This unannounced inspection took place on 14 and 23 March 2017. A previous inspection undertaken in October 2015 found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in connection with the safe management of medicines.

After the previous inspection, the provider sent us an action plan to show how they would rectify our concerns.

We returned to complete a full comprehensive inspection. We found the provider was now meeting the regulations.

Medicines were managed safely overall with people receiving their prescribed medicines on time.

Close House Nursing and Residential Care Home is situated on the outskirts of Hexham in a rural setting with extensive views across open countryside. It provides residential and nursing care for up to 22 people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the service with empty rooms expected to be filled in the near future.

The service had a registered manager 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. The registered manager was also the registered provider which he shared with his wife. He had taken over the family business from his mother who had originally set the business up and which we were told had been the first care home to open in Northumberland.

People we spoke with told us they felt safe living at the home. Family members also confirmed that they felt their relative was safe. Staff we spoke with had a good understanding of safeguarding procedures. They also knew how to report any concerns they had. The provider had a system in place to log and investigate safeguarding concerns.

Checks on the safety of the home were undertaken to ensure that fire equipment and other safety issues were monitored. People had personal emergency evacuation plans to allow staff to support them appropriately in the event of a fire. Risks regarding people’s care needs were also assessed and reviewed. Accidents were recorded and monitored by the provider to ensure that no trends were forming.

The provider had a system to review people’s needs and this information was used to determine appropriate staffing levels. Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the registered persons were complying with their legal requirements. Two people were subject to a DoLS authorisation.

We found that people’s health care needs were assessed. People and/or their representatives were consulted about their care and support. Records confirmed people's preferences. Care and support was planned and provided in accordance with their needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. Visiting health professionals told us staff were proactive in supporting people’s health needs.

People told us they liked the food made available to them and were given opportunities to choose a variety of meals. Anyone who required special diets were supported by staff and referred to the speech

During our inspection we spoke with four people and two relatives and looked at the care records for five people. One relative said, "The staff are dedicated and go that extra mile regularly." Another said, "Everyone is so friendly and kind."

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and we found that people looked clean and well cared for.

We found that safeguarding arrangements were in place at the service and staff we spoke with had a working knowledge of these matters.

We found that there were infection control systems in place and these were adhered to.

There were enough qualified, skilled and experienced staff to meet people's needs.

Care records contained accurate and appropriate information and could be accessed in a timely manner.

People spoken with said they were happy at the service. People said they had choices in how they spent their day and staff respected their wishes. One person said “I have lived in the countryside all of my life, I love the peace and quiet here. I have my own routine and I don’t feel as though I have to join in with everything”.

People confirmed that they received enough food and drink and were well looked after. One person said “my doctor said I was looking a lot better and I think I have improved since I came here”. Another person told us “We are very well cared for, it is excellent”.

One person told us “I feel safe here, the staff are lovely, it’s as clean as a whistle and I feel as though I can relax and be looked after”.

People said that they were consulted about the care they received at the service and that they are able to speak to the provider or the staff about their views. People said that they were satisfied with their accommodation and that it was always kept clean and fresh smelling. People said that they felt safe living in the home and that they could talk to staff if they had any concerns. People told us that they were well looked after. They said that their health needs were met and they were consulted about their care.

The unannounced inspection took place on 15 and 22 October 2015. We last inspected Close House Nursing and Residential Care Home in May 2013. At that inspection we found the service was meeting all the regulations that we inspected.

Close House Nursing and Residential Care Home is situated within a rural setting and was one of the first care homes to open in Northumberland. It is the only care home operated by the owners and provides residential and nursing care for up to 22 people, some of whom are living with dementia. At the time of our inspection there were 19 people living at the service, 13 of which had nursing needs.

The service had a registered manager 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.

We found some shortfalls in the management of medicines and we have asked the provider to take action to rectify these. For example ‘as required’ medicines had no protocols in place for staff to follow.

Staff were aware of their safeguarding and whistleblowing responsibilities and knew how to report any concerns they had. They had received appropriate training in this area.

Accidents and incidents were recorded and monitored to ensure that any trends developing were spotted quickly and acted upon, for example people who had begun to have regular falls. Where risks had been identified, for example those at risk of malnutrition, risk assessments had been put in place and regularly reviewed.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff had the skills and training required to adequately support the people in their care. Staff felt supported and received suitable and regular supervision and yearly appraisals.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the registered persons were complying with their legal requirements.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

People and their relatives felt the care team were good at their jobs and were very caring. People’s dignity and respect were maintained and we saw examples of staff knocking on doors before entering and being discreet when offering to support them with personal care. People’s independence was preserved. We observed one person making her way down the stairs on her own. Staff told us she wanted to do that and had been assessed as able to do it on her own.

People’s needs were assessed and care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

A range of activities were completed with people and the registered manager was looking into more dementia friendly activities that they could implement, to ensure as many people as possible were included.

People and their relatives knew how to complain and told us they would if they needed to. One complaint had been raised formally and dealt with effectively. A range of audits and checks were completed at the service to ensure that they maintained good quality practices.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.