Garden House is a residential care home situated in Berwick upon Tweed. It provides accommodation and personal care for up to 36 older persons, some of whom are living with dementia. There were 34 people using the service at the time of the inspection.

A registered manager was in post and our records showed they had been registered with CQC since November 2015. 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 service was last inspected in November 2014 and we found no breaches of the legal requirements we inspected at that time, however we made a recommendation that medicines should be improved in line with best practice. This inspection was carried out on 16 November and 2 December 2016 and was unannounced.

We checked the management of medicines and found that improvements had been made in this area. There were safe procedures in place for the ordering, receipt, storage and administration of medicines. Medicine records were complete and up to date.

Regular checks on the safety of the premises and equipment were carried out, including fire safety equipment, equipment used in the moving and handling of people, and electrical, gas and water safety. The premises were clean and well maintained and there were regular infection control audits and procedures in place to help prevent the spread of infection. Individual risks to people were assessed and monitored including risks of losing weight or experiencing falls.

Staff had received training in the safeguarding of vulnerable adults and knew what to do in the event of concerns. There were no concerns of a safeguarding nature at the time of the inspection. Safeguards were in place for the handling of people's money, and external audits showed that these were satisfactory.

There were suitable numbers of staff on duty during the inspection. We observed that they had time to care for people in an unhurried manner and were readily available. Safe recruitment procedures were in place which helped to protect people from abuse.

We checked whether the service was operating within the principles of the Mental Capacity Act 2005 (MCA) and found that capacity assessments had been carried out and applications had been made to deprive people of their liberty in line with legal requirements where necessary. Where decisions had been made in the best interests of people who lacked capacity, these were recorded appropriately.

People had access to a range of health services and told us they were happy with their access to healthcare. Support was provided with eating and drinking, and nutritional assessments were carried out. Where people were at risk of malnutrition, specialist advice was sought. People's weights were recorded and monitored and special diets were catered for. The cook was aware of how to fortify meals for people at risk of weight loss, and food was home cooked and locally sourced.

The premises had been adapted to meet the needs of people living with dementia, including the use of contrasting colours to aid people who may experience visual or perceptual problems associated with their condition. We found that music listened to by staff in the laundry invaded space used by people, and that there was a radio and a television playing at one point which was potentially unsettling. Neither was very loud, but neither could be easily heard. We spoke with the registered manager about this and she said she would address this.

Staff received regular training supervision and appraisals. They told us they felt well supported by their supervisors.

We observed that staff spoke kindly and politely with people during our inspection. Privacy and dignity was maintained and people and their relatives

People told us they were happy with the care and support they received at Garden House. One person said, "The staff are very good to me. I like it here very much and the food is good." Another person said, "I couldn't ask for better." A relative who visited the home regularly told us, "I am very pleased with the home. You can ring at any time. I think they are doing very well with X here. Any queries I have I just ask. The carers are great with him. I think they are doing a marvellous job."

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes.

We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard.

We looked at how the home managed medicines and found there were appropriate arrangements in place for the safe administration, recording, obtaining, handling, storage and disposal of medicines.

We found the provider had a structured staff selection and recruitment policy in place which aimed to ensure staff were suitably skilled, experienced and qualified to deliver care safely.

We saw the provider had a complaints policy and procedure in place, which people and their relatives had access to.

At this inspection we identified that the provider had not been notifying us of incidents, in line with the requirements of the Care Quality Commission (Registration) Regulations 2009. We are pursuing this matter separately with the provider.

People told us they enjoyed living in the home and their privacy and dignity was respected. They said the staff did not enter their bedrooms without their permission and they were given keys to lock their bedrooms if they wished. They said they were encouraged to make choices about how and where they spent their time. They told us they enjoyed the food served to them and were able to request alternatives if they did not like the dishes on the menu. They said they would feel confident to make a complaint if they were unhappy about any aspects of their care.

This inspection took place on 11 and 12 November 2014 and was unannounced. A previous inspection, undertaken on 9 December 2013, found there were no breaches of legal requirements.

Garden House is registered to provide accommodation for up to 36 people. At the time of the inspection there were 32 older people using the service, some of whom were living with dementia.

The home has not had a manager registered since June 2014. Our records showed the current deputy manager had made a formal application to become the registered manager of the home. 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 living at the home and felt the staff treated them well and respected their rights. The provider had policies and procedures designed to protect people from harm or abuse and staff understood safeguarding issues and demonstrated they could recognise potential abuse. They told us they would report any concerns to the deputy manager or the local safeguarding adult’s team. Staff were also aware of the registered provider’s whistleblowing policy and told us they would immediately raise any concerns they had about care. The premises were effectively maintained and fire systems and other safety checks carried out on a regular basis.

The deputy manager 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. We found some minor issues with the safe administration of medicines. We raised these with the deputy manager who said she would immediately look to address the areas we highlighted.

People told us they were happy with the standard and range of food and drink provided at the home. They said the meals were good and they could request alternatives to the planned menu. Kitchen staff demonstrated knowledge of people’s individual dietary requirements.

The provider was in the process of developing the environment to better support people living with dementia. They were changing the decoration to make it visually simpler, to aid people’s movement around the home. The deputy manager told us they were hoping to get further ideas when a dementia expert visited the home in the near future.

People told us they felt the staff had the right skills and experience to look after them. Staff confirmed that they had access to a range of training and updating. Staff told us, and records confirmed that regular supervision took place and that they received annual appraisals.

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. Staff understood the concept of acting in people’s best interests and the need to ensure people made decisions about their care wherever possible. We saw assessments and best interest meetings had taken place, where appropriate. The deputy manager confirmed she had been in discussion with the local authority safeguarding adults team and instigated a process to make formal applications for those people who met the threshold for DoLS, in line with the Mental Capacity Act (2005).

People told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists and district nurses. People said they were treated with respect and staff where able to explain how they maintained people’s dignity during the provision of personal care.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care, as necessary. A range of activities were offered for people to participate in and we saw photographs of past events at the home. People and relatives told us they would speak to the deputy manager if they wished to raise a complaint. We saw complaints were dealt with by the deputy manager using an appropriate process or approach.

The deputy undertook regular checks on people’s care and the environment of the home. The regional manager confirmed that she also carried out regular audits at the home Staff felt well supported and were positive about the deputy manager’s application to become the registered manager. There were regular meetings with staff and people who used the service or their relatives, to allow them to comment on the running of the home.