The inspection took place on 19 and 20 April 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Durham House in February 2015, at which time the service was compliant with all regulatory standards and was rated Good. At this inspection the service remained Good.

Durham House is a care home in Chester-le-Street, Durham, providing accommodation for up to 31 older people who require nursing and personal care. There were 24 people using the service at the time of our inspection.

The service had a registered manager in place and a new manager in post, who was being supported through their probationary period.

Risk management processes were in place and regularly reviewed, such as risk assessments and falls analysis, protecting people against a range of risks.

There were ample staff on duty to meet people’s needs and keep them safe. The provider used a dependency tool to ensure there were always ample staff to meet people’s needs.

The management of medicines was safe and adhered to National Institute for Health and Care Excellence [NICE] guidelines. Where we identified an area that could be improved the provider responded promptly.

The service was clean throughout and the premises effectively maintained.

Staff were trained in safeguarding, health and safety, moving and handling, infection control, mental capacity, dementia awareness and food hygiene. Staff demonstrated a good knowledge of these topics.

There was a consensus of opinion that staff effectively supported and managed people’s healthcare needs through ongoing liaison with external professionals.

All people who used the service we spoke with, relatives and visiting healthcare professionals stated staff demonstrated caring attitudes towards people.

There were patient and compassionate interactions displayed by staff throughout our inspection.

The atmosphere and culture at the service was homely and welcoming.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The manager and staff displayed a good understanding of capacity and we found related assessments had been properly completed. The provider had fulfilled their legal obligations in relation to assessing and arranging requirements in the Deprivation of Liberty Safeguards (DoLS) for those people who needed them.

People’s nutritional and hydration needs were met. Menus were varied and people had choices at each meal as well as being offered alternatives if they changed their mind. The provider agreed to look into implementing communication aids such as photographs to help people make choices about what they would like to eat.

Person-centred care plans were in place and were regularly reviewed. The activities co-ordinator was in the process of producing a one-page background for each person to ensure there was a concentrated amount of person-centred information available to any new staff.

The activities co-ordinator had made a range of external links in the community and ensured there was a selection of activities available that people found meaningful and enjoyable.

There were a range of quality assurance, auditing processes and policies and procedures in place. Auditing had identified and led to improvements in service delivery. The manager, director and provider had produced and acted on an action plan to ensure the service maintained good standards of care at a time of managerial change.

Staff, people who used the service, relatives and external professionals spoke positively about the approachability of the new manager, who demonstrated a good knowledge of the service and people’s needs throughout the inspection.

We spoke with several people who used the service. All spoke positively about the care they received.

People told us they could choose how to spend their day and the staff treated them with dignity and respect. One person said “They look after my privacy and dignity all of the time."

Everyone said they would have no hesitation in making a complaint if they were unhappy. One person said “If there was anything wrong, if I had any problems I would talk with the staff.”

Other comments from people included:

“I’m satisfied. They are very nice.”

“It’s a really good home.”

“They find out what I like and don’t like.”

“They provide a lot of entertainment.”

A relative said "I would recommend this home to others. My relative receives excellent care."

We watched how the staff supported the people in their care. We saw people were treated with dignity and respect. For example, when staff talked with people they made sure that they got down to their eye level. We heard staff address people respectfully and speaking quietly about private matters.

The manager told us they always ensured they carefully assessed the care and support needs of people wishing to come and live in the home. All people their relatives, representatives’and health care professionals, where necessary were involved in this process. The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.

The arrangements for keeping the home clean and tidy were more than satisfactory. The standard of the accommodation, décor and furniture and fittings were very good and provided a clean and comfortable place to live in.

There was a stable and competent staff team who had the training, skills and experience to meet the specific conditions of the people who lived there.

Without exception people told us this was a lovely place to live and that they were well supported by the staff and the proprietors.

Four relatives told us they were very pleased with the care and support of their relatives received. One relative described the care as "marvellous."

One person said. “When I came to have a look around with my daughter, I knew this was the place for me, everyone was so friendly and caring. That was two years ago and I have had no regrets at all”.

Another person said, “I looked at several places and this place was certainly the best, it is like living in a high class hotel. Everyone here treats me with respect and they listen to what I have to say”.

Another person said, “A while ago I was invited to a meeting, they asked me if I was happy living here or if I had any concerns. I told them that I was very happy and that I had no concerns at all”.

One service user said, “I have seen what is written about me, and I was asked if I agreed with this. They are very good at keeping me informed of everything”.

Another person said, “They are always asking me about what I think about being here, and I always feel that they listen to my views. I never feel alone anymore and I am very content living here”.

People told us that the food was always very good and that they were always offered a choice.

One person said, “The food can not be faulted, it is like a restaurant here”. Other comments included “The chef is always asking me what I like, and he makes lovely cakes and puddings”.

“Meal times are always a pleasure and a bit of a social occasion”.

This inspection took place on 23 and 24 February 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Durham House provides care and accommodation for up to 30 people. On the day of our inspection there were 27 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.

Durham House was last inspected by CQC on 26 March 2013 and was compliant.

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

We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations.

We saw comprehensive medication audits were carried out regularly by the manager.

We saw staff supporting people in the dining room at tea time and a good selection of food being offered.

Training records were up to date and staff received regular supervisions and appraisals. This meant staff were effectively supported to provide care, treatment and support to people who used the service.

All of the care records, including risk assessments and mental capacity assessments we looked at had been signed by the person who used the service or a close family member.

The home was very clean and fresh, 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 manager and looked at records. We found the provider was following the requirements in the DoLS.

People who used the service, family members and healthcare professionals were extremely complimentary about the standard of care at Durham House. They told us, “The staff are really lovely”; “they are so supportive and so nice.” A relative said, “Absolutely first class care here.” A healthcare professional said, “Durham House is probably the best care home that I visit.”

We saw staff treated people with dignity and respect and people were encouraged to maintain their independence.

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

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way.

We saw a copy of the provider’s complaints policy and procedure and saw that 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.