Ridgegate Home (Ridgegate) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Ridgegate accommodates up to 25 people in one building. The building is an old converted house set over five floors.

At the time of our unannounced inspection on 5 November 2018 there were 18 older people living at the home.

There was 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 registered manager assisted us with our inspection.

We last inspected Ridgegate in October 2017 when we rated the service as Requires Improvement. This was because we found shortfalls in medicines management practices, following legal requirements in relation to consent and the governance of the service. Following that inspection, the registered manager sent us an action plan telling us how when they planned to meet the regulations. We checked at this inspection whether or not they had followed their action plan and we found they had.

People were cared for by staff who had undergone induction and training for their role and had continued support from their line managers. However, we have made a recommendation to the registered provider to ensure all staff have a thorough induction period.

The service had gone through a period where maintaining consistent staffing levels had been a challenge, however recruitment had taken place and things were gradually settling down. Staff told us the culture within the staff team was good and the registered manager led the service well. Staff had undergone robust recruitment processes to help ensure they were suitable to work in the service. Staff also recognised their responsibility in safeguarding in order to keep people safe from abuse.

People lived in an environment that was adapted for their needs and free from infection due to the good processes staff followed. People were enabled to make decisions about their care, remain independent and participate in activities if they wished. People’s risks had been identified and staff followed good practices to help ensure risks to people were reduced and as such accidents and incidents occurred less.

People’s needs were assessed before they moved into the home. These pre-assessments formed the basis of their care plan which contained sufficient information to enable staff to provide effective and responsive care. Although we have recommended the registered provider ensures that care plans are person-centred. People received the medicines they required and were supported to access healthcare professionals when needed.

People were given a choice of foods and specific dietary needs were recognised. Staff demonstrated a kind, caring and attentive approach towards people. People were supported to maintain relationships that meant something to them as we saw visitors and relatives visiting during the day. Where people had end of life wishes these were recorded.

People’s consent was sought before care was carried out by following the requirements of the Mental Capacity Act 2005. Complaints were listened to and responded to appropriately. Staff had the opportunity to provide feedback to make improvements. The registered manager worked with external agencies to help ensure continued improvement within the service for the benefit of people.

On-going auditing undertaken to help ensure a good quality of care was provided. The registered manager submitted notifications in line with requirements.

Ridgegate Home is a care home that provides accommodation and support for up to 25 people with a variety of physical conditions, disabilities and long term conditions. At the time of our inspection 20 people were living in the home and other people used the home as a day centre.

This inspection took place on 4 October 2017 and was unannounced.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager helped us during our inspection.

We carried out this inspection because during our inspection in July 2015 we made a recommendation to the registered provider in relation to making decisions in line with the Mental Capacity Act (2005). We found at this inspection some improvement had been made in this area, but further work needed to be done. We also identified at this inspection some other shortfalls in the service.

People who were unable to make their own decisions did not always have the necessary processes carried out to help ensure that any decisions made for them were made in their best interest. Although people received the care that they required in the way that they required it records in relation to people’s care were not always up to date, contained incorrect information and lacked guidance for staff in relation to people’s care.

People’s medicines were provided to them when they needed them, however practices in relation to medicines records and storage required improvement.

Although quality assurance audits were carried out by staff and the registered manager they did not always identify shortfalls within the service.

People were cared for by staff who showed them kindness and attention. People were supported to be independent, make their own decisions and choices and have privacy if they wished it. There was a close, friendly atmosphere within the home. Relatives and visitors were greeted warmly by staff and they only had good feedback for us in relation to the care their family members were receiving.

People were offered choice in what they ate and staff were aware of people’s individual dietary requirements. People could choose where they had their meal but staff encouraged people to eat together to help people to socialise. People told us they could have the care they wished, but still retain a sense of caring for themselves. People lived in an environment that was cosy and their rooms were personalised to their individual tastes.

People could take part in activities if they wished and staff actively encouraged this. Those who preferred to stay in their room told us that staff popped in and chatted to them and they did not feel lonely or isolated.

People were supported to remain healthy and some people had been enabled to regain their health and mobility. When people’s health deteriorated or changed, staff ensured they had involvement from appropriate health care professionals.

People were cared for by staff who had access to relevant training and told us they felt supported and met with their line manager on a regular basis. We found the registered manager had a good working relationship between them and staff.

People and staff told us there were sufficient staff to care for people and we did not see people having to wait for their care on the day. Staff were aware of their role in keeping people safe so they would not be at risk of harm, either by an accident or from abuse. People told us they felt safe. Recruitment processes were in place to help ensure that there were only suitable staff working at the service.

Regular fire checks and fire drills were carried out to help ensure staff would know what to do in the event of an emergency. Individual fire informati

Ridgegate Home is a care home that provides accommodation and support for up to 25 with a variety of physical conditions, disabilities and long term conditions. Ridgegate Home is a large detached residence set in its own grounds in a residential area of Reigate. Accommodation is arranged over four floors and can be accessed by a passenger lift to all areas including the garden level. There were14 people living in the home on the day of our visit.

The home had registered manager in post on the day of our inspection. A registered manager is a person who has been 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 and associated Regulations about how the service is run.

People told us they were treated well by staff who were kind and caring. We saw staff interacted with people in a kind and caring way and we noted a relaxed and happy environment with people smiling and chatting.

We saw staff knocked on people’s doors before they entered and waited for a response.

