This inspection took place on 11 January 2017 was unannounced. This meant the registered provider and staff did not know we would be visiting. A second day of inspection took place on 12 January 2017, and was announced. The service was last inspected in July 2015 and was meeting the regulations we inspected at that time.

Greta Cottage provides care and accommodation for a maximum of 29 older people, including older people living with a dementia. Greta Cottage is a converted Victorian House in a residential area of Saltburn by the Sea. Accommodation is provided over two floors. At the time of our inspection 29 people were using the service.

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 and their relatives told us the service kept people safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Plans were in place to help keep people safe in emergency situations. Accidents and incidents were monitored.

Policies and procedures were in place to protect people from abuse. People’s medicines were managed safely. Staffing levels were monitored by the registered manager to ensure they were safe and recruitment procedures were in place to minimise the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively. Staff spoke positively about the training they received, and felt confident to request any additional training they felt would make them more effective. Staff were supported through regular supervisions and appraisals.

Staff understood and applied the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) to protect people’s rights. People were supported to maintain a healthy diet and to access external professionals to maintain and promote their health.

People and their relatives spoke positively about the care and support they received. Staff treated people with dignity and respect and were friendly but professional when delivering support. Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services where appropriate.

Care was planned and delivered on the basis of people’s assessed needs and preferences. People and their relatives told us people received the support they wanted. People were supported to take part in activities they enjoyed, both at the service and in the local area. The service had a complaints policy and people and their relatives told us they knew how to complain and would be confident to do so if any issues arose.

Staff spoke positively about the culture and values of the service and were supported with regular staff meetings. The registered manager and trainee manager carried out a range of quality assurance checks to monitor and improve standards at the service.

Feedback was sought from people using the service and their relatives through an annual questionnaire and resident and family meetings. Where issues were raised they were acted on. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications.

We carried out a comprehensive inspection of this service on 12 January and 12 February 2015. At this inspection a breach of legal requirements was found. The registered provider had failed to take proper steps to ensure that each service user was protected against the risks of receiving care or treatment that was inappropriate or safe. Staff failed to use safe moving and handling techniques when moving one person who used the service. The registered provider wrote to us telling us what action they would be taking in relation to the breach. As a result we undertook a focussed inspection on 14 July 2015 to follow up on whether action had been taken in relation to the breach.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Greta Cottage on our website at www.cqc.org.uk’

Greta Cottage provides care and accommodation for a maximum number of 29 older people and / or older people with dementia. Greta Cottage is a converted Victorian house in a residential area of Saltburn by the Sea. Accommodation is provided over two floors.

The home 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.

At this focussed inspection on 14 July 2015 we found that the registered provider had followed their plan and legal requirements had been met.

After the comprehensive inspection the registered manager held a staff meeting to discuss moving and handling of people who used the service. Staff were informed that people who used the service must not be manually lifted and for any person who was unable to weight bear then the hoist must be used. All care staff attended training in moving and handling and had supervision with senior staff. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff.

The registered manager and co-manager had assessed people who used the service and purchased new hoist slings and handling belts. The hoist slings and belts were stored in the main entrance and lounge so that staff could easily access them. Moving and handling assessment /care plans had been and updated, however these required further development to provide step by step instructions on how to move people.

At our last inspection of Greta Cottage in September 2013 we identified some concerns with the standard of record keeping. We carried out this follow up inspection to make sure that improvements had been made.

At this inspection we found that improvements had been made. Care plans had been reviewed and evaluated. We saw that care plans had been developed for those people who had dementia. Care plans recorded the impact the dementia had on life and the assistance and support the person required. Records were available to confirm that nutritional screening had been carried out to identify those people at risk of malnourishment or obesity. We saw that staff kept a record of food and fluid intake when people had been identified with weight loss. We saw that the outcome of visits from healthcare professionals was recorded. This helped to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

During the inspection we spoke with five people who used the service and three relatives. We also spoke with the manager, a senior care assistant and a care assistant. People who used the service told us that they were happy with the care and service received. One person said, “It’s lovely here and all of the staff are nice.” We spoke with relatives who said, “We are all made to feel part of a big family.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People’s health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We saw that people lived in safe, accessible surroundings that promoted their wellbeing.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We saw that records were stored securely, however up to date and appropriate records were not always maintained.

The visit took place because we were following up an issue raised at the last inspection about ensuring staff had the knowledge and understanding about abuse and safeguarding vulnerable adults. We also looked at other outcomes as part of a routine review of the service.

We spoke with three people who live at Greta Cottage and four relatives.

One person we spoke with said, "I believe I am being well cared for, they will get the doctor if I am unwell and the district nurse visits every two weeks.”

