This was an unannounced inspection which took place on 22 November 2018. This meant the staff and provider did not know we would be visiting.

We inspected the service to follow up on the breaches from the previous inspection and to carry out a comprehensive inspection.

At the last inspection in August 2017 the service was not meeting all of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regard to regulation 18, staff training.

At this inspection we found improvements had been made and the service was no longer in breach of regulation 18.

Addison Court is a care home that provides accommodation and nursing or personal care for a maximum of 70 older people including people who may live with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Addison Court accommodated 59 people at the time of the inspection.

A registered manager was in post. 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.

Appropriate training was now provided and staff were supervised and supported. Staff 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 said they felt safe and they could speak to staff as they were approachable. People and staff told us they thought there were enough staff on duty to provide safe care to people. Staff knew about safeguarding procedures. Staff were subject to robust recruitment checks. Arrangements for managing people's medicines were safe.

Detailed records reflected the care provided by staff. Care was provided with kindness and people's privacy and dignity were respected. Communication was effective to ensure people, staff and relatives were kept up-to-date about any changes in people's care and support needs and the running of the service.

Staff were skilled and knowledgeable about each person they cared for and they were committed to making a positive difference to each person. There was clear evidence of collaborative working and excellent communication with other professionals to ensure people’s care and treatment needs were met.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Activities and entertainment were available to keep people engaged and stimulated.

The home was being refurbished and people were very positive about the changes taking place. There was a good standard of hygiene. The environment promoted the orientation and independence of people who lived with dementia.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service.

The inspection took place on 29 and 31 August 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

The service was last inspected in January 2017, at which time the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, specifically Regulation 12 (safe care and treatment). We found medicines were not managed, stored or audited appropriately at the previous inspection. At this inspection we found medicines were managed appropriately and a range of improvements had been made.

At the previous inspection of January 2017 we rated the service as good. At this inspection we rated the service as requires improvement.

Before the inspection in January 2017 we were notified of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result both this and the previous inspection did not examine the circumstances of the incident.

However, since the date of the last inspection a further review of the incident has been carried out and identified potential concerns about the management of risk of falls from moving and handling equipment. This inspection examined those risks.

Addison Court is a care home in Crawcrook, Tyne and Wear. It is registered to provide accommodation for up to 70 people who need nursing and personal care. It provides a service primarily for older people, including people living with dementia. There were 57 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 directors, 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.

Improvements had been made to the storage, administration and disposal of medicines. This was generally found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). Where there were individual discrepancies or errors, we found the registered manager’s auditing system had also picked up on these areas and an action plan was in place. The registered manager’s medicines auditing process was robust.

Treatment rooms were clean, tidy and temperatures were recorded. Other areas of the building were clean and some carpeting had been replaced with vinyl flooring to ensure it was easier to clean. Additional hours for domestic staff and new cleaning products had also been sourced.

Risks to people were managed through risk assessments and associated care plans. These risks were reviewed regularly and, where appropriate, included or made reference to advice from healthcare professionals to keep people safe.

Staff were knowledgeable regarding safeguarding principles and what potential signs of abuse to look out for. People we spoke with and their relatives consistently told us the service maintained people’s safety. External professionals all agreed the service had improved in recent months and that they had no major concerns.

There were pre-employment checks of staff in place, including identity and Disclosure and Barring Service checks. There were enough staff deployed to meet people's needs safely.

Staff completed a range of training, such as safeguarding, health and safety, fire awareness, nutrition, dignity, moving and handling, dementia awareness, infection control and first aid. The system the registered manager used to monitor staff training demonstrated that training had not been delivered regarding breakaway training or the Mental Capacity Act.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager displayed a good understanding of capacity and we found the provider had followed the requirem

This unannounced inspection took place on 1 and 5 December 2016 and 26 January 2017. We last inspected the service in June 2016. This had been a focused inspection following up on previous inspection in October and November 2015. In June 2016 we found two breaches of the regulations, specifically Regulation 12, safe care and treatment, and Regulation 17, good governance.

Addison Court is registered to provide accommodation for up to 70 people who need nursing and personal care. It provides a service primarily for older people, including people with dementia. It is owned and operated by the provider Malhotra Care Homes Limited. At the time of our inspection there were 53 people accommodated there.

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.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed and applications made to appropriately deprive people of their liberty were made. However DoLs were not always correctly implemented. We made a recommendation about this.

As part of their recruitment process the service carried out background checks on new staff. Staff were aware of how to identify and report abuse. There were policies in place that outlined what to do if staff had concerns about the practice of a colleague.

