This inspection took place on the 20, 21 and 22 August 2018 and the first day was unannounced. This was the first inspection of Ringway Mews Care Home since it had been bought by HC-One in January 2018. The registered and deputy managers, as well as the staff teams remained the same. Changes had been made at the provider’s area manager level and above. The home, under its previous ownership (Bupa), was inspected in June 2017. References throughout this

report to 'the last inspection' concern this inspection.

Ringway Mews 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.

Ringway Mews accommodates 150 people across five separate units, each of which have separate adapted facilities. Three units are general nursing (Lancaster, Halifax and Wellington), one specialises in providing nursing care and support for people living with dementia (Halifax) and one is a residential unit for people living with dementia (Shackleton). Wellington unit also had six ‘discharge to assess’ beds contracted with the local authority. These were used where people were able to be discharged form hospital but required further assessment of their care and support needs. People were meant to stay on Wellington unit for a period of six weeks whilst being assessed, however some people had lived in Wellington unit for several months whilst a suitable care placement was found for them by their social worker.

Each unit has a lounge, dining area, a conservatory, and a kitchenette. All bedrooms are single with no ensuite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

There was a registered manager at Ringway Mews. 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 last inspection in June 2017 we found three breaches in regulations because care plans did not always reflect people’s current needs, medicines were not safely managed, sluice rooms and cleaning cupboards were not locked and issues identified in internal audits had not been addressed during the registered manager’s extended leave.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, responsive and well led to at least good.

At this inspection we found that the home had changed its care files, paperwork and management tools to the HC-One systems. The care plans reflected people’s assessed needs and were evaluated each month. Risks had been identified and steps taken to reduce the likelihood of the identified risk occurring. Where people might have behaviour that challenges, care plans gave details of potential triggers and behaviours.

People in the ‘discharge to assess’ beds had shorter 7 day care plans to briefly identify their needs. It was not evidenced that these had been evaluated. Two people had lived on Wellington unit in the discharge to assess beds for up to six months but their care plans were still very brief. The HC-One intermediate care plan was to be introduced which would enable more information to be recorded about people’s identified needs.

We found continued breaches in regulation because medicines were not safely managed and actions had not been taken when the internal auditing systems had identified there was an issue with medicines re-ordering.

You can see what action we told the provider to take at the back of the full version of the report.

Medicines were found to be out of stock on the first day of a new medicines cycle on one unit. Medicines au

We carried out an unannounced inspection of Ringway Mews Care Home on 12, 13 and 14 June 2017. This was the first inspection of Ringway Mews Care Home since it had been re-registered with the Care Quality Commission in January 2017. The re-registration had taken place as a business entity to reflect changes to the providers named responsible people. This did not create any changes to the overall registration of the home. The home, under its previous legal entity, was inspected in May 2016. References throughout this report to ‘the last inspection’ concern this inspection.

Ringway Mews Nursing Home is owned by BUPA Care Homes. The service consists of five 30 bedded units; Lancaster, Shackleton, Anson, Halifax and Wellington. Wellington had recently been re-opened and fifteen people lived there at the time of our inspection. Each unit specialises in either nursing or residential care. Each unit has a lounge, dining area, a conservatory, and a kitchenette. All bedrooms are single with no en-suite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

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. Shortly after our last inspection the registered manager took an extended period of leave, returning in February 2017. During their leave the home had two different relief managers.

The clinical service manager (CSM) for the service had moved to the position of unit manager shortly before our inspection. Two CSM’s had been recruited to support the registered manager, both of whom were due to start working at the service shortly after our inspection took place.

At the last inspection we found two breaches of the Health and Social Care Act 2008 because additional care plans were not in place for some people’s identified needs and the audits completed by the service had not identified the issues found during the inspection or issues that had been identified had not been actioned. At this inspection we found similar issues; however an improvement plan was in place for the service and all care plans were in the process of being re-written.

A new breach with regards to medicines was identified during this inspection. You can see what action we have told the provider to take at the end of the full version of this report.

Daily and weekly medicine monitoring sheets were in place on each unit to check that all medicines had been administered as prescribed. New cream charts had recently been introduced for care staff to sign when they had applied any creams. However these were not consistently completed so it was not possible to tell if the creams had been applied as prescribed. We identified a missing tablet on one unit. Bupa procedures for reporting and investigating this had not been followed. The registered manager initiated these procedures when we informed them of what we had found.

People and their relatives told us they felt safe living at Ringway Mews and that the staff knew their needs well. They also said staff were respectful, kind, caring, supported them to complete some tasks themselves and offered them day to day choices, for example about what they wanted to eat or wear.

A robust process was in place to recruit staff suitable to work with vulnerable people. New staff undertook a week’s induction and completed training, including safeguarding vulnerable adults, commensurate with their roles. Staff said they felt supported by the unit managers. Supervisions and staff meetings were held where staff were able to contribute to discussions about the service.

People and their relatives thought there were enough staff on duty to meet people’s needs, although one pe