This inspection took place on 23 November 2017 and was unannounced. This meant the registered provider did not know we would be visiting.

Peterlee Care Home was last inspected by the Care Quality Commission (CQC) on 20 and 21 July 2016 and was rated Requires Improvement overall and in two areas, Safe and Responsive. We informed the provider they were in breach of regulation 12 regarding the safe management of medicines and the management of risk assessments and regulation 9 regarding not having person centre activities which met people's individual needs.

Whilst completing this visit we reviewed the action the provider had taken to address the above breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had ensured improvements were made in these areas and this had led the home to meeting the above regulations.

Peterlee Care Home 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. Peterlee care home provides nursing and personal care for up to 44 people. At the time of our inspection there were 41 people living at the home, some of whom were living with dementia.

There was 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 the last inspection we found that the service didn’t have appropriate arrangements in place for the safe handling of medicines. This was in regard to topical medicines that were found to be not dated on opening and no guidance in place for staff to administer them correctly. As Topical medicines such as creams or ointments have a short shelf life such as 28 days once opened. At this inspection we found that improvements had been made to the storage and management of topical medicines and improved directions and recording were in place.

At the last inspection we found the service didn’t offer a varied range of activities for people that were individualised to their needs, wishes and preferences. At this inspection we saw that this had been improved and a wider range of activities were provided that were more meaningful and we saw people taking part and feedback was positive.

At the last inspection we found risk assessments were not managed appropriately. At this inspection we found that risks to people were assessed and improved. These risk assessments were up to date individualised. These were in place to ensure people could take risks as part of everyday life and minimise any potential harm by mitigating risks.

Accidents and incidents were monitored by the registered manager to highlight any trends and to ensure appropriate referrals to other healthcare professionals were made if needed.

The premises and people’s rooms were clean and tidy and throughout the inspection we saw staff cleaning communal areas. Staff had access to plenty of personal protective equipment.

People who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

Staff were supported to maintain and develop their skills through training and development opportunities.

Staff had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further training needs

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This inspection took place on 20 and 21 July 2016 and was unannounced.

Peterlee Care Home is a detached, two storey building in its own grounds. The home has 44 single bedrooms with en-suite facilities. The home also provides separate lounges and dining rooms both upstairs and downstairs and communal bath and shower rooms. There was also an enclosed rear garden with a patio area.

At the last inspection on 15 and 17 April 2015, we asked the registered provider to take action to make improvements to ensure their care documentation was accurate and up to date, and this action had been completed. We also asked them to improve their auditing of the home and found there were regular audit processes in place to monitor the quality of the service.

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.

Checks had been carried out on staff before they were able to start work in the home. This meant the registered provider ensured only suitable staff worked with people who used the service.

The home had in place a number of safety checks which were carried out on a regular basis these included fire checks, health and safety checks and portable appliance testing (PAT) to keep people safe in the home.

We found people’s care plans described their individual needs and gave staff guidance on how to care for people. The care plans were regularly reviewed to check if there had been any changes to people’s needs. The registered manager had in place a dependency tool which they used to measure people’s needs to determine the staffing levels. We found the registered manager had a staff rota in place to reflect the pre-determined staffing levels.

We observed people were given their medicines with patience. Medicine records were up to date. People’s medicines were stored safely. We found systems were not in place to manage people’s topical medicines and could not be assured people received their topical medicines as prescribed.

The service adhered to the principles of the Mental Health Act and had made appropriate applications to the authority to deprive people of their liberty. This meant people could be kept safe.

We saw there were arrangements in place to inform kitchen staff about people’s dietary requirements. Kitchen staff were aware of people’s dietary needs. People were offered a choice of menu. The service had work in progress to give people a choice of menu using pictures.

Staff were provided with support through supervision, appraisal and training. Staff confirmed to us they felt supported.

People who used the service and their relatives told us staff were caring. We noted staff spoke with people in kindly tones and we found people were treated with respect by the staff.

Relatives were involved in people’s care planning. We found staff had listened to people who used the service and their relatives and had responded to their wishes.

People had in place hospital passports. Hospital passports are documents which give information about people to medical staff if they need to go to hospital. We found the passports accurately recorded people’s needs.

We found there was a lack of stimulating activities in the home which met people’s individual needs and preferences.

Surveys had been carried out by the manager to measure people’s views of the service. We found the surveys which had been returned to the service showed professionals were positive about the service.

The registered provider had not met the requirement to display their latest CQC rating on their website.

The service worked with community based professionals to meet people’s needs. These included opticians, dentists, chiropodists, community b

The provider took over the responsibility of Peterlee Care Home on the 28 April 2014 and had been in ownership for nine days when we visited the service. We carried out an inspection due to concerns that had been raised regarding the quality of care people received at the service. The concerns were raised with CQC on the 5 May 2014 and contained information which pre-dated the takeover of the home.

We looked at the information provided to us and looked at the information we held about the service. As part of our inspection we spoke with 7 people who used the service, looked at 11 people's care records and spoke with 8 members of staff including the provider and the Quality Assurance Manager.

People who used the service told us "staff and social workers have stopped us doing what we want", "I’ve been here a long time it's ok, but it’s not home" and "the staff are ok, they help the best they can".

We found people did not receive care which was dignified or effectively planned and delivered. We found instances where people were spoken to like children, were left watching TV programmes where staff did not know if they enjoyed them or not.

We found people's care needs had not been appropriately assessed, for example people identified as being at risk of choking did not have robust assessments completed, where people had lost weight there were no assessments or care plans in place to ensure people received effective care. We also found where people had complex behaviours the service had not implemented the advice and guidance of professionals to ensure care plans contained sufficient strategies and interventions to ensure people's safety.

This inspection took place on 15 and 17 April 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting. On the 7 May 2014 the Care Quality Commission (CQC) completed an inspection and we informed the provider they were in breach of the following regulations:

• Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 (Outcome 4): Care and welfare of people who use services, as the service was not taking proper steps to ensure that people's care had been appropriately assessed, planned and delivered.

• Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010 (Outcome 1): Respecting and involving people who use services, as the service was failing to take people's views and experiences into account in the way the service was provided and delivered in relation to their care.

Whilst completing the visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led the home to meeting the above regulations

The home had a registered manager in place. A registered manager is a person who has registered with 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.

Peterlee Care Home provides nursing care and accommodation for up to 44 people. During our visit the service provided care to younger people with learning disabilities and people with older age conditions. On the day of our inspection there were 36 people using the service. The home was undergoing a planned programme of building work and refurbishment during our visit.

People who used the service and their relatives had conflicting views about the standard of care at Peterlee Care Home. All the care records we looked at showed people’s needs were assessed before they moved into the home.

Care plans and risk assessments were in place when required but were not always person-centred and reflective of people’s needs. Staff used a range of assessment tools however these were not always well completed or up to date. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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 type conditions.

The provider had procedures in place for managing the maintenance of the premises and there were appropriate security measures in place to ensure the safety of the people who used the service.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people using the service. Training records were up to date and staff received supervisions and appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act (MCA) 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 registered manager and looked at records.

We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. We also saw staff had completed training in the MCA and DoLS.

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

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

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

We saw people who used the service had access to healthcare services and received ongoing healthcare support. Care records contained evidence of visits from external specialists.

The provider consulted people who used the service, their relatives and visitors and stakeholders about the quality of the service provided.

You can see what action we told the provider to take at the back of the full version of the report.