We inspected the service on 22 and 23 March 2018. The inspection was unannounced. Ridgeway Care Centre is a care home providing accommodation, and personal care for people who live at the service. 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. Ridgeway Care Centre accommodates up to 32 people. On the day of our inspection 28 people were using the service.

A registered manager was in post and they were available during the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we previously visited the service we found them to be in breach of regulation 11 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. This related to consent and following the principles of the Mental Capacity Act. At that inspection the service was rated as requires improvement. At this inspection we found evidence to show they were no longer in breach of this regulation. However, we found further breaches of the regulations.

People were not always protected from abuse, as although there were processes for staff to report any concerns they had, we found they had not always done this. The risks to people’s safety were not always robustly assessed and information in people’s care plans about the level of risk was not always correctly assessed. However staff were knowledgeable about people’s individual risks and how to mitigate these.

People were not always supported in a timely way as recent changes in practice had affected staff deployment and this had been poorly coordinated by the management team. People’s medicines were not always managed safely and efficiently.

The cleanliness of the service was, in general, maintained but there were some areas of kitchen cleaning practices that needed addressing. There was a lack of learning from incidences in some areas of care.

People’s needs were assessed using nationally recognised assessment tools and staff had the skills to support them with their needs. Staff worked to ensure people had the freedom to express their choices and they were protected in line with the Equality Act.

Staff supported people with their nutritional needs and their relatives felt staff managed their health needs well. People lived in an environment that had been adapted to meet their needs and they were supported in line with the mental capacity act

We found staff caring and kind towards the people they supported and respected their views on their care. However, staff did not always respect people’s privacy and there were a number of occasions we noted staff did not knock on people’s bedroom doors before entering.

Some information in people’s care plans was not consistent, and the care plans did not all provide up to date information on the care people required.

The Accessible Information Standard for people was not always met. There was a lack of pictorial menus displayed for them and some people would have benefited from an easy read version of the company’s complaints process being displayed.

Although some activities were provided for people at the service, there had been a lack of an activities coordinator over the previous three month. During our inspection we saw a large number of people lacked the stimulation of social activity.

The registered manager responded to complaints in line with their company’s complaints policy and we saw this was displayed in the entrance of the service.

People were given the opportunity to discuss their end of life wishes.

There was a lack of consistent oversight of the service from

Ridgeway Care Centre was inspected on 4 and 5 September 2017. The inspection was unannounced. The service is registered for 32 people and 27 people were using the service on the day of inspection.

The service should have 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. At the time of the inspection there was no registered manager in post, however the present manager was in the process of applying to become registered with the Care Quality Commission (CQC).

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The home manager shared information with the local authority when needed and acted on concerns when they were raised.

The risks to some people’s safety were not always robustly assessed. However, staff showed a good knowledge of the risks to people’s safety and worked to protect them from these risks.

People were supported by adequate numbers of appropriately trained staff and their medicines were administered safely by staff who were supported to carry out this role.

The principles of the Mental Capacity Act (MCA) were not always followed so we could not be sure people’s right were protected.

People received a varied and nutritious diet and were supported with any special requirements to ensure they received a suitable diet in a safe way. People’s health needs were well managed.

People were supported by a group of caring and kind staff who understood and accommodated their needs and preferences. Staff supported people to be independent and they worked to ensure people’s privacy and dignity was maintained.

People told us they received individualised care but we found their care plans did not always contain enough up to date information to show their current needs.

People were supported to undertake social activities of their choice and staff worked hard to prevent people from becoming isolated. People felt able to raise concerns and felt they would be listened to.

The manager worked hard to improve team work at the service and people told us they were a visible and supportive manager. The manager was in the process of making changes to systems to improve the quality of the service.

We inspected Ridgeway Care Centre on 4 February 2015. The inspection was unannounced.

At the last inspection on 1 May 2014, we asked the provider to take action to make improvements to the way they managed risks associated with the premises and the completion of care records. These actions had been completed.

Ridgeway Care Centre provides care for up to 32 older people, some of whom may experience needs related to memory loss. It is located in the centre of the town of Lincoln. There were 30 people were living in the home during the inspection.

There was a registered manager in post at the time of the inspection. They were not available on the day of the inspection. The deputy manager and another manager from within the provider’s organisation were available. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection two people who used the service had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act, 2005 DoLS.

People were safe living in the home and they were treated with dignity and respect. They were able to access appropriate healthcare services and nutritional planning took account of their needs and preferences. Their medicines were managed safely.

People were involved in planning the care and support they received and staff respected their views about the way they wanted their care delivered. They were also supported to enjoy activities and interests of their choice.

There was a positive and open culture within the home. People could voice their views and opinions to managers and staff and felt able to raise concerns or complaints if they needed to. Managers and staff listened to what people had to say and took action to resolve any issues.

Staff were appropriately recruited to ensure they were suitable to work with vulnerable people. They received training and support to deliver a good quality of care for people. They understood how to identify, report and manage any concerns for people’s safety and welfare. They delivered the care that was planned to meet people’s needs and took account of their choices, decisions and preferences. They delivered the care in a patient, warm and friendly manner.

