The inspection took place on 18 October 2018 and was announced. We gave the provider short notice of our inspection because it is small and we needed to make sure they would be in.

Neville's Court is a 'care home'. People in care homes receive accommodation and nursing or 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. Neville's Court can accommodate up to four people with a learning disability. At the time of our inspection three people were using the service.

We last inspected this service in December 2016, and found the service was complying with all the regulations and we rated the service as ‘good.’

During this inspection we found the service now required improvement. Records and governance needed to be improved. There was one breach of Regulation 17 of the Health and Social Care Act relating to this .

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The goal is that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The manager had been in post for four months and was in the process of applying to be registered. The manager was based at another of the provider's larger services located close by. 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.

Regular quality audits had not been carried out at during 2018 and so areas for improvement that we found in relation to care record reviews and supervisions for staff had not been addressed. The regional manager and manager began to address this on the day of our inspection and confirmed to us in writing the following day that a range of audits had been carried out.

Whilst we did not find any detrimental impacts on people who used the service [in fact, feedback was extremely positive], the provider needed have suitable systems in place to ensure adequate oversight of all aspects of the service including support for staff in the form of supervisions.

Staff had been trained in safeguarding issues and knew how to recognise and report any abuse.

People’s medicines were managed safely.

There were enough staff to meet people's needs. Any new staff were appropriately vetted to make sure they were suitable and had the skills to work at the service.

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 made most meals but if people wanted they could make their own in their own kitchen areas. People's nutritional needs were fully understood and people told us staff encouraged them to eat a healthy diet.

Staff were respectful of people’s individuality. We saw staff promoted people's dignity and respect. There were positive relationships between people, staff and relatives.

People were supported, where appropriate, to manage their health needs. Staff responded promptly to any changes in people's health and worked with other services to promote people's wellbeing.

There was an accessible complaints process and we saw the service provided access to advocacy services and one person was currently using advocacy support.

The inspection took place on 20 December 2016 and was unannounced. This meant the staff and provider did not know we were visiting.

Nevilles Court is a care home which is registered to provide care for up to four people with learning disabilities and/or physical disabilities. The home has four apartments consisting of a bedroom, living area, kitchen and a bathroom.

The home does not currently have 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.

Although there was no registered manager in post at the home a new manager had been appointed and their intention was to apply to be the registered manager of the home. Management cover was provided this manager and by a care manager who worked at both this home and a nearby home run by the same provider. The service also had a team leader.

We found that the new manager had only just commenced in post and new management structures had not yet been implemented. Up to the point of our visit staff had been supported by the care manager and the team leader. Some staff and people who used the service told us they felt there had been a lack of regular management/provider oversight of the home.

People who used the service told us they felt safe and well supported by staff. Staff had received training in safeguarding. We found staff understood what actions to take if they thought people were unsafe.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

The premises were clean and well maintained. People were supported to keep their own apartments clean and tidy. We saw that equipment was in place to maintain the health and safety of people and staff, and were checked both by the service and approved contractors when required.

We found that some very recent fire checks had been missed. These were brought to the manager and care manager’s attention and we were given reassurances these would be completed with immediate effect.

There was a process for managing accidents and incidents to ensure the risks of any accidents re-occurring would be reduced.

Staff employed by the registered provider had undergone a number of recruitment checks to ensure they were suitable to work in the service. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Individual support plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm.

We found people who used the service and their representatives were asked for their views about the service, both through surveys and individual meetings. Survey results were broadly positive. We saw that there had been some improvement in the way the home analysed and responded to feedback about the service but that this could be developed to set targets for when improvements would be made.

There were quality assurance systems in place to ensure the effective running of the service, however we saw that compliance checks previously completed by the provider had not been completed since the last inspection of this home.

The home had established and maintained good links with health professionals.

The inspection took place on 12 and 13 July 2016 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Nevilles Court on 17, 18 and 21 July 2014 and informed the registered provider they were in breach of two regulations: care and welfare of people who use services and; assessing and monitoring the quality of service. The provider submitted an action plan in February 2015.

Whilst completing this visit we reviewed the action the registered provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the registered provider had ensured improvements were made and that they were compliant with the relevant regulations. We found the registered provider had ensured improvements in three areas previously rated as requiring improvement.

Nevilles Court is a residential home close to central Durham providing accommodation and personal care for up to four people with learning disabilities and/or physical disabilities living in their own apartments. There were four people using the service at the time of our inspection, although one person was in hospital at the time for a scheduled review.