Care plans were person centred and showed that individual preferences were taken into account. Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare. Though people were involved in information gathering about their preferences they were not always involved in the final stages of care planning, we made a recommendation about this.

People who used the service told us that they liked the people who supported them and thought the majority were caring and polite.

Staff had received training to support them to deliver care safely and effectively. The registered manager had identified areas for development in the overall training of staff and was sourcing appropriate training. The manger was also making improvements around supervision and appraisal.

People were supported to maintain their health and to access health services if needed.

People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed. However the service did not always communicate about people’s nutritional needs effectively. We made a recommendation about this.

Staff had developed caring relationships with people and communicated in a kind and professional manner. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak to about any concerns they had.

The service regularly sent questionnaires to people who used the service and their relatives to ascertain they were satisfied with the service. The registered manager had a clear vision for the future of the service.

The service did not manage medicines appropriately. They were not correctly stored, monitored or signed for correctly when administered. Clinical rooms and medication trolleys were disorganised and unclean.

Though equipment in the home was clean and well maintained some pressure mattresses had not been set properly accor

We carried out an unannounced comprehensive inspection of this service on 22 October, 6 and 9 November 2015. Three breaches of legal requirements were found relating to safe care and treatment, good governance and notifying the Care Quality Commission (CQC) of relevant events and incidents. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We undertook this focused inspection to check they had made improvements regarding the three breaches of legal requirements. This report only covers our findings in relation to those legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Addison Court on our website at www.cqc.org.uk.

Addison Court is a care home providing accommodation and personal care for up to 70 people who need nursing and personal care. It provides a service primarily for older people, including people living with dementia. At the time of the inspection there were 56 people accommodated there.

A manager was in post at the time of the inspection, however they had yet to become formally registered with CQC. They had applied to become registered and their application was being determined at the time of this inspection. 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.

We found some action had been taken to address previous concerns about safe care and treatment, but improvements were not consistent or sustained.

Improvements had been made to the way people were supported when using their wheelchairs. Foot plates were used when staff assisted people in their chairs to avoid the risk of foot entrapment.

Areas of concern remained. We found a significant delay from staff finding a person had developed a pressure ulcer to them implementing a care plan and monitoring the wound site. Records for the administration of topical medicines (creams applied to the skin) had long gaps. Instructions for how these medicines were used were not always clear. A person’s pain was not well managed and a delay in this being raised and followed through with the person’s GP was highlighted to the manager for immediate attention.

Improvements were still required to the governance of the service. The frequency of management audits for medicines and infection control, although undertaken, had reduced. Staff practice was not always improved when issues were identified. For example, hand hygiene and medicines storage issues identified through internal audits had not been resolved. Expected standards were not communicated to the staff team in a structured or consistent manner.

We found continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment and good governance.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. We found safeguarding procedures were in place and staff understood how to safeguard the people they supported. One relative told us, “It’s good care and treatment here and he’s safe. He’s treat well here and there’s nothing untoward to worry about.” Another relative commented, “It’s reassuring that she’s well looked after and safe here.”

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. One person commented, “They’re always in and out checking… staff come quickly.” One relative told us, “There’s enough staff to look after people here. There are occasions when they are pushed, like holiday time and staff training days, but it’s generally ok when I’m here.”

The building and grounds were well-maintained, secure and other appropriate measures were in place to ensure the security of the premises.

Is the service effective?

People and their relatives told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us, “I’m well looked after, they’re all really good… smashing.” A relative told us, “The staff are all polite, always pleasant and so respectful.”

We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. Staff received appropriate professional development, appraisal and supervision and the provider monitored training requirements appropriately.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “The staff are very patient and caring; very much so.” Another person said, “The staff are nice, kind and caring.” Relatives' comments included said, “Overall, we are very happy with his care. He is happy and content here, the staff do a grand job and they are all very caring,” and, “They treat her nicely and genuinely seem very caring and it’s obvious that they want to do their job.”

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed regularly to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

We saw the provider had a written complaints policy and procedure, which detailed the process that should be followed in the event of a complaint. The registered manager told us, and records confirmed that no complaints had been received by the service within the last six months.

We saw the service had policies and procedures in place in relation to the safeguarding of adults. This meant that people were safeguarded as required and the provider was able to respond appropriately to any potential allegations of abuse.

Is the service well-led?

