This inspection took place on 4 and 6 October 2017 and was unannounced. Redworth is a care home with nursing that is registered to provide care for up to 57 people. The home is located in Shildon, County Durham and is owned and run by Shaftesbury Care GRP Limited. At the time of our inspection 41 people were using the service.

At the last inspection on 26 August 2015 the service was rated Good but with a breach of regulation as it did not have a registered manager at that time. At this inspection we found the service remained Good.

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.

People told us staff at the service kept them safe. Risks to people using the service were assessed, and the premises and equipment were regularly checked to ensure they were safe for people to use. Medicines were managed safely by staff who had been trained to do so. Policies and procedures were in place to safeguard people from abuse. Staffing levels were monitored to ensure enough staff were deployed to support people safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff were supported to carry out their roles by regular training, supervisions and appraisals. 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. People were supported to maintain a healthy diet and to access healthcare professionals to monitor and promote their health.

People and their relatives praised staff at the service, describing them as kind and caring. People said staff treated them with respect and helped to maintain their dignity. People were encouraged to maintain their independence. Throughout the inspection we saw numerous examples of kind and caring support being given. Policies and procedures were in place to arrange advocacy support should this be needed.

People received the care and support they wanted. Care records were personalised to people’s needs and wishes and were regularly reviewed to ensure they reflected people’s current support needs and preferences. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints.

Staff spoke very positively about the registered manager and the culture and values of the service. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was regularly sought from people, relatives, external professionals and staff. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

As part of this scheduled inspection we followed up on two compliance actions set at the previous inspection in November 2012. We found improvements had been made in both of these areas.

The acting manager told us they were in the process of applying to become the registered manager at Redworth.

People told us they had been asked for their permission prior to receiving care or treatment.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People said they were happy with the care and support they received at Redworth. One person told us "I like it here. I’ve been here 2 years; I don’t think I’ll move from here.” Another person said “I haven’t got a complaint in the world.”

There was enough equipment to promote the independence and comfort of people who used the service. The acting manager told us the provider had contracts in place for the regular servicing and maintenance of equipment within the home. We saw records of maintenance and safety checks for the equipment used in the home to support this. We also saw records of other routine maintenance checks carried out within the home.

There were sufficient staff employed and deployed at the home to meet peoples' needs.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Comments about the staff and people’s experience of them included “You can’t fault them” and “They can’t do enough for you really.”

We used a number of different methods, for example observing how people were cared for, to help us understand the experiences of people who used the services. This was because we were unable to get people’s direct comments about the care they received.

People were given appropriate information regarding their care or treatment. We saw adjustments had been made within the home to help uphold and maintain the dignity and independence of people with dementia type illnesses who lived there.

People’s needs were assessed and care and treatment was planned, however there was a risk it was not always delivered in line with their individual care plans due to the deployment of staff.

The provider had a safeguarding policy and procedure in place. All of the staff we spoke with during the inspection were familiar with safeguarding procedures and knew how to respond to any allegations of abuse.

We found there were not enough qualified, skilled and experienced staff to meet people’s needs at all times.

The provider had a complaints policy and procedure and was able to demonstrate complaints and concerns raised had been investigated and resolved, as far as possible, to the satisfaction of the complainants.

Most people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how staff supported people and this was positive and respectful. We did not see any of the people who lived in the separate learning disability unit as they were all out as part of their daily activities.

We spoke with five people. Everyone we talked to spoke highly of the service. They said:

“You get well looked after”,

“It’s good here”,

“They found my dressing gown and it had been gone about six months!”,

“I enjoyed my dinner”,

“They have good food here” and

“I’ve been here two years, I like it here”.

We heard staff talking to people using their preferred name and people being asked questions about what they would like.

We heard staff saying:

“How would you like your tea” and

“Your hair looks lovely”.

We carried out an unannounced comprehensive inspection of the service in March 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this comprehensive inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Redworth on our website at www.cqc.org.uk.

The home provides care for up to 57 older people, On the day of our inspection there were 22 people using the service, 12 people required nursing care.

The home had a recently appointed acting manager who is not yet registered with CQC. 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 time of the inspection visit, our records show that no registered manager’s application had been submitted to CQC.

This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and under the Care Act 2014 Regulation 7 (b).

We spoke with care staff who told us they felt supported and that the acting manager was always available and approachable. Throughout the day we saw that people and staff were very comfortable and relaxed with the management team on duty. The atmosphere was calm and relaxed and we saw staff interacted with people in a friendly and respectful manner.

Care records 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. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary. We saw records were kept where people were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

We found people’s care plans had been written in a way to describe their care, treatment and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people or their representatives were involved in their care planning.

The staff that we spoke with understood the procedures they needed to follow to ensure that people were kept safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes.

We found robust systems in place for the safe management of medicines.

We found the premises were clean and hygienic with effective systems in place to control the spread of infections.

Those parts of the home that needed it had been refurbished to a high standard.

When we looked at the staff training records they showed us staff were supported to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended both face to face and e-learning training to maintain their skills. They told us they had regular supervisions with a senior member of staff, where they had the opportunity to discuss their care practice and identify further training needs. We also viewed records that showed us there were robust recruitment processes in place.

The management team and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

During the inspection we saw staff were attentive and caring when supporting people. Comments from people who used the service were very consistent stating they were happy with the care, treatment and support they received. Other professionals we spoke with were positive about the care and support people received.

We observed people were encouraged to participate in activities that were meaningful to them. For example, we saw staff spending time engaging with people on a one to one basis, and others had visited a local railway museum on the previous day.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a selection of choices.

We found the building met the needs of the people who used the service. We were told that work on the refurbishment of the home will continue throughout the remainder of the year.

We saw a complaints procedure was displayed in the main reception of the home. This provided information on the action to take if someone wished to make a complaint.

We found an effective quality assurance system operated. The service had been regularly reviewed through a range of internal and external audits. Prompt action had been taken to improve the service or put right any shortfalls they had found. We found people who used the service, their representatives and other healthcare professionals were regularly asked for their views.