This inspection took place on 5 and 10 April 2017 and was unannounced on the first day.

Ridgeway Nursing Home is located in a rural setting, close to the town of Belper and provides nursing and personal care for up to 37 older people, including people who have dementia. On the day of our inspection there were 32 people using the service.

A registered manager was not in post, although there was a manager who had applied to become the 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.

The providers arrangements for medicines administration, recording and storage was safe. People were supported to have their medicines when they needed. They were also supported to maintain good health and were helped to have access to appropriate healthcare professionals and services. Guidance from healthcare professionals was followed to ensure people’s needs were met.

Staff understood the need to include people with decision-making; staff considered people’s capacity and followed the key principles of the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed; people were supported to have choice and control over their life and staff supported them in the least restrictive manner. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff had been provided training so they were able to meet people’s needs and provide them with safe and effective care. New staff participated in a period of training and shadowing more experienced staff as part of their induction.

Staff supported people to have sufficient to eat and drink; when necessary, people were assisted with their meals and special diets were catered for. People’s individual needs were assessed and care plans were developed and reviewed. People’s dignity and privacy was respected; staff were kind, caring and compassionate.

A complaints procedure was displayed; people and relatives knew they could complain if they felt it was necessary. Staff felt supported by the management team; support and supervision was provided to staff. Audits were carried out to ensure people received safe and effective care.

This inspection took place on 16 February 2016 and was unannounced.

Ridgeway nursing home provides care for up to 37 people. On the day of our inspection there were 29 people using the service.

A registered manager was not in post, as the previous registered manager had left the service the day before the inspection. However an acting manager had recently been appointed and was present throughout the day. 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 the last inspection on 6 and 13 October 2015, we found that improvements we had required the provider to make, following our previous inspection in December 2014, had not been made. Consequently there were breaches in the regulations for person-centred care, safe care and treatment, good governance, premises and equipment, dignity and respect, the need for consent and staffing.

In all we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service was ‘Inadequate’ and the service was therefore placed in ‘Special measures’. At this inspection we found significant improvements had been made, particularly regarding risk management. However there were still areas, including person-centred care, premises and equipment and good governance, that we considered required further improvement. This inspection found there was enough improvements to take the provider out of special measures.

Staff followed the provider’s policies and procedures to help ensure people’s safety. Staff told us they had completed training in safe working practices and we saw they put this training into practice. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were involved in making decisions about their care. They were asked about their choices and individual preferences and these were reflected in the personalised care and support they received.

People were protected by thorough recruitment procedures and appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who were employed.

Medicines were stored and administered safely by staff who had received appropriate training.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) training to make sure they knew how to protect people’s rights. The manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates.

Systems to monitor the quality of the service Identified issues for improvement and these were resolved in a timely manner. There was a formal complaints process. The provider recognised that not all people could raise formal complaints and their feedback was sought through regular involvement with their keyworker. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

People able to express themselves told us that they enjoyed living at the home and felt safe. They spoke highly of staff. One person told us “they are very kind to me here”, and another said “they do a good job”.

We found that people living at the home were treated with respect and dignity. Staff ensured that people were supported to make choices in all areas of their care. One relative we spoke with told “he gets to choose when he gets up and when he goes to bed”.

We found that the systems for managing medicines did not ensure that people were protected from the risks associated with poor medicines management.

We found that the providers systems for monitoring quality and assessing risks to the health and welfare of people using the service were not always effective and in some instances were not in place.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. However, inconsistencies in the provision of staff training and supervision did not ensure that all staff were properly trained, supervised and appraised. In addition, the provider did not have recruitment and selection processes which would ensure that people were suitably qualified, skilled, experienced and fit to work in social care.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service, and a practicing professional.

A number of people who used the service had varying levels of dementia, so not everyone was able to tell us about their care and support. Therefore we spent some time observing how people were treated and how they were involved in their care and treatment. This helped us to understand the experiences of people who could not talk with us.

The majority of time we observed the staff treating people with respect and dignity. The registered nurse and care workers were polite and treated people in an appropriate manner. We saw staff were aware of people’s preferred names and used this name when speaking with people. We observed when people were assisted to access toileting facilities, care workers respected people’s privacy whilst maintaining their safety.

