Ritson Lodge 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.

Ritson Lodge provides care and support for up to 60 people who live with dementia and have nursing or residential care needs. At the time of the inspection, there were 49 people using the service. People were accommodated across three separate units in the home: Seabreeze (nursing care), Seashore (residential care) and Memory Lane (dementia care).

At our last inspection 31 October 2017, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. There were concerns over staffing level arrangements and the service was not consistently well-led. We rated the service 'Requires Improvement' overall. We told the provider to submit an action plan of how they intended to address the concerns we raised. At this inspection 31 October 2018, we found the provider had not made satisfactory improvements to ensure that they were consistently delivering a quality safe service and that standards of care had deteriorated.

During September and October 2018, we received several whistleblowing concerns, safeguarding concerns and other information of concern about the service. We therefore brought this scheduled inspection forward, so that we could check that people were receiving safe care. At this inspection we found people’s health, safety and well-being was being compromised in multiple areas and identified significant concerns regarding the management and leadership of the service due to ineffective governance and oversight arrangements. People were being put at risk of harm due to unsafe management of medicines, poor record keeping and ineffective risk management. We have rated this service overall inadequate.

We found the home was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One of these regulations is a continued breach from the last inspection 31 October 2017. You can see what action we told the provider to take at the back of the full version of the report.

Since the last inspection there had been several changes of manager. The registered manager of Ritson Lodge was no longer employed by the provider nor was the provider’s operations manager, who had been brought in as their replacement. A third manager has been appointed and they are in the process of registering with CQC. 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.

There were ineffective governance oversight arrangements in the service. The provider had not made the improvements expected since the last inspection, as a result people did not consistently receive safe care and remained at risk of harm. Systems in place to monitor the quality and safety of the service provided were not robust enough for the service to independently identify shortfalls and mitigate risk.

Risks to people’s health, safety and welfare were not managed effectively, placing them at significant risk. People’s care records were not always person centred and accurate. They lacked information to guide staff in how to meet their needs safely and effectively.

Systems for the safe management of medicines and safeguarding people from abuse were not robust. The service was not consistently working within the principles of the Mental Capacity Act 2005.

Although staff were caring in their approach, people were not consistently supported in a way that upheld their dignity and respected their privacy. Activities did not always meet the individual and specialist needs

The inspection took place on 31 October 2017 and was unannounced.

Ritson Lodge provides accommodation, nursing and personal care for up to 60 people, some of whom were living with dementia. At the time of our inspection, there were 50 people living in the service.

Ritson Lodge accommodates up to 60 people across three separate units; Seabreeze (nursing care) Seashore (residential care) and Spindrift (memory lane).

Ritson Lodge 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.

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 2008 and associated Regulations about how the service is run.

At our last inspection on 20 May 2015, we rated the service as Good.

During this inspection we found that the quality assurance and auditing mechanisms did not identify concerns we found during the inspection. Concerns regarding staffing levels had not been addressed promptly by the provider to ensure people were receiving responsive care. Some relatives told us that communication needed to improve between them and the management team. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, for good governance. You can see what action we told the provider to take at the back of the full version of the report.

The culture in the service was welcoming, friendly, and person-centred. The management team presented as open and transparent throughout the inspection, seeking feedback to improve the care provision.

People did not always receive the time and attention they needed to fully meet their needs. At times staff were unable to respond to people as quickly as they would like or perform their role effectively. This impacted on staff's ability to provide care which was consistently dignified and respectful.

Appropriate arrangements were in place to ensure people's medicines were obtained, stored and administered safely. Documentation relating to ‘as required’ and variable dose medicines were not always clear and accurate.

Activity provision was delivered by two activity co-ordinators within the service. However, some feedback suggested that this did not always meet the individual needs of people, and we have asked the service to review this to ensure it is effective.

People were referred to other health care professionals to maintain their health and well-being in a timely manner.

Staff interacted with people in a kind and caring manner. Staff were patient with people, and skilled in using different methods of communication which reassured people.

The service was meeting the requirements of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS). Staff understood the need to obtain consent when providing care. 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.

Staff were able to recognise abuse and knew how to report concerns if they suspected a person was being abused. Systems were in place to discuss potential safeguarding issues so they were escalated appropriately.

There was a complaints procedure available in the service for people and relatives to raise concerns.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

Ritson Lodge is a nursing home that provides nursing care, support and accommodation for up to 60 older people, some of whom are living with dementia. At the time of our inspection there were 37 people living in the home.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

Our previous inspection of September 2014 identified concerns that people were not fully protected from the risks of unsafe or inappropriate care and support because some of the care planning records held incomplete information and had not been reviewed. During this inspection we found that improvements had been made.

