The inspection took place on 9 and 22 January 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming.

We last inspected the service in January 2017 and at that time identified breaches in two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were related to safe medicines management and good governance.

We took action by requesting the provider send us an action plan stating how and when they would achieve compliance. During this inspection we found there had been improvements made in line with the provider’s action plan. As a consequence of these improvements the service was no longer in breach of the regulations detailed above.

Hadrian Park 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.

Hadrian Park can accommodate up to 74 people in a two-storey purpose built building. At the time of this inspection there were 55 people using the service.

The service was divided into three units, Lilly, Chester and Poppy. The Lilly unit provided residential care on the ground floor whilst the Chester unit, also on the ground floor provided care for people living with dementia. Upstairs the Poppy unit provided accommodation for people who needed a higher level of support. The first floor was accessed by stairs or a passenger lift. There were four dining areas and a variety of communal living areas.

The service had a manager in place. They had submitted an application to become registered manager and that process was underway at the time of our inspection. 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.

At the last inspection we identified that people’s medicines were not always managed safely. At this inspection we found that improvements had been made in the records for oral medicines, however improvements were still needed for the records of topical preparations and the guidance for when required medicines. We have made a recommendation about this.

Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

There was a sufficient number of staff on duty to care for people safely. People’s dependency levels were calculated regularly and used to determine the number of staff needed for each shift.

Care records contained detailed risk assessments. People had individual personal emergency evacuation plans in place. Accidents and incidents were recorded and analysed to look for patterns or trends. Regular maintenance checks and repairs were carried out and all areas of the service were clean and tidy.

The majority of staff were up to date with training and additional training courses linked to the needs of the people using the service had been completed by staff. Some training was not included on the matrix and this made keeping track of training more difficult.

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.

Requests for DoLS authorisations were being submitted appropriately. Capacity assessments were being undertaken and best interest decisions were being recorded.

Staff felt well supported and regular supervision sessions and annual appraisals were planned.

People were supported to maintain their health and wellbeing and had access to health professionals when needed.

People were happy with the food they received. There was a varied menu contain

We carried out an unannounced comprehensive inspection of this service on 1 June, 7 July and 21 July 2016. At which two breaches of legal requirements were found. These related to proper and safe management of medicines and monitoring and improving the quality and safety of the services provided.

Following our inspection we served a warning notice against the registered provider in respect of the breach in regulation 17, good governance and stated that they must take necessary action to comply with this regulation by November 2016.

We also issued a requirement notice in respect of the breach in regulation 12, safe care and treatment. The registered provider sent us an action plan detailing how and when they would take action in order to meet this requirement notice.

We undertook a focused inspection on the 20 February 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Hadrian Park on our website at www.cqc.org.uk

Hadrian Park is a purpose built care home in Billingham. The home is registered to provide care and accommodation for up to 73 older people and people with dementia. At the time of our visit there were 66 people living at Hadrian Park.

The property was divided into three units across a ground and first floor, accessed by stairs and a lift. The Lilly unit provided residential care on the ground floor whilst the Chester unit, also on the ground floor provided care for people living with dementia. Upstairs the Poppy unit provided accommodation for those people who had greater levels of dependency.

The home had a registered manager 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.

At the last inspection we found that accurate and complete records of people’s medicines were not being kept and some medicines were not always administered as prescribed by the doctor.

At this inspection we found there were still a number of issues with medicine management and records.

At the last inspection we found that accidents and incidents were being recorded but an analysis of the data to look for patterns and trends was not being undertaken.

At this inspection we found this had improved. We saw a monthly accidents and incidents analysis was done for each unit. A weekly analysis was also done for each individual and an accident and incident report produced.

At the last inspection we found that systems in place to monitor and improve the quality of the service were not effective. Issues found during the inspection had not been picked up by management audits. We also found that accurate and up to date care records were not always being kept.

At this inspection we found there were still a number of issues with the audit process. Medicine audits were not being carried out as described by the registered manager and the audits that were done had failed to identify the issues we found. Inaccurate recording on audits meant that statistics gathered from them was not correct.

We found that improvements had been made to the standard of care records and those we looked at were detailed and up to date.

At this inspection we found that some improvements had been made but people were still at risk due to medicines not being managed safely and there was an on-going breach of Regulation 12.