We saw that the majority of care workers were not particularly attentive when they were supporting individual people with their meal. Staff did not talk with people whilst assisting them to eat their meal or explain to them what food was on their plate. We observed one care worker standing when assisting people with their meals, rather than sitting down next to them. We watched care workers placed meals in front of people, without speaking to the person to tell them their meal was there and what it was.

We saw most people spent their time in the communal lounge areas. We saw people were able to come and go as they pleased around the building, and join with activities if they wished. We saw a small number of people supported by the activity co-ordinator and member of care staff during the morning play carpet skittles, and also use picture cards of days gone by to stimulate discussion.

We observed people were given choices of what meals they would like. We saw care workers asking people what choice they would like from the menu, although the staff member appeared rushed when asking people. Pictures of the meals were not used to help people make a choice. This does not enable people with dementia and communication needs to make a choice about their meal.

We saw that although people were offered drinks at certain times throughout the day, there was reluctance by staff to provide drinks when people asked for one. We heard people ask on several occasions for a drink, only to be told by staff that the drinks trolley would be round soon. We also saw people were not consistently offered a cold drink with their meal at lunch time and again, several people had to ask rather than staff offering. Although there was no evidence to suggest people were not receiving sufficient fluids, these observations do not support that people had access to drinks throughout the day or people’s wishes were being upheld.

No one spoken with raised any concerns about living at Ridgeway Nursing Home or the care they received. Staff had a good understanding of the forms of abuse people would need protecting from. They were keen to emphasise that this was not a recognised problem at this particular care home. Staff told us what action they would take if they witnessed any abusive practices and would “always report incidents to the manager.”

People spoken with did not raise any concerns that their needs were not responded to at any time. Staff told us the new manager had recently increased the staffing levels. Staff now felt they were able to spend more time with people. Staff told us training was provided. The told us the new manager was reviewing the training needs of the staff team and arranging additional training sessions.

None of the people spoken with made any comments about their care records. One person told us, “I am quite happy here and there was no complaint about the staff, as they are doing as much as they can.” We saw that people's nutritional needs and risks was assessed. We saw that if people were identified as at risk of losing or having lost weight, food and fluid diaries were kept. These diaries were not always completed in detail or for across the 24 hour period.

This inspection took place on 6 and 13 October 2015 and was unannounced. We had previously inspected the service in December 2014, where we found breaches in the regulations for person-centred care, safe care and treatment, good governance, premises and equipment, dignity and respect, the need for consent and staffing. We set requirement notices for these regulations and the provider sent us an action plan detailing how they were going to meet them. At this inspection we found the improvements we required had not been made.

There was a registered manager in place at Ridgeway Nursing Home. 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 service is registered to provide nursing and residential care for up to 37 older people. At the time of our inspection 33 people were being cared for, including people living with dementia.

Arrangements were not in place to ensure covert medicines were administered safely. Risks at the location were not well managed and appropriate actions to reduce risks were not taken. Parts of the building still had insufficient hot water. People did not always experience safe or timely care because sufficient staff were not at all times deployed to meet people’s needs appropriately. People told us they felt safe, and staff had been trained in, and understood how to protect people, should they be at risk of abuse.

Not all staff had the skills, knowledge and competence to meet people’s needs, even though they had received training. People were at risk of not having their day to day needs met safely because staff did not always show the required levels of competence in their role. The registered manager had not applied the principles of the Mental Capacity Act 2005 to how people consented to their care and treatment. People enjoyed the food on offer and had different menu options to choose from.

People’s experience of care varied because a caring approach that supported people’s dignity and promoted their independence was not demonstrated consistently by all members of the staff group. We observed some practices which did not support people’s dignity or privacy. Although people were asked to sign their agreement and consent to their care plans, some people’s views on their care and support were not obtained or recorded.

People did not receive personalised care that was responsive to their needs. Care plans did not always reflect people’s care needs accurately. Efforts were made to provide people with activities and support their interests, although not all staff, in the absence of the activities coordinator, contributed to sustaining a stimulating environment for people. People had opportunities to provide feedback on the service, but complaints were not always learned from.

We were concerned that the registered manager and provider had not taken effective action to fulfil their responsibilities to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Systems and processes in place to check on the quality and safety of services provided were ineffective. When concerns or issues were raised, improvements were not made or sustained. The service was failing in its aims to provide good quality, personalised care.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.