This inspection took place on 16 February 2017, and was unannounced.

Harton Grange is a residential care home for 61 people some living with dementia. The service is over two floors with people with more complex needs living on the upper floor.

The service was supporting 60 people at the time of this inspection. 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.

At the last inspection in December 2014, the service was rated Good. At this inspection we found the service remained Good.

Recruitment processes were thorough with all necessary checks completed before staff commenced employment. The registered provider used a dependency tool to ascertain staffing levels. We found staffing levels to be appropriate to needs of the service these were reviewed regularly to ensure safe levels. Call buzzers were answered in a timely manner and staff were visible throughout the building. Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. Medicine administration records (MAR) were completed with no gaps, medicine audits were completed regularly. Policies and procedures were in place for safe handling of medicines for staff to refer to for information and guidance.

Staff training was up to date. Staff received regular supervision and an annual appraisal. Opportunities were available for staff to discuss performance and development.

People were supported by kind and attentive staff, in a respectful dignified manner. Staff discussed interventions with people before providing support. Advocacy services were advertised in the foyer of the service accessible to people and visitors. Staff knew people's abilities and preferences, and were knowledgeable about how to communicate with people.

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’s nutritional needs were assessed and where necessary dietary intake was recorded and monitored. We observed people enjoying a varied diet, with choices given and alternatives available. Staff supported people with eating and drinking in a safe and respectful manner.

Care plans were individualised and person centred focussing on people's assessed needs. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date. People had access to health care when necessary and were supported with health and well-being appointments.

The registered provider had an activity planner with an extensive range of different activities and leisure opportunities available for people. Many of the activities were tailored to meet the needs of people living with dementia.

The registered provider had an effective quality assurance process in place to ensure the quality of the care provided was monitored. People and relatives views and opinions were sought and used in the monitoring of the service. Processes and systems were in place to manage complaints.

The registered provider ensured appropriate health and safety checks were completed. We found up to date certificates to reflect fire inspections, gas safety checks, and electrical wiring test had been completed.

A business continuity plan was in place to ensure staff had information and guidance in case of an emergency. People had personal emergency evacuation plans in place that were available to staff.

People were involved in planning their own care and staff supported people in an engaging way. People we spoke with told us they “Could not be better looked after” and “The staff are very busy but always make time to attend to me if I need help.”

The service had an effective recruitment and selection procedure in place and carried out relevant checks when recruiting staff. A relative told us how flexible and caring the staff were and how much her mother appreciated her being able to come in, have use of a hairdressing room and wash her hair.

The home was clean and well maintained and there were systems in place to regularly check the quality of the care and the maintenance and safety of the premises. People were consulted about the care they received and the service had an effective complaints procedure in place.

People we spoke with told us they were happy with the care they received and liked living at the service. A visitor we spoke with confirmed they were satisfied with the care their relative received and had no concerns. People said they liked how the manager kept them informed of any changes, and the care staff always made sure any concerns were passed to the senior staff members if they could not resolve it easily themselves. No one we spoke with had needed to use the complaint process.

Harton Grange is registered to provide accommodation for up to 61 persons who require personal care, some of whom may have dementia. It is a purpose built building with two floors of accommodation which are served by a passenger lift. The home has a balcony sitting out area and a safe, secure garden area. The home is situated in a residential area in South Shields, close to shops, amenities and public transport. At the time of our inspection, there were 60 people using the service.

This inspection took place over two days. The first visit on 16 December 2014 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 17 December 2014.

The last inspection of this home was carried out on 23 December 2013. The service met the regulations we inspected against at that time.

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 they felt safe at Harton Grange. They told us, “I feel really safe sleeping here. I don’t feel worried about anything” and “It’s lovely here. It’s the people; the way we all work and play together.” Relatives also considered the home to be a very safe place for their family members. One commented, “It’s lovely. I’ve got no worries. The girls are lovely. (My relative) is relaxed. I come every day. She is never upset when I go. They’re marvellous; from the handyman, the manager, and the catering staff – all of them. Safe, I couldn’t have picked a better place.”

The staff identified potential areas of risk in respect of people’s care, such as the risk of falls and skin damage, and took steps to reduce the likelihood of people being harmed by such risks occurring.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. Staff carried out their duties in a thorough and calm way. Relatives told us, “I’m sometimes surprised at the number of staff. There always seems to be plenty of staff,” and “Yes, there is usually enough staff. We’ve never felt it’s inadequate or the staff are not coping.” We found there were thorough recruitment procedures in place. This helped to protect people as checks had been carried out on potential staff before a decision was made to employ them.

People’s medicines were managed safely. Staff followed safe procedures which helped ensure people’s medicines were stored correctly, ordered in time and given to them when they needed them. Relatives we spoke with were confident their family members received the help they needed with medicines. One commented, “She gets her pills at the right time. She had conjunctivitis last week; they’ve been putting eye drops in and its cleared up.”

Staff told us they felt supported by the provider, by way of training, supervision and appraisal. This helped them provide effective care for people. People and their relatives were confident the staff team had the skills needed to care for people well. Similar views were also expressed by health and social care professionals who regularly visited the home. Their views included, “Staff are excellent and very caring,” and “Their communication skills are excellent.”

Staff sought people’s consent before they provided care to them. Staff followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS).

Comments from people, their relatives and dietetic professionals showed that the service provided effective support to people to provide them with good nutrition and hydration. Relatives told us, “The food is very good. There is always a choice. They keep an eye on (our family member’s) weight and fluids. She finishes her meal every day.” Another relative said, “My relative had put a bit of weight on, the last time she was weighed. She loves her grub.” A health professional said, “The cooks have an excellent understanding of nutrition needs and we’ve seen a 70%-80% decrease in the reliance on nutritional supplements, directly through the high standards of catering provided here.”

People were supported with their health care needs and prompt referrals were made for medical assistance when needed. A member of the community nursing team who regularly visited the service told us, “We work very closely with Harton Grange. We have no concerns from the past or present. They follow care plans. Their palliative care is very good. We work through any issues together.”

Staff had developed positive, caring relationships with people using the service. Relatives of people who used the service were confident that the staff team were caring and kind. Their comments included, “It’s brilliant,” and “Staff genuinely care.”

Staff showed people respect and dignity and safeguarded their privacy. Staff were able to spend time with people in meaningful tasks and conversations which meant people felt supported and cared for.

People received personalised care that was responsive to their needs. The service provided skilled and stimulating care for people with dementia conditions. The registered manager and staff had put considerable thought and attention into creating an environment which provided safe opportunities for people to keep busy, get involved in interesting activities or just spend time with staff and other people in a convivial atmosphere. Relatives and health care professionals we spoke with praised the positive impact this had made to people. A relative told us, “The change in my relative is unbelievable. They are doing crafts and she is going on trips. She was stuck in a rut. It is like she has gone to being fifty or sixty. The staff are amazing.”

People had no complaints about their care and were confident any issues would be dealt with appropriately. People were encouraged to share their views about the service and these were acted on. For instance, people were able to influence the decoration of the communal areas of the home and had been involved in the decoration of their own bedrooms.

The service was managed well and the registered manager ensured good quality and consistent care. This was reflected in the comments we received from a number of other professionals who had contact with the service. For instance, a local authority care manager told us, “The registered manager is lovely. She is fantastic as a manager. She has drive, enthusiasm and commitment. She is not a pushover; if there is a problem, she is onto it straight away.” Relatives of people who used the service were also impressed by the way the service was managed. One relative commented, “(The registered manager) is great. You only have to step in the home and it is always lovely. She is always on the ball and she watches the staff without being bossy. She has a good sense of humour. She keeps on top of her job.”