We inspected St Peter’s Court on 25 April and 5 May 2017. The first day of the inspection was unannounced, which meant that the staff and provider did not know we would be visiting. We informed the provider of our visit on 5 May 2017. When we last inspected the service in April 2015 we found that the provider was meeting the legal requirements in the areas that we looked at and rated the service as Good. At this inspection we found the service was also Good.

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.

St Peters Court provides care and accommodation to a maximum number of 67 people. Accommodation is provided over two floors. The ground floor of the service provides care and accommodation for those people who require personal care. On the first floor of the home, care and accommodation is provided to those people living with a dementia. There is also a rehabilitation unit. The aim of the rehabilitation unit is to help people to regain their independence which may have been lost because of their disability, illness or an accident. Communal lounges and dining facilities were available within each unit. There is an enclosed garden/patio area for people to use. At the time of the inspection there were 56 people who used the service.

Systems were in place for the management of medicines so that people received their medicines safely. However, written guidance for medicines prescribed to be given 'only when required' and records for the application of creams and ointments was not always available, fully completed or up to date.

Assessments of people receiving rehabilitation were undertaken by physiotherapists and occupational therapists; however care plans were not in place.

Care plans were available for people cared for on other units and detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information that was meeting people’s care needs. People were actively involved in care planning and decision making.

People were kept safe from avoidable harm and staff understood the process to follow to safeguard people if they needed to report any concerns. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring.

There were sufficient staff on duty to meet the needs of people who used the service. There was a system in place to ensure that staff recruited had the appropriate skills and experience and were of good character.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Any gaps in training had been identified by the management team and refresher training had been arranged. Staff had an understanding of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. This meant they were working within the law to support people who may lack capacity to make their own decisions.

We saw that people were provided with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. People were able to make decisions about their day to day care and support and staff supported people to maintain their health and attend routine health care appointments.

People were treated with kindness and respect. The care staff knew the people they were supporting well and respected the choices they made about their care. The staff knew how people communicated and gave them support to make and express choices about their lives. People’s independence was encouraged. Activities, outings and social occasions were organised for people who used the service.

The provider

We inspected St Peter’s Court on 8 April 2015. This was unannounced which meant that the staff and registered provider did not know that we would be visiting.

St Peters Court provides care and accommodation to a maximum number of 67 people. Accommodation is provided over two floors. The ground floor of the service provides care and accommodation for those people who require personal care. On the first floor of the home care and accommodation is provided to those people living with a dementia. There is also a rehabilitation unit. The aim of the rehabilitation unit is to help people to regain their independence which may have been lost because of their disability, illness or an accident. Communal lounges and dining / bistro facilities were available within each unit. There is an enclosed garden/ patio area for people to use.

The home had a manager who started working at the service in March 2015. The manager was in the process of completing their application to apply to be 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.

There were systems and processes in place to protect people from the risk of harm. People were protected by the service’s approach to safeguarding and whistle blowing (telling someone). People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. People told us that staff treated them well. Staff were aware of the different types of abuse and action to take if abuse was suspected. Checks of the building and maintenance systems were undertaken to ensure health and safety.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the care and support needed, this included the person's likes, dislikes and personal choices. We found that risk assessments were detailed and contained person specific actions to reduce or prevent the highlighted risk.

Staff told us that they felt well supported and that they had received supervision on a regular basis. We saw records to confirm that this was the case. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. We saw that staff appraisals had been planned for 2015.

Staff had undertaken training in fire safety, first aid, health and safety, infection control, safeguarding and dementia. Any shortfalls in training had been identified and training had been planned.

People, relatives and staff that we spoke with during the inspection told us that there were enough staff on duty to ensure that people’s needs were met. During the day there were 11 staff on duty shared between three units. During the night there were seven staff on duty shared across the units. We were told that staffing levels were flexible depending on need.

Staff had attended training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Staff had an understanding of the principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions.

At the time of the inspection, there was some people who used the service who were subject to a Deprivation of Liberty Safeguarding (DoLS) order. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. Staff had a good understanding of DoLS.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. People who used the service told us that staff were very caring, showed compassion and were patient.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged and they were encouraged to take part in activities. People told us that they were happy with the activities provided by staff at the service.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. This helped to ensure that the service was run in the best interests of people who used the service.

St Peter's Court provides care and accommodation for up to 67 older people, some of whom may be living with a dementia.

During the inspection we spoke with people who used the service, relatives and staff. We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People told us that they felt comfortable in raising a concern or complaint with the manager or staff.

The inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that their rights and dignity were respected.

Care plans and risk assessments were in place and were updated as people’s needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

We looked at the recruitment of new staff. We found that appropriate checks were carried out on staff before they started work.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

People are cared for in safe, accessible surroundings that promoted their wellbeing.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

We saw that regular checks were carried out on equipment used at the home to make sure that it was safe for use.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and there was evidence to show that these had been followed appropriately. Staff had received training in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

Is the service effective?

People’s health and care needs were assessed and where possible people and their relatives were involved in writing the plan of care. Specialist dietary and mobility needs had been identified in care plans. Care and support plans were reviewed and updated on a regular basis.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

People who used the service, their relatives and friends were regularly asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Discussion with the head of care and operations manager during the inspection confirmed that any concerns or complaints were taken seriously.

People took part in a range of activities both in and out of the home. This helped to keep people involved in their local community.

Is the service well led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and all senior staff understood and shared the responsibility of quality assurance processes. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke with nine people who used the service and two relatives. The manager was on annual leave at the time of the inspection, however, we spoke with the head of care, the operations manager, the senior operations manager and to care staff. A newly recruited care staff member told us that they had been through a thorough recruitment process and that they felt well supported whilst they were undertaking their induction.

People who used the service told us that they were very happy with the care and service received. One person said, “The girls are lovely and very hardworking.” Another person said, “The staff are good, they do their job efficiently and always with a smile.”

Of the 11 people we spoke with (nine people who used the service and two relatives) seven people thought that there was sufficient staff on duty to meet people’s needs, however, four people thought that more staff were needed. One person said, “Staff are always willing and there to help you.” Another person we spoke with said, “Sometimes I have to wait for 10 to 15 minutes before staff are available to help me.” A relative we spoke with said, “It’s improving. When the home first opened there wasn’t enough staff but now there is and I’m really pleased with the standard of care.”

During the inspection we spoke with two visiting professionals from the falls team. The falls team (South Tees Hospitals NHS Foundation Trust) provided specialist multidisciplinary assessment and intervention to people aged 65 and above who were deemed at risk of falls. They said, “Staff at the home are very proactive in terms of using the risk assessment. When people have been identified at risk of falling they make timely referrals to ask for our help.”