This inspection took place on 7 and 16 March 2018. The visit on the 7 March was unannounced. This meant that the provider did not know we would be visiting.

Hepscott Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. It accommodates up to 40 older people, some of whom are living with dementia. At the time of our visit 31 people were being cared for at the home.

The service was last inspected in October 2016 when we found five breaches of the Health and Social Care Act 2008. These related to safe care and treatment, person-centred care, need for consent, safeguarding people from abuse and improper treatment and good governance. We requested actions plans from the provider outlining the action they would take to make the necessary improvements.

At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.

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.

At the last inspection we found not all aspects of the service were safe. People were not fully protected from abuse and risks to them and towards other people had not been fully assessed or mitigated. Storage for controlled drugs (CD’s) was not suitable.

At this inspection we found general and individual risk assessments had been carried out and staff had received training in the safeguarding of vulnerable adults and were aware of the procedures to follow in the event of any concerns. New CD storage cupboards had been installed which were suitably secure.

We checked the management of medicines and found a small number of gaps in records for non-medicated creams and lotions. Instructions about when to use some medicines as required lacked detail. We spoke with the registered manager about this who told us they would address this issue.

Medicine training and checks on the competency of staff to administer medicines had been carried out. An air conditioning unit had been ordered due to the treatment room becoming warmer than the recommended maximum temperature for the storage of medicines. The room temperatures were monitored closely in the meantime.

The home was generally clean and well maintained. We noted malodour on one floor on the first day of the inspection which had been addressed by our second visit. New flooring had been laid in one room and additional cleaning carried out.

Regular checks on the safety of the premises and equipment were carried out. This included checks of fire safety equipment, window restrictors, water temperatures and equipment used for the moving and handling of people.

There were suitable numbers of staff on duty who cared for people in a relaxed unhurried manner. Safe staff recruitment procedures were followed which helped to protect people from abuse.

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.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. At the last inspection we found decisions had been made in people’s best interests where they lacked capacity, but records did not demonstrate how people’s capacity and been assessed. At this inspection we found cap

This inspection took place on 5 and 11 October 2016. The visit on the 5 October was unannounced. This meant that the provider and staff did not know we would be visiting.

Hepscott Care Centre is a residential care home in Morpeth. It accommodates up to 40 older people, some of whom have dementia care needs. At the time of our visit 26 people were being cared for at the home.

The service was last inspected in July 2015 and at that time was in breach of Regulation 17 HSCA (RA) Regulations 2014 Good Governance. During this inspection we found that whilst some actions had been taken to improve the quality and monitoring systems, shortfalls in care remained. The provider had failed to implement a robust system to assess, monitor and improve the quality and safety of the services 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.

People had not been fully protected from the risk of abuse and improper treatment. Allegations of potential abuse had not been shared with all of the relevant authorities. Where people displayed behaviours that challenge, the risk they posed to other people had not always been assessed.

Accidents and incidents were monitored and reviewed by the registered manager. However actions had not always been taken to reduce the risk of them reoccurring. Assessments to limit the risk of people choking when eating had not been undertaken.

People, relatives and our observations confirmed there were enough staff to meet people’s needs. Records showed safe recruitment processes had been followed.

Staff had been trained to administer medicines and followed good practice, however appropriate storage systems were not in place for controlled drugs.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

We found decisions had been made on people’s behalf, however the provider could not demonstrate how the person’s capacity had been assessed or that they had considered the principles of MCA and ‘best interests’ in determining the decisions. Some people’s liberty was deprived because it was considered that they would not be able to keep themselves safe if they left the home alone. However the provider had not applied for the legal authorisation to do this.

Staff received training and supervision to ensure they had the skills and knowledge to meet people’s needs.

People spoke highly of the food available and there was a plentiful supply of fresh ingredients. We found people’s dietary requirements had not always been recorded appropriately within their care records or within the kitchen.

People and relatives told us the staff were warm and friendly. We observed staff were considerate of people’s privacy and dignity.

Relatives told us the home maintained good communication with them about their family member’s needs and told us they felt welcome to visit the home at any time.

Assessments of people’s needs and the care plans which described how they should be cared for did not always contain accurate information and were out of date, which put people at risk of receiving unsafe or inappropriate care.

At the time of the inspection there was not a dedicated activities staff member and care staff shared this role. One relative told us that people sometimes seemed ‘bored’. The manager advised that a member of staff was about to become activities coordinator, and they were going to utilise some unused space within the home as a place for activi

People were asked their views about the service provided by the provider and manager and these were taken account of.

The provider had systems in place monitor care delivery and ensure the health, wealth and safety of people who used the service was maintained.

We confirmed the provider had a detailed and effective quality monitoring process in place.

At the time of our inspection the manager at the service was in the process of registering with the Care Quality Commission.

We found that records contained accurate and appropriate information. People’s care records were held securely in an office but were easily accessible for reference in an emergency.

We noted that care plans were in place for communication, personal hygiene and weight management and that they were regularly reviewed and information was entered and updated in a timely manner.

