About the service: Lanercost House - Carlyle Suite is a complex dementia care home which provides care for up to 15 people. The service specialises in providing care to people living with a complex dementia need. At the time of the inspection 13 people were being cared for at the service.

People’s experience of using this service: Relatives were very positive about the caring nature of staff and the quality of care people received. Relatives described their family members as happy and relaxed with staff. One relative said, “We have no concerns at all. My family member is safe and very well looked after.”

Improvements had been made to the way risks were assessed, monitored and communicated to staff. People received their care as planned. The provider had learned lessons from our previous inspection and a recent safeguarding incident. They had put in place a number of improvements in response.

Systems were in place and followed so people were safe. People received their medicines as prescribed. The home was clean.

There were enough staff to meet people’s needs. Recruitment processes had been followed. Staff received a range of training and regular supervision meetings.

People regularly went on trips in the community and a range of activities were planned around their interests to support people with their social needs.

Relatives and staff were very positive about how well the service was run. The provider listened to people’s feedback and made changes based on their views.

The provider had made improvements to the checks they carried out to monitor the quality of the service they provided. They had increased the management presence in the home and carried out more observations of staff practice.

Rating at last inspection: Requires improvement (previous report published September 2018).

Why we inspected: This was a planned inspection in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 14 and 15 November 2017. the first day of the inspection was unannounced which meant the provider did not know we would be visiting. The inspection was carried out by one adult social care inspector.

We last inspected the service in August 2016 where we found the service was no longer in breach of any regulations we inspected and a number of improvements had been made. The service was rated requires improvement as we needed to be sure improvements would be sustained.

Lanercost House Carlyle Suite provides care for up to 15 people and specialises in providing care to people living with dementia. There were 14 people in the home at the time of the inspection.

The home is situated in the grounds of Lanercost House which is a separately registered home belonging to the same provider. A new registered manager was in post and registered with CQC in November 2016.

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 had previous managerial experience and were considered a senior manager in the organisation which brought additional responsibilities. We found this did not detract from the running of the home as a stable management team was in post including a supernumerary deputy manager and a dedicated unit manager. There were clear managerial roles and responsibilities and effective systems were in place to monitor the quality and safety of the service.

Systems were in place to monitor the safety of the service. Routine maintenance checks were carried out on the building and equipment, and individual risks to people were assessed and plans put in place to mitigate these.

Systems were in place for the safe ordering, receipt, storage and administration of medicines. We found a small number of topical Medicine Administration Records (MARs) used to record creams and lotions showed creams had been applied more often than originally prescribed. Steps were taken to update these records by the second day of the inspection to reflect people's change in needs.

A record of accidents and incidents was maintained, and regularly reviewed for patterns or trends.

There were suitable numbers of staff on duty during our inspection. One member of staff was allocated during each shift to closely supervise and carry out regular checks on people. We have made a recommendation about reviewing the levels of observation for people at certain times of the day as we observed they could be more active at times.

Staff had received safeguarding training and were aware of the procedures to follow in the event of concerns. Issues of a safeguarding nature were responded to appropriately by the registered manager.

Staff received regular training and support to carry out their roles effectively. We recommended that skills and resources relating to the support of people exhibiting behavioural disturbance and distress should be further developed in recognition of the specialist remit of the service. Although we found people were supported well there was room for improvement in the detail of care plans and assessment methods.

People were supported with eating and drinking in ways that met their specific needs and preferences. People were supported to choose meals and receive support to eat when required which was sensitive and discreet.

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.

Staff were observed to be caring and attentive throughout the inspection. We received very positive feedback about staff from relatives of people using the service. We observed numero

This unannounced inspection took place on 17 & 18 August 2016. We last inspected Lanercost House - Carlyle Suite on 25 February 2016. At that inspection the overall rating for this provider was found to be ‘Inadequate’. This meant that it was placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

We also deemed it necessary to impose a condition on the provider’s registration in order to keep people safe. This stated that the registered provider must carry out individual risk assessments in relation to assessing the risks to health and safety of people living in the home. We took this urgent action as we were particularly concerned about the risk of people choking and the hazards people were exposed to.

The findings at this inspection mean that the overall rating is now 'Requires Improvement', and in line with our guidance the service will no longer be in special measures. The provider can now apply to have the imposed condition removed.

Lanercost House - Carlyle Suite is a nursing home for up to 15 older people who require assistance with all aspects of their care needs due to dementia related illness. The home is purpose built and comprises of 15 single rooms with full en-suite shower facilities which are accessible for wheelchairs. On the ground floor are therapy rooms including a kitchen and a sensory room. There are secure garden and patio areas, which are accessible from many of the bedrooms and from the communal areas.

The service did not have a registered manager in post at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Since the last inspection a new unit manager had been appointed for Lanercost - Carlyle Suite. Additionally an overall manager, not yet started, had been appointed to manage both the Carlyle Suite and Lanercost Nursing Home, which was in the same grounds. The intention was for the incoming manager to become the registered manager for both services.

At the previous inspection, February 2016, we had asked the provider to make improvements in meeting people’s health and welfare needs. We found that other improvements were needed around record keeping, safeguarding procedures, and general safety of the building. This led to improvements being necessary in the overall running and monitoring of the quality of service by the provider. These were classed as breaches of the regulations provider must abide by.

