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Inspection carried out on 27 November 2017

During a routine inspection

We conducted an inspection of Ringstead House on 27 November 2017. We previously inspected the service on 29 September 2015 and found the service was in breach of the regulation relating to safe staffing levels. The service was rated good overall. Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve staffing levels. At this inspection we found appropriate actions had been taken to provide safe staffing levels and meet all the fundamental standards

Ringstead House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service provides care for up to four people and there were four people using the service when we visited.

The service had a registered manager, which 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.

Risk assessments and care plans contained a good level of information for care staff about known risks and guidance for how they were expected to mitigate these.

Staff followed safe practices for administering, storing and recording medicines given to people.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs. People were supported to access activities they enjoyed. Care records included information about activities people attended and how staff could support them to do so.

The service ensured people's privacy and dignity was respected and promoted.

People were supported with their nutritional needs. Care records contained information about people’s dietary needs. Care was delivered in line with relevant legislation and standards.

Safeguarding adults from abuse procedures were in place and care workers understood how to safeguard people they supported. Care workers had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA). Care records contained details of people’s capacity and were signed by people using the service or those lawfully acting on their behalf.

People told us they were involved in decisions about their care and how their needs were met.

Recruitment procedures ensured that only staff who were suitable worked within the service. The service also ensured there were sufficient numbers of suitable staff to support people.

Complaints were investigated and responded to in a timely manner.

Staff had the skills, knowledge and experience to deliver effective care and support, and received support for their roles. There was an induction programme for new staff which prepared them for their role.

Quality assurance processes were thorough. Senior management completed a variety of audits and ensured learning was undertaken from these.

The provider had a vision to deliver high-quality care and support. Staff demonstrated that they were clear about the values of the organisation and how these supported their work.

Inspection carried out on 29 September 2015

During a routine inspection

This unannounced inspection took place 29 September 2015. The service provides care and accommodation to four people with mental health difficulties. There were two people using the service at the time of our inspection.

The service had a registered manager who has been in post for several years. 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 last inspection of the service was on 2 May 2014. We found the service met all the regulations we looked at.

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

There were not enough experienced staff on duty to safely meet the needs of people.

Care records showed that people had been given appropriate support and care. Safeguarding adults from abuse procedures were in place and staff understood how to safeguard the people they supported. Records showed that staff received training and support to do their jobs effectively.

People’s individual needs had been assessed and their support planned and delivered in accordance to their wishes. People were involved in reviewing their support to ensure it was effective. Risks to people were assessed and management plan put in place to ensure that people were protected from risks associated with their support and care.

People received their medicines safely and were supported to maintain good health. The service worked effectively with other health and social care professionals including the community mental health team (CMHT) to meet the needs of people appropriately.

People’s choices and decisions were respected. People consented to their care and support before it was delivered. The service understood their responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to ensure that best interests’ decisions were made for those who lacked the mental capacity to make such decisions; and people were not unlawfully deprived of their liberty.

People were provided with a choice of food, and were supported to eat when required.

People were encouraged to participate in their interests and develop new skills. People were encouraged to be as independent as possible.

The service held regular meetings with people to gather their views about the service provided and to consult with them about the care and support they received. People knew how to make a complaint if they were unhappy with the service.

The registered manager regularly checked the quality of service provided. Health and safety systems were well maintained. Records were up to date and kept securely.

Inspection carried out on 2 May 2014

During a routine inspection

This inspection was carried out by an inspector who gathered evidence to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Safeguarding and restraint procedures were in place and staff were trained and understood how to safeguard the people they supported. Risks were assessed for people and actions were taken to address any risk promptly.

Deprivation of liberty safeguards (DoLS) were obtained before people were restricted in anyway in accordance with the Mental Capacity Act 2005. Best interest assessment was carried out to ensure it was done for the best interest of the person.

Is the service effective?

People were involved in their care, support and treatment. The provider cooperated with other health professionals in the planning and coordination of their care and treatment. People were supported to access services as required. People�s support plans were tailored to reflect their individual needs and the outcomes they wanted to achieve.

Is the service caring?

Staff understood the needs of people they supported. They treated people with dignity and respect. Staff showed understanding of the needs of people they supported and their different circumstances. Interactions between people and staff were positive and open.

Is the service responsive?

People were supported to participate in activities within and outside the home. There was effective joint working between the home and other professionals to ensure the service responded to people�s needs. Support plans and risk assessments were reviewed monthly and reflected the changing needs of people.

Is the service well-led?

There was a range of quality assurance systems in place. External auditors visited annually to assess the quality of service. Monthly review meetings, daily handover meetings, meetings for people using the service and staff meetings took place where the quality of service was discussed. Staff and people using the service told us their views were listened to and feedback was used to improve the service.

Inspection carried out on 20, 22 May 2013

During a routine inspection

Two people using the service spoke with us about their care and support experiences in the home. One person told us, �My key worker is someone that supports me and gives me the help I need.� Another person told us, �I�ve been going to college, studying Maths, English and Music. They [the staff in the service] have been helping me with using the internet. I enjoy it.�

Throughout our inspection, we observed staff interactions with people using the service. We found that staff were friendly, approachable and supportive, yet professional in their interactions with people using the service.

People were protected from unsafe or unsuitable equipment because the provider followed appropriate guidelines that ensured people had access to safe equipment. All electrical equipment was Portable Appliance Testing (PAT) tested, fire safety equipment was in place and suitable furnishings were in place.

There were effective recruitment and selection processes in place, and appropriate checks were undertaken before staff began work.

Arrangements were in place to monitor the quality of the service, which included residents� meetings, key work sessions, and regular health and safety monitoring checks.