Earsdon Grange is a care home providing residential care for up to 48 people.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 44 people accommodated across two floors. People living with a dementia are supported on the first floor.

At our last inspection in November 2017 we rated the service good. At this unannounced inspection completed on 6 November 2018 we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since out last inspection.

At this inspection we found the service remained good.

People told us they felt safe, staff had attended training in safeguarding people and knew how to report any concerns which they were confident would be addressed. Risk assessments were in place which contained control measures to minimise risks and accidents and incidents were investigated and analysed for lessons learnt.

Electronic systems were used for medicines management and care planning. The system generated alerts to support the safe management of medicines, and to alert staff to any changes in people’s needs.

Care records included information on people’s preferences, medicines, mobility and nutritional needs. Documentation was completed in a timely manner and was reviewed to ensure people were receiving care and support appropriate to their needs.

A dependency tool was used to assess the number of staff needed to support people and staff said there were enough of them to meet people’s needs. Safe recruitment practices continued to be used.

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.

Some engagements with people were warm and respectful but others were task focused and reactive. We have made a recommendation about proactive and meaning engagement with people.

Dementia friendly signage was on display and the environment was clean, tidy and free from hazards. There were specific areas where people chose to spend their time and we observed these areas had insufficient seating for the number of people. The registered manger said additional seating had been ordered.

Training was comprehensive and covered a wide range of subjects. Staff said they were well trained, well supported and their career development was encouraged.

Complaints were documented appropriately and evidence was available that families had been updated following concerns.

A governance framework was in place and regular audits produced action plans which lead to continuous development and improvements.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 13 May 2016. We found the provider met the requirements of the regulations and we rated the home as Good.

After that inspection we received information relating to the safety of people living at the home. In particular, whether there were sufficient staff deployed to supervise people to keep them safe. As a result we undertook a focused inspection 9 November 2017 to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Earsdon Grange on our website at www.cqc.org.uk.

Earsdon Grange is registered to accommodate up to 48 older people who require assistance with personal care. There were 40 people living at the home at the time of the inspection.

The home 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 and staff told us the home was a safe place to live.

Staff showed a good understanding of safeguarding and knew about the provider’s whistle blowing procedure. Staff confirmed they did not have concerns and had not needed to use the whistle blowing procedure. They also said they would not hesitate to raise concerns if needed. Previous safeguarding concerns had been fully investigated in line with the local authority’s safeguarding procedures.

When we visited the home we found there were enough staff on duty to meet people’s needs. People and staff confirmed this was the case. We saw staff were visible around the home and answered nurse call bells quickly. The registered manager monitored staffing levels on a regular basis.

Medicines were managed safely. Senior staff had been trained to administer people’s medicines and accurate records were maintained to confirm medicines were administered safely.

Health and safety checks were carried out including checks of fire safety, gas safety, electrical safety and specialist equipment. Where potential risks had been identified, a risk assessment was in place to minimise the risk. The provider had up to date procedures to deal with emergency situations.

There were effective recruitment checks in place to help ensure new staff were suitable to work at the home. For example, requesting and receiving references and checks with the Disclosure and Barring Service (DBS).

Incidents and accidents were logged, fully investigated and monitored. Records showed appropriate action had been taken following incidents to help keep people safe.

People and staff gave positive feedback about the approach of the registered manager. They said she was supportive and approachable.

The provider carried out a range of quality assurance checks to help maintain people’s safety and wellbeing.

There were opportunities for staff to give feedback about the home through attending regular team meetings or speaking directly to the registered manager.

Earsdon Grange is residential care home situated in North Shields close to local shops and community facilities. The service provides accommodation for up to 48 people, most of whom have physical care and support needs and /or live with dementia. At the time of our inspection 41 people were living at the service.

This inspection took place on 13 May 2016 by two inspectors and was unannounced. We last inspected the service on 31 October 2014 where we found the registered provider to be meeting all regulations we inspected.

The service had a registered manager in place. 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 service had detailed safeguarding and whistleblowing policies in place which provided information about how to recognise the signs of abuse, and how to respond to any concerns people had.

Records within staff files demonstrated proper recruitment checks were being carried out. These checks include employment and reference checks, identity checks and a disclosure and barring service check (DBS). A DBS check is a report which details any offences which may prevent the person from working with vulnerable people. They help providers make safer recruitment decisions.

The provider had systems in place to manage medicines and people were supported to take their

prescribed medicines safely.

Staff were supported with regular training opportunities that linked to the care and support needs of people who lived in the service.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had followed the MCA code of practice in relation to DoLS.

Menus were available which provided a choice of meals for each day. People's nutritional needs were assessed and monitored by staff. Their preferences and special dietary needs were known and were catered for. Staff encouraged and assisted people to eat and drink, where necessary.

Staff respected people's choices and took their preferences into account when providing support. People were encouraged to enjoy activities and interests of their choice and were supported to maintain relationships with friends and family so that they were not socially isolated. Families and friends were welcome to visit the home and people were encouraged to maintain relationships that were important to them.

People’s care plans were specific and centred around their individualised care and support needs. There were a range of assessments in place to keep people safe. Care plans were up to date and were regularly evaluated. Staff were knowledgeable about people’s care and support needs.

People and their relatives told us staff were caring and kind. We observed positive staff interactions during our inspection and the service had a homely atmosphere.

The service had a complaints process in place. People living in the service and their relatives were provided with information to support them to raise any concerns or complaints they may have.

