This inspection took place on 11 December 2018 and was unannounced. Harwood Court 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.

Harwood Court provides care for up to 35 people. There were 30 people living in the home at the time of the inspection, some of whom were living with dementia.

At our last inspection on 24 May 2016 we awarded an overall rating of good and rated the key question ‘is this service caring?’ At this inspection we found the service remained good, we have therefore rated it good.

A registered manager was in post. 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.

There were safe procedures in place for the safeguarding of vulnerable adults, and recruitment procedures helped to protect people from abuse.

Risks to people and the premises and equipment were assessed and plans were in place to mitigate these. A record of accidents and incidents was kept and reviewed by the registered manager to help prevent reoccurrence.

Suitable systems remained in place for the management of medicines.

The home was clean and well maintained and had recently been refurbished. New signs were due to be put up to help people with finding their way around the home.

Staff received regular training, supervision and appraisals and told us they felt well supported by the provider to complete training they considered mandatory.

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 were supported with eating and drinking and told us they enjoyed the food at Harwood Court. Specialist advice was sought when there were concerns about people’s nutrition.

There were numerous examples of kind and compassionate care being provided. People told us they appreciated the atmosphere and the relationship and fun they had with care staff. People were also treated with dignity and respect.

Person centred care plans were in place which aimed to put people at the centre of their care. Care plans we read were up to date and regularly reviewed.

A variety of activities were available and people had access to outdoor space in better weather.

Close attention had been paid to supporting people at the end of their lives. A chaplain was employed who supported this, and resources were provided to promote the comfort of people and their relatives at this important time.

We received positive feedback about the registered manager, deputy and administrator, who were found by people, staff and relatives to be approachable and helpful.

The registered manager undertook a range of audits on the quality and safety of the service and sought the views of people using the service and their families.

There were close links with the local community.

Harwood Court is a large two storey residential care home based in Cramlington. The service is registered to provide accommodation, care and support to up to 35 people. At the time of our inspection, 26 people were using the service.

This inspection took place on 24 and 27 May 2016 and was unannounced. This means the provider did not know we would be attending. At our last inspection of the service in November 2014 we rated the service as ‘Requires Improvement’ overall. This was because we identified four breaches of the Health and Social Care Act 2008 related to staffing, care and welfare of people who use services, records and assessing and monitoring the quality of service provision.

At this inspection we found improvements had been made and the provider had achieved compliance with each of the regulations that had previously been breached. The service has a new registered manager in post. 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 living at Harwood Court told us they felt safe and comfortable with the support they received. Relatives we spoke with confirmed this. Policies and procedures were in place, such as those about safeguarding and whistle blowing, to protect people from harm and to ensure staff understood their responsibilities.

Risks associated with the health, safety and wellbeing of the people who lived at the home were well managed and included the provider carrying out checks of the premises in line with their legal responsibilities. People’s care needs had been assessed and we saw evidence in records that new care planning documentation had been drafted. These were evaluated and reviewed regularly. Accidents and incidents were investigated in a timely manner and where appropriate the manager had informed the local authority and the Care Quality Commission (CQC) of significant incidents. These records were analysed and used to review people’s care needs, risk assessments and implement preventative measures. All other records related to the management of the service were well maintained.

Medicines were managed safely and medicine administration records were completed and accurate. Medicine was stored safely and in line with best practice guidelines. Senior staff followed policies and procedures with regards to receiving, storing and disposing of medicines safely.

People and relatives told us there was enough staff deployed by the service to operate safely and to meet people’s needs. The manager used a ‘needs dependency’ tool to monitor staffing levels. The recruitment process was safe and staff had been appropriately vetted. Training was up to date, and staff had a variety of experience, skills and knowledge. Competency checks were undertaken to ensure staff remained suitable for their roles. Staff had been given the opportunity to progress their career through access to qualifications.

Evidence showed the manager and staff had an understanding of the Mental Capacity Act (MCA) and their own responsibilities to apply this act in their work. The provider had assessed people’s mental capacity and reviewed it. Care records showed that wherever possible people had been involved in making decisions, but significant decisions regarding people’s care were made in people’s best interests and had been appropriately taken with the involvement of other professionals and relatives.

