This inspection took place on 1, 8 and 20 November 2017 and was unannounced. This meant staff and the provider did not know that we would be visiting.

Sheraton Court is a ‘care home’. People in care homes receive accommodation and 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. Sheraton Court accommodates up to 80 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of this inspection 79 people were in receipt of care from the service.

At the last inspection in June 2015 we found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Sheraton Court as ‘Good’ overall and good in four domains but noted improvements were needed to ensure staff always treated people with dignity and respect. We rated the service as ‘Requires improvement’ in one domain, namely 'caring’.

On 25 January 2017, the registered provider changed their name from Helen McArdle Care to HC-One Beamish Limited.

The registered manager had been in post since 2008. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 this inspection we found that the registered manager was a driving force for improvement at the service and was totally committed to delivering personalised and effective care. The registered manager researched how to provide high quality care for people who used the service. The registered manager had consistently ensured that all people who used the service, families and staff had significant involvement and input into how the service has been developed. Everyone was encouraged to share any thoughts, ideas and innovations on a monthly basis. All of the people and professionals we spoke with told us this was positive example of the changes made to the service, which benefitted people who live at the service and also all who visited.

We found staff were exceptionally caring and dedicated to ensuring people experienced high quality care. We heard how staff treated people, very much as individuals and both welcomed them to the service and showed a great deal of respect when people passed away. One relative, who worked as a nurse, told us they were extremely impressed with how staff care for people at the end of their lives. They told us their relative could not have experienced a more dignified end and they were taken aback by the care shown them when staff lined up to pay their respects to their relative. We found that people who used the service and relatives routinely nominated staff for the provider’s ‘Kindness and Care’ award as did the manager. We saw that each month at least two staff received such an award.

We found staff drive and passion had created an exceptionally dynamic and vibrant service. The culture embedded in the service was of total commitment to delivering a service that focused wholly on the wants and aspirations of the people who used it. The team worked collaboratively with people and their relatives to ensure the care provided met each person's needs. We saw that staff always engaged people in conversation and outlined the actions they were proposing to take to assist people with all of their care and support.

Staff were devoted to ensuring each individual found their lives were enriched. The relatives and visiting healthcare professionals told us the service provided care that was exceptional and contrasted dramatically from any other provision they had experienced or visited. They described the service as one that had dramatically improved people’s quality of life.

Where people did not have the capacity to consent, the provider failed to act in accordance with legal requirements.

Staff told us that they had undertaken additional training on mental capacity. One person told us, "I think more training would be good for us".

We spoke with six people who lived at the home, three relatives of people who lived at the home and also five members of staff. People we spoke told us, "I love it here", and "I know I am well looked after and safe livng here." One relative told us, "She is very well cared for and there are very good staff here, no concerns at all."

Some of the people who lived at the home had marked problems with their memory and found it difficult to think about recent events or at times, to have a conversation. So that we could understand the experiences these people had of care and support, we carried out a structured observation during our inspection called a Short Observational Framework for Inspection (SOFI).

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare and there were enough qualified, skilled and experienced staff to meet people’s needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Where people did not have the capacity to consent, the provider had failed to develop systems to ensure that they acted in accordance with legal requirements.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained and the provider had an effective system to regularly assess and monitor the quality of service that people receive.

Sheraton Court delivered care and support in a positive way which promoted people’s independence and respected their individuality and cultural and personal preferences. People who lived there and their relatives were happy with how support was provided.

Risk assessments were carried out and care was delivered in line with people’s needs. Appropriate action was taken when people’s needs changed and health professionals and others were involved whenever they were needed.

On the whole, medication was dispensed safely and there were processes in place to ensure this. There were some concerns about the records held by the service because these were sometimes out of date and didn’t reflect the support people received. Recording related to some medication also needed to be improved.

Sheraton Court ensured that a robust recruitment process was followed and all staff had appropriate qualifications and experience to be able to deliver care and support to the people who lived there.

Some of the people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this, we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the ‘Short Observational Framework for Inspection (SOFI).

Throughout this observation we saw people being treated very much as individuals, being encouraged to participate in activities and being spoken to very kindly by staff.

People we spoke with told us they were treated with dignity and respect by the staff. One person said, "I love it here, the carers are absolutely perfect, they are always polite, lovely, do everything possible for you."

People we spoke with told us they were well cared for and supported by caring staff. People said, "The staff look after us so well, they give advice but you don't have to agree. The care couldn't be better, it is lovely here."

A relative said, "I wouldn't want them to be anywhere else, I am happy with the care and support given, they are respectful and kind and I feel that they really getting looked after." "I am aware of their care plan and that it is updated, they look after him/her the way I want them to and I am fully included."

Other relatives said, "We have peace of mind, they are well looked after, there are always staff about and we are kept informed of any changes." and "The attitude and approach of the staff is marvellous, without exception."

The inspection took place on 8 and 12 June 2015. Our first visit on 8 June 2015 was unannounced and our second visit on 12 June 2015 was announced. At our last inspection in November 2014 we found Sheraton Court was meeting the regulations we inspected.