The service had a registered manager in post and the provider had in place systems to monitor the quality of the service people received.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People’s relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Both staff, people who used the service and their relatives said communication was good. One relative told us, “We are always having meetings; they happen every month. Before the new management came in, you used to say something, or raise anything and it was ignored. We used to get fed up with mentioning things and asking for stuff – it was pointless having a meeting. The new management have made a massive difference and it gets sorted now; I’d highly recommend the new management for that.”

Staff received regular supervision and appraisal and told us they felt supported by the management team. Staff comments included, “They are going to be the best we have ever had,” and, “These are going to be the best managers we have had.”

A member of the management team was available on call for advice and support and in case of emergencies.

People were positive about the care provided at Addison Court. Comments included, "She’s well looked after”, “She’s had smashing care” and “We’re quite satisfied with the care.”

We saw people were cared for effectively and care was planned to meets individuals needs.

We found there was sufficient staff to provide care and support.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We did not discuss medication with people who use the service because many of them were unable to communicate with us about their care. We therefore looked at their medication records and medicines supplies in detail, and also looked at some care plans.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We did not discuss medication with people who use the service because many of the people were unable to communicate with us about their care.

This visit focused on checking whether improvements had been made following our last review in March 2012 and to ensure that other areas of the service were safe and fit for purpose.

We spoke with five people living in the home.

All of the people we spoke with said they were very satisfied with the quality of their care at Addison Court.

They told us it was a friendly and happy home and that they felt relaxed and safe living there.

One person told us “The home is smashing, I love it. The staff are great, lovely, nothings a bother to them”,

However other evidence did not support this. We found concerns over the management of medicines, staffing arrangements and record keeping within the home.

When we visited this location we were able to talk to six users of service who told us that ‘staff are excellent’, they ‘speak properly’ and ‘treat people with respect’ and staff treat people ‘fine’. They confirmed that they had been given information they needed about the home, including how to make a complaint and that they would feel comfortable about contacting the manager to discuss any concerns.

The inspection took place on 22 October, 6 and 9 November 2015 and was unannounced. This means the provider did not know we were coming. We last inspected Addison Court in September 2014. At that inspection we found the service was meeting the legal requirements in force at that time.

Addison Court provides nursing and personal care for up to 70 people, including people living with dementia. Nursing care is provided at the home. At the time of our inspection there were 48 people living at the home.

The service did not have a registered manager. The manager, who had been in post for a year, submitted an application to become registered at the time of our inspection. 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 said they felt safe at Addison Court. Staff were trained in and understood the importance of their duty of care to safeguard people against the risk of abuse.

There was a formal mechanism to help calculate staffing levels based on people’s needs. New staff were suitably checked and vetted before they were employed.

The home was clean. Safety checks were conducted to ensure people received care in a safe environment. People were not always protected from the risks of being pushed in their wheelchairs without the use of foot rests. This practice can lead to foot entrapment under the chair.

On the whole, medicines were managed safely to promote people’s health and well-being. Arrangements for managing external (topical) medicines were not sufficiently robust to demonstrate people received these medicines as prescribed.

Staff were supported in their roles to meet people’s needs. They received training relevant to their roles and although their performance had been appraised recently, formal staff supervision meetings had been carried out infrequently.

People’s nutritional needs and risks were monitored and people were supported with eating and drinking where necessary. People were supported to meet their health needs and access health care professionals, including specialist support.

People were consulted about and were able to direct their care and support. Formal processes were followed to uphold the rights of those people unable to make important decisions about their care, or who needed to be deprived of their liberty to receive the care they required.

Staff knew people well and the ways they preferred their care to be given. People and their relatives told us the staff were kind, caring and respectful in their approach. Our observations confirmed this. Alarm bells sounded infrequently and were responded to promptly.

A range of methods were used that enabled people and their families to express their views about their care and the service they received. This included formal care reviews, ‘residents and relatives’ meetings, quality surveys and a complaints system. Complaints were logged and documented, but investigation and outcome records were not consistently recorded and retained.

Staff assessed people’s needs and risks before they moved in and periodically thereafter. Staff ensured care plans were in place and regularly reviewed. A variety of activities were made available to encourage stimulation and help people meet their social needs.

The management arrangements ensured clear lines of accountability. Systems to monitor and develop the quality of the service were in place, but required further refinement to ensure standards of care and safety were more consistently assured. Quality monitoring arrangements included seeking and acting on feedback from the people using the service and their relatives.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the management of medicines, the safety of service users and good governance. You can see what action we told the provider to take at the back of the full version of this report.