Our previous inspection of September 2014 also identified concerns that there were not always enough staff on duty to meet people's needs. This was because not all staff absences had been covered. During this inspection we saw that improvements had been made to the consistency of staffing levels.

Appropriate recruitment procedures were followed with criminal record checks being carried out and suitable references obtained before people started working in the home.

Clear information regarding what constituted a safeguarding issue and directions on how to contact the safeguarding team were available for people and staff. Staff had regular training and updates on this subject. Staff knew how to recognise signs of possible abuse and were confident in the reporting procedure.

Identified risks to people’s safety were recorded on an individual basis, with guidance for staff to be able to know how to support people safely and effectively.

As Ritson Lodge was a new and purpose built home, a number of potential risks to people’s safety had been considered during its construction, to ensure the premises were as safe as possible.

The nurses were proficient with regard to the safe handling and administration of people’s medicines and people were able to safely take their medicines as prescribed. Staff were well supported and training was provided regularly. Staff could also attend additional courses, if they identified a need. Staff had the skills to assist and encourage people who may challenge the support offered.

The Care Quality Commission (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. These safeguards protect the rights of adults using the services by ensuring that, if there are restrictions on their freedom and liberty, these are assessed by professionals who are trained to assess whether the restriction is needed.

DoLS were being applied appropriately and mental capacity assessments had been completed for people living in the home. The appropriate procedures were being followed for people who were being deprived of their liberty and regular reviews were carried out to ensure the deprivation authorisation was still relevant.

People had sufficient amounts to eat and drink in the home and people who required support to eat were encouraged and supported appropriately by staff. Where needed, people’s weights were monitored, together with their intake of food and drink. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive and call bells were answered promptly. People were treated with respect and staff preserved people’s dignity. Relatives could come and go as and when they wished and were welcome to stay for meals if they chose. People were also able to follow pastimes of their choice, as well as joining in with group entertainment, events or activities.

Assessments were completed prior to admission, to ensure people’s needs could be met and people were actively involved in compiling their care plans. Where people were unable to do this, their relatives or other appropriate people had contributed either with them or on their behalf. Care plans and assessments were clear and detailed and gave a full description of need, relevant for each person. Risk assessments detailed what action was required or had been carried out to remove or reduce the risk.

People were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible.

Improvements were evident since the new manager had been in post and consistency and communication was much better throughout the service. The manager and deputy manager were hands on and approachable and operated an open door policy. ‘Resident and Relatives’ meetings were being held more often.

There were a number of effective systems in place to regularly monitor the quality of the service being provided for people and a number of different methods were used throughout the year, to obtain people’s feedback regarding their thoughts on the quality of the service they were receiving.

The inspection team who carried out this inspection consisted of two inspectors. They spoke with fifteen of the thirty-four people who were living at the home, six relatives and eight staff members. We carried out this inspection to look into the concerns we had been told about regarding insufficient staffing levels and staff training, inadequate medication administration procedures and poor cleaning standards at the home. During the inspection, the two inspectors worked together to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People told us that the staff working at Ritson Lodge were kind and treated them with respect. However, they told us that they sometimes had to wait for help because the staff were busy. They and their relatives said that there were not always enough staff working in the home to provide people with the care and support they required, when they needed it. Improvements were needed to ensure that there were sufficient numbers of staff on duty to meet the needs of people living at the home. A compliance action has been set for this and the provider must tell us how they plan to improve.

The environment was seen to be safe, clean and hygienic in all areas. Infection control procedures were robust and people were protected from the risk of cross infection. We found that people had received their medication when they needed it and that the provider had monitored the medication administered to people.

People received the care and support they needed. However, some people’s care planning records were incomplete and were not all up to date. The information and guidance that some contained put people at risk of receiving inappropriate and unsafe care and support. Improvements were required to ensure that accurate records were held. A compliance action has been set for this and the provider must tell us how they plan to improve.

The service was meeting the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). There was a process in place in relation to DoLS and policies and procedures were held by the provider. There was a plan in place to ensure that all staff had been trained and knew when a DoLS application was needed. The manager knew how to submit a DoLS application to ensure that people who could not make decisions for themselves were protected.

Is the service effective?

People’s health and care needs were assessed by staff but had not been reviewed with them or their family member. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person told us. “This is a nice home and the staff will do anything to help you.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that the staff were sometimes busy but did not rush them. Our observations confirmed this. A visitor told us. “I am happy with the care given to my family member. The members of staff are polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed but not all had been recently reviewed. The care and support provided was adjusted to meet the needs of each person. Improvements were being made to ensure that any change in care and support was recorded in the person’s plans of care. A record was held of people’s preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People did not have access to a range of planned daily activities because the staff were too busy to provide them. The manager showed us that improvements would be made when the new activities co-ordinator was in post.

