The inspection took place on 12 March 2018 and was unannounced. Mavesyn Ridware is a care home that provides accommodation with personal care and is registered to accommodate 21 people. The service provides support to older people who may also be living with dementia. The shared accommodation is on the ground floor and there are bedrooms on the ground and first floor. There are three lounges and one dining room for people to use. The home is located in the village of Mavesyn Ridware. There are no public facilities or public transport services within easy reach of the home.

Mavesyn Ridware is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 18 people using the service.

There was a registered manager in post. 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.

This inspection was unannounced. Mavesyn Ridware was last inspected in January 2017 and the service was rated as Requires improvement. We identified concerns as systems to monitor and improve the service had not always been effective and improvements were needed to ensure medicines were managed safely. Where people lacked capacity to make some decisions, this had not been suitably assessed to ensure decisions were in people’s best interests.

At this inspection, we saw that improvements had not been made. This is the third consecutive time the service has been rated ‘Requires Improvement’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective.

People felt that there were enough staff to meet their needs and they felt safe. However, they were not always able to summon support when staff were not visible to them. Improvements for how medicines were managed had not been made and staff were making decisions about how some prescribed medicines were given.

People had access to healthcare services, however where people needed support with eating or drinking, a referral had not been made to ensure they remained safe and well. People were not supported to have maximum choice and control of their lives. Improvements had not been made to ensure people’s capacity to make specific decisions had been assessed.

Staff generally developed caring relationships with people however, their privacy and dignity was not always respected. Interactions with people was often focused around when personal care was delivered.

Visitors were welcomed at any time. People knew who the registered manager was and the staff felt they were approachable and provided support to them. People were able to share their views though a survey, although meetings to gain their views were no longer carried out.

Staff received opportunities to receive training and support to enable them to fulfil their role and they were encouraged to develop their skills. The staff recognised where people may be at risk of harm and understood their responsibilities report abuse. Mealtimes were not rushed and people enjoyed the food that was prepared.

We found 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 the report.

This inspection took place on 26 January 2017. The inspection was unannounced. At our previous inspection in January 2016 we rated the service as requires improvement and we found the provider needed to make improvements with how people were supported to make decisions and how they monitored the quality of the service. During this inspection, we found improvements were made although further improvements were required.

Mavesyn Ridware provides residential for up to 21 older people, some of whom may be living with dementia. There were 19 people resident at the time of our inspection. There was a registered manager in post. 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.

Systems to monitor and improve the service had not always been effective in identifying improvements needed to ensure medicines were managed safely. Where people lacked capacity to make some decisions, this had not been suitably assessed to ensure decisions were in people’s best interests.

Staff understood their role in protecting people from the risk of harm and people were supported by staff who had the knowledge and skills to provide safe care. There were sufficient staff available to meet the identified needs of people who used the service in a way that they wanted this.

People were supported to eat and drink what they liked. Where concerns were identified, people received support from health care professionals to ensure their well-being. Health concerns were monitored and people received specialist health care intervention when this was needed. Medicines were managed safely and people received their medicines at the right time, as prescribed.

People were treated with dignity and respect and had their choices acted on. The staff were kind and caring when supporting people. People were confident that staff supported them in the way they wanted. Staff knew people’s likes and dislikes and people’s preferences were considered and incorporated in their support plan. There were regular reviews of people’s care to ensure it accurately reflected their needs.

People enjoyed the activities and opportunities to socialise. People were able to stay in touch with people who were important to them as visitors could come to the home at any time. People knew who to speak with if they had any concerns and they felt these would be taken seriously. Arrangements were in place so that actions were taken following any concerns being raised.

We found a breach 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 the report.

This inspection took place on 28 January 2016. The inspection was unannounced. Our last inspection took place in August 2014 and at that time we found the provider needed to make improvements with how they monitored the quality of the service. During this inspection, we found improvements had been made and quality assurance systems had been introduced to review how the service was managed. Further improvements were needed with how medicines were audited to ensure the provider was able to identify people had their medicines as prescribed.

Mavesyn Ridware provides residential for up to 21 older people, some of whom may be living with dementia. There were 19 people resident at the time of our inspection.

There was a registered manager in post. 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.

People made decisions about their care and staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves because they may lack capacity, the provider had not always assessed whether people could make these decisions themselves; this meant that some decisions that had been made may not be in their best interests. Some applications to restrict people of their liberty had been made without ensuring that the person did not have the capacity to make the choice. We have asked the provider to make improvements.

Staff were available at the times people needed them and staff had received training so that people’s care and support needs were met. The provider had not introduced the new Care certificate for new staff to ensure they developed and demonstrated key skills, knowledge, values and behaviours which should enable them to provide people with safe, effective, compassionate and high quality care.

Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence.

There were processes to review the experiences of people who used the service. This was through regular communication with people and staff to make sure people were supported in the best way. Arrangements were in place so that actions were taken following concerns raised, for the benefit of people.

People were confident that staff supported them in a manner which protected their welfare and they told us they felt safe. Staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Where harm or abuse was suspected, the staff knew how to respond to protect people.

