This inspection took place on 15 August 2017 and was unannounced. This meant the provider and staff did not know we would be visiting.

Ann S Proctor House is a care home located in Shotley Bridge. It is registered for the regulated activity of accommodation for persons requiring nursing or personal care. It can accommodate up to 14 people who have a learning disability. At the time of our inspection 11 people were using the service.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service remained Good.

The service had a registered manager. 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 the service kept them safe. People’s support needs were regularly reviewed to identify any risks to them. The premises and equipment were regularly reviewed to ensure they were safe for people to use. People were safeguarded from the types of abuse that can occur in care settings. People’s medicines were managed safely. Staffing levels were monitored to ensure they were sufficient to provide safe support. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

People were supported to access external professionals to maintain and promote their health. Staff were supported with training and regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) were protected and promoted. People were supported to maintain a healthy diet.

People, their relatives and friends consistently gave very positive feedback on the service. We saw numerous examples of very kind and caring support and interactions between people and staff. The manager and staff said providing high quality, personalised care was at the heart of what the service did. People had very close but professional relationships with people. The emphasis and ethos of the service was of it being people’s home. Principles of equality and diversity were applied by staff when planning and delivering care. Staff encouraged people to be as independent as possible while also being available to provide support when needed. Independence was emphasised in people’s care plans. People’s privacy and dignity was protected at all times. Policies and procedures were in place to support people to access advocacy services should this be needed.

People received personalised care based on their assessed needs and preferences. People were supported to access activities they enjoyed. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service. Staff said they felt supported in their role and involved in the running of the service. The manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was regularly sought from people using the service and their relatives. The manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

During the inspection we were able to observe the experiences of the ten people who used the service. We also spoke with people who used the service. We spoke with carers of people who used the service, two staff, the manager and proprietor. One person who used the service told us, “It’s alright here, I love it, and the staff will always help me”. Another person told us that, “You can go and see the staff about anything and they will help you”. Most of the people at Proctor House had learning disabilities which limited their ability to communicate and some could not tell us their views.

We were able to observe the experiences of people who used the service. For instance, we spent time with people as they had their breakfasts and lunches and observed how staff supported and encouraged them. We saw staff encouraged people to make their own choices and decisions. We saw staff understood each person’s different needs, for example, when they required additional support.

We saw that staff supported people to make choices about how they spent their day and the range of activities offered. On the day of our visit some of the people who used the service went out to various day centres and clubs. We saw staff had supported people as they got ready to go out.

We saw that staff treated people with dignity and respect. People had freedom of movement around their home and could spend time in their bedrooms whenever they wanted.

We saw that each person had their own bedroom which was personalised. We saw the provider had made suitable adaptations to meet people’s physical needs.

We observed that staff respected people’s privacy and knocked before they entered their rooms. We saw that the staff communicated well and appropriately with people in a way that was easily understood.

People told us that there had been activities in the home if they wanted to take part. Some people preferred to go out. One person told us, “I am going to my day centre today, and I go to my friendship club on Friday”.

The manager had carried out a survey of people who used the service, the staff, and relatives. In the survey everyone said that the care at the home was very good, the staff felt they had been supported and the people who used the service felt safe.

We found that before people received any care or treatment they were asked for their consent and the provider had acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service were protected and safe. We found that there was an effective infection control system in place and that the home had a clean and suitable environment.

We found that people who used the service had their care and welfare needs met.

We found that staff were well supported to deliver care and treatment safely. We were able to speak with two staff on duty at the home. Both of the staff told us they were well supported by their manager.

We found that people’s views were important and listened to. We found that there was an effective complaints system in place.

We watched how the staff supported the people in their care. We saw that staff talked with people in a respectful manner and had a good understanding of their communication and psychological needs. We saw how staff encouraged people to take part in the daily activities within the home. One person made their own lunch, whilst other people helped to set the table for the evening meal. In these ways people’s dignity was respected and opportunities provided for people to retain/develop their independent living skills.

People were supported to make choices. One person told us how she had chosen the decoration for her bedroom. They also told us that they could get up and go to bed when she wanted.

People told us how they were involved in the local community. They told us they took part in the weekly food shop and attended local clubs, where they met up with their friends.

People also told us how their social needs were met. They told us that they regularly went out with staff, for example to Washington Galleries shopping or Dobbies Garden Centre as well as trips to Saltwell Park.

One person told us that they had been to visit friends that weekend. They also showed us a scrapbook, which staff had helped them to make, which contained lots of photographs and information about the person’s family, friends, trips and holidays. Other people told us of their plans to go to Haggerston Castle Caravan site for a holiday.

People told us that if they were unhappy or had any concerns they would talk to the manager or the staff. One person commented “If I’m not happy I would talk to the staff.”

Other comments from people included:

“I love it here”, and “I like the staff and Sheila (the manager). We are well looked after.”

The inspection took place on 1 and 2 July 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We last inspected this service on 28 October 2013. The service was meeting all our regulatory standards at that time.

Ann S Proctor House Care Home, known to people who live there as Proctor House, is a small care home in Shotley Bridge providing residential care for up to 14 adults with learning disabilities. There were 12 people using the service when the inspection took place.

The service has a Registered manager in place. 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.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service. All staff were sufficiently trained in core areas such as Safeguarding, as well as training specific to the individual needs of people using the service. We found that staff were passionate about providing the best care possible for people using the service and were knowledgeable regarding their needs, likes and dislikes. People’s preferences were considered and acted on with regard to meal options, personalisation of bedrooms and activities.

Capacity, compassion, dignity, respect and independence were themes underpinning management and staff behaviours, as well as the Service User’s Charter put in place by the provider. We observed these behaviours during our inspection and saw evidence of them in recorded documentation. Visitors and healthcare professionals also told us that people were treated with dignity and respect.

There were effective pre-employment checks of staff in place and robust supervision and appraisal processes.

The service had in place person-centred care plans for all people using the service and we found people using the service were partners in their care planning. The provider sought consent from people for the care provided and regular reviews ensured that people’s voices were heard and their medical, personal and nutritional needs met.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The Registered manager was knowledgeable on the subject of DoLS and had provided appropriate paperwork to the local authority to deprive people of their liberty, where it was in their best interests.

The service had robust risk assessments, policies and procedures in place to deal with a range of eventualities. We saw these processes were reviewed regularly and that the service was flexible enough to update and add to such processes where individual needs, or external guidance on best practice, changed.