We carried out an unannounced inspection of Ridgewood on 3 & 5 December 2018. The service is registered to support up to 12 people with complex needs who have a learning disability and/or mental health conditions. At the time of the inspection there were 6 people using the service.

Ridgewood Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Ridgewood is a detached house in a residential area of Camborne. It has two floors and 12 individual rooms. Refurbishment work was underway on the first day of the inspection. This was to improve kitchen, communal bathing and en suite facilities. On completion of the work the service will have 5 rooms with en suite facilities. There were bathing facilities on each floor. A wet room had been added to a bathroom as well as a separate shower facility in another bathroom. There was a lounge and separate conservatory. A previous quiet lounge had been converted to a kitchen preparation area as well as a main kitchen used to cook meals. There was a rear garden area.

A manager was in post, and had applied to be registered with the Care Quality Commission. The manager was responsible for the day-to-day running of 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 19 October 2017. In October 2017 we found governance systems were not effective and did not demonstrate clear oversight of the service. Incident reporting was not always happening when it should. For example, there was no evidence of how an incident might have occurred and action to prevent it occurring again. Medicine systems were not being managed effectively. A cream had not been dated when opened to ensure staff knew when the cream would remain effective to use. There were three gaps in administration records for when the cream was applied. Stock control was not always accurate. We made a recommendation for the service to improve the medicine audit system. People’s risks were not always being managed effectively because assessment for a person living at the service had not been completed. The staffing rota was not an accurate record which could be relied upon. Staffing levels supported people to have choices in activities during the week. However, during weekends this could be limited because of staffing levels in the service.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the previous inspection the Nominated Person [A person who has overall responsibility for supervising the management of the regulated activity] had changed. They had introduced new recording and management systems and reviewed all operational systems for the governance of the service. This had been carried out with the manager who had experience of working at a senior level. New governance systems had been put in place including reporting of accidents and incidents. Audit systems relating to accidents and incidents were in place so the manager could identify any patterns or trends to mitigate the possibility of it occurring again.

Medicine administration systems had been reviewed. Weekly auditing processes meant any omissions and stock control issues were being identified and managed more effectively. Staff understo

We carried out a comprehensive inspection of Ridgewood on 19 October 2017. At the previous inspection in November 2015 the service was rated good.

Ridgewood provides accommodation and personal care for up to twelve people who have a learning disability, mental health needs and maybe also on the autistic spectrum. During this inspection nine people were living at the service.

The service is situated close to the centre of Camborne. People living at Ridgewood were mobile and did not require mobility aids to support movement around the service. People using the service were supported to use community facilities either independently or with staff support.

The registered manager who was also the nominated individual (Person with legal responsibility for the service) had recently left the service. There is a requirement to register a manager with the Care Quality Commission (CQC), in order to meet a condition of the services registration. 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 was currently being managed by the owner who was also taking the position of acting manager of the service supported by a deputy manager. Throughout this report the owner will be referred to as the acting manager.

Governance systems were not effective and did not demonstrate clear oversight of the service. Incident reporting was not always happening when it should. For example there was no evidence of how an incident might have occurred and action to prevent it occurring again.

Medicine systems were not being managed effectively. A cream had not been dated when opened to ensure staff knew when the cream would remain effective to use. There were three gaps in administration records for when the cream was applied. Stock control was not always accurate. We have made a recommendation for the service to improve the medicine audit system.

People’s risks were not always being managed effectively because assessment for a person living at the service had not been completed.

The staffing rota did not identify staff roles with no indication of who was senior for each shift. The staffing rota was not an accurate record which could be relied upon.

Staffing levels supported people to have choices in activities during the week. However during weekends this could be limited because of staffing levels in the service.

The service was clean and of a domestic nature, which was suitable for the people who used the service. People’s rooms were personalised and decorated to a satisfactory standard. Health and safety checks were being carried out by the manger and maintenance staff.

People had their healthcare needs met and there were examples of how people's health needs had been effectively responded to. People were treated with dignity and respect and independence was promoted wherever possible.

The service had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff understood the importance of people consenting to support and encouraged choice making where possible. They understood the importance of enabling people to make their own decisions wherever possible and seeking the involvement of appropriate people when making decisions to provide care in a person's best interests.

People were protected from the risk of poor nutrition and staff were aware of people's nutritional needs. Care

We inspected Ridgewood on 26 October 2015. This was an announced comprehensive inspection. We told the provider two days before our inspection visit that we would be coming. This was because we wanted to make sure people would be at home to speak with us. The service was last inspected in November 2013. During that inspection visit we found the service was meeting regulations.

Ridgewood provides care and accommodation for up to twelve people who have a learning disability, mental health needs and autistic spectrum disorders. Twelve people were living at the service during this inspection visit.

