The inspection took place on 27 June and 3 July 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.

Lanchester 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. Lanchester Court provides residential and nursing care and support for up to 22 people with learning, neurological and physical disabilities. At the time of our inspection there were 18 people living in the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have an active registered manager. A new manager had been recruited and there was an acting manager in place, overseeing the service. 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 in December 2016 we found that there was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to staff supervisions and appraisals. We found that supervisions and appraisals had not been consistently maintained for all staff with some staff not receiving appraisals since 2014. During this inspection we found the service had made improvements.

When we previously inspected Lanchester Court in December 2016, the service was not meeting all regulatory standards and was rated ‘Requires Improvement’. At this inspection we found the service had improved to 'Good'.

People felt safe living at the service. Staff had completed training in safeguarding people and the manager actively raised any safeguarding concerns with the local authority.

Risks to people’s safety and wellbeing were assessed and managed. Environmental risk assessments were also in place.

There were enough staff to meet people’s needs. Staff continued to be recruited in a safe way with all necessary checks carried out prior to their employment.

People continued to receive their medicines in a timely way and in line with prescribed instructions. Staff administering medicines were adequately trained and had their competencies checked. Regular medicines audits were completed by senior staff.

Staff received up to date training, regular supervisions and an annual appraisal to support them in their roles.

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 assisted to access a range of health professionals and recommendations following healthcare interventions were clearly recorded in care records and incorporated into care plans, where appropriate.

People and a relative/friend were complimentary about staff and told us the service was caring and friendly. Staff treated people with dignity and respect when supporting them with daily tasks as well as when having conversations and speaking with them.

People had access to advocacy services if they wished to receive independent support. Some people had advocacy services involved in decision making relating to specific aspects of their care.

People had a range of care plans in place that were personalised and tailored to meet their individual needs. Care plans were very detailed to ensure staff knew how to support people with daily ta

This was an unannounced inspection which took place on the 20 and 22 December 2016.

The service was last inspected in April 2016 and recommendations were made relating to making decisions in a person’s best interests, staff having regular supervisions, providing care with dignity and to the dining experience.

Lanchester Court is a residential nursing care home providing accommodation and nursing care for up to 22 people. There were 18 people living there at time of inspection. Care and support is provided for people with learning, neurological and physical disabilities.

The service had a 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.

We found that checks by the provider proactively identified issues in the service that posed risks to people. We found the environment had been maintained to ensure it was a safe place for people.

People and staff told us they felt there was enough staff to provide support. We saw that nursing, care and ancillary staff were deployed over the week to support people and provide one to one staffing as required.

Staff had been trained and supported to raise any concerns about people’s safety and wellbeing. Staff knew how to identify possible safeguarding concerns and felt able to raise these with senior staff.

Staff were recruited safely and inducted to ensure they had the required skills and were safe to work with vulnerable people. People’s medicines were well-managed by the service.

Staff were trained and monitored to make sure people received their medicines safely. Care plans were in place to support the use of ‘when required’ medicines.

Staff were trained in and demonstrated they had knowledge of the Mental Capacity Act 2005, and this was reflected in some work supporting a person to decide about serious medical treatment.

Staff told us they received day to day support from senior staff to ensure they carried out their roles effectively. However, formal supervision and appraisal processes were not used consistently to enable all staff to receive feedback on their performance and identify further training needs. The issue of supervision and appraisal had been raised at a previous inspection and the action taken had not been robust to ensure staff received this in line with the provider’s policy.

Arrangements were in place to request health and social care support to help keep people well.

External professionals’ advice was sought when needed. This was integrated into people’s care plans.

Care was provided with kindness, compassion and in a dignified manner. People could make choices about how they wanted to be supported and were treated with respect. People told us they felt cared for by staff who listened to them.

People who used the service were supported to take part in therapeutic, recreational and leisure activities in the home and the community.

People's care plans were detailed, personalised and reviewed regularly. People had ‘three page profiles’ where staff could see at a glance how best to support them. We saw that some records were placed in peoples bedrooms in order that staff could refer to them as required.

The registered manager responded positively to concerns or complaints and we saw they took clear action to learn from such events.

The registered manager and provider had not always identified and responded to issues in the service around staff supervision and appraisal. We have made a recommendation in relation to this.

The registered manager had made a significant number of improvements to the service across care planning, staffing and the dining experience.

People, relatives, staff and an external professional all felt the registe

We carried out an unannounced comprehensive inspection of this service on 29 and 30 October 2015 as a result of concerns we had received about the service. Eight breaches of legal requirements were found. As a result of the inspection findings enforcement action was taken by CQC against the provider. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. These related to the breaches of regulation regarding staff competency and staffing levels, safe care and treatment, cleanliness and suitability of the premises, nutrition and hydration, dignity and respect, requirements of the Mental Capacity Act, record keeping and good governance.

We inspected the service on 7 April 2016 to follow up on the breaches and to carry out a comprehensive inspection as the breaches related to several areas of the peoples’ care and treatment. This inspection found that improvements had been made to ensure people receive safe care and treatment.

Lanchester Court provides accommodation for personal and nursing care for up to 22 people. Care and support is provided for people with learning, neurological and physical disabilities.

A new manager was in place but they were not yet registered with the Care Quality Commission. 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.

Due to their health conditions and complex needs not all people were able to share their views about the service they received.

