About the service: Cramlington House is a purpose-built home which is registered to provide personal care and accommodation for up to 63 people, some of whom are living with dementia.

People’s experience of using this service: People, relatives and professional visitors told us it was a homely home with kind, friendly, helpful staff. People using this service benefitted from an outstandingly responsive service.

Care was highly personalised and tailored to meet people's needs. Care staff knew people and their relatives extremely well. They took care to involve and include them and were highly responsive to people’s needs. The quality of activities and experiences provided by wellbeing coordinators and care staff was exceptional.

The home was safe, clean and well maintained. Staff had received training in the safeguarding of vulnerable adults and knew the procedures to follow in the event of concerns.

The design of the home took into account best practice, particularly in relation to the needs of people with a dementia related condition.

Staff received regular training including bespoke dementia training developed in-house. This had been accredited by an external training provider, and staff demonstrated a good understanding of people's dementia care needs.

People were well supported with eating and drinking and enjoyed the food at Cramlington House.

Staff were very caring and we saw numerous examples of kind and compassionate care.

The provider and registered manager were supported by a carefully selected senior management team, who had various strengths to bring to the organisation which the provider used to full effect.

There was a strong focus on caring for staff to enable them to provide the best care possible. The provider strived to meet their support and development, and health and wellbeing needs, and had achieved bronze and silver awards in better health at work.

The service continued to have a good track record and close links with the local community.

Rating at last inspection: Good (published 20 July 2016).

Why we inspected: This was a planned inspection which was based upon the previous rating.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate and high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Cramlington House is a residential care home based in Cramlington, Northumberland which provides accommodation and personal care to up to 63 older people. People are accommodated in three separate units and most people living at the service have some form of dementia. The last inspection of this service took place in May 2015 where the provider was found to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of the management of medicines. At this inspection we found improvements had been made and the provider was no longer in breach of the aforementioned Regulation.

This inspection took place on the 16 and 20 June 2016 and was unannounced. The inspection was carried out by one inspector.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since August 2014. 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 were complimentary about the service and the staff who supported them. This was echoed by their relatives. Staff were complimentary about the support they received from each other, the registered manager, the operations manager and the provider. Healthcare professionals said they enjoyed a good working relationship with the service.

People told us they felt safe living at the home and we saw they were appropriately and safely supported in their daily lives. Safeguarding policies and procedures were in place to monitor and respond to any matters of a safeguarding nature and we saw that historically these had been dealt with correctly by the registered manager. Staff were aware of their personal responsibility to report incidents of a safeguarding nature and they had received training in safeguarding vulnerable adults. Risks that people had been exposed to in their daily lives and within the environment of the home had been assessed and mitigated against. Accidents and incidents were monitored, analysed and measures were put in place where necessary to prevent repeat events.

Recruitment procedures were robust and medicines were managed safely and appropriately in line with best practice guidance. Staffing levels were sufficient on the days that we visited the home to meet people's needs and staff confirmed that they were not unduly rushed in the pursuit of their duties. When people called for assistance we observed staff attended to them promptly to meet their needs. Staff were trained in key areas relevant to their role such as moving and handling, and also in areas such as Non Abusive Psychological and Physical Intervention (NAPPI) training, which was relevant to the needs of some of the people they supported. There was a thorough induction package in place and supervisions and appraisals took place regularly to provide support to the staff team.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken in line procedures set out in the MCA, and records about such decision making were maintained.

People were supported to eat and drink in sufficient amounts to remain healthy. There were monitoring tools in place which ensured that where there were changes in people's heal

We spoke with two people who were happy with the support they received with their medicines and one relative.

Overall we found that medicines were not always safely handled and improvements are needed.

We found that improvements still needed to be made in regard to the management of medicines.

Cramlington House provides accommodation and personal care and support for up to 63 people. Most of the people living at the home were living with some form of dementia or cognitive impairment. At the time of our inspection there were 63 people living at the service.

