This inspection took place on 6 and 10 July 2017. The first day of the inspection was unannounced which meant that the staff and provider did not know that we would be visiting.

At our last inspection of this service we awarded an overall rating of Good.

At this inspection we found the service remained Good.

Defoe Court is a care home for 41 people who require nursing or personal care. Some people who use the service are living with dementia. The home is situated in its own grounds with an enclosed garden area, set over two floors. Defoe Court has a range of communal areas for people and their relatives to use, including a café area. There were 40 people using the service at the time of our inspection.

The service 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.

The provider had a robust recruitment process in place to ensure only appropriate staff were employed to work at the service to support people safely. Staffing levels were appropriate to the needs of the people using the service. The manager used a dependency tool to ascertain staffing levels.

Risks to people and the environment were assessed and plans put in place to mitigate them. The provider had a business continuity plan in place for staff guidance in case of an emergency. People had Personal Emergency Evacuation Plans (PEEPS) in place which were updated regularly. Accidents and incident were recorded and analysed regularly to identify any patterns or themes that may need to be addressed.

There were systems in place to keep people safe. We found staff were aware of safeguarding processes and now to raise concerns if they felt people were at risk of abuse or poor practice.

Medicines were managed safely by staff who were appropriately trained and had their competency to administer medicines checked regularly. This meant the provider had systems in place to ensure the people who lived at Defoe Court were safe.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates were in place which reflected that fire inspections, gas safety checks and portable appliance tests (PAT) had taken place.

Staff received an in-depth induction on commencement of their employment, which included shadowing experienced staff. The manager kept an electronic matrix to monitor staff training. Staff training was either up to date or plans for refresher courses were in place. Staff received regular supervision and an annual appraisal.

People’s nutritional needs were assessed on admission and regularly thereafter. Staff supported people to eat a healthy varied diet. Records to monitor people’s nutritional intake were in place where necessary. Staff ensured people had access to health care professionals to maintain their general health and wellbeing.

Staff were extremely caring in their approach with the people they supported. Staff put people at the heart of everything they did. They also offered kindness and maintained relationships with relatives as part of their caring role. The culture within the service was one which promoted personalised care tailored to each individual’s needs. The service provided outstanding end of life care that had a positive impact on people and their relatives at difficult and upsetting times. Staff provided support for bereaved relatives to return to the home whenever they wished to.

Advocacy services were advertised in the foyer of the service and were accessible to people and visitors. At the time of inspection no one was using an advocate.

Staff knew people's abilities and preferences, and were knowledgeable about how to communicate with people.

People were supported to have maximum

Defoe Court is a care home with nursing care provided. The home is situated within its own private grounds and provides care and accommodation for up to 41 people. The home is purpose built with accommodation provided over two floors. It is located in Newton Aycliffe, County Durham and is owned and run by HC-One Limited. At the time of our visit there were 36 people living in the home.

The manager wasregistered with CQC but not for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Staff were recruited using procedures to help keep people safe. Additionally staff undertook training to have the skills to carry out their role effectively and safely. However, we found staff were not always utilised correctly to meet people’s needs.

The environment was not designed for people with a dementia yet over half of the people living in the home had needs related to this condition. Previously, two areas of the home were separated and run as two individual units. One was specifically for people who required support for needs in relation to dementia. However, the two units of the home had been combined. This change had caused some concerns and problems for people living in the home.

People who did not have a diagnosis of dementia were concerned about living with people with this diagnosis. One person told us about another person coming into their room and another raised comments about people’s use of language. Additionally no work had been undertaken to help people with recognising different areas of the home.

People living in the home, their relatives and staff attended meetings. However, not everyone felt well informed. People had not been involved in the decision to combine the two units whilst this had impacted on their lives. Staff did not feel consulted this did not reflect an open culture in the home.

People did not always receive caring support from staff. Staff ignored people and were not respectful. This is a breach of Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010 Respecting and involving service users. You can see what action we told the provider to take at the back of the full version of the report’

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS are part of the MCA (Mental Capacity Act 2005) legislation which is in place for people who are unable to make decisions for themselves. The legislation is designed to ensure that any decisions are made in people’s best interests. We found that correct procedures were followed if anyone had needed to be referred regarding any Deprivation of Liberty Safeguards (DoLS) queries.People were not supported to have their rights fully met when making decisions. This was because staff did not follow the correct procedures for this. However, there were risk assessments in place that helped make sure people were safe whilst they took responsibility for their lives and were independent. Additionally staff knew how to support people when there had been any allegation of harm.