The registered manager and the provider maintained systems to regularly assess, monitor and improve the quality of the services provided for people.

This inspection was carried out by one inspector. We met with ten people who used the service and observed their experiences of care to support our inspection. We spoke with the registered manager, four staff, and two relatives.

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. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. People told us that they were happy living at the home and were supported to remain independent as safely as possible. They also told us that they felt their needs were met because staff supported them. People also told us that they felt safe living at the home and their relatives confirmed this. We saw safeguarding procedures were in place and that staff understood how to safeguard the people that they supported. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements.

We found a shortfall in the accuracy of care records, including for example; risk assessments, nutrition tools, and personal evacuation plans. This meant that people were at risk of unsafe or inappropriate care and support. We asked the provider to tell us what they were going to do to meet the requirements of the law in relation to the maintenance of accurate and appropriate records.

The registered manager had suitable arrangements to safeguard people from foreseeable emergencies.

There were general risk assessments in place to protect people who lived at the home, staff and visitors.

There were regular audits completed to make sure that the building and procedures were maintained and further improved and provided a safe environment for people to live in, although we found that not all actions were completed.

Is the service effective?

All of the people we spoke with and their relatives, told us that they were happy with the care that was delivered and their needs were met.

We were told that a new activity coordinator was being recruited to ensure that activities were maximised within the home.

We saw staff displayed a good understanding of the people they cared for. We observed staff calming down one person who had become agitated by talking with them about a hobby they liked.

Staff had received training to meet the needs of the people who lived at the home.

Is the service caring?

People told us that were happy with the care provided and that the staff were caring. One relative told us, “The staff have been very good to me and my family.”

Observations during the visit showed staff were compassionate and caring to the people they supported. We saw staff responded quickly to people who required support.

We saw from records that people who lived at the home had been escorted to hospital by staff when a visit was required. This meant that people, particularly those with dementia related health conditions, were provided with familiar staff faces to support them outside of their usual environment.

Is the service responsive?

Information was collected by the service with regard to the person’s ability and level of independence. Regular reviews were carried out to make sure the person’s care and support needs had not changed.

Information collected by the service also gave staff an insight into the interests, likes and dislikes of people in their care. Staff told us this information enabled them to understand what was important to the people who lived at the home.

Staff were knowledgeable about the support needs of people and the services ethos of maintaining safe independence and involvement of the person whatever their level of need.

One relative told us that they had been impressed by the level of communication they had received since their relative had moved into the home. They told us, “Staff have not only looked after my relative, but me and my family too.”

Meetings took place with staff and the people who lived at the home, to discuss the running of the service and to ensure the service was responsive to people's changing needs. People who lived at the home were able to discuss their views. This meant that people were involved in communications about the running of the home and staff listened and took action. People we spoke with confirmed they felt that they were listened to and knew who to contact if they had a problem. One person told us about changes to the menu that had occurred when they had verbally complained.

Is the service well-led?

People who used the service had regular contact from the registered manager and other senior staff to check their wellbeing. The quality of service provided by care givers was monitored and this was done through quality audits and also through meetings arranged with the people who used the service.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with eight people who used the service and a relative and asked them for their views. We also spoke with three care workers, the activities coordinator, the deputy and the registered manager. We also looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff.

We found where people were able to they gave consent to their care and support. A person told us, “I signed my care plans when we talked about them.”

We found people had a choice of suitable and nutritious food and their preferences were taken into account. One person told us, “The Sunday dinners are really good, but I miss not having the crackling on the pork. Another person said, “We get pasta, I love pasta.”

We found there were suitable arrangements for the management of medicines. A person told us, “They always have my tablets, I have never run out.”

We found the provider had taken steps to ensure there were sufficient and suitable staff available. One person told us, “They (staff) are very good, if I ask for anything they will help me.” A relative told us, “I have never thought there are not enough staff on, there always seems to be someone around.”

We found people’s comments and complaints were acted upon. A person told us, “If I say anything is not right they are straight onto it.”

We asked people if they were happy with the care and support they received and one person told us, “They are lovely staff, I love living here.” Another person said, “I can’t fault it, “The food is very good. Everywhere is always clean. I like to play bingo, we can win prizes like make up or bath salts and sometimes jewellery.”

We asked people if they felt safe in the home and they said they did. One person said, “I have to have someone with me when I’m walking otherwise I might tumble.”

People said staff were always there for them, one person said, “If I need someone when I am in my room I only have to ring the bell.” People told us the staff knew how to meet their needs. One person said, “There isn’t anybody that doesn’t know what they are doing, I trust them all, that’s why I am happy here.”

People said they were supported to be as independent as they were able to be and they thought their privacy and dignity were respected. One person said “I have to rely on people, I can wash my hands and face but I need someone to get me dressed.” Another person stated, “I can look after myself and do so.”

We asked people if they felt the care they received was appropriate to their age and gender and they said that it was. They also told us their healthcare needs were met.

People told us they felt safe in the home and this was helped by having people around them. They said staff knew what they were doing. One person told us, “They know what they are doing, but some are not as experienced as others, they have to learn.”