We inspected the service on 6 and 8 August 2018 and telephoned relatives on 13 August 2018. The inspection was unannounced which meant the provider and staff did not know we were coming.

Farmborough Court Intermediate Care Service 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 is registered to support up to 56 people.

This service offers short term rehabilitation usually for up to six weeks, to people who have been discharged from hospital or whose needs have changed.

A registered manager was 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.

At our last inspection in July 2017 we rated the service Requires Improvement. People's care records did not accurately reflect their needs or were incomplete. The service did not always follow their own medication safety policy and the provider did not have effective quality assurance processes to monitor the quality and safety of the service.

At this inspection we found the service had made great improvements and addressed the issues identified at the last inspection. Care records were personalised, medicines were managed safely and quality assurance processes were well established and effective.

The registered manager had implemented a number of new initiatives to drive improvement including the creation of a family forum group, leading consultation regarding the development of the pre- assessment tool, the introduction of ‘huddles’ meetings and restructuring of team leader’s roles.

Risks to people were identified and guidance was in place to support staff to minimise these risks. The provider had systems to safeguard people from abuse. Staff were extremely knowledgeable about the potential signs of abuse and the actions to take to ensure people remained safe.

The provider had a robust recruitment process. Sufficient staff were deployed to meet people’s needs. Safeguarding concerns and accidents or incidents were fully investigated and lessons learned were cascaded all the provider’s services.

The provider ensured people had a safe clean environment. Health and safety checks were carried out regularly.

The service was compliant with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People and relatives were involved in all areas of people’s care and support.

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.

Staff were attentive to people’s needs and treated people with dignity and respect. People and relatives, we spoke with were complimentary about the caring nature of staff. People were supported to maintain their interests. The service provided information to support people when they returned to the community.

Care records were concise and captured how people wished to be supported. All people who used the service and their relatives knew how to raise concerns. The service worked with people to achieve positive outcomes. The service had developed good working relationships with health care professionals and other organisations within the community.

The registered manager regularly sought feedback from people using the service, relatives and health care professionals. Staff were well trained and supported by the provider and a strong management team. The registered manager ensured statutory notifications had been completed and sent to the CQC in accordance with legal requ

Farmborough Court Intermediate Care Service is registered to provide accommodation and personal care for up to 54 people. On the first day of our inspection there were 35 people being supported.

The Intermediate Care Centre offers intensive rehabilitation for people recovering from a physical illness or trauma, rehabilitation for people suffering from a cognitive impairment such as memory problems and re-ablement/convalescence for people who need a shorter term intervention to recover their abilities. People used the service for a short period of time with six weeks being the usual maximum term.

A registered manager was 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.

At our last inspection in October 2014, the service was rated Good. During this inspection we found the service had breached a number of regulations. People’s care records did not accurately reflect their needs or were incomplete. The service did not always follow their own medication safety policy. We also found that the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure that people received appropriate care and support.

You can see what action we told the provider to take at the back of the full version of the report.

People were protected from abuse and harm. Staff had completed safeguarding training and were confident in identifying the signs of abuse and what action to take to keep people safe.

Sufficient, appropriately trained staff were employed to meet people’s need. Staff demonstrated a general knowledge about the people they supported and their families.

Accidents and incidents were recorded, collated and analysed to identify any patterns or trends. Where risks were identified they were assessed and managed to minimise the risk to people who used the service and others.

People were provided with a choice of healthy food and drinks to help ensure that their nutritional needs were met. The service ensured people received care and support from healthcare professionals including community psychiatric nurses, occupational therapists and GPs.

Where people had no family or personal representative we saw the home provided information about advocacy services.

Staff told us they enjoyed working at Farmborough Court Intermediate Care Service and they felt supported by the registered manager.

Feedback was encouraged from people who used the service, relations and staff. We observed positive interactions between staff and people who used the service. Staff promoted people's privacy and dignity.

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.

People and relatives we spoke with told us they had no complaints about the care provided at the home. The provider had developed a clear vision and values which staff repeatedly demonstrated. Systems were in place to monitor, identify and manage the quality of care provided.

The inspection took place on the 29 October 2014 and was unannounced. We visited again on 30 October 2014 and the provider knew we would re-visit on that date.

Farmborough Court is a large modern, 2-storey purpose built care home, which provides a range of intermediate care services for older people who need convalescence or a rehabilitative stay.

The provider is registered to provide accommodation for persons who require nursing or personal care at Farmborough Court Intermediate Care Centre. The intermediate service is provided in partnership with Sunderland Teaching Primary Care Trust, the Mental Health NHS Trust and the City Hospitals NHS Trust

There is a registered manager in post. 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.

The home does provide care that is safe. There are procedures in place in relation to protecting vulnerable adults and all staff are trained in what to do if they suspect abuse. The home makes careful assessments of the risks associated with peoples care. Staff work proactively to ensure people’s rights are protected and they are supported to take risks in developing abilities to enable people to live as independently as possible.

The home is careful to protect peoples freedom and applies the Deprivation of Liberty Safeguards well (these are set of requirements to ensure homes do not restrict peoples liberty unless there has been a thorough assessment of the absolute need for that and it is agreed by the local authority.

The home is well staffed. Staff are well trained to their jobs. People spoke well of the care they received and how it helped them with their future plans.

Medicines were well managed with good systems in place to ensure they were administered as they should be. The home was clean and the registered manager had systems in place to ensure that staff know how to reduce the chance of infection and how to ensure the home is kept hygienically clean.