The service did not have 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 directors, 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 saw that, since the last registered manager had left the service, the registered provider had recruited two interim managers who had since left the company. The current manager was going through the process of applying to be registered with CQC.

There were sufficient numbers of staff on duty in order to safely meet the needs of people using the service and to maintain the premises. All areas of the building were clean.

Staff were trained in safeguarding and displayed a good knowledge of safeguarding principles and what they would do should they have any concerns.

People who used the service and their relatives expressed confidence in the ability of staff to protect people from harm.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). There had been particular improvements in relation to topical medicines (creams).

Risk assessments had also been improved and staff displayed a good knowledge of the risks people faced and how to reduce these risks.

People received the treatment they needed through prompt and regular liaison with GPs, nurses and specialists.

Staff training had been updated to ensure staff had a good working knowledge of people’s physical needs. Staff had also received refresher training in areas the provider considered mandatory, such as safeguarding, risk assessment, fire safety, first aid, epilepsy awareness and infection control.

Staff received regular supervision and appraisal processes as well as regular team meetings.

We checked whether the service was working within the principles of the MCA. Staff displayed a good understanding of capacity and consent and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

The atmosphere at the home was relaxed and welcoming. People who used the service, relatives and external stakeholders told us staff were patient and dedicated and we observed staff interacting with people in this way.

Person-centred care plans were in place and people pursued hobbies and interests meaningful to them with the support of staff.

We decided to visit the home on an evening to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

Nevilles Cross comprises of four separate apartments with a communal lounge. Each apartment is self contained, with a kitchen and living area, bedroom and en-suite bathroom. During our visit we looked around the building and found it to be clean and well maintained.

We observed how staff asked people for consent. For example, before entering someone’s apartment, staff asked the person if it was OK to go in. We saw another member of staff asking someone if they wanted help to sit down.

We spoke with several people who lived at the home and some of their relatives. People were very happy with the care provided. Comments included “I like the staff, everything’s fine and I’m doing well” and “They are the best.”

We spoke to some staff, people who lived at Nevilles Court and their relatives about staffing levels. They all said they thought there was enough staff on duty. However, some said they would prefer to have more male staff to support them. One person said “There should be another male; (resident’s name) prefers a male carer to help them with personal care.”

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would speak to them, they would sort it out.” Another said “I haven’t had to complain but I know what to do.”

We spoke with two people who used the service. Both of them told us that they felt safe living at Neville’s Court. They explained that they knew who to talk to if they had any concerns and they thought that staff treated them well.

People also told us how their social needs were met. One person told us that he was a keen football supporter and that staff frequently took to him to watch the team he supported. Another person explained that he enjoyed going to see comedy shows and staff supported him to go to these.

One person said “I can go swimming or ride my bicycle if I want to”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

Nevilles Court provides accommodation and personal care for four people with learning and physical disabilities living in their own apartments on one floor. Each apartment consists of a kitchen, dining area together with a bedroom, a sitting area and a bathroom.

This inspection was unannounced and took place 17, 18 and 21 July 2014. At our last inspection in May 2013 we found the service we found the service to be meeting all the regulatory requirements looked at during the inspection.

The registered manager was also registered in respect of other services owned by the provider and was not based at Neville’s Court. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found people were not always protected against the risks associated with their diagnosed conditions, although they were safe through the appropriate use of medication. The provider’s policy on medication did not include topical medication.

People were supported to undertake a weekly food shop and maintain a balanced diet. However we saw that this was not always put into place by staff.

People who used the service, their relatives and staff all told us there were sufficient staff at the service. We found staff were used to task based practice when supporting people who required additional support. For example staff were aware

The managers who were present at the time of the inspection and the staff were able to describe to us Deprivation of Liberty Safeguards (DoLS). We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.

Staff received training and supervision to assist them in undertaking their role. However we were concerned staff did not always receive training to allow them to perform their role with sufficient competency and skill. For example staff were caring for people with medical conditions about which they had not received any training or given any information.

People were supported to access appropriate health professionals where they experienced a change in their health and well-being.

Care was not always delivered in a way that was responsive to people’s individual assessed needs.

People who had not had any reason to complain told us they were aware of how to make a complaint if necessary. We saw in one person's file if they became angry about an issue they were to be given an opportunity to complain.

Quality monitoring processes did not always identify shortfalls in the quality of care planning and risk assessments.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.