Haydon View Residential Home 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. Haydon View Residential Home accommodates 27 people in one adapted building. At the time of our inspection, 19 people received care from the service, some of whom were living with dementia.

This inspection took place on 17 November 2017. The inspection was unannounced.

The last inspection we carried out at this service was in August 2015 when we rated the service 'Good', and found the provider was meeting all of the regulations. At this inspection, we found the provider had maintained a rating of 'Good'.

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 we spoke with were relaxed in the home, and at ease with staff. People told us they felt safe living at the home. Staff had all undertaken training in spotting any signs of safeguarding concerns, and in discussions with us were able to describe appropriate steps they would follow if any arose. Prompt referrals had been made to the local authority safeguarding team when necessary.

Risks were well managed. Care records contained assessments of risks such as falling, choking or developing malnutrition. Mitigating actions were highlighted to staff to reduce any known risks. Some areas of the upper floor were sloping and we considered more could be done to reduce the risk of people tripping. The registered manager assured us this would be addressed. Accidents and incidents were well monitored.

People and staff told us there were enough staff to operate the home safely and to meet people's needs. Staff were had time to sit and talk with people as well as carrying out their tasks. Robust recruitment procedures had been maintained, and recruitment included checking prospective staff employment details with the Disclosure and Barring Service (DBS) which would highlight any known reasons why staff should not work with vulnerable people.

.

Staff received appropriate training so they had the skills and knowledge to meet the needs of the people they supported. Training was monitored to ensure it stayed up to date. Staff met regularly with their supervisors to discuss their role and personal development.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

The principles of the Mental Capacity Act 2005 (MCA) were embedded in care records, and staff had a good understanding of the process to follow if they had any concerns over people's capacity to make decisions. Where people’s liberty had been restricted for their own safety, the registered manager had applied for authorisation through the Deprivation of Liberty Safeguards (DoLS).

People spoke positively about the food on offer, and during our observations, we saw people enjoyed their meals. Some adaptations had been made to the environment to enable people living with dementia to move around the home as independently as possible. The provider told us they were researching best practice in dementia care and had plans to incorporate more adaptations to make the home as dementia friendly as possible.

People were supported to access health professionals and to have their healthcare needs met. A district nurse we spoke with told us the home worked well with them.

Staff were warm, friendly and knew people and their needs well. During the inspection, we saw staff responded to people's distress

We spoke with seven relatives to find out their opinions of the care and treatment at the service. One relative told us, “The quality of care is superb, they are so caring.”

We were unable to speak to all of the people who used the service because of the nature of their condition. We spoke with staff and observed their practices to determine how care and support was delivered.

Relationships between people and staff were clearly good. Relatives told us and we saw in practice staff treated people with respect and helped them to remain as independent as possible.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke to were positive about the care and support people received.

The home was clean and we saw there were effective systems in place to reduce the spread of infection.

We walked around the premises and found that they were of a suitable design and layout, but not always adequately maintained.

We saw staff recruitment procedures were in place and records showed that these were followed when new staff were appointed. We saw appropriate checks were undertaken before staff began work.

We found that effective systems were not in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We found that records held in relation to people’s care and treatment were not always accurate and fit for purpose.

During our unannounced visit we talked to six people who used the service and one relative. We also talked to a member of the district nursing team and the manager of the service. The people who used the service said they were happy at Haydon View and had no complaints. The relative we talked to said, “I couldn't praise Haydon View highly enough.” We looked in detail at four care records and saw that care and support was being provided in line with individual plans of care. During our visit we observed care that was person-centred and provided in a way which promoted independence, choice and respect.

We talked to four care staff employed by the service and looked at four staff records. We saw that care staff provided person-centred care and this was reflected in the feedback we read and heard from people during our visit. We found that care staff were trained and supported to meet people’s needs safely and effectively.

People told us that they were happy with the care and attention they received at Haydon View. They said that they were given choices in life and that staff supported them to take some risks and be independent.

People said they received enough to eat and drink and they said ‘the food is lovely’ ‘it always smells nice and makes you look forward to eating’ ‘you can have as much to eat and drink as you like’ 'the staff are always coming around with tea and something tasty' ‘lovely home cooked meals’.

People confirmed that they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said ‘there is something to do’ ‘I enjoy my knitting‘ ‘I can join in or relax in my room’ ‘I like sitting outside the views are superb’ 'I like the dominoes'.

