This inspection was completed on 2 August 2018 and was unannounced.

Ryehill Country 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.

The service provides accommodation and care for a maximum 24 older people and up to four people attending day services each day. There were 22 people living at the service and one person attending day services at the time of the inspection.

The service had a manager who had registered with the Care Quality Commission. 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 previous inspection in December 2015, this service was rated good overall. This is the first time the service has been rated requires improvement.

Notifications relating to safeguarding incidents had not always been made to the local safeguarding authority, or CQC as required by law. We reviewed the service's safeguarding records and found there were incidents of safeguarding which we should have been notified of.

Parts of the environment were not always safe. The laundry area was accessible to people and we found this contained substances which would be hazardous to people if ingested. There was no evidence that the fire alarm and detection system had been serviced by a competent person since December 2014. An upstairs toilet was dirty around the bottom, and a metal pedal bin had mould around the base. A landing window contained bird faeces on the sill.

The registered manager was able to demonstrate they had an understanding of Deprivation of Liberty Safeguards (DoLS) and the Court of Protection. However, we found that Mental Capacity Act (2005) guidelines were not always followed. We have made a recommendation about this.

The quality assurance system in place was not always effective. Checks carried out failed to identify and mitigate risks to people regarding infection control practices and the safety and maintenance of the premises. The system had failed to identify the MCA had not been applied consistently. The registered manager began to address some of the concerns we raised during the inspection.

People told us they felt safe living at the home and that they would tell someone if they were worried about anything. Staff were able to demonstrate they knew the different types of abuse and how to report any safeguarding concerns and had access to training on how to safeguard people from abuse.

Risks to people had been identified and recorded in their care plans. Where people presented with behaviours that placed others and themselves at risk of harm, staff knew how to support them.

Recruitment practices were robust to ensure the suitability of people who worked in the service. There were sufficient numbers of suitably skilled and experienced staff positioned across the service to meet the needs of people and keep them safe.

Medicines were managed safely and staff had appropriate training.

We saw that staff completed an induction process and had regular training to equip them with the skills and knowledge to meet people's needs.

People's nutritional and hydration needs were assessed and planned for. People enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day. People’s comments were positive about the provision of food and drink.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. The guidance contained in some care plans was not always sufficiently detailed on how staff were to suppor

This inspection took place on 4 December 2015 and was unannounced. We previously visited the service on 25 June 2013 and we found that the registered provider met the regulations we assessed.

Ryehill Country Lodge provides accommodation and care for up to 24 older people and up to four people receiving day care each day. The service is in the village of Ryehill to the east of the city of Hull and has two wings named Cottage and Nielson. There are both single and shared en-suite bedrooms. The upper floor is accessed by a stair lift and there is parking to the front of the house for up to eight cars. There were 23 people living in the service and two people receiving day care at the time of the inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (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.

People told us that they felt safe whilst they were living at Ryehill Country Lodge. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities for protecting people from the risk of harm.

Staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people’s individual needs.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. They told us that they felt well supported by the registered manager, could approach them if needed and received formal supervision. The training records evidenced that staff had completed training that equipped them to carry out their roles effectively.

People told us that staff were caring and that their privacy and dignity was respected. We found people were cared for by staff with a positive and responsive approach. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs.

Comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided.

People benefitted from a system of quality monitoring, to which they could contribute their views, be listened to and have a say in how the service was run.

People experienced care, treatment and support that met their needs and protected their rights. Their needs were assessed and their care was planned: care plans were used as working documents to ensure their needs were met. People said, "I am quite contented. No one is ever rude or unkind and I am safe living here" and "It is just like living at home."

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. One person said, " Staff look after my medicines, I prefer it that way."

People were protected from unsafe or unsuitable equipment. We saw that people used equipment they had been assessed and risk assessed for and we saw that staff were skilled in using equipment.

There were enough qualified, skilled and experienced staff to meet peoples' needs. Staff were satisfied with their shifts and said they liked coming to work. They covered each others' absences and had sufficient support from their seniors and manager.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare

of people using the service and others. Audits and surveys were used to obtain peoples' views, but the main quality monitor was the manager's discussions with people and relatives and daily observation of peoples' demeanour and the care they received.

We spoke with three people who used the service about their experience of living in the home.

People told us they understood the care choices available to them. They told us they were asked about their opinions and that their privacy and dignity was respected.

People told us they had their needs well met. They thought the service of care in the home was excellent and that the staff were kind and courteous.

People said they liked the food and they could ask for drinks any time.

People said they thought the home was comfortable and they had furniture and equipment to meet their needs.