Records showed that supervision and appraisals were held regularly and staff confirmed this. Staff and relatives’ meetings were held and notes were taken. This demonstrated that everybody involved with the service had an opportunity to speak with the manager.

Staff encouraged people to maintain a healthy, balanced diet. We observed people i

We found that people were asked for consent before care and support was delivered.

People's care needs were assessed and care was planned and delivered safely. People spoke highly of the care at the home. One person said, "It's so good here when you come through the door you feel welcome, it is just like home." People commented very positively about activities and care. A relative said, "The activities organiser thinks up some really good ideas" and "My Mum is over 100 and she is so happy, they take care of her and have her looking so nice, I can go away confident that she is content here. They look after her how I want her looked after."

People were safely supported to move around the home and the equipment the staff used was suitable and safe.

Staff recruitment ensured people were cared for safely by suitable people. One relative said the following about the staff, "The girls are so caring, so sincere, good humoured."

The provider had an effective complaints system and people felt able to raise concerns. One person said, "The main thing here is everyone takes everyone's position into account. If we do not like a thing all we need to do is talk to the ladies in the office."

We found that people were consulted about their care needs and were treated with respect for their dignity and privacy. One person said, "I am asked about what I like, what I don't like, how I like things done." Records showed that people were involved and had signed their care plans.

We found the provider had arrangements in place for asking for people's consent and staff asked permission before providing care. However we noted significant decisions had been made without the service provider fully considering the capacity of people to make these decisions.

People had their care needs assessed with risks to their safety and welfare taken into account. Care was planned and delivered to meet people's needs and ensure their welfare. People felt cared for. One person said, "I felt at home as soon as I moved in." Another person said, "The staff are really nice, they have always been so kind."

We found in records, and people confirmed, that the organisation assessed the quality of the service and identified risk by asking the opinions of people who use the service and their representatives.

We did not discuss the support staff receive with people who lived at the service.

This was an unannounced inspection which took place on 6, 11, 12 and 17 November and was carried out over three days and one evening. We last inspected Harwood Court in May 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

Harwood Court is a care home for older people. It is registered to accommodate 35 people and 29 people were living at the home at the time of our inspection. Nursing care is not provided. A registered manager was in post. 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 registered manager was away from work and a temporary manager took charge part way through our inspection.

During our tour of the premises no safety hazards were noted and medicines were safely managed.

The home used safe systems when new staff were recruited. All new staff completed thorough training before working in the home. The staff were aware of their responsibility to protect people from harm or abuse but lacked confidence in the management of the home to be consistent in responding to this.

Although people told us that they felt safe in this home, there were times when there was not enough staff to meet people’s needs. We also found that a standing aid was not in service and the risks had not been assessed regarding this.

Staff received on-going training and support to help them carry out their work and provide support to people living at the service. Supervisions, appraisals and staff meetings had fallen behind schedule.

People spoke highly of the food and we saw mealtimes were pleasant social experiences. The cook had contact with people on a daily basis and visitors had access to small kitchens for preparing drinks and snacks. We saw drinks were readily offered throughout the day.

Some aspects of people’s consent to care and treatment were not being managed in accordance with the Mental Capacity Act 2005.

The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. People had access to community based health care services.

People told us that they, and their families, had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. However, we found that care plans did not always reflect people’s care needs because they had not been updated and some people’s risks had not been reviewed. This meant people did not always receive support in the way they needed it.

People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home. One person had chosen to bring a pet into the home. They told us that it was very important to them that they were able to have their pet with them.

Activities were varied, stimulating and well planned throughout the week. We saw people enjoyed these and were assisted and supported to take part, where necessary.

The systems used to assess the quality of the service had not identified the issues that we found during the inspection. This meant the quality monitoring processes were not effective as they had not ensured that people received safe care that met their needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to; the number of staff on duty; safe delivery of care; keeping accurate records; assessing and monitoring the quality of the service. You can see what action we told the provider to take at the back of the full version of this report.