We received an action plan from the provider detailing how these improvements would be made. We received regular updates on progress towards meeting the action plan. Throughout this period the provider worked closely and co-operatively with CQC and the local county council commissioning team.

At this inspection of 17 & 18 August 2016 we looked at all the areas where the home had breached the regulations described above, and other areas to ensure that we carried out a fully comprehensive inspection of the service provided. We found that there had been improvements across all areas that we looked at.

The provider, had after the last inspection, ensured that support had been made available to assist the home in meeting safe standards of care through improved quality monitoring and input from senior managers within t

This unannounced inspection took place on 4, 12 & 26 February 2016. We last inspected Lanercost House - Carlyle Suite on 07 January 2014. At that inspection we found the service met all the regulations that we reviewed.

Lanercost House - Carlyle Suite is a nursing home for up to 15 older people. The service provides care and support for people living with dementia. The home is purpose built and has 15 single rooms with full en-suite shower facilities, which are accessible for people using a wheelchair. On the ground floor are therapy rooms including a kitchen and a sensory room. There are secure garden and patio areas, which are accessible from many of the bedrooms and from the communal areas.

The service did not have a registered manager in post at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. Since the inspection a manager has been appointed. A nurse with experience of the Carlyle Suite has been put in place as the interim Head of Carlyle unit until a permanent appointment can be made.

At the inspection there were 15 people living in the home. Some people’s ability to communicate was limited due to their illness. Those we did speak with told us that they felt safe living there, that staff were “kind” and treated them well. The majority of relatives we spoke with told us that they were happy with the care and support provided. However a number of relatives told us they were concerned that staff had been under pressure recently and that it was difficult to know who was in charge.

We found a number of breaches related to the safe care and treatment of people, medicines management, staff support and supervision, infection control and in providing effective leadership. We were particularly concerned about the risk posed to people from choking. We took urgent action to ensure that the home put measures in place so that people were protected, as far as possible, from being exposed to avoidable harm or risk to harm.

We found that people’s safety was being compromised in a number of areas. This included: how care plans and risk assessments were written and updated; how medicines were administered and recorded; making sure that high risk areas such as bathrooms and kitchen areas were locked; and having staff on duty who were up to date and knowledgeable of people’s current needs.

We found that some areas of the home’s environment required attention. We found chairs and carpets that were not clean. The home was malodorous. The areas we highlighted on the first day of our inspection were attended to quickly. On the second day of our inspection the provider had the home deep cleaned by professional cleaners. The bedrooms we identified as needing attention had been repainted and new carpets were ordered and had been delivered.

We found that there were not always sufficient staff on duty to meet people’s needs; to supervise people and spend time on a one to one basis with socialising and offering meaningful activities. While the home had very good facilities downstairs, including a sensory room, craft room and an adapted kitchen, the use of these were dependent on staff availability. Over the three days we visited we did not see anyone using these facilities or being taken out of the home by staff. We also found that there was little in the way of equipment or adapted environment for people living with dementia to be engaged with on the top floor, where people spent most of their time.

We saw that staff were attending to the basic care needs of people. However, staff did not always keep up with the other tasks that were assigned to them, such as updating people’s notes and domestic duties of keeping the kitchen clean

We found that the Lanercost House - Carlyle Suite was a safe, secure and pleasant environment for people with dementia to live and spend time in.

People were being well supported and encouraged by staff to maintain skills and to be involved in their care, wherever possible. Staff were observed treating people with respect and in a sensitive and considerate manner. A noticeable feature was a sense of humour and affection shared between staff and people in the home.

The relatives we spoke with were satisfied with the care and one told us, “We have been amazed how well he has settled since coming out of hospital. The staff are really good with him. He looks so much better, happier and his health has improved.”

We found the home to be appropriately staffed to meet the range of complex needs of people living in the home. The staff team were experienced and well trained with specialist skills in caring for people with dementia. The organisation had a physiotherapist and an assistant to ensure that people were encouraged to be as mobile and independent as possible.

The home had developed a good working relationship with the local healthcare teams in order to ensure people had access to expert healthcare advice.

We found that the Lanercost House - Carlyle Suite was a safe, secure and pleasant environment for people with dementia to live and spend time in.

People were being well supported and encouraged by staff to maintain skills and to be involved in their care. Staff were observed treating people with respect and in a sensitive and considerate manner. We observed warm and caring interactions between people using the service and staff. One person told us, “The staff are ‘brill’, they always have time for a chat and I’m often out for a bar meal with them.” Relatives we spoke with were also complimentary on the care and treatment their relatives received. One relative told us, “It’s been very reassuring since my wife came here. I’m made to feel welcome at anytime and always kept informed and included in their care.”

We found the home to be appropriately staffed to meet the range of complex needs of people living in the home. The staff team were experienced and well trained with specialist skills in caring for people with dementia. The organisation had a physiotherapist and an assistant to ensure that people were encouraged to be as mobile and independent as possible.

The home had a good working relationship with the local healthcare teams in order to ensure people had access to expert healthcare advice. The organisation had a well established quality monitoring system in place to ensure the quality of the service provided.