We found significant improvements had been made to ensure the safe care and treatment of people. People and staff told us they felt safe and there were enough staff on duty at all times to provide safe and individual care to people. There was an improved emphasis on providing person centred care to ensure people received care and support in the way they wanted and at times they chose rather than task centred care being provided. Staff had time to interact and spend time with people and not just when they carried out tasks.

Risk assessments were in place and they accurately identified current risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

Records had been updated and they were regularly reviewed to reflect peoples’ care and support requirements. Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were mostly respected. We considered some improvement was still required in one area to protect a person’s dignity.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. Not all the relevant people had been involved in the decision making process when people without mental capacity received medicine without their knowledge.

Staff received other opportunities for training to meet peoples’ care needs and in a safe way. A system was in place for staff to receive supervision and appraisal but improvement was necessary to ensure all the staff team received an updated supervision in a timely way.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people and people were being consulted to increase the variety of activities and outing

The reason for this visit was to check if improvements had been made in the area of staffing following a previous inspection.

We spoke with staff who provided care to people at the home. They were positive about the staffing levels. Comments included, “It’s much better here now we have more staff” and “You have more time to provide personal one to one support because staffing levels are much better”.

We saw there was sufficient qualified, skilled and experienced staff to meet the needs of people.

People were given all the information they needed to make an informed decision about their care and were asked to provide their consent to such care.

We saw people were cared for effectively and care was planned for the individual.

We saw the home had systems in place to manage medicines.

We found there was insufficient support staff on duty to provide care and support to people.

The provider had an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

People who used the service were positive about the care and support provided. Comments included “I like it here” and “The staff are good to me”.

Some of the people who use this service could not tell us how they feel about their care due to a variety of complex needs. Those we could speak to were positive about their experience of living at Lanchester Court. One said, "the staff are always nice to us" and another said "they always help us when we need it" and another said "the staff are lovely, and always nice to me". Those we could not speak to were observed when in being support by staff to determine their reaction. They were seen to be interacting with staff in a way that suggested a level of trust and appropriate friendliness.

Gateshead Local Authority told us that they have worked with the service around a number of areas of care delivery following safeguarding issues being raised. This involved a number of visits to the home to assess the necessary changes required and review of the improvements made. These improvements included wound management procedures, record keeping and process issues, medication and management arrangements. As a result of the concerns a temporary suspension of the Local Authority contract was agreed with the service commencing 24th December 2010. Although this was in place during some of the time of this review it has since be lifted. There is now an agreement between the Provider and the Local Authority as to the phased return to admitting new residents into the service.

During the visit the inspector spoke to eight of the people living at the service and three visiting relatives/representatives. We also spoke to the staff on duty including the manager and the senior manager who is currently based at the service.

All of the people living in the home, who were spoken to, said that they were happy with the service provided by the staff. They said that staff responded promptly and politely to any requests for assistance. One person said that she felt that the staff “were always kind” and that they received help to “do the things that they couldn’t do on their own”.

One visiting relative said that they were satisfied with the “quality of the care given” to their relative and were really happy that they had “settled well into the home “. They said that they felt that it was because of the way the staff had helped them in the early stage of the placement.

People said that they were asked about what help they needed when they moved into the service and were consulted about any changes in their care provision. All of those spoken to were aware that they had a care plan. One confirmed that he had read and signed his. Another said that they did not want to see it and were happy with the way that the staff discussed the contents with them when any changes were made. The relatives spoken to said they had been consulted about the care plans.

The people living at Lanchester Court said that the food was good and that there was always a choice at mealtimes. People told us that they were “happy” with the accommodation. One person took time to show us their flat and appeared to be very proud of how they had organised it. She said that she “loved” her flat and that staff always complemented her on how “nice” she had made it.

We spoke to two people living in the home about their medicines and both said that they received them when required and that staff assisted them appropriately to take their medicines. One person said that when he went out of the home on social leave arrangements were put in place so that he could continue to take his medicines when he was away from the home.

This was an unannounced inspection carried out on 29 & 30 October 2015.

We last inspected Lanchester Court in March 2015. At that inspection we found the service was meeting all the legal requirements in force at the time.

Lanchester Court provides accommodation for personal and nursing care for up to 22 people. Care and support is provided for people with learning, neurological and physical disabilities.

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.

Due to their health conditions and complex needs not all of the people were able to share their views about the service they received.

People told us they felt safe but we had concerns that there were not enough staff on duty at all times to provide safe and individual care to people.

Risk assessments were carried out but they were not all accurate and up to date to identify current risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe and timely way. However we have made a recommendation about the management of some medicines.

Staff received regular training, supervision and appraisal. However, not all staff had received specialist training that showed they were competent to carry out their role.

Systems were not in place to ensure people received a varied diet with special diets when the regular cook was not on duty.

Lanchester Court was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff did not all have a good understanding of the Mental Capacity Act (MCA) 2005 and Best Interest Decision Making and the Mental Health Act 1983 Code of Practice 2015 when people were unable to make decisions themselves.

Not all areas of the home were designed for the comfort of people who used the service.

People were supported to be part of the local community. They were provided with some opportunities to follow their interests and hobbies.

Staff said the manager was supportive and approachable. People were consulted and asked their views about aspects of service provision.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection to ensure people received safe and individual care that met their needs.

Enforcement action is being taken as a result of our inspection findings outside of this report.