People told us that their home was clean, comfortable and warm and they said ‘the place is very clean’ ‘always looks and smells so clean’ 'my clothes are well looked after'. They said staff were kind and caring, they said 'these lasses cannot do enough', 'nothing is too much trouble' and 'they are kindness itself'. People confirmed that they were given the opportunity to comment on the service, change routine or raise complaints. They said that their visitors were made to feel welcome and information exchange was good.

Haydon View Residential Home is a care home located in Haydon Bridge which can accommodate up to 27 people. At the time of our inspection 12 people received care from the service, some of whom were living with dementia.

This inspection took place on 4 and 10 August 2015. The inspection was unannounced.

The last inspection we carried out at this service was in December 2013 when we found the provider was not meeting three of the regulations we inspected. These breaches related to safety and suitability of premises, assessing and monitoring the quality of service provision and records. At this inspection we found improvements had been made and the provider was meeting the legal requirements of these regulations.

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.

We saw that staff engaged with people positively, using their knowledge of people’s family lives, interests and the local area to encourage to people to take part in activities and interact with other people using the service. People, relatives and health professionals were overwhelmingly positive when talking about the care provided at the home.

Care was centred the individual person. Care plans records included photographs and detailed information about what was important to the person being supported. People gave us examples about how the choices about their care were respected, such as staff supporting them to get up late on a morning.

Staff had received training in end of life care, and those people who wished to, had considered and planned for how they would like to be cared for as they approached the end of their lives. Comments recorded in the compliments file included messages of thanks about how well relatives had been treated as they approached the end of their lives.

People we spoke with told us they felt safe and comfortable living at the home. Staff had been trained in how to respond to any safeguarding concerns. A social worker we spoke with told us staff shared any safeguarding issues with them promptly.

Risks related to care delivery and the environment had been assessed and information was available to staff on how to mitigate these risks. Accidents and incidents were analysed to determine where action should be taken to reduce the likelihood of reoccurrence. Medicines were well managed, and systems were in place to prevent the spread of infection.

The standard of accommodation had been improved since our last inspection, for example, a bathroom had been refurbished the décor within the home had been refreshed. Maintenance staff carried our regular checks to the premises and equipment to ensure these were safe to use and in good working order.

There were enough staff to meet people’s needs. We saw staff were able to complete their tasks in a calm unhurried manner and they had time to sit and talk with people. People, relatives and staff confirmed this. Staff personnel records showed recruitment policies were robust and procedures had been followed to confirm new employee’s identities and previous employment details.

Staff received appropriate training and this training was up to date. They had undertaken a range of care and safety related training, in addition to training based around the specific needs of people they supported. Staff met regularly with their supervisors to discuss their role and personal development.

Staff we spoke with, including the registered manager had a good understanding of the Mental Capacity Act 2005 (MCA). Where decisions had been made in peoples’ ‘best interests’, records were available to show MCA principles had been followed. Where people’s liberty had been restricted in their best interests, and for their own safety, Deprivation of Liberty Safeguards (DoLS) had been applied for and approval granted.

People were happy with the food choices available to them. They told us they were given a choice at every meal, and snacks were available throughout the day. Adaptations had been made to the environment to enable people living with dementia to move around the home as independently as possible. People were supported to access health professionals and to have their healthcare needs met. A district nurse and general practitioner (GP) we spoke with told us referrals were made to them at appropriate times.

People told us their needs were met by staff at the home. Assessments of people’s needs were in place and reviewed regularly. Plans of people’s care were easy to follow and detailed. When we spoke with staff they were able to tell us how they supported people, and this information reflected information in their care records.

Activities were planned around people’s interests. An activities coordinator planned and arranged trips, entertainers and formal activities, whilst one to one activities were arranged by people’s key workers.

People were able to share their experiences of the service through regular meetings, and completion of satisfaction surveys. No complaints had been received in the 12 months prior to our visit.

People and relatives spoke highly of the registered manager. They told us she was approachable and that the service was well-led. Staff confirmed this, telling us that the manager’s door was ‘always open’.

Feedback from staff and visiting professionals were valued. Staff were asked to share their views on the home during regular staff meetings. Health professionals had been asked to provide feedback on the quality of the service provided. There was evidence that actions had been taken to make improvements where possible.

A range of audits were carried out to assess and monitor the quality of the service.

Improvements had been made to the standard of record keeping. Records were stored appropriately and on the whole well maintained.