This inspection took place on 4 February 2019 and was unannounced.

We last inspected Hebburn Court in March 2018. At that inspection we found the service was in breach of its legal requirements with regard to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because robust quality assurance systems were not in place to effectively monitor all aspects of care provision.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question good governance to at least good.

We found improvements had been made so the service was no longer in breach of its legal requirements.

Hebburn Court is a care home. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hebburn Court accommodates a maximum of 55 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 34 people were using the service.

A manager was in post who had applied to become registered with the Care Quality Commission. At the time of writing the report the manager had become registered. 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.

Governance processes were more robust and any audits that identified areas of improvement were responded to. Parts of the building were showing signs of wear and tear. We received an action plan straight after the inspection with timescales to show how this would be addressed in a timely way. Improvements had been made to record keeping to help ensure people received person-centred care.

People said they felt safe and they could speak to staff as they were approachable. However, we have made a recommendation about keeping staffing levels and staff deployment under review as staff were busy during parts of the day and did not always have time to engage with people. Systems were in place for people to receive their medicines in a safe way.

People received a predominantly positive meal time experience and they received a choice of food. People said staff were kind and caring. Activities and entertainment were available to keep people stimulated.

Staff were aware of people’s care and support needs. Care was provided with kindness and patience. People were involved in decisions about their daily care requirements but improvements could be made to make more information accessible to keep people informed.

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.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.

Communication was effective to ensure people, staff and relatives were kept up-to-date about any changes in people's care and support needs and the running of the service. There were opportunities for people to engage with the local community and all people were supported to maintain relationships that were important to them.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received a varied and balanced diet to meet their nutritional needs.

A complaints procedure was available. People told us

Hebburn Court Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Hebburn Court Nursing Home accommodates 55 people in one adapted building, across two floors. There were 38 people using the service at the time of our inspection, including some people living with dementia.

This unannounced comprehensive inspection took place on 26 and 29 November 2017. This means that neither the provider nor the staff knew we would be visiting the home.

We last inspected this service in February 2016 and at that time we rated the service as 'good'. However, during this inspection we found some shortfalls at the service, and have now rated the service as 'requires improvement'.

A registered manager was not in post. The previous registered manager had formally de-registered with CQC in May 2017. A new manager had been employed but was absent at the time of our inspector. The deputy manager, with support from two managers from the provider's other services was responsible for the day to day management of the service whilst the manager was not at work. . 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 was a strong unpleasant smell around the home, including corridors, lounges and people's bedrooms. The provider was aware of this smell and was working to address it. We have made a recommendation about this. The décor of the home had not been well maintained, as paint was peeling and in bathrooms the woodwork was damaged. Maintenance staff were working through a list of improvement actions, however some absence meant they were running behind schedule. The home was clean and staff followed infection control procedures.

People who used the service and relatives told us staffing was adequate to run the service safely. During our inspection we found there were enough staff to respond to people's requests and meet their needs. However, staff expressed concern over staff numbers overnight. The provider's regional manager advised us that following a staffing review they were increasing the number of staff to cover the busier times of the night. The night before our inspection staffing numbers had fallen below the usual staffing levels, and the contingency protocol had not been followed leaving the service ‘short staffed’. The provider’s regional manager advised us they would ensure the contingency plan was followed in the future.

The systems in place to keep people safe had been maintained. Staff were knowledgeable about the safeguarding process. Accidents and incidents were well recorded and monitored to determine if any trends were occurring. Risks were managed. Safe recruitment processes, including pre-employment checks had been followed.

Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. Medicine administration records were well completed. Health and safety checks on the building and equipment were regularly carried out.

Staff training was up to date. Staff received regular supervision and an annual appraisal. New staff were provided with an induction and opportunities to shadow more experienced staff.

Feedback about the food on offer was positive. People were usually provided with a visual choice so they could decide at the time what they would like to eat, based upon how it looked and smelled. Where people needed support to eat, this was given in a dignified way.

People were supported to have maximum choice and control of their lives and staff supp

The inspection took place on 6 January 2016 and was unannounced. This meant the staff and the provider did not know we would be visiting. Hebburn Court was last inspected in June 2014. The service met all the regulations we inspected against at that time.

Hebburn Court is a care home with accommodation for up to 55 people who require nursing or personal care, some of who are living with dementia.

The service had 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.

People and relatives were complimentary about the service and made positive comments. They were happy with the care and support they received at Hebburn Court. One relative said, “It’s grand, we can come when we like, no problems at all.” One person said, “Its lovely here, they look after you.” Another told us, “They are so kind.”

The service had a robust process in place for recruiting staff. Appropriate checks were carried out before commencing employment. We viewed current and historical rotas and found the service employed enough nurses and support staff to meet people’s needs. One care worker said, “It’s so nice to work somewhere orderly and to feel valued, there is a good skill mix, we are able to rely on each other.”

The service uses an electronic system of online training, with face to face training for moving and assisting and first aid. Mandatory training was up to date for all staff. Staff felt supported in progressing their skills and knowledge, and received regular supervision and appraisal to aid their development.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make decisions and the Deprivation of Liberty Safeguards (DoLS) to make sure people are not restricted unnecessarily.