Sheraton Court is registered to provide personal care for up to 80 people, some of whom are living with dementia. At the time of this inspection there were 78 people living at the service, with a further two people in hospital.

The home 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.’

All of the people and family members we spoke with told us the service was safe. They went on to say they were treated equally and fairly. One person said, “Yes, I do feel safe living here. I am safer because I can get help when I need it.” Another person said, “We are all treated the same and that is as it should be.” One family member said, “I have only seen [my relative] being treated with kindness. I don’t think it makes any difference who you are, everyone seems to be treated well.”

Medicines were mostly managed safely and people received their prescribed medication on time. Records relating to the application of creams and information about ‘when required’ medicines were not up to date. 

Staff had a good understanding of safeguarding adults and whistle blowing. They said they would report concerns to the registered manager or deputy manager straightaway. All of the staff we spoke with told us they had not witnessed anything of concern whilst working at Sheraton Court.

People, family members and staff said there were usually enough staff to meet people’s needs in a timely manner. One person said, “The girls are very good and help me as soon as they can. They are always rushing about. I don’t have long to wait to get help. At night sometimes I have to wait a bit longer because of needing the toilet. More staff then would be appreciated.” One staff member told us staffing levels were, “Adequate”, and the home was, “Fully staffed on all shifts.” There were recruitment and selection procedures to check new staff were suitable to care for vulnerable adults.

The registered provider carried out regular checks to ensure the premises and equipment were safe for people to use. Staff we spoke with knew what to do in an emergency and confirmed regular fire drills took place. Risk assessments were in place for all aspects and areas of the home. A business continuity plan had been developed to respond to emergency situations. Incidents and accidents were investigated and action was taken to help keep people safe. The premises had been adapted to meet the needs of people living with dementia.

Staff received regular supervision and could access the training they needed to fulfil their caring role. Records confirmed supervision, appraisal and training were up to date. The registered provider acted in accordance with the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of MCA. DoLS authorisations had been agreed by the relevant local authority.

We observed people were supported to make sure they had enough to eat and drink. People told us the meals were good and said the registered provider aimed to meet their preferences. One person said, “We get weighed very often to make sure we don’t lose weight. You will never lose weight living here; we get so much to eat.” The registered provider was pro-active in ensuring people with special dietary needs received appetising, well presented meals. A new process of moulding pureed food was being introduced.

People were supported to meet their healthcare needs. We saw people had regular access to health professionals when required. We spoke with two visiting community nurses who gave us positive views about the home.

People told us they were well cared for by kind staff who listened to them. One person said, “I am sure I am well cared for. Everything I need is provided for me. I get good food and a good clean bed. Staff know how important it is for me to have a nice clean bed.” Another person said, “I don’t think you could get better help anywhere. You just have to ask for something to be done for you and they are there doing as you ask. Yes they do listen and are very kind.” Family members we spoke with were also happy with their relative’s care.

People told us they had a key worker with whom they had a positive relationship. One person said, “I am very happy with my key worker, she will do anything I ask her to do.” Another person said, “My key worker will do anything for me, always seems happy and is always helpful. She comes quite quickly when I use the call bell.”

People were not always treated with dignity and respect. Some staff did not know people’s needs well and relied on a more experienced care worker for assistance. On occasion they called across the dining room to each other to check about individual people’s preferences. People told us staff tried to spend one to one time with them but this was often rushed.

People had their needs assessed when they were admitted into the home including gathering details of people’s preferences. This was used to develop person centred care plans. Care plans identified specific goals for people aim towards. Care plan review records lacked meaningful information about the continuing relevance of each person’s care plan. Family members told us they had the opportunity to be involved in reviewing their relative’s care.

People said they enjoyed the available activities both inside and outside of the home. One person said, “We are going to the sing-a-long this afternoon. I enjoy it. We all sing the old songs which are better than the rubbish you hear today. We have had ‘singing puppets’ they were really good.” Another person told us, “I went out in the bus they have. We had fish and chips at Seaton Carew. The run out and the dinner was lovely.”

People knew how to make a complaint if they were unhappy. One person said, “Yes I do know that you can make a complaint about anything you are unhappy about. I have nothing to complain about. I am well looked after and happy.” Complaints were logged and investigated with action taken to prevent the situation from happening again. The registered provider had received compliments about the care delivered at Sheraton Court.

People and family members had opportunities to give their views through regular meetings and surveys. Minutes of previous meetings confirmed these were well attended. Positive feedback had been received following the most recent survey.

Staff described the registered manager as approachable and supportive. One staff member said, “The Manager is good. If we had any worries we know we could go to her and she would help if she could.” Staff told us they enjoyed working for the registered provider. Staff were able to give their views about the service through attending regular meetings, daily handover meetings and ‘huddles.’

The registered provider’s vision and values underpinned the care delivered at the home. Some staff we spoke with were unable to tell us what the vision and values were. One staff member said they were, “Not sure.”

A quality assurance programme was in place. An action was developed following completion of the various audits. Checks carried out on the accuracy of care records had been successful in identifying areas for improvement.