About the service: Ridgecourt Residential Care Home provides accommodation and personal care for up to 17 older people some of whom were living with dementia. People who live at the home access nursing care through the local community healthcare teams. At the time of the inspection 14 people were living at the home.

People’s experience of using this service:

• People, relatives and healthcare professionals spoke very highly of the home. People said they felt safe and well cared for. People’s preferences were respected and staff were sensitive and attentive to people’s needs.

• Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well.

• People, relatives, staff and healthcare professionals said the home was well managed. One relative described the home as “The best in the west country.”

• There were sufficient numbers of staff employed to ensure people’s needs were met. However, some people thought the staffing at night should be increased from the one waking and one sleeping-in member of staff currently on duty: the registered manager said they would review this with the provider.

• Recruitment practices were safe and staff received the training and support they required for their role.

• Risks associated with people’s healthcare needs were assessed and managed well. However, the actions being taken to reduce risks were not always recorded in people’s care records. Staff were aware of their responsibilities to safeguard people.

• People and their relatives were involved in making decisions about their care. Care plans still required some improvement to reflect level of knowledge held by the staff about people’s needs and their preferences. The operations manager said the soon to be implemented electronic care planning system would address this.

• People received their medicines safely and as prescribed. Medicine management practices were safe.

• The home was spacious and well furnished. The environment was safe and equipment regularly serviced to ensure it remained in safe working order.

• Consideration was given to providing a variety of social activities for people to enjoy. However, some people said they would like to see more planned activities and the registered manager said they would review this.

• A new quality assurance system to assess, monitor and improve the quality and safety of the home was being developed and introduced.

The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

Rating at last inspection: requires improvement (March 2018).

Why we inspected: This inspection was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Ridgecourt Residential Care Home 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.

Ridgecourt Residential Care Home provides personal care for up to 17 older people some of whom were living with dementia: 15 people were living at the home at the time of the inspection. The home does not provide nursing care, people receive nursing care through the local community health teams. The home also has a detached supported living accommodation unit for up to five people. Personal care packages delivered by Ridgecourt Residential Care Home, or other homecare providers, can be arranged for people living in this unit as required. None of the three people living in the supported living accommodation unit at the time of our inspection were receiving personal care.

This inspection took place on 27 and 28 November 2017. The first day of the inspection was unannounced. One adult social care inspector and an expert-by-experience undertook this inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care home. The expert-by-experience for this inspection had experience in the care and support of people living with dementia.

The home was previously inspected in May 2015 was rated ‘Good’. At this inspection we found improvements were required to the systems used to record and monitor the home to ensure people received safe, effective and responsive care.

The home had a registered manager. 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.

Improved recording of the information obtained in relation to new staff member’s employment history was required to ensure the suitability of staff to work at the home. The home had obtained disclosure and barring check (police checks), proof of identify and references for newly employed staff. However, for two of the four recently recruited staff, the home could not demonstrate they had recorded a full employment history or information about why the staff members had left their previous care positions. The registered manager was aware of some of this information but they had not recorded it. Following the inspection, the provider and registered manager confirmed full employment histories had been obtained.

People received their medicines as prescribed to promote good health. People’s medicines were reviewed regularly by the local pharmacist as well as the GP. However, staff had not received up to date training in the safe administration of medicines and no records were kept of assessments to monitor staff members' competency to administer medicines safely. Records of the administration of protective skin creams were not being maintained. Following the inspection, the provider and registered manager confirmed staff had received training in the safe administration of medicines and had their competency assessed.

People, staff and the registered manager told us that more staff were required to meet people’s needs. One person told us, “They could do with a few more staff. It often appears they have too much to do.” While staff agreed people’s care needs were being met they felt they had little time to spend with people in conversation. We reviewed the staffing arrangements with the provider who felt there were enough staff employed to meet people’s needs. They said they used a dependency tool to help them assess the home’s requirements. Following the inspection, the provider undertook a review of people’s care needs and their staffing requirements. They provi

Fifteen people lived at Ridgecourt at the time of our inspection. People we spoke with told us that they were treated with respect. Comments included, "I could not be treated better." We found that people's choices and preference were respected and we observed that staff treated people in a calm, friendly manner.

