We last carried out a comprehensive inspection of Ridgemount in May 2017 where we found the registered provider was rated ‘Good’ in each of the five key questions that we ask.

This inspection took place on 18 May 2018 and was unannounced.

Ridgemount 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. Ridgemount is a care home service without nursing for up to 66 older people, some who may have dementia. At the time of our inspection 55 people lived here.

There was not 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 2008 and associated Regulations about how the service is run. This is the third inspection in a row where Ridgemount has not had a registered manager in post. A manager was in post after our last inspection, but they left the service before completing the registration process with CQC.

During this inspection we found that the lack of a registered manager had impacted on the staffs ability to maintain a good rating across the five key questions. The management arrangements to cover the lack of a registered manager had not been effective at supporting the staff to maintain a good rating. A long serving member of staff had just been promoted to manager within the home, and they had begun the application process to become registered with CQC. The manager was at the home during the time of our inspection.

People’s safety could not always be assured. We identified three issues during our inspection when we asked ‘Is the service safe?’ Risks of harm that had been identified were not always well managed to ensure people were kept safe. We identified that improvements were required in how staff managed people’s medicines. Staff deployment around the home on the day of our inspection meant that there were times during the day where numbers of available staff fell below the minimum specified by the provider.

Where complaints and comments had been received the staff had not always responded or recorded how things would be corrected. People knew how to make a complaint.

People’s access to activities had been impacted by the loss of two activities coordinators. The provision of activities was under review by the manager to ensure people did things that were meaningful and of interest to them. One replacement activities coordinator was going through the induction process and the manager said they were still recruiting for a second.

Staff received an induction when they started at the home and ongoing training, tailored to the needs of the people they supported. However staff did not always put into practice what they had learned.

People’s experience of accessing relevant healthcare professionals to maintain good health was inconsistent. Some people were referred to specialists in good time, however other people had not been referred by staff as quickly as they could have been.

The provider had not always completed an appropriate assessment of people’s ability to make specific decisions for themselves. We made a recommendation that the recording of where best interest’s decisions had been made for people could be improved. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People told us they found the staff to be kind and caring and respected them. However, some felt that because staff moved around the building from shift to shift they weren’t able to build relationships with them. We observed some interactions which showe

Ridgemount is a care home service without nursing for up to 66 older people, some who may have dementia. 61 people lived here at the time of the 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 recruited to become the registered manager and was due to start at the home within a few weeks of this inspection. Senior management support was available at the home while the recruitment process was underway.

At the last inspection on 17 May 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People were safe living at Ridgemount. Staff understood their roles in keeping people safe and protecting them from abuse. Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

Staff understood any risks involved in people’s care and took action to minimise them. Accidents and incidents were recorded and reviewed to ensure any measures that could prevent a recurrence had been implemented. There were sufficient numbers of staff to meet the needs of the people who live here.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them.

Staff received comprehensive training, regular supervisions and annual appraisals to ensure they could meet and understand the care needs of the people they supported.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met. People’s healthcare needs were monitored and they were supported to obtain treatment if they needed it. People who had ongoing conditions were supported to see specialist healthcare professionals regularly.

Staff treated people with respect and maintained their privacy and dignity. People were supported to maintain relationships with their friends and families. People were encouraged to be independent.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical needs. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs.

The management team provided good leadership for the service. They were experienced in their role and communicated well with people, relatives and staff. Staff felt valued and had access to support and advice from the management if they needed it. Team meetings were used to ensure staff were providing consistent care that reflected best practice.

The provider had effective systems in place to monitor the quality of care and support that people received. Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The deputy manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.

Further information is in the detailed findings below.

Ridgemount is a care home that provides care and accommodation for up to 66 people who are elderly, some of whom are living with dementia. The home is purpose built and divided into five units, each with its own lounge and dining area. The home is owned and operated by Anchor Trust. Accommodation is arranged over two floors and has a lift access provided. There were 61 people living in the home on the day of our visit.

There was not a registered manager in post on the day of the inspection. The home was being manager by the care manager until a permanent manager is appointed. 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 associated Regulations about how the service is run.

The home has been refurbished throughout since our last inspection on 12 June 2014 and all areas were clean bright and comfortably furnished.

People told us they felt safe. One person told us staff and said “This is a safe place to live”. A relative said “I have every confidence in this home knowing that my family member is safe”.

Staff had a good understanding of adult safeguarding procedures and what action they should take if they were unhappy about any poor practice.

There were enough staff working in the home and people were well cared for. There were safe recruitment procedures in place to help keep people safe. The provider had systems in place to ensure all safety checks were in place before staff started work.

The staff were aware of risk and there were risk assessments in place that promoted peoples safety and did not compromise people’s independence. For example how people’s mobility needs were managed.

People received their medicine safely and according to the procedures in place. Medicines were administered by staff who had received the necessary training and had been assessed as compeneten to do so.

We found the home had a relaxed atmosphere and people were going about their daily routines either enjoying the group activities, reading their daily newspapers, sitting in their rooms attending the hairdressing salon, or going to the polling station to vote. People were treated with respect and dignity and staff spoke to people in a kind and polite manner.

