This inspection took place on 17 May and 23 May 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

Ryton Towers 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.

Ryton Towers accommodates a maximum of 43 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 36 people were using the service.

At our last inspection in November 2016 we rated the service good. There was one breach of legal requirement, regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to governance. At this inspection we found improvements had been made and the service was no longer in breach of the regulations.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Improvements had been made to the quality assurance processes. A range of systems were in place to monitor and review the quality and effectiveness of the service. There was regular consultation with people or family members and their views were used to improve the service. Staff and people who used the service said the registered manager was supportive and approachable.

Changes were being made to the environment. It was being refurbished and more communal areas were being provided to benefit people. There was a good standard of hygiene and minimum disruption whist improvements were being carried out.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care, however records did not always reflect the care provided.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. People told us they were safe. There were enough staff to provide individual care and support to people.

People had access to health care professionals to make sure they received appropriate care and treatment. People received their medicines safely. They told us staff were kind and caring and they felt comfortable with all the staff who supported them. Appropriate training was provided and staff were supervised and supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. A variety of activities and entertainment was available for people. However, we considered people should be stimulated and engaged when the activities person was not available.

Further information is in the detailed findings below.

This inspection took place on 2 and 15 November 2016 and the first day was unannounced. This means the provider did not know we were coming. We last inspected Ryton Towers in February 2016. At that inspection six breaches of regulations were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements. During this inspection we checked that they had followed their plan and that they are now meeting the legal requirements.

Ryton Towers is a care home for older people, some of whom have a dementia-related condition. It does not provide nursing care. It has 43 beds and 32 people were living there at the time of this inspection.

The service did not have a registered manager. A manager was in post and was in the process of applying to become registered with the Care Quality Commission. A registered manager is a person who had registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living in the home were kept safe from harm. Staff had received safeguarding training and were aware of the different types of abuse people may suffer and their responsibility for reporting any potential signs of abuse.

Systems were in place to identify and minimise possible risks to the health and safety of people using the service. General risk assessments were also completed to identify and mitigate potential risks to staff and visitors.

People were assisted to take their medicines by staff who had received training in the safe handling of medicines. Staff were knowledgeable about the medicines people received and medicine administration records we reviewed were up to date with no unexplained gaps. We found records in relation to the administration of topical medicines could be improved to provide clearer instructions to staff.

Staffing levels were calculated based on the dependency levels of people using the service. The manager reviewed the staffing levels on a weekly basis to ensure these continued to meet people’s needs.

Staff had been provided with the support they required in terms of training, supervision and appraisal to enable them to perform their roles effectively. Staff told us they felt supported in their roles and able to raise concerns or request additional support.

People’s capacity to make decisions about their care and treatment was assessed by the service. Where a person was found to lack the capacity to make a particular decision records showed a “best interest” decision was made on their behalf. However we found people and their representatives had still not been asked to formally consent to their care and treatment.

The service had a complaints policy and procedure in place. Copies of these were available throughout the home for people to refer to. Complaints records were complete and provided full details of the action taken by the service in response to complaints.

New care plan documentation had been introduced by the provider since our previous inspection in February 2016. This documentation covered a wider range of care and support and was tailored to suit the individual needs of people using the service. However at the time of the inspection we found this documentation had not been introduced for all of the people using the service.

People and visitors we spoke with were complimentary about the kind and caring nature of the staff. People told us they were well cared for and that their privacy and dignity was respected.

The service had an activities programme in place to help prevent people from becoming socially isolated. People and relatives we spoke with told us there were plenty of activities for people to get involved in. The activities co-ordinator had also recently started to hold bi-monthly residents and rel

This inspection took place on 17, 18 and 19 February 2016. The first day was announced.

We last inspected this service in May 2014. At that inspection we found the service was all the legal requirements in place at the time.

Ryton Towers is a care home for older people, some of whom have a dementia-related condition. It does not provide nursing care. It has 43 beds and 32 people were living there at the time of this inspection.

The service did not have 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.

People and their relatives told us they felt safe and well protected in the home. Staff had been trained in the safeguarding of vulnerable people, but this training had not always been put into practice in recognising potential abuse.

There was an experienced, skilled and trained staff team, but staffing levels were variable and did not always meet the minimum levels needed to meet the assessed needs of people in the home. Staff recruitment processes were not fully robust and required more stringent checks to be carried out.

Risks to people were assessed and appropriate measures were taken to ensure their safety. People’s medicines were safely administered. Building safety was regularly checked and routine maintenance and servicing of equipment and services took place.

Staff knew people’s needs and preferences well and treated them as individuals. Staff were given regular training to enable them to recognise and meet people’s needs, and were encouraged to undertake personal professional development. Staff were supported in their roles by regular supervision and an annual appraisal of their performance.

People were not asked to give their consent to their care, and their rights under the Mental Capacity Act were not fully respected. Where people lacked capacity, decisions made in their best interest were not always made in consultation with the appropriate people, and lacked sufficient detail.

People’s healthcare needs were assessed and met appropriately. Routine health checks were arranged and the service worked with other professionals and services to ensure specialist needs were met. People were supported with their nutritional needs and enjoyed a good diet.