Staff had a good understanding of safeguarding and whistleblowing. They knew how to report concerns about people’s care, health and wellbeing. Staff were confident in speaking to the registered manager and felt concerns would be acted on. The registered manager had a record of all safeguarding alerts which showed appropriate action had been taken.

Systems were in place to manage safeguarding concerns, complaints, accidents and incidents. Records were kept along with immediate actions which showed the service responded to situations with lessons learnt from such events to reduce risk. Relatives knew how to make a complaint and were confident the service would respond.

Effective systems and processes were in place for the management of medicines so people received their medicines safely.

People’s healthcare needs were monitored and assessed with access to other health care professionals when necessary. Records showed community nurses, GP’s and dieticians had visited the service.

Care records demonstrated person centred care with peoples’ choices and preferences being acknowledged. Independence was promoted throughout the care planning process. People had access to activities in the home and in the community.

People were supported to be as involved as possible in choosing meals. People’s dietary needs were assessed and monitored to ensure they had a healthy diet. One person said, “The food is lovely, lots of it and we have a choice.”

Support was given in a respectful, caring and compassionate way. Staff maintained people’s dignity and promoted independence in a sensitive manner. Staff knew how to communicate with people in an accessible way using gestures, pictures and body language. One person said, “It’s nice here, they are so kind from the moment they come in.” Relatives felt involved in their family member’s care and were kept fully informed of any changes. One relative said, “My daughter goes to all the mee

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

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found –

Is the service caring?

We saw people's needs were assessed and care was planned in line with their assessed needs. One relative told us, "We’ve seen other homes but we knew from our first visit this was the one for our aunt.”

We observed care being delivered throughout our inspection and undertook specific observations over a lunch time and in the lounge area. We found that staff interacted positively with people and were attentive, gentle and kind. We observed people for 40 minutes and saw that people interacted and spoke freely with staff.

We observed staff delivering care and saw they were patient and compassionate. They supported people to be as independent as possible and addressed people’s needs where they were unable to do so themselves.

We spoke with one district nurse following our visit who told us, “I have no concerns about the home and staff respond quickly in seeking our support.”

Is the service responsive?

People’s care plans were assessed and kept under review and staff responded promptly when people’s needs changed. People had access to a range of outside services to ensure their health and wellbeing was maintained including doctors, opticians and district nurses.

Care plans were evaluated each month to ensure they remained up to date and reflected people’s current needs. We saw examples within people’s care records of action taken to respond to people’s changing needs, such as referring them to various health professionals for advice and guidance, including specialist nurses, speech and language therapists and dieticians.

Is the service safe?

We walked around the home on arrival and found that the premises were clean, tidy and suitably maintained. Staff were able to talk in detail about the need to use personal protective equipment (PPE), such as aprons and gloves, and the need to change PPE between tasks. We observed staff wore PPE when providing personal care to people and during meal times.

On the day of our inspection the fire alarm was alerted. Staff responded appropriately and we noted that alarms could be heard throughout the building and automatic doors closed when the system was tested.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that one application in relation to DoLS had been submitted and the person’s care plan reflected this. The majority of people who used the service were assessed as not having capacity to make decisions about their care and there was an indication that best interest decisions would be made, where necessary. Staff within the home had received training on DoLS and the Mental Capacity Act 2005.

Is the service effective?

People’s care records indicated that the provider worked closely with other professionals and services to support their needs. We saw that where necessary district nurses, speech and language therapists and palliative care staff were involved in people’s care.

Relatives told us they were happy with the care that had been delivered and that their relative’s needs had been met. One person we spoke with told us, “The staff are lovely, they really help me.”

It was clear from our observations and from speaking to staff that they understood people’s care and support needs. One staff member said, “You always ask people if they are happy, and be able to give people a physical choice, if possible.”

Is the service well led?

The home had a range of quality assurance systems in place to monitor the quality and consistency of care. The manager carried out a range of checks and audits. We saw copies of documents regarding checks on nutrition, equipment and the general environment within the home.

We saw that complaints were investigated and, where necessary, action taken to change or improve care delivery. Relatives of people who used the service confirmed that there were meetings and we saw a copy of minutes from the most recent meeting. One relative told us, “I can talk to the manager anytime about any issues I have.”

Staff told us they had regular staff meetings with the manager and how supportive she was.

We spoke with three people who used the service, four relatives, two staff members and the manager during the course of our inspection. We observed that people's care was unhurried and that people with dementia care needs were supported to make choices during the day. Where people were unable to comment, peoples family members told us they were happy with the care their relative received. One person told us, "My mum has come on leaps and bounds here, and the staff in the kitchen are first class”

People who were able told us they liked living at the home. All of the four relatives we spoke with confirmed they were satisfied with the care their relative received. One of the relatives we spoke with told us how she “Just wanted her mum to be safe” and how her mum had fallen from her chair the day before and was still in a state of shock” Other relatives told us “How they liked how the care staff always made them feel welcome and how any concerns were passed to the senior staff members if they could not resolve it easily themselves”.

People's personal records were accurate, fit for purpose and held securely.

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 knows them by their Christian name, and the care staff always made people feel welcome when visiting the home. No one we spoke with had needed to use the complaint process.