People’s needs were assessed and their care and treatment was planned and delivered in line with their individual care plan. We saw that prompt and appropriate referrals had been made to GPs and specialist health services as necessary. A GP who visited people at the home told us that Ridgecourt delivered "very good levels of care". People’s care and treatment reflected relevant research and guidance. The provider had systems in place to deal with emergencies.

People told us that they felt safe at Ridgecourt. We saw that people were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse and to prevent abuse. For example, care workers and ancillary staff had received appropriate training in the safeguarding of vulnerable adults. The provider had effective recruitment systems in place to ensure that people were suitable to work with vulnerable people.

The provider had effective quality assurance systems in place. People, relatives and staff had opportunities to influence and improve the service. We received very positive feedback on the quality of service. Comments included, "a top notch service".

There were twelve people living at Ridgecourt Residential Care Home on the day of our visit. A detached supported living unit at the home, where people did not have personal care packages in place on the day of our visit, was not part of this inspection.

People who lived at the home told us that their care was good and that they felt safe. Comments included, "The care is amazing, I can't speak highly enough." We saw that the home was clean, warm and well maintained. People that we spoke with told us that they liked the homely touches, such as bird tables and flower filled pots placed outside their windows.

People told us that they were involved in their care, as much as they wanted to be. Relatives of people who lived at the home told us that were involved in decision making too.

People had clear assessments of their individual needs and plans were in place to meet those needs. Visiting health professionals told us that this home provided, "really good, personalised care."

Staff had suitable training and experience to enable them to meet people's needs. They were positive about their work and felt well supported. They were aware of their role and responsibilities in safeguarding of vulnerable adults.

Regular recorded checks were carried out on the safety of the premises and the equipment used.

The home used a variety of quality monitoring methods including surveys, reviewing incidents and the manager making unannounced spot checks.

Ridgecourt Residential Home provides personal care for up to 17 people. People who live at the home receive nursing care through the local community health teams. The home also has a detached supported living accommodation unit for up to five people. Personal care packages delivered by Ridgecourt Residential Home can be arranged for people living in this unit as required. One person was receiving personal care in the supported living accommodation unit at the time of our inspection. This inspection was unannounced and took place on 28 and 29 May 2015. One adult social care inspector conducted this inspection. At the time of our inspection there were 20 people using the service, including five people living in the supporting living accommodation. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the time of our inspection a safeguarding incident had occurred which was under investigation. Systems had been in place to protect people from harm, however, these had not protected all people. Immediate action had been taken to protect people and the service was working with partner agencies.

The service had ensured people’s needs were regularly assessed and management plans were in place to respond to people’s needs. People were protected from the risks associated with medicines as the service had appropriate systems in place to manage medicines. The service ensured there were sufficient numbers of staff to keep people safe and meet their needs. Staff had been trained in safeguarding and what processes to follow in order to report suspected abuse.People were supported by staff who had received training and monitoring of their performance through the use of supervisions and appraisals. The registered manager had put in place a training programme and ensured learning had taken place by regularly reviewing and enhancing staff’s knowledge. Staff understood people’s rights under the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. Appropriate referrals had been made for people.

Staff working at the home at the time of our inspection treated people with dignity and respect. These staff supported people in a caring manner and did their best to improve their quality of life and wellbeing. Care was person centred and encouraged staff to spend time with people.People were involved in their individual care plans and these contained lots of information about people’s needs and preferences. The service responded to people’s changing needs appropriately and referred people to appropriate healthcare professionals in good time. Staff were instructed on how to avoid people becoming isolated and people were encouraged to give feedback which was then acted upon.

The home was managed by a registered manager who had systems in place to support staff to deliver a good standard of care to people and to support them to be appropriately trained and supervised. Regular audits were carried out and there was a clear complaints procedure which people were encouraged to use. There was a culture of openness and a desire to improve on people’s enjoyment of life.People said “I love it. All the helpers are all good. Nothing is too much trouble” and “It’s a really nice atmosphere, the staff are particularly caring”.