This inspection took place on 8 August 2018 and was unannounced. Following our inspection visit to the home we spoke with relatives and other professionals on 10 and 14 August 2018.

At our last inspection in August 2017 we rated the service as Requires Improvement and found breaches of regulations 12 and 17. The breaches concerned the safe administration of people’s medicines and the effectiveness of the provider’s quality monitoring system.

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 questions safe and effective to at least good. We found improvements had been made to return the service to a rating of good.

Leazes Hall 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 home can accommodate up to 48 people in one adapted building. At the time of our inspection 44 people were using the service including people with dementia and learning disabilities.

The care service had developed in line with the values that underpin the CQC guidance, 'Registering the Right Support' and other best practice guidance for people with learning disabilities. These values include choice, promotion of independence and inclusion.

There was 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.

Staff were assessed as competent before administering people’s medicines in a safe manner. We found the administration of people’s medicines complied with the guidance issued by National Institute of Health and Care Excellence.

Pre-employment recruitment checks were carried out by the service before staff began working in the home. When a new member of staff began to work in the home they were supported through an induction period, training and supervision. Staff training included how to safeguard vulnerable adults and staff knew how to do this.

The registered manager monitored the staffing levels to ensure the service could meet people’s needs. We found there was enough staff on duty.

Cleaning was on-going during our inspection to reduce the risk of cross infection. We found the home including people’s bedrooms and communal areas were clean and tidy.

Checks were carried out on a regular basis including fire safety to ensure people lived in a safe environment. People had individual emergency plans in place to help if emergency services evacuated people from the building. Adaptations had been made to the environment to support people living with dementia and promote their independence.

Personal risks had been assessed by the staff and actions taken to reduce risks such as falls. The registered manager reviewed in detail accidents and incidents which occurred in the home to see if they could be prevented.

Kitchen staff were aware of people’s dietary needs and prepared fluids and nutrition accordingly. We found the food was well-presented.

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.

Relatives were complimentary about the caring nature of the staff. Staff spoke to people in kind tones and respected their dignity and privacy. Care professionals who visited the home told us staff provided support when they visited and made sure people’s privacy was protected.

Activities were provided by the service. People were able supported to carry out activities of their choosing. These included outings, animal care

This inspection took place on 16 August 2017 and was unannounced. This meant the provider and staff did not know we would be visiting.

Leazes Hall Care Home is a residential home which provides nursing and personal care for up to 48 people. At the time of our inspection there were 43 people in receipt of care from the service, some of whom were living with dementia. Care is also provided for people with learning disabilities and autism spectrum disorder. The home also provides emergency short term care, intermediate care for up to three weeks (usually after people are discharged from hospital or to avoid admission to hospital) and care on a 'time to think' basis for up to 12 weeks, which gives people the opportunity to trial residential care.

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.

We last inspected this service on 14 June 2016 when it was rated Requires Improvement. This was a focused inspection after we received concerns in relation to the building and the care provided to people using the service. Prior to this we had inspected the service in December 2014 when it was rated Good. At our last inspection in June 2016 we found breaches of Regulations 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the premises required adaptation to meet the needs of people diagnosed with dementia type conditions and accurate and up to date records related to the management of people's topical medicines were not in place. We asked the provider to send us a plan of the actions they would take to meet legal requirements. We found some improvements had been made during this inspection, however some regulations were not being met.

Medicines were not always managed in the right way. Records relating to the administration of topical creams were incomplete. Guidance relating to ‘when required’ medicines was not detailed. Handwritten instructions on medicines records had not been double signed and there was a lack of detailed instructions for the administration of covert medicines (medicines that need to be given in a disguised form).

The provider had a quality assurance system in place but this was not always effective as it had failed to identify all of the issues we found during this inspection. It had also not effectively addressed the concerns raised at our last inspection and we found some shortfalls in similar areas.

Improvements had been made to the premises since our last visit so it that it was more suited to people with dementia care needs. There were visual and tactile items to engage people living with dementia and doors to rooms were brightly coloured to help people identify them independently. Menus were available in picture format so they were more accessible for people.