The service is situated close to the centre of Camborne. It had good access to a local transport network including rail links. The service also had its own transport to support people to attend community facilities and events.

The service had a registered manager in place. 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 was not consistently heated. Some areas of the service were cold including bathrooms and peoples rooms. We raised this issue with the registered manager due to the potential to restrict people’s movement in these areas. A maintenance employee checked the issue. A fault was recognised and actioned to ensure the system was operational throughout the service.

Due to people’s communication needs we were unable to gain people’s verbal views about the service and therefore we observed staff interactions. We observed that people were relaxed, engaged in their own choice of activities and appeared to be happy and well supported by the service.

People at Ridgewood were supported to lead fulfilled lives which reflected their individual preferences and interests. There were enough staff available to make sure everyone was supported according to their own needs. On the day of the inspection visit six people were attending separate day placements, five people remained at the service and one person was in hospital. People were engaged in their individual routines and activities and one person went out for part of the day into town. Relatives told us they believed their family members had choice and control in their lives and were supported safely and with respect. Comments included, “Nothing but praise for the staff” and “They [people using the service] have so much choice in what they want to do. It’s lovely”.

Staff were trained in a range of subjects which were relevant to the needs of the people they supported. New employees undertook a structured induction programme and told us this was beneficial and prepared them well for their roles. Staff told us, “The new induction programme is very intense but it’s prepared me for my role”. The staff team were well supported by the registered manager and received regular supervision and staff meetings. These were an opportunity to share any concerns or ideas they had with the staff team and management.

Care plans were informative and contained clear guidance for staff. They included information about people’s routines, personal histories, preferences and any situations which might cause anxiety or stress. They clearly described how staff could support people in these circumstances.

Where people did not have the capacity to make certain decisions, the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People had a choice of meals, snacks and drinks chosen by themselves, which we saw they enjoyed. People had been included in menu planning. Some people were actively involved in meal preparation and this was reflected in risk assessments.

We saw evidence that quality assurance processes were regularly undertaken to ensure the service were aware of people’s views of the service and could monitor auditing processes at the service. This ensured an open service culture that is open to challenge and learning from issues affecting the quality of the service as they arose.

This inspection visit was completed in order to check the home had carried out improvements to ensure people's dignity and choices were respected at all times.

We spoke with three people who lived at the home. One person told us "I am happy here". We were invited into three bedrooms and people told us they were comfortable.

The kitchen remained open throughout the day and people were able to walk freely around the home.

The records we reviewed documented individuals choices and preferences.

We brought forward our inspection at Ridgewood because we received anonymous information regarding the quality of care plans and concerns that the needs of one person who used the service were having a negative impact on others. There were also concerns the staff team were unsupportive of each other.

During our inspection we spoke with two people who lived at Ridgewood and two relatives. People told us “I quite enjoy it here” and “I’m happy”. A relative said, “X is well looked after and safe”.

We saw people did not have keys to their lockable bedroom doors and there was no documentation to show they had been asked about this. People were not always able to move about the home freely and without restriction due to the kitchen door being locked.

Staff told us they felt supported and one person said: “We are a team”.

We spoke with four people who used the service. By observing people’s verbal and non-verbal communication, we established people thought the staff were kind and helpful. We observed the staff talking with people who used the service and saw that they were respectful, friendly and supportive to them. The atmosphere in the home was warm and welcoming.

We saw people were comfortable with each other and with staff at Ridgewood.

Care plans and associated documentation were detailed, informative and directed and guided staff of the action they needed to take in order to meet people’s assessed care needs. People's records were personalised, detailed and provided clear information about the person’s needs, wishes and abilities.

We saw people’s wishes were respected. We observed people moving around the home without restriction.

We found people’s privacy, dignity and independence were respected and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse.

People were protected from the risk of infection although appropriate guidance had not been followed.

We found the service could not demonstrate that staff had received appropriate professional development because accurate records were not maintained.

We reviewed all the information we hold about this provider, carried out a visit on 7 January 2012, observed how people were being cared for, talked with people who use services, talked with staff, and checked records.

Some of the people using the service were not able to comment in detail about the service they receive. Two people told us that they were happy at Ridgewood and they approached the inspector spontaneously and without inhibition. They were happy to talk and to ask or answer questions. We saw people’s privacy and dignity being respected and staff being helpful. There were no issues raised by people using the service or by staff. People who use the service were moving freely around the home and staff were seen to interact well with them. We saw that residents were spoken with in an adult, attentive, respectful, and caring way.

Staff told us that training was provided, and they confirmed that they received regular supervision. Staff told us they were not wholly confident in some training, such as First Aid, as this had not been practical training only theory. Staff told us they enjoyed working at Ridgewood.