Is the service well led?

Staff we spoke with had an understanding of the ethos of the home and quality assurance processes were in place. Relatives told us that they had been asked for their feedback on the service their family member received. Visitors and staff said that they had recently felt listened to when they had made a suggestion or raised their concerns. People told us that the new manager was approachable.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with four people who used the service, the manager, a supporting manager and three members of staff. We reviewed records relating to the management of the home which included, five care plans, daily care records, training records, support/supervision records of staff and quality information.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

The four people who used the service told us that they were happy with the care and support provided. Two people told us that they felt safe, and one person said, “I would go straight to the manager if I thought there was a problem."

We looked at five sets of care records. Prior to a recent management change, risk assessments were not always in place, for example to minimise the risk of choking for people with swallowing difficulties. However we were satisfied that measures had been put in place to minimise any risks to people who used the service that ensured they were supported safely. For example, risk assessments were in place to ensure that the environment in which care was provided was safe, that medication was safely administered and that people who needed to be moved with a hoist were transferred safely. We also saw that risks to people’s health and wellbeing through malnutrition, falls or pressure ulcers were assessed and minimised.

Care plans detailed the support required by people and how this was safely delivered but we noted that further improvements were needed to ensure the safety of people who used the service. For example, diabetes care plans to guide staff in safely managing people’s condition.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. The new manager of the service was aware of the procedures and explained a recent occasion where such an application had been considered. We were satisfied that people who used services would only be deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards.

There were sufficient numbers of trained and competent members of staff employed to provide people with safe and appropriate care as identified in their assessment and care plans.

Is the service effective?

During our inspection we saw that people who used the service were treated with dignity and respect. However, we noted a lack of involvement in day to day matters regarding their care. This was borne out at a meeting held with the new manager a few days prior to our inspection.

Quality assurance measures were in place to identify the quality of the service offered but we found that in past months these had not been effective. A monthly quality visit had identified issues of concern but these were not addressed and merely repeated on subsequent monthly reports

Is the service caring?

We saw that people were cared for in an appropriate manner. However, although records were in place to show that people’s needs had been assessed, we noted that they did not contain sufficient detail and were of variable quality.

During our inspection we spoke with four people who used the service. They said they were happy with the care and treatment they received. One person we spoke with said, "I feel well looked after, staff are very good but on occasions there are not enough staff." We asked whether call bells were answered quickly and whether staff were available when they needed support and they told us that, "It has not really affected me personally but I know others have commented." We asked them about activities that were arranged and they said, "There are things to do some of the time, but there is not enough stimulation of the mind for me." They said they enjoyed reading and had access to newspapers, books and magazines and their own telephone which enabled them to keep in touch with family and friends.

Another person we spoke with said their care was, "Satisfactory." They told us about a film that had been shown that afternoon and said, "It was really interesting, the reminiscence work here is really good."

Is the service responsive?

The five records we looked at showed that people's needs, choices and personal preferences had been assessed and planned for. However, the quality of the assessments was variable and some related to their stay in another service. Records we looked at during our inspection did not provide sufficient detail about the individual person, their likes and dislike, cultural or spiritual needs and social interests. This meant that people’s individual needs were not identified or met.

Is the service well-led?

A new management team had been introduced to the service shortly before our inspection. It was clear that problems from previous management of the service were still impacting on the quality of care provided. However, we saw that an action plan had identified the issues and some of the more urgent actions needed had already been taken

There were monitoring and reviewing systems in place to measure the quality of the care and support provided but these were not always effective. There was no evidence of any analysis of incidents or accidents. We spoke with three members of staff who told us that they had the training and support they needed to safely do their job, which they said they enjoyed.

Records showed that staff had received support and supervision in the past month but this had not been delivered consistently prior to that.

We were satisfied that the changes made to the management team and the new measures being introduced would ensure that the service was managed better in the future

During our inspection we spoke with eight people who used the service. They told us that they were happy with the care and support they received. One person told us that the staff were, "Always so careful with me, they are lovely." Another person said, "They (the staff) are always asking if everything is OK, they are very interested in everything I say."

People told about the care they received. One person said, "It’s marvellous, there doesn't seem to be anything we can't have." Another person told us that," I feel safe and well looked after. The staff here treat us very well indeed."

We found that records maintained by the service were up to date, stored securely and readily available although we did see two areas within the care records that required improvement. The provider was made aware of this and agreed to take action immediately.

People who used the service were safe and knew who to speak with if there was a problem, and the staff team had received the required training in safeguarding adults from abuse as well as a range of other relevant training. Recruitment procedures were robust ensuring staff had the values and qualities required to look after the needs of people who used the service.