The inspection took place on 20 April 2017. The inspection was unannounced.

St Helens Care Home is based in a residential area of West Auckland, County Durham. The home provides personal care and nursing care for older people, people with acquired brain injury, physical disabilities, mental health and people living with dementia. The service is situated close to the local amenities and transport links. On the day of our inspection there were 36 people using the service.

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.

We last inspected the service in October 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

The atmosphere of the service was busy, but very welcoming. People who used the service and their relatives told us they felt at home and visitors were welcome and that the home was 'like one big family.'

Without exception we saw staff interacting with people in a person centred and caring way. We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with kindness. We saw staff communicating with people well and at times use their skills positively to reassure people who used the service.

People were encouraged to enhance their wellbeing on a daily basis to take part in activities that were valued and this contributed positively to the busy atmosphere of the home. Staff spent their time positively engaging with people as a group and on a one to one basis in meaningful activities. People were supported to go out regularly too. Throughout the day we saw that people who used the service, relatives and staff were comfortable and had a positive rapport with the registered manager and also with each other.

People’s care plans were written in plain English and in a person centred way and they also included a ‘my choices’ booklet that made use of, personal history and described individuals preferences and support needs. These were regularly reviewed and some had included family members in the process.

Care 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. The care plans showed that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, dentist or optician.

People who used the service were supported on a one to one basis or by sufficient numbers of staff to meet their individual needs and wishes in a person centred way.

Staff training records, showed staff were supported and able to maintain and develop their skills through training and development opportunities that were accessible at the service. The staff confirmed they attended a range of valuable learning opportunities.

Staff had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. Records that showed there were robust recruitment processes in place.

We observed how the service administered medicines. We looked at how records were kept and spoke with nursing staff who administered medicines and we found that the process was safe.

People were encouraged to eat and drink sufficient amounts to meet their needs. They were offered a varied selection of drinks and snacks. The daily menu was reflective of people’s likes and dislikes and offered varied choices and it was not an issue if people wanted something different.

A complaints

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

The relationships between staff and the people who they supported were good and personal support was provided in a way that people had consented to. This promoted and protected their privacy and dignity. This was confirmed when we spoke with six people who used the service.

Suitable arrangements were in place for handling complaints and for protecting people from abuse.

There was a competent staff team who had been appropriately recruited and had the training, skills and experience to meet the specific conditions of the people who they supported.

The manager told us they always ensured they carefully assessed the care and support needs of people wishing to come and live in the home. All people their relatives, representatives’ and health care professionals, where necessary were involved in this process. We saw detailed care plans of how staff would then help people to meet their needs. This meant staff had the information they needed to support each person and keep them safe.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

Suitable arrangements were in place for people to take part in appropriate activities in line with their needs and preferences.

The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.

The meals provided by the home were satisfactory and gave people a varied, nutritious diet.

Suitable arrangements were in place for handling complaints and for protecting people from abuse. People told us they could share any worries with the staff and felt their views were listened to.

There was a stable and competent staff team who had the training, skills and experience to meet the specific conditions of the people who lived there.

This inspection took place on 27th 30th October 2014 and was unannounced.

St Helens Care Home provides care and accommodation for up to 43 people. The home specialises in the care of people who have mental health needs including a small separate 14 bed unit for older people living with dementia.  On the day of our inspection there were a total of 37 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 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 and associated Regulations about how the service is run.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful manner. One person told us, “I feel safe living here. I have nothing to worry about anymore.” One visitor said, “I have no concerns. My relative is settled here and they are safe, and happy.”

Staff and visitors we spoke with described the management of the home as open and approachable. Throughout the day we saw that people and staff appeared very comfortable and relaxed with the registered manager on duty.

People had their physical and mental health needs monitored. There were regular reviews of people’s health and the home responded to people’s changing needs. 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.

People said staff were ‘reliable’ and ‘always helpful.’ One visitor told us, “The staff were knowledgeable and always friendly. They keep me informed of anything that happens.”

We saw people’s care plans described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The provider told us the care plan format was currently under review, and being piloted in other locations. This is necessary as the current format style is cumbersome and makes important information difficult to locate.

We found the quality of care which people received in their last days was as important as the quality of life which they experienced prior to this. This meant their physical and emotional needs were met, their comfort and wellbeing attended to and their wishes were respected. The manager told us that for some younger people who used the service their thoughts, wishes and beliefs regarding this subject had not been routinely addressed with them. The manager said she would seek professional advice about how to address this sensitive subject.

Staff we spoke with staff they said they received appropriate training, good support and regular supervision. We saw records to support this.

Staff had received training in how to recognise and report abuse. We spoke with seven staff and all were clear about how to report any concerns. Staff said they were confident that any allegations made would be fully investigated to ensure people were protected.

Throughout the day we saw staff interacting with people in a caring and professional way. We saw a member of staff supporting one person with their mobility. They were interacting happily and laughing together. We saw another member of staff offering to assist a person to go to the smoking room. The staff were gentle and encouraging and the person happily agreed to their support We noted that throughout the day when staff offered support to people they always respected their wishes.

People who were unable to verbally express their views appeared comfortable with the staff that supported them. We saw people smiling and happily engaging with staff when they were approached.

We saw on the dementia care unit there was a weekly activity programme and records showed an activity worker supported people to take part in activities on a one to one basis. In other parts of the home, people were more independent and activities were more personalised and we saw that people made suggestions about activities and outings at monthly meetings. Where necessary, additional staff were provided to enable people to access community facilities appropriate to their ages and abilities.

We saw some people were able to access the community facilities independently or with friends and family. Several people received additional one to one support (agreed with the placing authority) for their care and support needs.

People told us they were treated with respect and privacy was upheld.

People received a wholesome and balanced diet in pleasant surroundings and at times convenient to them.

We saw the provider had policies and procedures for dealing with medicines and these were adhered to.

The provider had an effective complaints procedure which people felt they were able to use.

We saw people who used the service were supported and protected by the provider’s recruitment policy and practices.

The home was clean and well maintained, and equipment used was regularly serviced.

The provider had a quality assurance system, based on seeking the views of people, their relatives and other health and social care professionals. There was a systematic cycle of planning, action and review, reflecting aims and outcomes for people who used the service.