We inspected Blyth Country House Care Home on31 July 2017. This was an unannounced inspection. The service is registered to provide accommodation and nursing care for up to 30 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 26 people living at the service.

At our last inspection on 10 March 2015 the service was found to be fully compliant and was rated good in all areas.

A registered manager was in post and present on the day of 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. They were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Meaningful activities were provided for people, which reflected their identified interests and preferences.

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

The service provides care and support for up to 30 people. When we undertook our inspection there were 15 people living at the service.

We inspected Blythe Country Care Home on 10 March 2015. This was an unannounced inspection. Our last inspection took place on 25 October 2013 during which we found the service was not meeting all the standards we assessed. This was because we found at our October 2013.

inspection the provider needed to establish how many staff needed to respond effectively to peoples’ needs. The provider sent us an action plan and at this inspection the provider addressed the breach.

There was not a registered manager in post, but the position had only been vacant for seven days. 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.

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. There were no people living at the home that were subject to any such restrictions.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed thorough training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual. There were sufficient staff to meet people’s needs.

People had been consulted about the development of the home. However, the provider had not complete all the checks to ensure the quality of the service met peoples’ needs. Some areas of the home and some equipment required refurbishment but there was a plan in place to ensure the environment and equipment was updated.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with seven people who used the service and a relative and asked them for their views. We also spoke with four care workers, the cook and the registered manager. We also looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to they gave consent to their care and treatment. A person told us, “I can ask for what I want. They (staff) will make an adjustment for me.” Staff showed a caring manner to people who did not have capacity. We observed staff speak patiently and gently, and provide appropriate physical comfort to people who were unable to answer them.

We found people were provided with a varied and nutritional diet. A person told us the food was very good. They also said, “They tell you what it (the meal options) are and we choose. If we want something else they will accommodate us.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A person told us, “The nurse brings my medication to me at the breakfast table, if I have gone to the lounge they bring it to me there.” We found improvements could be made to the storage arrangements for people’s medication.

We found there were not sufficient staff at night to meet people’s needs. A person told us, “They (staff) are pretty good when I buzz them. Sometimes I am waiting a bit at night time.” Another person told us the staff did not seem to be as patient in the night.

The provider maintained records that were accurate and fit for purpose. We saw there were various records kept on the nurse workstation for the running of the service.

On the day of our follow up visit there were 21 people living at Blyth Country House Care Home.

We spoke with two people who used the service and two relatives of people who lived at the home.

One person we spoke with told us, “I’m very happy here, the girls (staff) are friendly and caring. I get a choice of food and the quality is good. I’m supported to go to bed and get up when I wish.” and, “I like to watch the television and do my cross word, there are other activities but I prefer to do my own thing.”

Another person said, “I feel safe here, my needs are well met, I have no complaints.”

A relative we spoke with told us, “I’m very happy and satisfied with the care and treatment my relative receives. The communication is good, if I need to raise anything I speak to the staff direct.”

As part of our inspection we spoke with a number of people who used the service and their relatives or friends. We also spoke with the registered manager, nursing and care staff. On the day of the visit there were 21 people living at Blyth Country House Care Home.

The people we spoke with told us they were happy with the care and accommodation provided and staff treated them on the whole with dignity and respect. People said they felt safe and able to raise any issues or concerns with the staff.

One person told us, “Everybody goes out their way for you. I can’t complain it’s better than where I was before.”

Another person said, “I’m very happy here some staff are better than others.” and “I tell the girls (the staff) if they are ratty with me but there’s some nice girls.”

When we asked people about how they liked the food most people told us the food was excellent freshly cooked and plentiful. People said they had a choice of what to eat and we saw the menu plans advised what the choices were. Someone else said they liked spicy food which was not often on the menu.

The people we spoke with told us there were daily activities on offer they could join in if they wished. On the day of our visit we saw there was a games activity in the morning and a baking session in the afternoon.

A friend of a person who was visiting on the day of our inspection told us, “My friend has settled well, they have thrived since being here.”

We spoke with a relative who felt some staff were more knowledgeable than others and raised some concerns about the care provided.