People told us they felt safe and secure in the service. We saw staff had undertaken training in safeguarding adults and were aware of what procedures to follow if they suspected abuse was taking place. There was a copy of Surrey’s multi-agency safeguarding procedures available in the home for information.

The provider had a good understanding of the Mental Capacity Act 2005, however we noted not all the appropriate DoLS applications had not been submitted.

Risk assessments were in place for all identified risks for example choking, falls, and emergencies. During discussions with staff they were able to demonstrate to us correct procedures to follow to keep people safe.

Care plans were reviewed at least monthly and information kept up to date. For example when people had seen a doctor or attended an external health care appointment.

People’s health care needs were being met. People were registered with local GP’s who visited the service when required. People felt it was important to them to be able to keep their own GP following admission to the home. Visits from other health care professionals also took place.

People had sufficient food and drink to maintain a healthy lifestyle, and people were complimentary about the food.

We looked at the medicine policy and found medicine administration was managed safely.

There were enough staff working in the home to meet people’s needs. People spoke highly of staff and were pleased that staff turnover was low and that staff knew them well.

Staff recruitment procedures were safe and the employment files contained all the relevant evidence to help ensure only the appropriate people were employed to work in the home.

People chose to take part in activities if they wished. Some people were engaged more than others and told us that was how they liked it. Some people said they liked their own company and some told us they liked to go out. People were looking forward to the annual garden party planned for the following week.

Systems were in place to monitor the service being provided. Health and safety audits were undertaken and customer feedback surveys were undertaken. People had been asked to complete satisfaction feedback questionnaires and we were able to view comments received.

People had been provided with a complaints procedure. We looked at the complaints record and noted two informal complaints were recorded. These were resolved with satisfactory outcomes. We saw several thank you letters and cards from relatives expressing their appreciation and gratitude for the care provided their family member.

We spoke with two people who live at the home. They were both satisfied with the care and support they received, how it was delivered and were happy living at Ridgegate Home. One person told us, "I couldn't ask for more. I hope I never have to leave here". We also spoke with three visitors. One said, "It's so friendly and homely here. it's like one big family". We noted that the home employed an activities co-ordinator and there were a wide variety of social events and opportunities provided, in both group and individual settings. The people we spoke with were happy with the number and types of activities on offer.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. We noted that staff were supported in delivering safe care. This meant that the care was of an appropriate standard. We also found that systems were in place for people and relatives to make a complaint about the service if necessary and that complaints were dealt with in a timely and satisfactory manner.

As part of our inspection we spoke with six people who used the service about the care and support they received. We also spoke with the Registered Manager and four support staff. During the inspection we saw that the atmosphere in the home was friendly and relaxed and the interactions between the people and staff were positive.

People spoke highly of the staff and told us they were happy with the care provided at the home. Comments included "The staff look after me very well", "It's lovely" and "very nice here".

We found that people were encouraged to be as independent as possible, were supported to make choices and be involved in their care. People said staff are "Good" and if they had any concerns they knew who to speak to.

All of the people we spoke with said they liked the food and could choose something different if they didn't like what was on the menu. One person said "The food is very good here" and "They will always make me something else if I want it".

People told us they felt "Comfortable" and "Safe" at the home and didn't have any concerns.

Staff told us they felt "Supported" by their manager and worked well as a team. One staff member said "I love it here" and another said "It's nice and homely".

Our inspection visit involved two compliance inspectors and took place between 11.00 and 17.30 hours on one day. Our inspection visit was carried on an 'unannounced' basis. This means that the service was not told beforehand that we would be visiting.

The majority of people who live at the service were involved in the review of the service through either their feedback or our observations of their interactions at the service and with staff. We spoke with three carers (relatives or people who act on behalf of people who live at the service) either on the day of our site visit or via telephone following our visit. We also consulted with seven staff members. The site visit was facilitated by the registered manager. On the day of our site visit there were seventeen people living at the service.

People who live at the service consistently told us that they liked living at Ridgegate Home. This was because they felt relaxed and that it was a friendly and “happy” place to live. A person told us “It is absolutely super living here they look after us incredible well”. A carer told us “They are absolutely marvellous mum wants for nothing” and “Good atmosphere every time we visit”.

Some people do not use verbal forms of communication. Observation showed that some people used single words or gestures. Other people had their own style of communicating. For example, the use of body language, facial expressions or other forms of behaviour. We observed that staff recognised these none verbal communication and responded to them.

A carer told us of the prompt actions of the service in seeking medical advice and support for their relative. A person told us that “the activities are fun and that there always seems to be a lot going on”.

People told us that they felt safe living at Ridgegate Home. A carer said “It gives me great peace of mind that mum is so well cared for and is in such safe hands”. People and carers told us that they felt confident to raise any concerns they had with management and felt that this would be dealt with promptly.

All people we consulted told us how nice the food was describing their meal as : “wonderful” “excellent” and “the food always looks fantastic”. A carer told us that they have been invited to stay for meals and eat privately with their relative

People who live at the service consistently told us that staff worked very hard and were helpful. They said “there is always someone around to help” and “you can ring the call bell and they always come very quickly even during the night”. Carers spoke positively about staff saying how caring staff were, their comments included: “the staff just don’t provide care they provide friendship” and “absolutely unbelievable wonderful most loving caring and efficient friendly staff”. A carer spoke of the importance of there being a consistent staff team and the positive impact that this continuity has had on their relatives care.

Carers and people living at the service told us that they are regularly asked for their views about the service and if there was anything that could be improved upon. They said that in response, their views had been listened to and they felt that they had some influence over what happened at the service.