The premises were clean and largely well-maintained although some carpets in communal areas were worn and needed replacing.

People and relatives told us it was a safe place to live. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols..

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check being undertaken.

Each person had a Personal Emergency Evacuation Plan (PEEP) which provided staff with information about how to support them to evacuate the building in an emergency situation such as a fire or flood.

We found that overall, there were enough staff on duty to meet people’s n

We carried out an unannounced comprehensive inspection of this service on 18, 22 December 2014 and rated the service as ‘Good’ After that inspection we received concerns in relation to the building and the care provided to people using the service. As a result we undertook a focused inspection on 14 June 2016 to look into those concerns. This latest inspection was also unannounced. 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 Leazes Hall on our website at www.cqc.org.uk.

Leazes Hall Care Home is situated in the village of Burnopfield, County Durham. It is an extended Grade II Listed building originally built in the late 18th century and can accommodate up to 50 people. At the time of our inspection there were 45 people using the service.

The home 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 had in place emergency evacuation plans and these were readily available to emergency rescue services.

We found people were given their oral medication in a safe manner and the clinic area was well organised and well run. However we could not be assured that everyone was given their prescribed topical medicines (creams to be applied to the skin) as required.

People living in the home had been diagnosed with a dementia type condition and we found the premises required further adaptations to ensure people living with dementia were able to safely navigate around the building.

Staff, including night staff and agency nurses were provided with appropriate training and supervision to enable them to carry out their duties. We saw staff also had in place an annual appraisal where they discussed their performance.

The home met the requirements of the Mental Capacity Act 2005 and we found applications had been made to the required authority under the Deprivation of Liberty Safeguards (DoLS). This meant people were appropriately deprived of their liberty and kept safe in the home.

The service had worked with other agencies to ensure people’s nutritional needs were met. We saw the home had in place arrangements which meant people who required nutritional supplements were given them as prescribed.

Checks on the building were carried out at regular intervals to ensure people who lived in the home were kept safe. These included fire checks, specialist bed checks and checks on bedrails. We found the home had in place an in date fire risk assessment and updated gas and electric certificates.

The service had in place robust recruitment procedures. Checks were carried out on staff before they commenced working in the service and prospective staff were required to provide details of their past experience and knowledge.

People had a choice of food to eat at mealtimes. We observed staff supporting people to eat at their own pace.

A monthly newsletter was provided to relatives and visitors about the home.

We observed staff communicating with each other about people’s care needs. There was handover information available in the clinic room and tasks had been allocated to staff to carry out at each handover. This ensured the smooth running of the service.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy with the care they received and staff checked they were in agreement with it. We saw they were relaxed and there were good interactions between people who used the service and staff. We saw staff consulted people before they

provided care and support. One person told us, "They (staff) always ask me before helping me, I like this as I can choose."

We found people's needs were assessed and care was planned in line with their needs. One person told us, "I have a lot of complicated health needs, the staff know me and know when to get further involvement of my doctor." One relative told us, "My mother's care here is good." Careplans were regularly updated and contained clear information about individuals' care.

We found medicines were managed in a safe way.

Staff recruitment procedures were followed and appropriate checks were undertaken before staff began work.

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. One person told us, "I am upstairs but feel safe as I know the staff check on me and they always respond when I press my buzzer."

People's personal records, including medical records, were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.

We spent time observing how staff supported people living at the home. We found staff were very respectful in their approach, treating people with dignity and courtesy.

People we spoke with said they were happy with the staff. Comments included, “They always respect me”, “They are very good that way” and “They’ve all been good to me”.

We saw people being involved in day to day decisions about their care; we also saw documentary evidence that care needs assessments were compiled in discussion with people using the service or their families.

We spoke with several people who lived at Leazes Hall, they were all very positive about the care they received. Comments included “I think they’re a nice set of girls” and “They would do anything for you”.