People’s needs were assessed very well with good clear records. The home had effective multi-disciplinary meetings every day where people’s needs and progress was discussed and plans changed accordingly. Records of training showed that staff had the necessary skills to do their work well. The staff felt they were suitably trained for their work.

We noticed that people participated in their plans for care and the goals they wanted to achieve. We saw people’s signatures on relevant documents and were told by people who lived there and their relatives that they felt involved in all of the decisions about their needs and progress.

There were good records that showed what peoples dietary needs were and how the home would support people. There were assessments about people’s ability to swallow safely. Many people told us the food was very good. Meal times were social occasions with the right amount of staff support around. Staff were careful to monitor people’s fluid intakes to ensure they did not become dehydrated.

The home worked very closely and well with other services There was a community nurse based at the home to help with onward planning of peoples care when they left. There were many multi-disciplinary meetings that involved care staff, nurses occupational therapist, speech and language therapists, GPs, social workers, and other relevant professionals needed to ensure a person’s care was right in the home and continued when they left.

Staff were seen to be very caring and people we spoke with said they were. People commented, “The staff are great,” “The staff are wonderful,” “The staff have really helped me.” We saw staff were attentive to people’s needs and polite and courteous whilst friendly. There was a very jovial mood and lots of laughter during meal times. It was clear the staff were skilled at quickly forming friendly caring relationships with people who lived there for a relatively short time whilst being rehabilitated.

During all of the interactions between people and staff we saw staff were careful to seek people’s opinions, or to ask if they needed anything else. For example we saw that when staff were giving out mid-morning drinks they asked if everyone had sufficient or if they had their choice of drink right.

We saw staff treated people with dignity and were respectful to them. One person told us “It’s better than a hotel here.”

We examined eight sets of care records and saw they were personalised to individuals needs and when people’s needs changed plans were altered accordingly. Staff responded on a personal level too. We saw one person wasn’t keen on either of the puddings on offer so at their request a member of staff went to the kitchen and got them an ice cream in their favourite flavour ( the person saying “oo vanilla my favourite”.

We saw evidence in the care plans that people participated in their plans and signed them. We saw that the home had regular meetings with people living there and their relatives to gain their opinions about how the home was run. The registered manager explained that as they were under a new provider they were changing their annual surveys and these would go out in the summer of 2015.

The registered manager kept a record of all of the complaints they received. These recorded what the issues were and how they had all been resolved.

The service was well led by an experienced registered manager who monitored the way care was provided in the home. People and staff we spoke with told us they were approachable. They also commented that they were often seen out talking with staff and people rather than spending all of their time in the office.

Staff told us they received good support and guidance from the registered manager, the deputy and the seniors. We saw records that showed staff had good training to do their roles and that they received regular one to one guidance.

We saw that the registered manager regularly audited care records and other records to ensure there was a consistent high quality in assessments, the plans and that systems within the home were checked as they should be.

We spoke to three people using the service and two relatives. One person told us, “Staff are very good." Another person said, “Nothing is a bother for staff."

One relative said, “This place is great." Another relative told us, “I have seen a difference in my relative, she is more herself now."

We found people's needs were assessed and care was planned in line with their needs. Relatives told us they felt included in the care arrangements and decisions.

People who used the service were protected from the risk of abuse.

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

This inspection was a themed inspection focussing on dignity and nutrition. People told us what it was like to spend time at Farmborough Court and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an “Expert by Experience”; people who have experience of using services and who can provide that perspective and also joined by a Practising Professional.

During this themed inspection visit, we spoke to eight people who used the service and three relatives. This is what they told us: People who used the service said they were given appropriate information and support regarding their care and treatment. Each person had a written agreement. No-one had moved into the service without having had their personal and health needs assessed. People told us they had been involved in and had contributed to the assessment process.

People told us their privacy and dignity was upheld by staff working in the care centre. The people we spoke with said they had a choice of at least three hot meals each day. People said portion sizes were good. They said second helpings were always available if they wanted more. One person said, “We get three large meals each day and we are offered more if we want. I always enjoy the meals. The chef spoke to me when I arrived about what I like to eat and he knows exactly what I like and dislike. The food is always very good.”

Another person told us, “We are always offered a choice for every meal. I really enjoy the puddings best of all.” Other comments included, “I have no complaints at all about the meals.” “The meals are super.”

People told us they felt safe here. They said they could express themselves freely and without fear. People told us they would know who to speak to if they had any concerns. People also told us they were well supported by the staff team and were happy with the care, treatment and support they received. One person said, “The physiotherapist and the occupational therapist and the enabling staff have been fantastic. With everyone’s help I shall be going home soon. I am so grateful for all the support I have received.”

People told us they were treated with respect at all times and said staff listened to their views and acted upon them.”

We spoke with three visitors. They told us the care their relatives and friend received was first class. They said the whole team were very knowledgeable about their relatives/friend support needs. One relative told us the staff were very good at keeping them informed about their relative’s health and wellbeing and the progress they were making.

The service users spoke to us about their experiences at Farmborough Court. They told us that they were involved in the management of their own care as part of their rehabilitation programme to get them back to their own homes.

We spoke to a number of service users to find out how they felt about the care and support they received at Farmborough Court. They commented that they were well looked and supported by a team of professionals to enable them to get back home. They all said that they were consulted on all aspects of the rehabilitation programme.