There was an open culture in the home and people, relatives and staff were comfortable to speak with the manager if they had a concern.

The service had a quality assurance system which included a range of internal checks and audits to support with continuous improvement. Actions plans were put in place to address any shortfalls in service provision and to demonstrate how areas of improvement were addressed.

At the time of the inspection there were 40 people living at the home. Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. We spoke with the manager, 11 people who lived at the home, seven visitors and six care staff.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

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

Is the service safe?

Care records contained risk assessments and instructions on how these risks should be managed. For example, there was consideration of the risks associated with skin integrity, nutrition, preventing falls and infection control/prevention.

Systems were in place to ensure that management and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

The CQC monitors the application of the Mental Capacity Act 2005 and operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. DoLS is a legal process used to ensure that no one has their freedom restricted without good cause or proper assessment. There was a policy in place related to people's mental capacity and the deprivation of liberty safeguards. There was evidence to show that mental capacity assessments and deprivation of liberty checklists had been completed.

Personal evacuation plans were in place in case of an emergency and the home had a business contingency plan, which contained emergency telephone numbers and guidelines for staff to follow.

We saw that checks on electrical and gas systems, fire-fighting equipment and water systems had been undertaken and were also being monitored. There was a system in place to ensure that maintenance was carried out at the home.

Is the service effective?

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met. They said the care plans contained sufficient information to help them meet individual needs. We saw people's health and care needs were assessed and the care plans provided staff with information about how each person's care needs should be met. The service worked well with other agencies and prompt referrals were made to health care professionals, which helped ensure people's health care needs were addressed.

People and their relatives told us that the care was very good and staff looked after them well. Comments included, "I am so glad I chose this place for my Mum. She looks better and sounds better since she came in. The staff are so friendly and helpful."

People's privacy and dignity was respected and surveys and meetings were held to ensure dignity was respected and assess if any improvements could be made. One relative had commented, "Staff treat her as a respected individual and are conscious of her needs which they handle with dignity."

Is the service caring?

We spoke with 11 people who used the service and their comments included, "Everything is tip top" and "I really like it here. The staff are lovely and really help us in lots of ways. I am treated well."

We spoke with six relatives who were visiting the home. They told us they felt their relatives were very well looked after. Their comments included, "I looked around at other homes before I chose this one. I am so pleased with my choice. I cannot find fault. The staff are friendly and the manager is so approachable. This is the best I have seen and my Mum really likes it" and "My daughter chose this home for my sister. It is absolutely fine. In fact it is great. There are no problems. The staff respond to any needs. They are lovely and so good."

We observed the interactions between staff and the people they cared for. We saw staff interacted well with people and were attentive and sensitive to their individual needs.

Is the service responsive?

There was a complaints procedure displayed in the home and each person was provided with a copy of this. A complaints book was maintained to record any complaints received in the home and the outcome of the investigation.

We saw prompt referrals were made to health care professionals, when required, and appropriate training was provided for the staff to help meet individual needs.

Is the service well-led?

The manager of the home was registered with the Commission and there were systems in place to monitor the quality of the service people received. People were asked their opinion of the service and meetings were held regularly to discuss day to day issues in

the home.

The manager and a quality assurance manager carried out regular audits which included areas such as medications, infection control, health and safety, safeguarding and care records.

The people who lived in the home, their visitors and the staff told us the manager was very approachable if they had any concerns or suggestions. Comments included, "I would definitely tell them if I wasn't happy but everything is fine" and "If I want to know anything or have any small problem, I just speak to one of the staff."

Surveys were issued to gain people's opinion of the service. The manager acted on the comments made to improve the service. For example, a suggestion had been made to improve the garden and this was being done. The analysis of the surveys was displayed in the home.

You can see our judgements on the front page of this report.

During our inspection we spoke with six people who used the service, two relatives and five members of staff. People told us they were happy living at Earsdon Grange. One person said, "I'm going to spend the rest of my life here and I don't mind that, I'm happy and they look after me well, what more can I ask for."

We found people were involved in decisions about their care whenever possible and their privacy and dignity was respected.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and people looked well-presented and well cared for.

We saw that the provider had a safeguarding policy in place which detailed the actions to be taken should staff have concerns about care or witness a safeguarding incident.

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance.

People were asked their views about the service provided and these were taken account of. People were aware of the complaints procedure. The provider had systems in place to monitor care delivery and ensure the health, welfare and safety of people who used the service was maintained.

During our unannounced visit on 11 September 2012 we talked to four people who used the service and one relative. The people who used the service were satisfied with the care they received at Earsdon Grange. One person said, “the staff know me by name…we have laughs” and “I am as happy as I can be not in my own home.” The relative said, “staff have been fabulous…I have never had cause for concern…I can ask them any questions.” They told us that since coming to Earsdon Grange, their relative’s mobility had improved. All of the people we talked to said they were confident that Earsdon Grange would handle any problems appropriately and effectively.

We looked in detail at three care plans and checked with people living in the home that care and support was being provided in line with their care plan. During our visit we observed care was person-centred and provided in a way which promoted independence, choice and respect.

We talked to four care staff employed by the service and looked at three staff records. We also talked to the manager and North Tyneside Council about the service. We saw that care staff were positive about working at Earsdon Grange and were appropriately supported by the manager. This was reflected in the feedback we read and heard from people who used the service.