This inspection was carried out on 8 August 2017 and was unannounced. The inspection was prompted in part by notification of an unexpected death. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of medicines, management of weight loss and skin care. This inspection examined those risks.Ramsgate Care Centre provides accommodation and personal care for up to 42 older people and people living with dementia. The service is a large purpose built property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. There were 40 people living at the service at the time of our inspection.
The registered manager was leading the service and was supported by an area manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. 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.
At our inspection in April 2015 we found that accurate and complete records had not been maintained in relation to people’s medicines. At our inspection of August 2016 we found that some improvements had been made. At this inspection we these improvements had not been consistently maintained and accurate records had not been maintained in relation to all the medicines people received. There was a risk that information would not be available to staff and health care professionals to help them plan people’s care. The stock of one person’s medicine was inaccurate by one tablet. Other records about people’s care were accurate and complete.
At our last inspection we found that checks on the quality of the service had not been effective. At this inspection we found that checks on the quality had been completed to make sure it was at the standard the provider required. Action was taken quickly to address any shortfalls found. However, the most up to date medicines check had not identified the shortfalls we found at the inspection.
Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. The registered manager understood when CQC should be notified of significant events however we had received notifications as required.
People told us the menu was 'boring' at our last inspection. At this inspection we found that staff had planned menus with people and people were offered a balanced diet. People told us they enjoyed the food and there was a wide variety of food on offer. Meals were prepared to meet people preferences and spiritual and cultural needs.
People had privacy and staff provided the supported they needed discreetly. People were involved in planning what happened at the service. Staff and people planned the activities on offer together. People told us they had enough to do every day and were planning outings.
At our last inspection we found that some risks to people had not been assessed and action had not been taken to mitigate all risks. At this inspection we found that assessments of people’s needs and any risks to them had been completed. People had agreed ways to manage risks with staff. Their care was planned and reviewed with them, to keep them safe and help them be as independent as possible. People’s care plans had been reviewed and updated when their needs changed. People were supported to have regular health checks such as eye tests.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had applied to the supervisory body for a DoLS authorisation when people who lacked capacity to consent were restricted. People were supported to go out and could move around the service and grounds freely. Staff followed the principles of the Mental Capacity Act 2005 (MCA) and supported people to make choices in all areas of their life.
Plans were in place to keep people safe in an emergency, including plans to evacuate people from the building. Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team.
Complaints received had been investigated and people had received a response to their concerns. People and their representatives were confident to raise concerns and complaints they had about the service.
At our last inspection we found that action had not been taken to seek and act on feedback people and other stakeholders. At this inspection we found that people, their relatives, staff and visiting professionals were asked for their views of the service. Everyone was satisfied with the service provided. Staff had regular opportunities to share their experiences of the service and told us the management team supported them to try new ideas they had.
The registered manager supported staff to provide a good level of care and held them accountable for their practice. Staff were clear about their roles and responsibilities. They shared the provider’s view of a good quality service and were motivated.
There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staff worked as a team to meet people’s needs.
The provider had recruitment procedures in place and staff had been recruited safely. Staff had completed the training and development they needed to provide safe and effective care to people and held recognised qualifications in care. Staff met regularly with the registered manager to discuss their role and practice and were supported to provide good quality care.