The inspection took place on 12 and 13 April 2018 and was unannounced.

New Tyne is a residential care home registered to provide accommodation and care for up to 20 people who have a diagnosis of dementia or who are being assessed for this condition. At the time of our inspection, 19 people were living at the home. Fifteen rooms are allocated on a permanent basis, with five rooms reserved for people on short breaks or on respite care. Communal areas include a large sitting room with adjacent dining area and access to enclosed gardens. Accommodation is on one floor and bedrooms have en-suite facilities. New Tyne is a ‘care home’. People in care homes received accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and care provided and both were looked at during this inspection.

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, the service was rated Requires Improvement under Effective and a requirement was made in relation to a breach of Regulation 11, need for consent. Staff did not have a thorough understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. At this inspection, we found that steps had been taken to address the issue. Overall the rating has improved to Good.

Staff did not receive regular supervision with their line managers in line with the provider's policy, however, this lack of supervision did not impact on the care people received. The registered manager was already aware of the issue and was striving to complete all outstanding supervisions with staff at the time of the inspection. Following the inspection, the registered manager sent us an action plan which stated that all staff would have a supervision by the end of May 2018. Supervision dates for each staff member would be planned at eight weekly intervals for the year ahead. However, systems were not effective in ensuring that staff received supervisions as needed. We have made a recommendation in relation to this.

Staff completed a range of training relevant to their work and were encouraged to become ‘Dementia Friends’, to make a positive difference to people living with dementia. New Tyne provided a ‘dementia friendly’ environment for people and thought had been given to exploring ways of working with others to promote understanding of this condition. People were supported to have sufficient to eat and drink and had access to a range of healthcare professionals and services. When people were referred to the home, meetings took place between professionals and staff to ensure people’s needs could be met and the appropriate support provided. The home and gardens were accessible for people with safe space to explore outside. 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 support this practice.

People felt safe living at the home. Staff knew what action to take if they suspected abuse was taking place and had been trained appropriately. Risks to people were identified, assessed and managed safely; care records provided staff with information about people’s risks. Staffing levels were sufficient to meet people’s needs. Recruitment systems were robust. Medicines were managed safely and staff were trained in the administration of medicines. The home was clean and smelled fresh. Infection control audits were completed. When things went wrong, staff learned from these incidents.

People were looked after by kind and caring staff who knew them well. People and the

The inspection took place on 22 March 2016 and was unannounced.

New Tyne is a home that provides care and accommodation for up to 20 people who have a diagnosis of dementia; some have additional health or sensory needs. Referrals for people to be admitted to the home come through social care professionals from the local authority. Accommodation is provided for 15 permanent residents and five rooms are dedicated to provide care to people on short-term breaks or respite. At the time of our inspection, 19 people were living at the home. New Tyne is situated in a residential area on the outskirts of Worthing. People have their own rooms with en-suite facilities. Communal areas comprise a large reception and seating area, dining room and sitting room. In addition, there is a sun lounge and separate small lounge. A day centre is located next door to the home and some people spend time there.

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.

Staff had not received training on the Mental Capacity Act 2005 and associated legislation on Deprivation of Liberty Safeguards. Staff did not always gain people’s consent in line with the requirements of this legislation because of their lack of understanding about consent, people’s right to take risks and the necessity to act in people’s best interests who lack capacity. However, the registered manager was aware of their responsibilities and acted in accordance with the legislation.

Staff were trained in a range of areas including safeguarding adults at risk, infection control, health and safety, moving and handling and dementia awareness. New staff followed the Care Certificate, a universally recognised care qualification and safe recruitment practices were in place. Staff received supervision meetings, although some staff had not received supervision every six weeks in line with the provider’s policy. Staff meetings were organised, but attendance was not consistently high, although staff could read the minutes of the meetings afterwards. Staffing levels were adequate to keep people safe and meet their needs.