During our inspection we spoke with three people who used the service and three relatives. We examined the care records for five people. We found people were involved in decisions about their care wherever possible and their privacy and dignity was respected.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One staff member said, “I feel really supported, there has been big improvements.”

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

We found that care records did not always contain accurate or appropriate information and documentation.

During our inspection we spoke to two members of staff and viewed five care plans.

We found that people's needs were not always assessed and care and treatment was not always planned in line with people's individual needs.

As a result of our findings on the day we included the review of records. We found that care and records did not always contain accurate or appropriate information.

During our visit we talked to three people who used the service and two relatives. We also talked to the manager of the service. The people who used the service said they were happy at Terravis Park and had no complaints. The relatives we talked to said care at Terravis Park had improved considerably since the current manager was appointed. We looked in detail at three 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 three care staff employed by the service and looked at their records. We saw that staff provided person-centred care but found that individual staff supervision meetings were not taking place as often as required. We also found that the home’s policy and procedures for managing complaints and gathering feedback about the service were inadequate.

We found that safeguarding arrangements were in place at the service and staff were aware of their responsibilities in this area.

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

People we spoke with said, "I am happy the lasses are lovely" , "I enjoy the food" and "it is a nice place to live".

People said they received enough to eat and drink. They said "the food is very tasty", "plenty to eat here" and "always coming around with drinks".

People confirmed they could receive medical and specialist attention when they

needed it and were helped to fulfil their social needs within the home and community.

This inspection was unannounced and carried out on 29 March 2015. We had received information about concerns in relation to people’s care and welfare. We were also told that people who used the service were woken up very early. We visited the service at 6.30am. We did not find evidence that staff were getting people out of bed early or that people’s needs were not met. We returned for the second and third day of inspection on 30 and 31 March.

We had last inspected the service in February 2014, and at that visit found the service was meeting all of the regulations that we inspected.

Terravis Park Residential Home is a care home in Morpeth. It accommodates up to 42 older people, some of whom have dementia care needs. At the time of our visit there were 16 people being cared for at the home.

At the time of our visit there was 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. Our records showed they had been registered with us since November 2013.

Risks relating to the building had not been assessed. Two people who used the service were accommodated on the first floor. The risks of uneven flooring and open stairs had not been assessed. Some individual risks due to people’s needs had not been taken into consideration in risk assessments.

We found that the décor of the premises did not fully meet the needs of people who had a dementia related condition. We have made a recommendation to ensure that the décor and design of the premises meets the needs of all people who lived at the home.

Staff were able to describe how they would respond to any safeguarding concerns, and were aware of how to contact the local authority safeguarding team.

We observed there were enough staff to meet people’s needs. The atmosphere in the home was calm and unrushed. Staff told us the staffing levels were consistent. There were recruitment procedures in place. However, when we checked these procedures we saw one member of staff had started working in the home before their Disclosure and Barring Service check had been returned.

Medicines were managed in a safe way. There was a system in place to order, receive, store, administer and dispose of medicines.

Staff had received a range of training, we saw this training was monitored and it was up to date. We saw all staff had received training in dementia care. Staff spoke positively about the training opportunities available to them. Staff were not aware however, of some of the key principals of the Mental Capacity Act 2005 (MCA). The manager told us training in MCA was planned for this year. We have made a recommendation to ensure that the service follows the relevant requirements of the MCA.

Staff regularly met with their supervisor to discuss their role and the people they supported. In addition to yearly appraisals to discuss their performance and development.

The provider was aware of their responsibility to assess any restrictions placed on people’s freedom through the delivery of safe care. The provider had assessed those who required a Deprivation of Liberty authorisation, and sent applications to the local authority.

People were supported to eat and drink. We saw on the whole people’s weight had increased since they started receiving care from the service. People were given a choice at each meal. The cook was knowledgeable about people’s dietary needs.

People were very positive about the way they were treated by staff. People told us they felt respected and that staff were kind. We saw staff appeared to know people well and the atmosphere in the home seemed warm, with staff and people sharing jokes. Staff told us they enjoyed their role.

People told us their independence was promoted and their privacy was respected. We saw documentation relating to people’s care were kept securely.

We saw staff were responsive to people’s needs. During our visit we saw staff regularly checked with people if they needed any help and support.

Activities were planned throughout the day and we saw groups of people taking part in games with staff. Staff told us they accompanied people on walks around the garden of the home, and that trips out of the home were occasionally planned.

People knew how to make complaints. We looked at the complaints and compliments book. We saw there had been three entries within the last 12 months. Two were positive praising the service, and one was a complaint. We saw the complaint had been investigated and responded to.

Accurate records relating to people’s care and the management of the service had not been maintained. Audits were carried out regularly but these had not highlighted the concerns which we found during our inspection.

People spoke highly of the registered manager and of the changes which she had implemented since she had begun her role. Staff told us leadership within the home was good, and that they were able to contact the manager whenever they needed to.

There were processes in place to gather feedback from people who used the service, relatives and staff members.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to records and assessing and monitoring the quality of service provision. These correspond with one breach of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance. You can see what action we told the provider to take at the back of the full version of the report.