The inspection took place on 8 August 2018 and was unannounced. This meant the provider and staff did not know we would be coming.

We previously inspected Risedale Rest Home Limited in May 2017, at which time the service was in breach of regulations 9 (person-centred care), 12 (safe care and treatment), 17 (well-led) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the previous inspection we rated the service as requires improvement. At this inspection, whilst there had been some improvements, the service remained requires improvement.

We found risk assessments were not managed appropriately, care plans were not person-centred, staffing levels were too low, training had lapsed, premises were not adequately maintained or cleaned and that there was a lack of management oversight.

Risedale Rest 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.

Risedale Rest Home accommodates a maximum of 17 people across two floors. Nursing care is not provided. There were eight people using the service at the time of our inspection, some of whom were living with dementia.

The service did not have a registered manager in place at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager had applied to be registered with CQC and was registered as the manager after the inspection.

At this inspection we found the manager had made a range of improvements and addressed the majority of the areas where the service was previously in breach of the regulations.

We found there were still improvements required with regard to the planning of staffing levels, which were not always adequate to meet people’s needs. Staffing levels were determined by a dependency tool which was not effective. We have made a recommendation about this.

People’s social needs, for example activities and hobbies, could not always be supported because of the lack of appropriate staffing levels. On at least one day a week, the manager was required to assist the one member of care staff on duty. Care staff also had to complete cleaning duties as the provider had not ensured adequate levels of staffing cover in this regard.

Activities provision was not effective. There was no activities co-ordinator and the manager did the bulk of activities planning. Staff helped people with individual activities or played games with people, but none of this was planned in line with people’s preferences. The provider had not ensured there was sufficient staffing in place to provide person-centred care. Subsequent to the inspection the provider confirmed they were seeking the help of a volunteer to help deliver activities.

There had been significant improvements in terms of cleanliness since our last inspection, with evidence of recent refurbishment and more planned. Infection control training had been delivered to staff and all visitors and people who used the service agreed the service was cleaner.

Medicines administration practices had improved and were now safe. Protocols for ‘when required’ were not yet in place.

Risk assessments were in place and described the factors which may put people at risk of harm, and what staff needed to do to minimise these risks. Documentation regarding risks, along with all aspects of care planning, were under review and would benefit from more detailed, person-centred information. Staff knowledge regarding how to keep people safe was good.

All staff were aware of their safeguarding responsibilit

This inspection took place on 16 and 23 May 2017 and was unannounced. We last inspected the service on 6 and 7 May 2015 and found the provider was meeting the regulations we inspected against.

Risedale Rest Home provides residential care for up to 17 people. Most of the people who are cared for at the home are older people, and some people who use the service have mental health needs. At the time of our visit there were 11 people living at the home.

The home had a registered manager who had been unexpectedly absent from the home since April 2017. 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.

During this inspection we found the provider had breached the regulations relating to safe care and treatment; person-centred care; staffing and good governance. In particular, we found the provider had not been effective in assessing risks to people’s wellbeing and safety. The provider had also not ensured risks posed to people and others were managed appropriately.

Due to the registered manager's absence from their post there was a lack of leadership and management in the home. The interim management arrangements were unclear and many aspects of the home had lapsed. This included essential training, supervision, appraisals, meetings for people and staff and some quality assurance checks. Staff were also unable to locate important information we required to provide assurances the building was safe, such as electrical and gas safety checks and an up to date fire risk assessment.

The provider was unable to evidence there were sufficient staff on duty to meet people’s needs in a timely manner. Staff told us staffing levels were insufficient and people gave mixed views about there being enough staff.

Care plans were not personalised and lacked sufficient detail to accurately describe the care and support people required. Two people who moved to the home in March 2017 did not have care plans in place when we inspected.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service do not support this practice. We have made a recommendation about this.

People and relatives said the care provided at the home was good. People said staff were caring and treated them respectfully. They also said they felt safe living at the home.

Records confirmed medicines were administered by trained and competent staff. People and relatives told us they received their medicines in a timely manner.

Staff had a good understanding of safeguarding including how to report concerns. Previous safeguarding alerts had been referred to the local authority safeguarding team and investigated in line with expectations.

Incidents and accidents were logged, investigated and analysed to ensure appropriate action was taken to keep people safe.

People were supported to have enough to eat and drink in line with people’s needs. Relatives told us staff supported people to access health care when required and they were kept informed.

People had opportunities to take part in activities in the home, such as bingo, cards, dominoes, quizzes, exercise sessions, sing-alongs and a Sunday church service.

People did not raise any complaints with us but knew how to do so if needed. The provider had not received any complaints about the home.

The provider was in the process of looking to employ an interim manager for the home. Shortly after our visit they confirmed they had employed an experienced manager to oversee the home during the registered manager’s absence.

Relatives said the home had a welcoming and friendly atmosphere.

The provid

We spoke to five people who used the service. People told us they were consulted about their care and asked for their consent before they received care and treatment. People said the manager and staff were very caring and looked after them well. Comments included, "I filled in my care plan with the staff", "I like the staff and I'm well looked after during the night", "I wouldn't change anything in here", "They are very kind here and we have a good laugh" and "The manager and staff are very good to me and there is a good choice of meals".