People were cared for by staff that had the training and skills to undertake their roles efficiently. Staff felt the training provided was appropriate and we saw two training sessions in progress during our visit.

Where people lacked the capacity to make decisions for themselves staff followed the requirements of the Mental Capacity Act 2005, and staff had received relevant training.

The care manager understood their role and responsibilities in relation to the Deprivation of Liberty Safeguards (DoLs). Individual applications had been submitted to the local authority when appropriate to ensure people were not illegally deprived of their liberty.

People’s health was maintained and they had access to sufficient food and drinks. There was a choice of food for people. People’s specific nutritional needs were catered for. People had regular access to a GP and their health needs were being met.

People had agreed care plans in place and care was undertaken in accordance with people’s preference and needs. People had been involved in their care planning and relatives were also included in this process when appropriate. There were a wide range of activities available that people enjoyed. Complaints were responded to appropriately and in line with the stated complains policy. People and their relatives knew who to speak to if they had any concerns or complaints.

Systems were in place to monitor the quality of service provision being offered. For example customer satisfaction questionnaires were used and any improvements followed up. Staff told us that they felt supported by the care manager and were well managed.

During our inspection we set out to answer our five questions; 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. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

A person who used the service told us they felt the home was a safe place to live and they were well care for. They told us they had "tested the home twice before making a choice to live there". A relative of a person who used the service told us they felt the home was a safe place and felt confident that their family member received good care safely. They said they could talk to the provider if they felt unhappy regarding anything about the service. Safeguarding procedures were in place and staff understood their role and responsibility regarding safeguarding the people they cared for. We saw safe manual handling procedures being undertaken and saw no negative practices during our visit. We saw staff were recruited according to the home's recruitment policy and had all the required security checks in place. This ensures the welfare of the people they were supporting.

The service was clean and safe and provided people with safe access to all areas of the home.

Is the service effective?

People's health care needs were assessed with them whenever possible and written in a care pan. Arrangements were in place for people to see their GP when necessary to monitor their individual health care needs. People also had effective support to manage their dementia needs. Other support for example the chiropodist, dentist, optician, dietician and a Community Psychiatric Nurse (CPN) or clinician was provided on a regular basis and records were maintained in people's care plan.

Is the service caring?

People who used the service told us the staff were caring and always treated them kindly. We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner. We were told by a relative of a person who used the service that they were reassured by the care their family member received and felt they made "the best choice possible for their relative". We saw people who required help to eat their meals were supported by staff in a sensitive and caring manner. We also saw staff took the time to enable people to be as independent as possible. .

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allow the individual to be as independent as possible. This included the management of falls. We saw that grab rails had been fitted in hallways and in bathrooms to promote mobility and encourage independence safely.

The service also provided entertainment people who used the service to enjoy following a suggestion at a home meeting.

Is the service well led?

The home is managed by the registered business manager with the support of the head of care and team leaders. They have a good understanding of the needs of the people who used the service.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment.

Complaints and accidents were monitored and the provider discussed the management of these in order to reduce the reoccurrence of these.

You can see our judgements on the front page of this report.

People who used the service told us that they enjoyed living there and that they had been involved as much as possible with their move to the home. One person told us "My daughter did all that for me", and she made a good choice.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Relatives told us they were generally kept informed of events in the home and any significant chances to their family member's care and treatment.

The home was busy with people undertaking a variety of activities. Some people who used the service were going on a trip organised by a voluntary group and were looking forward to it. Some people were having their hair "done" by the visiting hairdresser, others were watching television, reading their daily newspaper, or enjoying the garden.

We saw that staff were polite and professional and addressed people in an appropriate way. People who used the service told us that staff were kind and caring.

Staff felt they had the training and support necessary to undertake their roles and meet peoples assessed needs.

People were very satisfied with the catering arrangements and told us that the food was very good.They said " we can have a choice and have extra if we wish.

We saw the service had quality assurance monitoring processes in place to measure the quality of the service provided. Feedback was acted upon.

People told us that they were happy living at the home and that the care and support they received was good. We spoke to six people who used the service, one said that they "Couldn't fault it" and the care was "Very, very, very good".

We saw several examples where people were supported by staff in an appropriate manner. We also spoke to three relatives who told yus that they felt that the care that people received was "Good".

We found that there were suitable arrangements in respect of the administration of medicines. People told us that they felt "Safe". One person said that “When it’s time for my medication, they knock before entering; when I have guests they ask me if they would like the guests to stay or leave the room whilst I have my medication”.

We found that many of the staff had not received up to date training and supervision which could affect the care and support that was provided.

People were very positive in their feedback of the home. They said that they were always kept informed about their care and treatment. They told us that there is plenty to do, and it was their choice if they wanted to join in the daily activities provided. One person was excited about going to Bognor Regis with a group of service users for a holiday accompanied by staff. We were told that staff are kind and caring and treat people with respect. There was good comments about the meals provided and someone told us that the food was plentiful and tasty.