One relative who was spoken with said, “I have been fully consulted about mum’s care and support needs, they keep me well informed of changes.” They also told us that certain personal needs had improved since admission to the home. The other three relatives spoken with also confirmed that they had been involved and consulted about their relative’s needs and lifestyle preferences.

Another relative said, “She is now so much more sociable, definitely treated with dignity and respect, it seems that people care.” They said that where personal care was involved, staff carried this out swiftly and with discretion.

A further relative said, “She had been here for five years, in all this time the care has been wonderful, they have looked after her really well.”

During the inspection we observed that staff interacted with people in a caring and respectful manner. We observed an exercise class taking place during the visit, people were smiling and laughing and joining in with the class. We observed people being offered a choice of hot and cold beverages.

We observed a person becoming upset; we saw that this was dealt with extremely kindly by the staff, with much reassurance given.

During our visit we spoke with four people who used the service and three relatives. Some people were less able to express their views because of complex needs. Those people we did speak with expressed satisfaction with the care and service that they received. One person said, "They look after me well. The staff are caring and very kind." Another person said, "They treat us very well." Relatives spoken with during the visit said, "I'm well satisfied. He/she gets well looked after and I find the care staff quite good." One relative said, "He/she has come on a treat since coming in here. They give a lot more than I could offer." Another relative said, "I think it's marvellous. It's like home from home. The staff are lovely and keep in touch. Staff keep you up to date about medication changes. I feel really confident that he/she is well looked after."

We inspected Greta Cottage on 12 January and 12 February 2015. The first day of the inspection was unannounced which meant that the staff and provider did not know that we would be visiting. We told the provider we would be visiting on 12 February 2015

Greta Cottage provides care and accommodation for a maximum number of 29 older people and / or older people with dementia. Greta Cottage is a converted Victorian House in a residential area of Saltburn by the Sea. Accommodation is provided over two floors.

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. The registered manager was on annual leave at the time of the inspection visits.

There were systems and processes in place to protect people from the risk of harm. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

There were individual risk assessments in place. These were supported by plans which detailed how to manage the risk. This enabled staff to have the guidance they needed to help people to remain safe.

Staff told us that they felt well supported; however formal supervision sessions with staff had fallen behind. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. We saw that staff had received an annual appraisal.

Staff had undertaken training in safeguarding vulnerable adults, fire, health and safety, infection control moving and handling, medicines administration, bereavement, and working with challenging behaviour. Staff were aware of their roles and responsibilities and had the skills, knowledge and experience to support people who used the service. Staff told us that they thought the training they had received was good and provided them with the skills and knowledge they needed to care and support people.

We saw that there were six care staff on duty during the day until 5pm. From 5pm until 10pm there were three care staff on duty and on night duty there were two staff on duty. At the time of the inspection there were 28 people who used the service. We questioned the drop in staff on an evening to three staff. We asked people who used the service, staff and relatives if they thought there was enough staff on duty. Four people who used the service thought there was enough staff on duty. One person told us that thought more staff were needed. One relative we spoke with thought that there should be more staff on duty and one thought there were sufficient staff to meet people’s needs. During the inspection we spoke with management and senior care staff and asked that staffing levels be reviewed to determine if there were enough staff on duty.

Staff had attended training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Staff had an understanding of the principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions.

At the time of the inspection four people who used the service were subject to a Deprivation of Liberty Safeguarding (DoLS) order. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. Staff we spoke with had a good understanding of DoLS.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. However we did note that some medicines prescribed should be given before food and the pharmacist had failed to write these instructions on the MAR. The senior care staff told us that they would make immediate checks with the pharmacy and get MAR charts changed to reflect directions for use.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. However care records needed further development to ensure that they were focussed to the specific need of each person to ensure care and support was delivered in a way that they wanted it to be.

People’s independence was encouraged and they were encouraged to take part in activities and outings. Those people who wanted to took part in daily chair exercises and stretches. Staff told us that as the majority of people had some form of dementia they did daily reminiscence and quizzes with people to encourage people to talk and socialise with staff and each other. There was manipulative stimuli in the form of activity cushions for those people living with a dementia. These were made of different fabrics and textures. We saw how people enjoyed playing with these cushions. This meant that people were provided with activities that were beneficial and therapeutic.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

We watched staff when they were moving some people. We saw staff inappropriately moved one person who used the service who was unable to weight bear. Staff supported this person by putting their arms under their armpits and moving them from the chair to the wheelchair. This meant that the person was not protected against the risks of receiving care and support that was inappropriate or unsafe. This was pointed out at the time of the inspection to the management and senior care staff who told us that they would ensure that this did not happen again.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations have been replaced with the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.You can see what action we took at the back of the full version of this report.