People received support from health care professionals where they needed this to keep well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People were supported to eat and drink and there was a choice of foods available. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed assistance, this was done in a caring and supportive way.

People were treated with kindness and compassion by staff who knew them well. We saw that people’s privacy and dignity was respected and people were called by their preferred name. People were confident that staff supported them in the way they wanted.

People knew how to make complaints. They were confident that the staff and registered manager would respond to any concern and they could approach them at any time. Complaints

This was an unannounced inspection. We completed this inspection to check that the providers had taken action to address the concerns we had raised at the previous inspection in April 2013.

Following the previous inspection the provider sent us information to tell us how they were going to become compliant with the regulations. At this inspection we saw that improvements had been made.

When we visited previously 'end of life' plans had not been completed appropriately to ensure people's wishes were followed. On this inspection the home had improved these plans and they included evidence that a medical professional had authorised decisions.

People living at the home had the opportunity to take part in some activities. The manager told us that there were plans in place to further develop this aspect of people's care.

The provider had made progress in putting in place a system to review and monitor the quality of the care people received but this had not yet been fully implemented. Audits had been completed to make sure that the people were protected from the risks of infection. A medication audit was in the process of being completed.

We completed this inspection to check that the provider had made the improvements needed to become compliant with the regulations. This was an unannounced inspection and the home did not know we were visiting.

People were satisfied with the care they received. We spoke with nine people. One person told us: “The staff are kind, I find it very good here I have no complaints”. Another person said: "I have my ups and downs but on the whole it’s okay here”.

Plans of care had improved. We spoke with staff and they told us how they provided care for people each day. We looked at two care plans and the information recorded in the plan corresponded with what staff had told us. People's care was being evaluated every month. Care staff had been trained in manual handling and people were now being moved in a safe way. We saw in two files that end of life plans and preferences had not been completed properly. Decisions not to resuscitate people had not been approved by a medical professional.

Records confirmed that care staff's training had improved since our last inspection. Training to meet people's needs had been provided.

The provider had made some improvements to the way the service was monitored and reviewed. Relatives had been asked for their views about the service. Audits that were completed on the quality of the service were not recorded and therefore there was no information to show that any shortfalls had been acted upon.

We spoke with the majority of the people who used the service, some people were able to speak with us, and some people were unwilling or unable due to frailty. We spoke with one visitor, the deputy manager and other members of staff.

We spent time in the sitting room observing how staff and people got on with one another. We observed staff to be very busy but we did not see or hear that anyone waited for assistance when they needed help.

Some people told us that they were able to make decisions and choices for themselves. Other people were unable to do so; staff told us the ways they helped people with decision making. We did not see any record for assessing a person’s capacity to consent to the care and treatment in any of the care plans we looked at.

Staff told us how they provided support to people each day. We looked at the care plans and documentation for four people. The information recorded in the plans did not accurately correspond with what staff had told us.

People told us the food was very good and that they enjoyed the meals that were provided. We saw that staff helped people with their meal when it was needed.

We saw that care staff arranged and organised recreational activities in addition to their care duties. Two people told us that life at the home was boring. A visitor told us of a recent outing that their relative had thoroughly enjoyed.

Staff told us the actions they would take if they had any suspicions of neglect or abuse. We saw that most staff had received training in safeguarding vulnerable adults in 2010 and that more training was planned for this year. We were unable to determine when this would take place or the staff members who would be offered this training.

We saw some items of equipment being used incorrectly. This put people who used the service and staff at risk of harm.

We saw a limited number of staff on duty at the time of our inspection. They were very busy for the whole of our visit and had very little time to do anything else but provide the basic care.

We saw that staff training had been sporadic over the past few years. We saw that opportunities for training had been identified this year, but we were unable to identify when it would be taking place.

We saw the current systems for assessing and monitoring the quality of the service was ineffective.

We spoke to people as well as observing people at the service. One person told us that they made choices about their life including the time they went to bed and got up and what she ate.

People we observed had choices over times they got up and went to bed and over their meals. People also made choices over where they spent their time.

People had accommodation that was clean. The provider had recently put in new procedures to make sure that the risk of the spread of infection were controlled.

This visit took place at four thirty in the morning. Two people were up, one who has a disturbed sleep pattern and another who told us that they had woken up early and preferred to sit in their arm chair rather than going back to bed.

Staff said that they started getting people up at five in the morning and that around ten people were usually up before half past seven. Staff said that people were always asked if they wanted to get up. One staff confirmed that this had been the routine since they had worked there – the last seven years. We stayed for about an hour and no one requested to get up.

Two records we looked at did not provide evidence of a wish to get up before seven thirty.

People who use the service told us that they were getting the support they needed. Plans of care provided staff with the information to understand people's needs and with the information about how to meet their needs. Care planning took account of needs relating to dementia care including how people communicate and also their likes and dislikes.

People are supported by staff who have the necessary training to give them the knowledge and skills to meet their needs. People are treated with respect and dignity.