We carried out an unannounced comprehensive inspection of this service on 11 July 2018. We found that improvements had been made at the service and there were no breaches of legal requirements

We undertook this focused inspection to check that the improvements made at the last inspection had been embedded and sustained. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Ramsgate Care Centre 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. The service accommodates 42 people in one purpose built building. There were 40 people living at Ramsgate Care Centre at the time of our inspection.

Improvements seen at our last inspection to the way medicines were managed had been sustained. The stocks of medicines were correct, records were accurate and detailed guidelines were in place for the administration of each person’s medicines. Effective checks had been completed on medicines.

A registered manager was leading the service. 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 provider and registered manager had oversight of the service. Effective systems were in place to continually improve the service and act on information received about changes to best practice. The registered manager and the provider checked the service regularly to make sure it met the required standards. The views of people, their relatives, staff and community professionals were asked for and acted on.

Staff felt supported by the registered manager and were motivated. The registered manager or deputy manager were always available to provide the support and guidance staff needed. Staff worked together as a team to support people. Records in respect of each person were accurate, complete and kept secure.

Assessments of risks to people had been completed and care had been planned with them, to meet their needs and preferences and keep them safe. Accidents and incidents had been analysed and to look for patterns and trends.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager or provider. People were not discriminated against and received care tailored to them.

There were enough staff to provide the care people needed when they wanted. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed to make sure staff were suitable for their role.

The service was clean and staff followed infection control processes to protect people from the risk of infection. The building was well maintained

The registered manager had informed CQC of significant events at that had happened at the service, so we could check that appropriate action had been taken.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall.

Further information is in the detailed findings below.

This inspection took place on 11 July 2018 and was unannounced.

Ramsgate Care Centre 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. The service accommodates 42 people in one purpose built building. There were 42 people living at Ramsgate Care centre at the time of our inspection.

At our last inspection we found that accurate records had not been maintained about everyone’s medicines and one medicines check had failed to identify these shortfalls. Following the inspection, we added a condition to the provider’s registration requiring them to send us a monthly report of any actions they had taken to address medicines shortfalls and prevent them from happening again. We received these reports as required. At this inspection we found that the action taken to improve the management of medicines at the service had been effective and people were protected from risks associated with medicines. We will continue to monitor medicines management at the service to make sure that the improvements have been sustained and people receive a good service.

A registered manager was leading the service. 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 provider and registered manager had oversight of the service. They had learnt lessons from previous incidents and used these to improve the service. The registered manager and the provider checked all areas of the service regularly to make sure it met the standards they required. The views of people, their relatives, staff and community professionals were asked for and acted on to continually improve the service.

Staff felt supported by the registered manager and were motivated. A senior manager was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be. All the staff and health care professionals we spoke with told us they would be happy for their relatives to live at Ramsgate Care Centre. Records in respect of each person were accurate, complete and kept secure.

Staff were kind and caring and treated people with dignity and respect. They took time to get to know each person well and provide the care people wanted in the way they preferred. People received the care and support in the way they preferred at the end of their life.

Assessments of people’s needs and any risks had been completed and care had been planned with them, to meet their needs and preferences and keep them safe. Accidents and incidents had been analysed and to look for patterns and trends. The registered manager worked in partnership with local authority safeguarding and commissioning teams, and a clinical nurse specialist for older people and acted on their advice to develop the service and improve people’s care.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager or provider. People were not discriminated against and received care tailored to them. A process was in place to investigate and respond to complaints and small day to day issues had been resolved immediately to people’s satisfaction. People had enough to do during the day, including activities to keep them physically and mentally active.

Changes in people’s health were identified and people were supported to see health care professionals, including GPs and community nurses when they needed. People were offered a balanced diet of food they liked and that met their cultural needs and preferences. Staff continued to support people

This inspection was carried out on 8 August 2017 and was unannounced. The inspection was prompted in part by notification of an unexpected death. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of medicines, management of weight loss and skin care. This inspection examined those risks.

Ramsgate Care Centre provides accommodation and personal care for up to 42 older people and people living with dementia. The service is a large purpose built property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. There were 40 people living at the service at the time of our inspection.

The registered manager was leading the service and was supported by an area manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our inspection in April 2015 we found that accurate and complete records had not been maintained in relation to people’s medicines. At our inspection of August 2016 we found that some improvements had been made. At this inspection we these improvements had not been consistently maintained and accurate records had not been maintained in relation to all the medicines people received. There was a risk that information would not be available to staff and health care professionals to help them plan people’s care. The stock of one person’s medicine was inaccurate by one tablet. Other records about people’s care were accurate and complete.

At our last inspection we found that checks on the quality of the service had not been effective. At this inspection we found that checks on the quality had been completed to make sure it was at the standard the provider required. Action was taken quickly to address any shortfalls found. However, the most up to date medicines check had not identified the shortfalls we found at the inspection.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. The registered manager understood when CQC should be notified of significant events however we had received notifications as required.

People told us the menu was 'boring' at our last inspection. At this inspection we found that staff had planned menus with people and people were offered a balanced diet. People told us they enjoyed the food and there was a wide variety of food on offer. Meals were prepared to meet people preferences and spiritual and cultural needs.

People had privacy and staff provided the supported they needed discreetly. People were involved in planning what happened at the service. Staff and people planned the activities on offer together. People told us they had enough to do every day and were planning outings.

At our last inspection we found that some risks to people had not been assessed and action had not been taken to mitigate all risks. At this inspection we found that assessments of people’s needs and any risks to them had been completed. People had agreed ways to manage risks with staff. Their care was planned and reviewed with them, to keep them safe and help them be as independent as possible. People’s care plans had been reviewed and updated when their needs changed. People were supported to have regular health checks such as eye tests.

The Care Quality Commission is required by law to monitor th