We also found that, although some improvement had been made to care records, people were still at risk because effective quality assurance of the service was not taking place and there was an on-going breach in Regulation 17.

The inspection took place on 1 June 2016, 7 July 2016 and 21 July 2016. The inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting.

Hadrian Park is a purpose built care home in Billingham. The home is registered to provide care and accommodation for up to 73 older people and people with dementia. The home does not provide nursing care. At the time of our visit there were 64 people living at Hadrian Park. The property has been divided into three units across a ground and first floor, accessed by stairs and a lift. The Lilly unit provided residential care on the ground floor whilst the Chester unit, also on the ground floor provided care for people living with dementia. Upstairs the Poppy unit provided accommodation for those people who had greater levels of dependency. The home was clean, nicely decorated and had a well organised lay out with a variety of communal space.

On the first day of inspection 1 June 2016, the home had a registered manager in place. On the 7 and 21 July we were informed that the registered manager had handed in their notice and the deputy manager was acting as 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.

We last inspected the service in November 2015 and found the provider to be in breach of four regulations regarding safe care and treatment, good governance, staffing and need for consent.

At this inspection we found that, despite some changes being made, people were still at risk due to medicines not being managed safely and there was an ongoing breach in relation to safe care and treatment. We also found that people were still at risk because effective quality assurance of the service was not taking place and there was an ongoing breach.

We found that improvements had been made in some areas. Staff had received training on challenging behaviour and a number of new training courses had been implemented to improve staff knowledge and skills. The registered provider was therefore no longer in breach of this regulation.

We saw evidence of consent and best interest decisions on people’s records, although there was still some work to be done in this area significant improvements had been made and the registered provider was no longer in breach of this regulation.

We found that medicines were not always administered as prescribed by the doctor. Creams and ointments in particular were not administered as regularly as directed. We found errors on some medicines administration records (MAR) and the fridge that was used to store medicines in on one of the units was faulty and not maintaining the correct temperature for safe storage.

There were systems and processes in place to protect people from the risk of harm. We saw that individual risk assessments were in place and that they covered the key risks specific to the person. These did not always contain sufficient information and we identified some risks that had no associated risk assessment.

Staff had received safeguarding training and demonstrated knowledge of the procedure to follow.

We found that safe recruitment and selection procedures were in place and appropriate pre-employment checks had been undertaken.

Accidents and incidents were being recorded but an analysis of the data to look for patterns and trends was not being undertaken.

We were shown how the service calculated their staffing levels using a dependency tool. We were able to see from this and from checking staff rotas that the service was adequately staffed according to the level identified by this method. Staff felt that there were not always sufficient staff to provide the correct level of care for people and

The inspection team who carried out this inspection consisted of two inspectors. During the inspection, we spoke with ten people, three relatives, the manager, deputy manager and seven staff. We looked at ten sets of care records and eight staff files. We also observed care practices within the home.

The service had a registered manager in post. The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health safety and welfare of people.

During the inspection, the team worked together to answer five key questions which are outlined below.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure living in the home. Staff were knowledgeable about the procedures they needed to follow to ensure that people were safe. Staff took quick action when needed to ensure that the risk of harm to people was minimised.

We saw that the home was very clean and well-maintained. All the people we spoke with told us this was always the case. All staff took action to ensure that infection prevention and control procedures were followed.

People had access to the equipment which they needed at all times. Equipment was clean and fit for purpose. Referrals for equipment were carried out when needed.

Recruitment procedures were rigorous and thorough. Staff records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support older people including people living with a dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care home. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand where an application should be made, and how to submit one.

Is the service effective?

People had individualised care plans which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

People had access to a range of health care professionals some of which visited the home. People told us staff escorted them to healthcare appointments if needed. When people were admitted to hospital, staff kept in regular contact.

People spoke highly of the staff and the care which they received. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well.

There was a flexible but robust activities schedule in place which catered for everyone’s needs. Activities were provided individually and in a group. People were encouraged to maintain links with their local community by attending local events.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people whilst helping them to remain independent.

Care plans were individualised and included people’s preferences, interests, aspirations and diverse needs. Our observations of the care provided showed that staff were very knowledgeable about people’s needs and wishes.

Is the service responsive?

Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

The home was responsive to people’s needs, wishes and preferences. We saw that changes were made when needed, such as menus and activities. Fundraising activities had been taking place to raise money for a minibus which would help to increase people’s access to the community and to access holidays within the region.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. People and their relatives told us they were kept informed of changes which affected them.