People and their relatives spoke highly of the very caring nature of the staff team. They told us they were treated with care, consideration and affection by all the staff, They said staff responded to people’s changing needs.

People and their relatives told us they were kept aware of any developments in the service and were given the information they needed to make decisions about their care. Relatives were informed of any changes to a person’s health or wellbeing, and were invited to reviews of care. Advocacy was made available where required.

Staff took care to protect people’s privacy and dignity at all times and to enhance their wellbeing. People were encouraged and supported to be as independent as possible. Regular activities and trips out were arranged.

The format used to assess people’s needs did not adequately address their social, cultural or spiritual needs. Care plans were sensitive and person-centred, but did not always set clear goals or have sufficiently detailed guidance to staff about how they should meet people’s needs.

People told us they were listened to by the management and staff and had few complaints. Where complaints were received, they were not properly documented and the outcomes were not clear.

The service did not have a registered manager in post. The acting manager had ensured that there was good continuity of care whilst a new manager was being recruited. There was a positive atmosphere in the service and the views of peop

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. We found safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, “I am alright here, I feel safe.” Another person said, “I’m safe here, I have no worries. I’d press my buzzer if I ever had a problem during the night.”

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. The building was clean, well maintained and secure and other appropriate measures were in place to ensure the security of the premises. One relative told us, "The care is very good. The staff are confident and competent and it’s a great relief and reassuring he’s safe there.”

We found the provider undertook appropriate checks before staff began work and effective recruitment and selection processes were in place. We also found people were protected from the risks of unsafe or inappropriate care and treatment, because accurate and appropriate records were maintained.

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Staff were supported to deliver care and treatment safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home and their training was refreshed when required. One relative told us, “The way they care for her is excellent and there is always someone on hand to help her.” Another relative commented, “I took a friend's advice, to go and visit at different times and days; you’ll soon spot if anything’s wrong. To be honest, I haven’t experienced anything I do not like. We are very satisfied and more than happy with the service. It was a big step to take, but it’s ideal for my mam; it’s fantastic and I love the feel of the place.”

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “The staff are polite, courteous and cheerful and I have no complaints. I am happy here, well looked after and cared for.” One relative commented, "The staff are very nice, it’s wonderful care and I’m impressed. The care is unhurried, staff have time for everyone and nothing is a problem.” Another relative said, "The service is really good and so far she has received excellent care.”

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed every six months to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

People and their relatives knew how to make a complaint if they were unhappy. We saw that two complaints received by the service during 2014, had been recorded, investigated and resolved to the satisfaction of the complainant. We also noted that seven compliments had been received by the service during 2014.

We saw the service had policies and procedures in place in relation to the safeguarding of adults and the Deprivation of Liberty Safeguards. This meant staff had access to information which helped them to identify and report suspected abuse. We noted the registered manager had recently made a Deprivation of Liberty safeguards application to the local authority and reported three safeguarding incidents to the local authority safeguarding team in the six months prior to our visit. This meant that people were safeguarded as required and the provider responded appropriately to any potential allegations of abuse.

Is the service well-led?

The service had a registered manager who had been in post since 2011 and the provider had in place systems to monitor the quality of the service people received. One relative told us, “The home has a good manager, with a good consistent staff team. Most of the staff have been there between ten and 20 years.”

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People and their relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. One person told us, “It’s a really good service they provide for us here.” This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Both staff, people who used the service and their relatives said communication was good. One relative told us, “We get plenty information and are kept up to date with everything. We speak with staff regularly and we attend formal reviews of her care every six months. We can talk to any of the management time at any time; communication is good.”

Staff received regular supervision and appraisal and told us they felt supported by the management team and a member of the management team was available on call for advice and support and in case of emergencies.

We observed the care given to people who used the service and we spoke to people who used the service and their relatives.

They said that they had ‘no complaints at all’, and that they ‘get on well with staff’, who were ‘polite and very good’. We were told that if there were any issues, these were dealt with ‘immediately and always with a positive response’. We were also told that the ‘appointed carers did a good job’.

During this inspection we checked on the safety and suitability of the accommodation and environment. People who used the service said that they ‘were well looked after’ and that the home provided ‘good food’ in a ‘nice and clean’ environment. One family member said that ‘nothing could be done better’.

Family members had commented that ‘the staff never stop and are always friendly’ and ‘... is cared for very well, her health has improved and also she is mentally alert’.

People spoken to had access to their care plan and we were told that any changes in their care had been discussed with them and their family members.

We spoke to a number of people both living in and visiting the home. People told us they were happy at the home and the service provided. Most people who were able to express an opinion said that they were encouraged to be as independent as possible. One told us, “I make my own choices. I get up when I want, and do what I want”. Another person said, “If I don’t want something, I just tell them”.

The people we spoke with were very positive about their care in Ryton Towers. Comments included, “I’m very happy with my care. The staff are very nice”; “The staff are very pleasant, and they treat us with respect”; and, “Staff have been absolutely marvellous, they help you all the time. They are very good with visitors, too”.