The inspection took place on 23 January 2019 and was unannounced. This meant the provider and staff did not know we would be coming.

We previously inspected Ella McCambridge Care Home in August 2018, at which time we found the provider to be in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service requires improvement. There were a number of instances of poor practice in terms of medicines administration and these had not been identified by the auditing and governance systems the provider had in place. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good.

At this inspection we found the provider had made suitable improvements in all the areas identified and was compliant with the regulations. At this inspection, the service was rated good.

We undertook an unannounced focused inspection of Ella McCambridge Care Home on 23 January 2019. This inspection was done to check that improvements to meet legal requirements planned by the provider after our August 2018 inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and safe? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Ella McCambridge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ella McCambridge accommodates a maximum of 67 older people across two floors. Nursing care is not provided. The first floor supported people with higher levels of dependency. There were 55 people using the service at the time of our inspection, some of whom were living with dementia.

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 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 supported by staff who were knowledgeable and competent in the administration of medicines. The administration, storage and disposal of medicines was safe and in line with good practice, with appropriate checks and auditing in place.

Risk assessments were in place and were specific to people’s individual needs and circumstances.

Incidents were reported and acted upon appropriately. The registered manager had ensured lessons were learned after investigations took place.

The building was well maintained and clean throughout, with repairs made in a timely fashion.

Staffing levels were appropriate to the needs of people who used the service and rotas were planned in advance.

The registered manager and all staff we spoke with were passionate about people who used the service receiving high quality care. They had reflected on the improvements required to medicines administration and other areas, and made these promptly.

Auditing of medicines had significantly improved. Auditing at provider level needed to focus more on continual service improvement and strategic objectives. We have made a recommendation about this.

The culture remained one focussed on people’s needs and safety and the registered manager had ensured this was better supported through well planned checks, audits and delegation of

The inspection took place on 21 and 22 August 2018 and was unannounced. This meant the provider and staff did not know we would be coming.

We previously inspected Ella McCambridge Care Home in August 2017, at which time the service was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the previous inspection we rated the service as requires improvement. At this inspection, whilst there had been improvements in some areas, the service remained rated requires improvement.

Ella McCambridge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ella McCambridge accommodates a maximum of 67 older people across two floors. Nursing care is not provided. The first floor supported people with higher levels of dependency. The service supported people, on both floors, living with dementia or a dementia related condition. There were 55 people using the service at the time of our inspection.

A registered manager was in place, with suitable skills and experience. 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. The manager had applied to be registered with CQC and was registered as the manager prior to the completion of this report.

Medicines administration practices required improvement, particularly with regard to topical medicines (creams), patches, and protocols for when people required medicines ‘when required’. The registered manager and deputy managers began improving these processes during the inspection, as well as reviewing how medicines were audited. This was another area identified as requiring improvement.

At the previous inspection we recommended that the provider review guidance regarding dementia friendly environments and make improvements. We found they had done this and the surroundings were in line with dementia-friendly good practice. The premises were suitable for the needs of people who used the service, with ample bathing, communal and outdoor facilities.

Risk assessments were in place, specific to people’s needs and regularly reviewed.

There were sufficient staff in place to keep people safe and meet their needs. Staffing was well planned.

The service was clean throughout with sufficient domestic staff and resources.

All staff were aware of their safeguarding responsibilities.

A range of mandatory and additional training had been delivered to staff or was planned. Staff were knowledgeable in the areas they had been trained in and external professionals confirmed they engaged well and took an interest in new practices.

People received a range of meal options and we observed pleasant mealtime experiences. The use of showing people different plates of food to help them choose was used intermittently and needed to become part of the culture. Feedback about food was consistently positive.

People were supported to have maximum choice and control of their lives in the least restrictive way possible. Staff had received training in the Mental Capacity Act (2005) and were able to answer a range of questions. Consent was sought with regard to day to day interactions throughout the inspection. Some care files needed reviewing to ensure consent was appropriately documented.

Care plans were being reviewed at the time of inspection but contained sufficient person-centred information for staff to understand and act on people’s needs. Staff knowledge of people’s needs was good. Interactions with and advice from external healthcare professionals was well documented.

People who used the

This was an unannounced inspection which took place on 2 August 2017.

At the last inspection in May 2015 the service was not meeting all of the legal requirements with regard to person centred-care. At this inspection we found improvements had been made and the service was no longer in breach with regard to person-centred care. However, we considered more improvements were required with regard to record keeping.

Ella McCambridge Care Home is registered to provide care and support for up to 67 older people, some of whom may have dementia or a dementia related condition. At the time of inspection 60 people were using the service.

A registered manager was 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.

People said they were safe and staff were kind and approachable. There were sufficient staff to provide safe and individual care to people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

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. Staff knew the needs of the people they supported to provide individual care. Care was provided with kindness and people’s privacy and dignity were respected. Records were not all in place that reflected the care that staff provided.

The environment was well-maintained and plans were proposed to promote the orientation and independence of people who lived with dementia. We have made a recommendation the environment should be designed according to best practice guidelines for people who live with dementia. Activities and entertainment were available to keep people engaged and stimulated.

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/ or family members and their views were used to improve the service. People had access to an advocate if required.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to people’s dining experience, environmental design and record keeping.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

Appropriate training was 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 received a varied and balanced diet to meet their nutritional needs.

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 had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

You can see what action we told the provider to take at the back of the full version of the report.

This follow-up information in this report relates to the outstanding compliance action for the archived Ella McCambridge Care Home location record.

We found the provider had undertaken a review of the home's audit systems to make them more effective in order to identify gaps in care and medication reords.

This was an unannounced inspection which took place over two days, 18 and 19 May 2015. The last inspection took place on 20 November 2013. At that time, the service was meeting all the regulations inspected.

Ella McCambridge Care Home is registered to provide care and support for up to 67 older people, some of whom may have a dementia related condition. It is a two storey building in a residential area of Walker, Newcastle upon Tyne. It is registered to provide accommodation for persons who require personal care. There were 48 people living at the service when we inspected.

Ella McCambridge Care Home has a registered manager who has been in post since 2008. 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 told us they felt safe and were cared for by staff who knew them well. Staff told us they knew how to raise concerns about people’s safety and had confidence action would be taken if they had any issues. Relatives told us they felt their families were safe at Ella McCambridge Care Home and the service was welcoming and had a family atmosphere.

Risk assessments had been carried out, but some audits and reviews did not clearly demonstrate how the care plans had changed. This did not give the details needed for staff to meet people’s changing needs. Staff were aware of people’s needs and provided the care needed, but the written care plans did not always have the details required.

Staff were recruited and trained so they would be safe to work with vulnerable people and able to meet their needs. There were sufficient staff to meet people’s needs throughout the day and night.

People’s medicines were managed safely. Stock control and ordering were managed by trained staff who carried out checks to ensure that the risk of errors was minimised. Audits of medicine administration were carried out regularly to ensure that staff were competent and that any errors would be quickly identified.

We found that care was effective and based on best practice. Staff had the knowledge and skills they needed to ensure people’s needs were met. People’s consent was sought throughout the care planning process and at the point of delivery. Families and others were involved in making decisions about the care of people who had lost the capacity to consent.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. There were a number of people subject to DoLS and these had been managed well by the service with referrals for local authority authorisation being made appropriately. The service had a system in place to ensure that renewals of authorisation were requested promptly.

People were supported to eat and drink in a dignified manner. People were given support to access healthcare services and maintain their wellbeing. External health care professionals’ advice was sought and referrals were made for specialist input as people’s needs changed over time.

Care was delivered by staff in a positive way, and there were good relationships between people and the staff. All staff we spoke with knew the people’s needs well and spoke about them in a positive manner. People were encouraged to express their views and make decisions about their care and support and these decisions were respected by staff.

People’s choices and rights were respected. Staff knocked on doors before entering, offered people choices in their daily living and looked at alternatives if they were requested.

Where people had complained or raised queries about the service, the registered manager responded positively and people were satisfied with the outcomes.

The registered manager sought the views of people, families, visitors and external professionals to help them assess the quality of the service and make changes. Everyone we spoke with told us that the registered manager was open, supportive and responsive to ideas to improve the service.