A robust system to assure the quality of the service provided at the home was in place. The way the service was run had been reviewed regularly. Prompt action had been taken to improve the service or put right any shortfalls they had found.

Regular audits were carried out which were used to identify changes and improvements to minimise any risks to people and staff.

People told us they had completed a customer satisfaction survey. They confirmed they had been listened to and as a result of the survey changes to the menu had been made.

Regular meetings were in place for people and their relatives which were well attended. Further to this there was a weekly drop-in session in place to discuss any queries or concerns. Relatives told us they found the management team very approachable.

What people said

People who were able to express their views told us they were satisfied with the care and support they received. One person told us, “The staff are nice to me.” Another said, “The staff are very helpful.”

Everyone we spoke to told us they enjoyed living at the home and they were happy with the care provided. People told us, “I like it here. The atmosphere is very relaxed” and “Staff are very good, I can’t praise them enough. I am very happy.”

Relatives also spoke positively of the staff and the care provided to their relatives. Two relatives told us, “The staff are responsive to people’s needs.” One relative told us, “I have happy with the care my relative has received. They have been putting on weight and are encouraged to keep active.

Staff told us they enjoyed working with older people. Staff spoke highly of their team and of their manager. One staff member told us, “The manager is brilliant.” “Another told us, “The manager is easy to talk to and very supportive of our work.”

At our last inspection we found that care did not always meet people’s individual needs and ensure the safety of people who used the service. During this inspection we reviewed the care records and spoke with people and their relatives to make sure that the provider had taken action.

People and relatives told us that they were extremely happy with the care. One person said, “The staff are very, very good.” One relative said, “It is like a five star hotel here. You could not get a better set of staff anywhere else.” Another relative we spoke with told us, “I can sleep at night knowing that my mum is safe and happy. It takes a lot of concern away. I think the staff are tremendous.”

People had been supported to make decisions about their health checks and treatment options. We saw that people were provided with care and support from a range of health professionals, such as their GP and community nurses.

We saw that people were protected against the risks of abuse. Staff we spoke with were very knowledgeable about the signs of abuse and knew the procedures to follow if they suspected abuse was taking place.

Staff had received appropriate training to dispense medication and followed procedures carefully.

The provider took action to ensure the quality of the service. We saw that there was enough staff to care and support people. We found evidence to show that the views of people and their relatives were taken into account.

We spoke with six people who used the service. One person said, “The staff are lovely, there’s lots of new staff but they are good.” Another person said, “When I ring the bell they are usually quite quick to respond.” We spoke with one relative of a person who used the service and they said, “I like the fact that staff care about people.”

We found that most care records were held electronically on computer and that these were kept up to date and fit for purpose. We found that additional paper records, such as weekly weight charts and fluid charts, were being kept to protect people’s safety and wellbeing.

However we found that although records contained detailed up to date information, the delivery of care did not always meet people’s individual needs and ensure the safety of the person who used the service. We found that one person had nine falls within a two month period. This person had been referred to the falls team in December 2012 by the district nurse; however the home had not followed this up. We observed that one person was not assisted by staff to eat their lunch as stated in their care plan. We found that care had not always been delivered in line with care plans and referrals to the falls team had not been followed up.

We have written to the provider separately, regarding referrals to the falls team, and requested further information be provided to us within 7 days.

We spoke with one person about their medicines. They said that staff applied the prescribed creams they required regularly each day.

In this report the name of the registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People told us “It’s a nice place, I get well looked after”, “The staff here are vey good.”, “It’s nice here, nice and clean”, “Most of the staff are nice.”, “I’m only here for respite care, but I find it fantastic, I’ve come on leaps and bounds since I’ve been here.”, “If I had to come into a home full time I’d choose to come here.”, “I wouldn’t leave here now, I really like it here. I would recommend the home to anyone. I don’t know what I’d do without it.”, “My son was worried about me living by myself. We both feel much safer now I live here.”, “Staff talk to me about my care.”, “I took part in a sing-a-long this morning, I really enjoyed it.” and “The hairdresser comes every week, she’s really good.”

People told us about their medications, “The staff help give me my medication, I wouldn’t want to look after it myself.” and “The staff look after my medication. I’m happy for them to do this, I prefer it.”

