Ridgemede Care is a residential care home and provides accommodation for up to 36 people older people and those living with dementia. At the time of the inspection, 30 people were living at the home. Accommodation is provided within a large detached house with communal areas, lounge, dining room and a secure garden to the rear of the property. The home is located close to the town centre of Bishops Waltham. All bedrooms have en-suite toilet and hand wash facilities. Bathrooms with shower facilities are provided on both floors. The service is not registered to provide nursing care.

The service 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.

We last inspected this service on 4 January 2017 and found the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of the breach. We also identified three areas where improvement was required in respect of medicines management, environmental safety and consent to care and treatment.

Following our inspection the provider sent us an action plan to tell us about the actions they were going to take to meet these regulations and make the necessary improvements. Action had been taken to meet the requirements of regulation the service had breached. We also found that improvements in the other areas of concern had also been made.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment. Staff were aware of their responsibilities in relation to safeguarding.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People received their medicines safely, accurately, and in accordance with the prescriber’s instructions. Medicines were stored safely.

The provider operated safe and effective recruitment procedures.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were knowledgeable about strategies’ in place to keep people safe.

People were supported to maintain good health and have access to healthcare services. The home worked in partnership with a nearby GP practice and received regular visits and support from an Advanced Nurse Practitioner.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support this was delivered quickly.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles. Training records showed that staff had received training in a range of areas that reflected their job roles.

People and where appropriate their relatives were involved in their care planning, Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

Care plans were developed and maintained about every aspect of people’s care and were centred on individual needs and requirements. This ensured that the staff were knowledgeable about the person and their individual needs.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

Staff responded appropriately to accidents or incidents. Staff recorded all accidents and incidents and the registered manager responded appropriately and further actions were taken to prevent incidents reoccurring.

People knew who to talk

This inspection took place on 20 October 2016 and was unannounced. Ridgemede Care is a care home that provides accommodation for up to 36 people, including people living with dementia care needs. There were 25 people living at the home when we visited. The home is based on two floors with an interconnecting passenger lift. All bedrooms have en-suite facilities. In addition, bathrooms are provided on both floors, together with a range of communal rooms for people’s use.

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.

At our previous inspection on 4 & 5 August 2015, we identified four breaches of regulations. Medicines were not always managed safely; risks to people were not always assessed and mitigated; staff did not follow guidance designed to protect people’s rights; information about the employment histories of staff was not always available; and quality assurance processes were not always effective. The provider sent us an action plan detailing the steps they would take to become compliant with the regulations. At this inspection we found action had been taken, but further improvement was required.

Providers are required to conspicuously display their CQC performance ratings on their website and within the home. The rating from the previous CQC inspection was not displayed on their website. Within the home, the rating was displayed on the office wall, but was not easy for people to see.

A new policy had been introduced which required staff to act in an open way when people were harmed. Whilst staff had been open with family members after a person fell, they had not followed this up with a written explanation as required.

There were appropriate arrangements in place for managing medicines. However, the quantity of medicines in stock was not carried forward from month to month, so the provider was not able to check that people had received their medicines as prescribed. The registered manager was still developing a system to regularly check the competence of staff to administer medicines.

Regular checks were conducted to make sure the building was safe for people, although these had not identified that some first floor windows did not have restrictors fitted to prevent people from falling out.

Improvements had been made to the way staff assessed people’s ability to give informed consent. Staff sought verbal consent before providing care and support, and knew how to protect people’s freedom. However, further work was needed to ensure that action taken to protect people’s rights was fully documented.

A quality assurance process had been developed. This had identified and addressed some areas that needed improvement. However, it needed further time to become embedded in practice to ensure it was effective.

People were protected from harm in a way that supported them and respected their independence. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

There were enough staff to meet people’s needs and recruitment processes helped ensure only suitable staff were employed.

People’s needs were met by staff who were skilled and suitably trained. New staff completed a comprehensive induction programme and all staff were suitably supported in their roles by the management team

People praised the quality of the food. Their dietary needs were met and staff provided people with appropriate support to help ensure they ate and drank enough. Staff monitored people’s weight and took action if they started to lose unplanned weight. People could access healthcare services and were referred to doctors and specialist n

This inspection followed up on one area of non compliance relating to people’s personal records. This non compliance had been identified at our last inspection in January 2013. The provider had completed an action plan that we saw had been implemented.

During our visit we saw that people were being treated with dignity and respect and people’s independence was encouraged. People were spoken to in a respectful way. People we spoke with told us that the staff were polite, friendly and helpful and that their privacy was respected whilst they were supported to maintain their independence. One person told us: “I can't fault the staff, they are always professional”.

People experienced safe and effective care based on detailed care plans and risk assessments that met individual needs. They told us that if they had any concerns they would report them to the manager or senior person on duty.

Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting. People told us they could rely upon receiving the help they needed because staff knew what to do and they looked after them well.

There were policies and procedures in place to ensure that the safety and suitability of the premises was maintained, these were understood and followed by staff.

There was an effective system in place to deal appropriately with comments and complaints made by people, or persons acting on their behalf.

During our visit we saw that people were being treated with dignity and respect and people’s independence was encouraged. People were spoken to in a respectful way.

People we spoke to told us that the staff were polite, friendly and helpful and that their privacy was respected whilst they were supported to maintain their independence.

One person told us: “carers are very good they are wonderful, I have a say in the care I receive.”

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would report them to the manager of senior person on duty.

Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting. Staff records were not available to be inspected.

People told us they could rely upon receiving the help they needed because staff knew what to do and they looked after them well.

We spoke to a health professional who made us aware that they felt staff had the required skills to do the job. They told us: “The staff know what they are doing; there is an overall feeling of kindness.”

The Provider had effective systems in place to monitor and assess the quality of the service.

People told us they were happy in the home. They said staff were wonderful and nothing was too much trouble for them. People told us the management and staff would always do their best to sort things out for them. They felt listened to and involved in the home.

We conducted this unannounced inspection on 4 and 5 August 2015 in response to concerns received about people’s safety.

Ridgemede Care provides accommodation and personal care for up to 36 older people who were frail and some were living with dementia. Accommodation is provided over two floors in a converted domestic dwelling. At the time of our inspection 31 people were living in the service.

The service has a registered manager and she has managed the service since 2001. 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 had introduced some systems to monitor the safety and quality of the service provided over the past year. However, we found improvements were needed to ensure these systems were effective in identifying issues of quality and safety so that robust action would be taken to manage risks in the service. Overall we found that the service was not always well led and that management systems were not always fully in place or robust. Some records relating to the management of the service were available. However, these were not consistently maintained or available to ensure care workers would always have clear guidance in emergencies and operational procedures would be kept under review and improved as needed.

People, their relatives and professionals told us the home was a safe place to live. Though people consistently told us they felt safe, we found people did not always receive the appropriate care and support they required to keep them safe. People’s risks of falling out of bed and the risk to people from using equipment were not routinely assessed to ensure it was used safely. Medicine recording arrangements were not sufficiently robust to prevent errors occurring so that people would receive their medicine as prescribed.

Care workers had received training in safeguarding and were able to demonstrate an awareness of abuse and how concerns should be reported.

There were sufficient care workers to support people’s needs and keep them safe. However, the required information relating to care workers employed at the home had not always been obtained when care workers were recruited to evidence safe recruitment practices had been followed. Care workers received training and supervision and they told us they received sufficient support and guidance to enable them to fulfil their roles effectively.

People were supported to stay healthy. Care workers identified when people became unwell and worked closely with the local GP surgery and other health professionals. People and their relatives were complimentary about the food served at the home. People were supported to eat and drink enough to meet their needs.

We were concerned that opportunities and appropriate support had not been provided for people to be involved in decisions about their care and that their rights under the Mental Capacity Act 2005 had not been upheld. Where the provider placed restrictions on people to keep them safe, they were waiting for legal authorisation instructing them to do so. The registered manager could not show restrictions were only placed on people as a last resort after less restrictive approaches had been exhausted. There was a risk that people’s rights might not be upheld and restrictions might be placed on people unlawfully, whilst the registered manager awaited the outcome of Deprivation of Liberty Safeguarding (DoLS) applications.

People’s needs were generally assessed and their care planned. Care workers knew people’s needs, what was important to them and their preferences well. However, the care records we saw were disorganised, confusing and did not always contain up to date daily care records to support care workers to provide consistent care.

People and their relatives and visiting professionals were complimentary about the quality of care provided. They liked the friendliness of staff, and the homely atmosphere. People we spoke with commented positively about the staff and how they were cared for. We saw instances of caring interactions between staff and people. We observed staff offer reassurance to people when they were providing support and promoted independence.

People who used the service had written information about the formal complaints process available in their care file. There had been no complaints since our previous inspection. People and relatives were encouraged to give their views about the service. However, their feedback had not been used to make significant improvements to the quality of activities provided to people.

People’s care had not been planned to ensure opportunities were created for people to engage in meaningful activities, maintain their social skills and pursue their interests. We were concerned that some people who were at risk of loneliness and boredom might not receive the support they required. We have made a recommendation about involving people in activity choices and supporting them with meaningful activities.

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.