There were policies and procedures in place to ensure the home was clean and hygienic.

There were systems in place to help ensure appropriate staff were recruited to care for the people who used the service.

There was an effective procedure in place for dealing with complaints. People were given support to make a comment or complaint where they needed assistance. People said they knew how to make a complaint if they needed to. Comments included, "I have nothing to complain about", "I know I can make a complaint but I think everything is okay" and "I would complain if I needed to but there is no need".

People told us they enjoyed living in the home and their privacy and dignity was respected. They said the staff did not enter their bedrooms without their permission and they were encouraged to make choices about how and where they spent their time. They told us they enjoyed the food served to them and choices were available. They said they would feel confident to make a complaint if they were unhappy about any aspects of their care.

The people we spoke with who were able to make comment were very positive about the home’s care staff and management. They told us that staff were friendly, helpful, and supportive. They told us that they had a choice in how they spent their day and that they could join in activities if they wanted to. People told us that there was always something going on and that they had visited the neighbouring sea front last week for fish and chips. Our observation of people who use the service was that they were cared for and appropriately dressed. We saw people sitting in the ground floor lounge and that there was positive interaction from staff. One visitor told us that staff were approachable and kind. Staff members told us that they liked working at the home with some staff members being employed at the home for a number of years. Staff members were supportive of the manager and said everyone would help one another to get the job done. People told us that the standard and choice of food was very good, and staff members knew what each person like and disliked.

This inspection took place on 6 and 7 May 2015 and was unannounced We last inspected the service in April 2013, and at that visit found the service was meeting all of the regulations we inspected.

Risedale Rest Home is a care home in Whitley Bay. It accommodates up to 17 people. Most of the people who are cared for at the home are older people, and some people who use the service have mental health needs. At the time of our visit there were eight people living at the home.

At the time of our inspection there was not 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. A new manager had been employed at the service in December 2014. The new manager had applied with CQC to become registered. At the time of our inspection their application was being processed. In the weeks following our inspection this application to become registered manager was successful.

There were systems in place to guide staff on the appropriate action to take if they had any concerns over people’s safety or wellbeing. We saw staff had been trained in identifying and responding to potential abuse. The manager had assessed their knowledge of the safeguarding process to ensure staff were competent at following the correct processes.

There were enough staff to meet people’s needs. During our inspection we saw there was a good staff presence in the communal areas of the home. Staff did not appear to be rushed. We saw staff were able to support people with their needs and any requests, as well as spending time engaging with people in activities and conversation. Recruitment procedures had been followed to ensure staff were of good character and appropriately skilled for their role.

People’s medicines were managed safely and appropriately. There were systems in place to administer, store and dispose of medicines properly.

We reviewed the staff training matrix for all of the staff who worked in the home. Training had been planned for the next year so staff’s skills remained up to date. Staff had received refresher training in all health and safety related training within the last year. Training had been planned around the needs of people who used the service, with staff receiving training in mental health conditions. Staff received regular supervision and appraisals with the manager to discuss their role and performance.

The manager was aware of their responsibilities under the Mental Health Act 2005 (MCA) and was able to describe to us situations where they had put this into practice. Deprivation of Liberty Safeguards (DoLS) were lawfully applied. DoLS authorisation had been granted for one person who used the service, and the application was pending for another. Staff were aware of who had DoLS authorisation in place and could tell us about the safeguards in place to ensure these people were safe.

People were positive about the food on offer at the home. We saw people were given a choice of meals which were displayed using a pictorial menu. We spoke with the chef who was knowledgeable about people’s nutritional needs.

People and their relatives told us staff were very kind. We observed lots of good practice during our visit. Staff spent a lot of time speaking with people and sharing jokes. The atmosphere in the home seemed warm and light-hearted. Staff and people who used the service knew each other well and seemed to enjoy each other’s company.

Care records showed that people had been included in planning their care. Their preferences had been documented throughout their records. People were encouraged to maintain their independent skills. For example, some people visited the local shops by themselves and one person managed their own medicines.

People’s care plans were personal and specific. Their needs had been determined through a range of assessments. Care plans were in place to describe to staff how best to support people with their needs. People’s needs and care plans were reviewed on a regular basis. Staff were knowledgeable about people’s needs and how to support people.

A complaints procedure was in place. The manager told us no complaints had been received in the previous 12 months. Relatives we spoke with were aware of how to make a complaint, but told us they had never had any issues with the service. People and their relatives were invited to regular meetings to discuss the service and any improvements they would like to make.

People, their relatives and staff spoke highly of the manager of the service. They told us the manager was approachable and ran the service well. The provider of the service was also very involved in the home. She visited regularly and fed back her observations on the quality of the home both informally and through quality monitoring assessments.

A range of checks and audits were carried out regularly to monitor the quality of the service. These included reviewing accidents and incidents that occurred within the home and responding to any preventative measures that needed to be put into place. Action plans had been created to address any improvements which were required and these were monitored and updated when improvements had been made.