People’s nutritional needs were assessed and when necessary people had received professional support. However, people did not always receive good support when eating their meals. This did not help to ensure their nutritional needs were met.

People’s hobbies and interests were recorded in their care files. However, people told us they were not happy with the activities on offer. Some people felt they spent a lot of time alone and we observed people spent time in their rooms alone.

We spoke with a number of people using the service and visiting relatives. Everyone commented positively about the care provided. Comments included “The staff here have an awful lot of passion. Nothing is too much trouble for them,” “The staff are very good. They put me at my ease” and “This is a good place to come. They look after me very well, there is wonderful food. It’s really nice. We all have a nice time.”

However, despite these positive comments we found peoples’ care and welfare needs were not planned in a way which ensured their safety and welfare. This was because for some people who had been assessed as at risk of developing a pressure ulcer and/or at high risk of falling, risk management plans had not been put in place to guide staff and to ensure people’s safety.

People who used the service were given appropriate information and some were involved in making decisions about their care and treatment. Some people described how their right to privacy and respect was promoted. However, we found this was not the case for people with dementia. For example, people who needed assistance with their meals were referred to by some staff as “feeds.” We also found where people lacked capacity to make an informed decision about their care and welfare a “best interest” meeting with families, care managers, key workers, staff and advocates had not always been held. This meant the provider could not demonstrate any decision made on behalf of the person was done so in their best interests.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We also found the provider had made suitable arrangements to manage and store peoples’ medicines safely.

Due to the nature of the essential standard we were looking at we did not seek the views of people using the service.

At our last inspection in January 2013 we found the provider was not compliant with the essential standard supporting workers. This was because staff had not been provided with an annual appraisal or regular one to one meetings with a senior member of staff. This meant staff did not have the opportunity to discuss work related matters on a formal basis.

At this inspection we found improvements had been made. We found staff had been receiving regular one to one meetings with a senior member of staff. We also saw staff had received an annual appraisal where their overall performance for the previous year was discussed.

People's diversity, values and human rights were respected. One person said "I find it quite nice in here” and another person said “It’s a good place, they look after you well.”

People told us they were happy with the care and support they received. One person told us "They (the staff) look after you well here” and another person said “They (the staff) look after you in here – they do things my wife couldn’t do for me.”

We found people were cared for by staff who were trained to deliver care and treatment safely and to an appropriate standard. However we found staff had not received support in the form of regular supervision or appraisal.

People said they were happy with the staff employed by the service and the care they provided. One person said "The staff are very good" and "You just ring the buzzer and they are there immediately.” Other comments made by people who used the services included "Very good staff, very good leaders" and "I think the staff are marvellous."

Everybody we spoke with told us they felt safe at Defoe Court and with the care staff employed by the service. One person told us “I feel very safe” and another person said “They (the staff) come to see if you’re alright.”

The provider had an effective system to regularly assess and monitor the quality of service that people received.

When we visited this location we were able to talk to four users of service who told us that ‘staff are good’, they ‘treat people well’. We further observed staff interacting with people in the lounges and dining room.

This inspection took place on 20 and 24 April 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Defoe Court provides general nursing, residential and respite care for older people and people with a dementia type illness. On the day of our inspection there were 41 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 (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.

Defoe Court was last inspected by CQC on 13 May 2014 and was none compliant in one area; respecting and involving people who use services.

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

Thorough investigations had been carried out in response to safeguarding incidents or allegations and comprehensive medicines audits were carried out regularly by the nursing staff.

Staff training was up to date and staff received regular supervisions and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The home was clean, spacious and suitable for the people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the provider was following the requirements in the DoLS.

People who used the service, and family members, were complimentary about the standard of care at Defoe Court.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

We saw that the home had a full programme of activities in place for people who used the service.

Care records showed that people’s needs were assessed before they moved into Defoe Court and care plans were written in a person centred way.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources.