The inspection took place on 30 and 31 May and 5 June 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Redwell Hills Care Home in July 2015, at which time the service was compliant with all regulatory standards and was rated Good. At this inspection the service remained Good.

Redwell Hills is a care home in Leadgate, Consett, providing accommodation and nursing care for up to 51 older people who require nursing and personal care. There were 35 people using the service at the time of our inspection.

The service 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.

People were protected against a range of risks by risk assessments and care plans that were regularly reviewed. Risks were considered with the input of external professionals where appropriate.

People we spoke with and relatives agreed staff faced a challenging workload, but there were sufficient numbers of staff on duty in order to meet people’s needs and keep them safe.

Pre-employment checks ensured the service did not employ people who were unsuitable to work with potentially vulnerable people.

Staff were trained in areas such as dementia awareness, moving and handling, safeguarding, health and safety, infection control, mental capacity and food hygiene. Training needs were monitored and managed well at location and provider level.

Infection control procedures were in place and we found all aspects of the home to be clean and well maintained.

Staff received consistent support through supervision and appraisal meetings, as well as group supervisions and staff meetings.

The management, administration, storage and disposal of medicines was carried out in line with National Institute for Health and Care Excellence [NICE] guidelines.

People healthcare needs were well managed with the support of external healthcare professionals where necessary.

All people who used the service we spoke with, relatives and visiting healthcare professionals agreed staff were caring in their interactions with people and we saw evidence of this during our inspection.

The registered manager was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). They had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. 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 and hydration needs were met by kitchen staff who had up to date information about their preferences and specialised diets. We observed calm and unhurried mealtimes, with people able to choose alternative options and staff attentive to their needs.

Care plans were sufficiently detailed and staff demonstrated a good knowledge of people’s needs, likes and dislikes. The registered manager was in the process of introducing additional one-page profiles to ensure new staff had readily accessible person-centred information.

The service had an activities co-ordinator in place and there were a range of group activities on offer. At times the activities co-ordinator did not have sufficient time to ensure people who chose not to engage in group activities were able to engage in activities meaningful to them.

The service had a range of quality assurance and auditing processes in place to continually review service provisions. Relevant policies and procedures were in place and regularly reviewed.

People who used the service, relatives and staff

We carried out this focused 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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out an unannounced focused inspection of this service on 30 July 2015. A breach of legal requirements was found following the comprehensive inspection on 9 February 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to this requirement. At the last inspection on 9 February 2015 we asked the provider to take action to make improvements. We asked the provider to provide staff with a minimum of six one to one supervision sessions annually.

The inspection was led by an adult social care inspector.

The service 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Redwell Hills Home on our website at www.cqc.org.uk

During our inspection of 23rd April 2013 we found people were not fully protected or consulted about their care. This was because behaviour interventions plans had not been completed to keep people and staff safe from harm. We found people’s care plans and risk assessments showed no evidence that people or their representatives had been involved in the planning and delivery of their care.

Following this inspection we asked the provider to send us an action plan detailing how improvements would be made. The action plan we received told us there were procedures in place to review all people’s care and support plans. All people who used the service or their representatives would be involved with the review, planning and decision making of their care and support needs. In addition, all people’s risk assessments and behaviour interventions plans would be reviewed and agreed with people, or where necessary other professionals involved and their representatives.

During this inspection we found people’s personal records including risk assessments and personal intervention plans were accurate. We saw people who used the service had been involved and their consent had been sought. Where people lacked capacity, we saw the provider had involved others who had sufficient knowledge about the person's care, treatment and support needs to make a decision on their behalf. This meant the provider's record keeping was up to date and protected people's safety and wellbeing.

During the visit we talked with people who used the service, relatives, staff, and the covering manager. (This was a manager from another home who was overseeing the home in the manager's absence) We looked at information about the people who used the service and how well their needs were met. We also looked at other records which must be kept, checked staff had the knowledge, skills and training to meet the needs of the people they cared for, looked around the building/parts of the building to make sure it was clean, safe and comfortable, and checked what improvements had been made since the last visit.

Each person had an assessment of their social needs that gave details of their background, lifestyle, routines and interests. The information was used to implement individual care plans. Wherever possible staff supported individual needs and requests for one-to-one activities and outings.

We identified some gaps in the provider's record keeping. These could potentially lead to peoples care and support needs being compromised and not fully met.

People who used the service told us they choose whom they wished to see and where to receive visitors. Contact with friends and family was supported through visits, telephone calls and letters/cards.

Three visitors said they are always kept up to date with important issues affecting their relative.

People told us that they were encouraged to make choices and decisions for themselves.

One person said, “I was given lots of information about the home before I moved in. My family looked at several other homes but they thought this one was the best one for me. I gave it a trial run for a couple of weeks, I then decided to stay.”

People we spoke with said they were very satisfied with all aspects of the care they received.

One person said, I have been here for two years, the care and support I receive is very good. All the staff are very nice, and they spend lots of time chatting to me about everything, they are forever asking me what I want or need. I am happy to be living here.”

People told us that they were happy with the facilities within the home.

One person said, “I have a lovely bedroom and everywhere is always clean, tidy and fresh.”

One person on the dementia care unit told us, “It is nice here, I like the people (meaning staff) they look after me and we all sing happy songs together.”

One person told us,” The staff here are wonderful, they do a great job. When I first came here I was extremely poorly, only their expertise pulled me through. I am very grateful to them.”

Service users told us that the service always kept them informed of any decisions made about their care, treatment and support needs.

During the visit we spoke with 3 relatives. They told us that they were extremely happy with the care and support their relatives were receiving. They said that staff were always respectful and discreet when supporting their relatives with personal care needs.

“I am very fussy about my appearance, but they make sure that I can choose what I want to wear, I like to make sure that things match properly”.

“The staff are good, they know what my preferences are and they stick to these”.

“I have only been here for a few weeks. They have asked me over and over again about what I want, and about my needs. They wrote these down. They asked me to check the information to make sure it was right, it was, so I then signed it”.

When we spoke with people using the service, they said that they felt safe.

One person said, “I no longer feel isolated or afraid, when I lived on my own I worried all of the time and I didn’t sleep very well. I do now”.

Another said, “I am treated very well and always with respect. If I ever had any concerns, I know they would be dealt with immediately. I have no fears living here, it is a good place”.

People said that they liked the lay out of the home because there were lots of different rooms that they could use.

One person said, “I like my bedroom, it has great views over the countryside”

Another person said, “It is lovely and clean, the girls work hard at keeping it nice and tidy”.

People told us that they were always treated with respect and they said that staff listened to what they had to say.

One person said, “I feel valued, I am supported to make decisions and continue to be as independent as I can be”.

“I think the staff are very good, they always seem to know what they are doing. I think they do a good job”.

This inspection took place on 9 and 10 February 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

The home provides care and accommodation for up to 46 people. On the day of our inspection there were 40 older 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.

The home was last inspected by CQC on 19 February 2013 and was compliant.

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

We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations.

We saw a copy of the provider’s complaints policy and procedure and saw that complaints had been fully investigated.

We saw comprehensive medication audits were carried out regularly by the provider.

Training records were up to date. However staff did not received regular supervisions and appraisals, which meant that staff were not properly supported in their role.This is a breach of Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We saw staff supporting people in the dining rooms at lunch and choices of food and drinks were being offered. People told us the food was always good with a good selection of choices available at every meal.

All of the care records we looked at contained care plan agreement forms, which had been signed by the person who used the service or a family member.

The home was clean, spacious and suitable for the people who used the service.

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 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 provider was following the requirements in the DoLS.

People who used the service, and family members, were complimentary about the standard of care. They told us, “This is the best place, all the staff are caring it’s absolutely superb, five star.” A resident said, “They’re a great lot here, as soon as you want something they are there for you.”

We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity and respect and people were encouraged to remain as independent where possible.

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

On both days of our inspection, we saw people were actively involved in a range of activities.

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way that always involved people or their representatives.

We saw the provider worked in partnership with other health and social care professionals.

The provider had a quality assurance system in place and gathered information about the quality of their service from a variety of sources.

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