This inspection took place on 5 and 18 May 2015 and was unannounced. The last scheduled inspection we carried out at this service was in June 2014 when we found the provider was not meeting Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2010, Management of medicines. In January 2015 we revisited the home to check that improvements had been made and found that there was continuing non-compliance in relation to this regulation. We took enforcement action at that time and issued the provider and registered manager with a warning notice stating they must improve by February 2015.

This inspection was carried out as a comprehensive inspection to review the overall quality of the service and to rate it under the Care Act 2014. As part of this inspection we checked whether the provider had met the requirements of the warning notice related to the safe handling of medicines, that had previously been set.

At the time of our inspection there was a registered manager in post who had been formally registered with the Care Quality Commission (CQC) since August 2014. A registered manager is a person who has registered with the 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 found that whilst some improvements had been made in respect of the management of medicines, a serious medication error had occurred which had not been identified by the provider. One person had received incorrect, and potentially harmful treatment, as medicines that were discontinued in hospital were accidentally restarted and taken alongside replacement, newly prescribed medicines. The error occurred because the process for booking in new medicines was not robust enough.

Safeguarding policies and procedures were in place and the registered manager followed these when matters of a safeguarding nature arose. Staff were clear on the different types of abuse and their own personal responsibility to protect people from abuse and report any incidents of abuse that they may witness or suspect. People told us they felt safe living at the home and comfortable in the presence of staff.

Risks that people were exposed to in their daily lives had been assessed, such as risks associated with mobility and skin integrity. Environmental risks within the home had been assessed and measures put in place to protect the health and wellbeing of people, staff and visitors.

Staffing levels were sufficient to meet people’s needs and staff were not unduly rushed. People had their needs met in a timely manner on the days of our inspection. Staff turnover had been high recently but management had plans in place to address a small number of vacancies. Recruitment procedures were robust and ensured that the staff employed by the provider were appropriately skilled and of suitable character to work with vulnerable adults. Records showed that staff were trained in a number of key areas such as moving and handling, infection control and the Mental Capacity Act 2005 (MCA). In addition, staff had received training in areas specific to the needs of the people they supported, such as training in dementia care. Staff told us they felt supported by the registered manager and they received supervision and appraisal.

The MCA was appropriately applied and the best interest’s decision making process had been followed where necessary. Some records related to decisions made in people’s best interests were not appropriately maintained. The registered manager told us that this would be addressed and that in future the decision making process would be better documented.

People told us, and records confirmed that their general healthcare needs were met. General practitioners were called where there were concerns about people’s health and welfare as were other healthcare professionals such challenging behaviour clinicians. People told us the food they were served was good and we saw there was a variety of wholesome food on offer. People’s nutritional needs were met and specialist advice was sought when needed, for example from dieticians.

Our observations confirmed people experienced care and treatment that protected and promoted their privacy and dignity. Staff displayed caring and compassionate attitudes towards people, and people, their relatives and healthcare professionals linked to the home all spoke highly of the staff team. Staff were aware of people’s individual needs and care was person-centred. Overall people’s care records were well maintained and staff told us they felt they had enough information available to them, to provide effective and safe care. People told us they were supported to engage in activities within the home if they wanted to and relatives told us they appreciated the fact that the provider arranged excursions locally for their family members.

The environment of the home aided people living with dementia care needs, by orientating them. There was signage around the home and in people’s bedrooms to enable them to be as independent as possible whilst going about their daily lives. People also had unlimited access to outdoor space which benefitted their wellbeing.

The provider gathered feedback about the service from people, their relatives and staff via meetings and surveys. There was a complaints policy and procedure in place and records showed that historical formal complaints were handled appropriately and documentation retained. Low level concerns and complaints were not as well documented and we discussed this with the provider who told us that this matter would be addressed.

Quality assurance systems and care monitoring tools such as weight charts, were used to monitor care delivery and the overall operation of the service. For example, audits related to health and safety within the building were carried out regularly. Checks on the building and equipment used in care delivery were undertaken in line with recommended time frames.

This inspection found that the provider was in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was related to safe care and treatment of service users, in respect of the proper and safe management of medicines. Where we have identified a breach of regulation which is more serious, we will make sure action is taken and we will report on this when it is complete.