The inspection took place on 9 November 2015, 10 November 2015 and 12 November 2015. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visits on 10 and 12 November 2015.

We last inspected the service in May 2014 and found that it was not in breach of any regulations at that time.

Hadrian Park is a purpose built care home in Billingham. The home is registered to provide care and accommodation for up to 73 older people and people with dementia. The home does not provide nursing care. At the time of our visit there were 67 people living at Hadrian Park. The property has been divided into three units across a ground and first floor, accessed by stairs and a lift. The Lilly unit provided residential care on the ground floor whilst the Chester unit, also on the ground floor provided care for people living with dementia. Upstairs the Poppy unit provided accommodation for those people who had greater levels of dependency. The home was clean, nicely decorated and had a well organised lay out with a variety of communal space.

The home had a registered manager 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.

At the time of our inspection the registered manager had only been in post for six months. After the change in management a number of staff had left the service but new staff had been recently recruited to fill these vacancies.

People told us they felt there were sufficient staff on duty. The rota for the previous four weeks which appeared to show gaps caused by staff sickness but were also shown another document which evidenced extra staff had been deployed to fill these gaps. The rota had not been altered to reflect this. Whilst the staffing levels were adequate for the number of people using the service and their level of need, these figures included new staff who were not yet fully trained or competent to deliver care unsupervised. We have made a recommendation about this.

Staff had received some of the appropriate training and had the skills and knowledge to provide support to the people they cared for, however they had not received training on the correct way to deal with challenging behaviour. Some newer staff members were still undergoing induction training.

Medicines were stored correctly but record keeping was poor. There were gaps on the Medication and Administration Record (MAR) charts where staff should have signed to show medication was administered. We counted drugs and found the stock did not tally with the paper records. Poor record keeping such as this places people at risk of not receiving their medication correctly. We found that one person had not received one of their medicines for six consecutive days.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns without fear of recrimination.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

We saw that individual risk assessments were in place and that they covered the key risks specific to the person. These included things such as risk of falls, pressure ulcers and eating and drinking.

We looked at care plans and found that they were written in a person centred way and the care records we viewed also showed us that people had appropriate access to health care professionals such as dentists and opticians. The care plans were held on an electronic system and contained all necessary information relating to the day to day care needs. Those we looked at were up to date and had been regularly reviewed. Paper files were also held for each person but the information on these was not consistent and did not always match the electronic records.

Staff were observed to be caring and respected people’s privacy and dignity. People who used the service said that staff were caring and kind.

We observed that people were encouraged to be independent and to participate in activities that were meaningful to them. People we spoke with were happy with the level and variety of activities available in the home.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. Staff had not been receiving regular supervision or yearly appraisals to monitor their performance however the new registered manager had recognised this. A programme of regular supervision had begun and we saw that a full schedule had been drawn up for future meetings.

We saw that there were policies in place in relation to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Staff had received training and demonstrated an understanding of the requirements of the Act and we saw that the service had been applying the DoLS appropriately. However, we did not see evidence within care plans that capacity assessments or best interest decisions were being undertaken.

We saw that people were provided with a choice of food and drinks to help ensure their nutritional needs were met. We saw that there was a four week menu in place offering a variety of dishes and staff also demonstrated knowledge of people’s likes, dislikes and special dietary requirements. We were told by people using the service, family members and staff that the food was not always of good quality and often not hot enough. A new chef was due to start shortly after our visit and the manager was going to work with them on improving standards.

There was a complaints procedure in place and this was clearly displayed in communal areas. We saw evidence that complaints had been dealt with appropriately and lessons learned passed on to staff.

There was a relaxed atmosphere in the home and we saw staff interacted with each other and people who used the service in a very friendly and respectful manner. Although the change in management had caused some unrest amongst staff this seemed to be settling down by the time we visited and staff told us they would feel confident raising any concerns or issues.

Staff meetings were held regularly and were seen as a robust method of communication.

Although there were systems in place to monitor and improve the quality of the service provided they were not effective. Clear ownership of responsibilities in respect of quality assurance was not apparent during our inspection and the quality of the records in a number of areas reflected this.

We found the provider was breaching four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the proper and safe management of medicines, staffing, the need for consent and monitoring and improving the quality and safety of the services provided. You can see what action we told the provider to take at the back of the full version of the report.