team working and mutual support and were proactive in suggesting changes. They demonstrated commitment and willingness to learn in order to improve the service. The accommodation provided was well furnished and maintained to a good standard with a variety of social areas. The atmosphere in the home was relaxed and happy, with daily activities giving an obvious sense of purpose and contentment. The provider had made changes to some aspects of the building to improve safety with more planned.

Staff understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, family members and health and social care professionals were involved in “best interest” decision-making.

People were offered a varied and balanced diet and those with special needs relating to nutrition were well supported and closely monitored. Health care needs were met by access to professionals as required. Professionals visiting the service confirmed that staff were providing good quality care and acted on their health care recommendations.

Inspection carried out on 18 December 2015 and 5 January 2016

During a routine inspection

This inspection took place on 18 December 2015 and 5 January 2016. The first day of the inspection was unannounced.

Ridgeway Residential Home provides personal care for up to 16 people over retirement age, who may be living with dementia or may have a physical disability. It does not provide nursing care. This is provided by the community nursing service. At the time of this inspection there were 14 people using the service.

We last inspected this service on 21 January 2014 and found that the service was meeting the requirements of the regulations we inspected at that time.

A registered manager was in place and they were present on the second day of the inspection. The registered manager is also registered as the manager of another residential service and they divided their time between the two services. 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.

The recruitment process was not robust and did not ensure all the required information about prospective staff had been obtained prior to them working at the service.

The management of medicines was not always adequate. Medicines were not always stored at the manufacture’s recommended temperature. Records relating to medicines were not always signed by staff to ensure their accuracy.

The Mental Capacity Act 2005 requires providers to ensure safeguards are in place when someone does not have the capacity to make an informed decision about their care and treatment. People’s capacity to consent had not always been assessed. The provider had not taken appropriate action in line with legislation and guidance to ensure people’s rights were fully protected.

The majority of people said there were enough staff on duty to maintain their care needs and safety. However people said staff did not always have the time to engage with them in social activities or to sit and chat.

We received mixed responses about the food provided at the service. The registered manager and provider were aware of people’s concerns about the food and were keen to listen to them to ensure this improved.

The service offered a weekly activities programme. However, activities on offer were limited and did not always reflect people’s individual abilities, hobbies or interests. This was an area several people identified for improvement.

Some people expressed concern about the approach and attitude of some staff. The registered manager was aware of these concerns and was working with staff to ensure their approach improved. During the inspection staff demonstrated a kind and caring approach and were mindful of people’s privacy and dignity.

Quality assurance and audit processes were in place to help monitor the quality of the service provided. However improvements were needed as some of the shortfalls we found during this inspection had not been picked up prior to our visit. Not all records were accurate or up to date.

People said they felt safe living at the service. Comments included, “I’ve got nothing I could fault this place for at all…” and “They’re very good at helping me.” There were systems in place to protect people from the risk of harm. Risks associated with people’s conditions or care needs had been identified and actions were in place to reduce risks. However, risk assessments and care plans were not always up-dated following changes or accidents to ensure actions remained adequate. Staff had a good understanding of safeguarding vulnerable adults and knew what to do should they have any concerns about poor practice or possible abuse.

Two people said they would be reluctant to raise concerns. However, people knew who to speak with should they have any concerns and complaints were investigated and resolved as far as possible.

People were supported to eat and drink enough and maintain a balanced diet. Staff, including the cook were knowledgeable about people’s individual nutritional needs. People had access to healthcare professionals to meet their health needs. Feedback from a visiting health professional showed the service worked in partnership with them for the benefit of people using the service.

Staff had opportunities for regular training to enhance their skills and knowledge of working with people at the service. Staff said they were well supported by the deputy manager and registered manager.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 21 January 2014

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. A registered manager from a 'sister' home was managing the home temporarily on a part-time basis with a senior carer to assist them. We spoke with the provider, the provider's representative, the temporary manager, the senior carer and five care staff.

There were 15 people living at the home on the day of our visit.

We met with all of the people living at the home. We spoke for longer periods with six of the people and one visiting relative

People living at the home appeared comfortable, looked after and at ease with all the staff. They told us "staff look after us" and "they don't just pop up, but they come as fast as they can when I need them".

Each person had a plan of care that contained all the information necessary to meet their needs. Most people liked to spend time on their own in their private rooms. Social activities were currently limited but being improved.

Staff demonstrated that they understood the signs of abuse and how to report any concerns. Staff are recruited safely and felt supported by senior staff.

People were encouraged to made comments/concerns to improve the service.

People benefitted from living in a home that had been updated both internally and externally.

Inspection carried out on 12 September 2012

During a routine inspection

This inspection was unannounced and took place on 12 September 2012. The visit lasted six hours and 15 minutes. We last visited Ridgeway in January 2011. No compliance actions were made on this inspection as the home was compliant under the Health and Social Care Act 2008.

The registered manager told us that there were 13 people living at the home. During this visit, we met with nine people who lived at Ridgeway and five people commented directly on their care. We met with people in their rooms and in communal areas. People looked well cared for and told us that the care provided by the service met their needs. We saw that people looked relaxed and staff had a caring manner. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People told us that their pain was well managed with their medication given to them on time.

People told us that they were happy with the standard of cleanliness of the home, and they were positive about their rooms and the standard of the décor. People that we spoke with told us that they had no concerns regarding the staff group that worked at the home and were positive about the quality of the care provided. They told us that there was little turnover of staff. There were enough qualified, skilled and experienced staff to meet people’s needs. All the people we spoke with confirmed that they felt the staffing levels met their care needs.

Inspection carried out on 21 January 2011

During a routine inspection

People living at the home told us they were treated respectfully, were involved in discussions about their care, and could influence how the service was run, with someone describing the atmosphere as ‘cheerful’. Some told us about various changes and events taking place at the home, such as building works and planned activities.

A small number of people were less able to voice their opinions about their treatment and life at the home, but we heard staff offering explanations and choices to them at times during the day. Staff were beginning to have particular regard for people’s capacity to consent to care and treatment, although this was not yet evidenced in everyone's case.

We noted that people had had their personal care needs met, where they needed support with this. One person said ‘They look after me very well’. People felt the home attended to their health needs well, and told us they enjoyed activities organised by the home. They thought they had the equipment and adaptations to their accommodation that they needed. We found that people’s various needs were assessed, although their care was not always planned or delivered in such a way as to meet individuals' more diverse needs and ensure their welfare and rights. This included some medication needs.

People confirmed that staff were quick enough in responding to call bells. They felt safe with staff and were positive about them. We found staff were not fully enabled to acquire further training and skills relevant to the work they undertake so that they can appropriately meet people's diverse or changing needs.

Asked about the food provided, people were very positive. One person exclaimed ‘It’s like a first class hotel!’ Another said ‘The food is good – there’s too much of it though!’ People were also satisfied with the levels of cleanliness at the home, someone commenting ‘Yes - they’re very fussy about that.’ Several told us they could speak to the manager about any issues, and she would sort them out.