During our inspection we looked around the home. We saw the building was kept clean and tidy. We also looked at equipment such as wheelchairs, hoists and shower chairs that were provided to help meet people's mobility needs. We saw this equipment was clean.

We spoke with five staff; most had worked for the provider for several years. They told us without exception, they felt supported. We saw they attended regular training courses and had appropriate supervision.

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would just speak to the girls", another said “I’m confident they would sort it out if I had any problems”.

One person said, “The manager and another person came to see me in hospital, they gave me lots of information about the home and asked me lots of questions. I came for a couple of weeks and then decided to stay. That was a year ago, and I am now quite content.”

One person said, “This is a marvellous place, I settled in immediately. I have a lovely woman who takes care of all my personal needs and we sometimes go shopping together. She is always asking me what I want or need. I am very satisfied with the support that I get.”

Another person said, “I am aware of the file that they have about my care needs. I have looked at this a few times, and I agreed with what it said, I then signed lots of pages”.

Another person said, “I can make my own decisions, and I am happy with the support that I receive.”

One relative said, “I am kept fully informed about my relatives care. Generally I think that the care here is excellent.”

Another relative said, “I visit every day, I don’t have any concerns. My relative receives very good care, and I am actively involved in my relatives care. It would be nice to have more staff around sometimes.”

People told us that they were confident that staff would take seriously any worries they may express, and would act upon them.

One person said, “I don’t have any concerns at the moment but if I had, I would certainly speak up and make sure that they were dealt with.”

Another person said, “I once lost a dress in the laundry, and this was replaced with a new one within a few days.”

Two relatives said that they thought the staff were very supportive and well trained.

Two service users told us that they were actively involved in the service user committee.

One person said, “We certainly make our views known, and most of our suggestions are carried through.”

This inspection took place on 18 and 22 December 2014 and was unannounced. This meant the staff and the provider did not know we would be visiting.

Leazes Hall Care Home is situated in the village of Burnopfield, County Durham. It is an extended Grade II Listed building originally built in the late 18th century and set in its own grounds with outstanding views from the back and well maintained gardens to the front. The accommodation included 48 bedrooms, 3 lounges, 2 dining rooms, a conservatory, several bathrooms and communal toilets.

Leazes Hall Care Home provides nursing care and accommodation for up to 50 people. On the days of our inspection there were 48 people using the service.

The home had a registered manager 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.

Leazes Hall Care Home was last inspected by CQC on 19 August 2013 and was compliant.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) is part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the manager and looked at records. We found the manager was following the requirements of DoLS.

We found evidence of mental capacity assessments or best interest decision making in the care records. Staff were following the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions and the provider had made applications under the Mental Capacity Act Deprivation of Liberty Safeguards for people being restricted of their liberty.

People were protected against the risks associated with the unsafe use and management of medicines.

The levels of staff provided were based on the dependency needs of residents.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Training records were up to date and staff received regular supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

People had access to food and drink throughout the day and we saw staff supporting people in the dining room at lunch time when required.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home but could be more suitably designed for people with dementia.

People who used the service were complimentary about the standard of care at Leazes Hall Care Home. They told us, “I am very happy with the home.” and “I can’t say anything against the staff they are wonderful.”

We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity and respect. People were encouraged to care for themselves where possible.

We saw that the home had a programme of activities in place for people who used the service.

All the care records we looked at showed people’s needs were assessed before they moved into Leazes Hall Care Home and we saw care plans were written in a person centred way.

We saw that pre-admission assessments had been carried out. We saw that daily records were up to date. Care plans and risk assessments were in place when required. Care plan reviews were up to date.

We saw weight, malnutrition universal screening tool (MUST), food charts, fluid balance charts and waterlow records, which assess the risk of a person developing a pressure ulcer, were completed regularly and were up to date.

We saw records of visits by healthcare professionals, such as GP’s, social worker, speech and language therapist, podiatrist, falls team, community psychiatric nurse, physiotherapist, dentist and district nurse.

We saw evidence that people using the service, their relatives, visitors or stakeholders were asked about the quality of the service provided.