People were supported to have sufficient to eat and drink and people at risk of malnourishment had plans in place to manage their food and fluid intake. People had access to a range of healthcare professionals and services. The home was adapted to meet the needs of people living with dementia. Medicines were managed safely and administered by trained staff. People were looked after by kind and caring staff who understood their likes and dislikes and treated people with respect. People were encouraged to express their views and to be involved in planning their care, as were their relatives.

People were protected from the risk of abuse and harm by staff who had been trained in this area and knew what action to take. Risks to people had been identified and assessed and support was in place to mitigate risk. Premises and equipment were managed safely and checks undertaken. Care plans provided comprehensive, detailed information about people and their care needs. Staff had information on how to care for people in a person-centred way. A range of activities was on offer at the home and, where possible, outings organised into the community.

Complaints were managed appropriately in line with the provider’s policy. People and their relatives were asked for their feedback about the home through questionnaires; staff were also asked for their views. Overall, people were happy with the quality of care delivered and with the management and leadership of the home. Relatives’ meetings were organised every month which provided a forum for carers to meet

At the time of our visit there were 20 people living at this location; it is registered for 20. The manager told us that 14 people were permanent residents, five people were on respite or short breaks and one person had been admitted for assessment purposes. We spoke with three people using the service, one relative and with five staff.

There is a day centre linked to the care home, but this is not regulated by CQC. We were told that some people who used the service were also able to access activities in the centre and were supported to do this. We did not visit the day centre.

Our inspection was undertaken by one inspector. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People had risk assessments in place and these were reviewed regularly. We saw that risks were rated from a ‘4’ which meant a serious or imminent risk, down to ‘0’ which indicated no apparent risk. This meant that staff had a clear idea of people’s risks and could support them accordingly.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications have needed to be submitted. However, the manager told us that they would be re-assessing and reviewing all people who used the service in the near future. This meant that people would be safeguarded as required. Relevant staff had been trained to understand when an application should be made and how to submit one.

Medicines were kept safely and securely. We saw that appropriate arrangements were in place in relation to the recording of medicine. We looked at the medication administration record (MAR) charts for people and these had been completed appropriately. Senior care staff had received training in medication and we saw that this had been updated in January 2014.

Is the service effective?

People who used the service had varying needs and levels of capacity. One person confirmed that they could always make their own decisions and said, “Yes, I can make my mind up”. Staff we spoke with confirmed that they would always ask people’s permission before carrying out their care needs.

Care records we looked at had been reviewed and updated on a monthly basis. Any changes that had been identified were documented in the care plan. Routine updates to the plans meant that people’s most up to date needs were met.

Care staff described the training they had received in areas such as safeguarding adults at risk, manual handling and dementia awareness. We saw details of mandatory training that had been completed by care staff and that there were also opportunities for care staff to study for additional qualifications. This meant that staff were appropriately qualified to deliver care to an appropriate standard.

Is the service caring?

On the day of our visit, we observed some people were supported to eat their lunch by care staff. One person was unable to put food on their fork and the care staff gently pushed a mouth sized portion of food onto their fork. The person was then able to lift the fork and feed themselves; this action encouraged them to maintain their independence. One person told us that, “People are wonderful – kindness itself”.

One person told us that they enjoyed laying the table and clearing away plates and that staff encouraged them to do this. They said, “Lovely. Home from home”. We observed that care staff interacted with people in a warm and sensitive manner. For example, one person could not decide whether they had finished their lunch or not. We saw their plate of food was left for them a little longer, rather than being cleared away.

Is the service responsive?

We looked at records that related to accidents and incidents or ‘near misses’. One record described how a person had tried to climb out of a window and that they were more anxious in the afternoon. We saw that the risk assessment had been updated following this incident. This meant that learning had occurred and that appropriate preventative measures had been put in place to reduce the risk of reoccurrence.

A dessert on offer at lunchtime did not appear to be liked by many people who were in the dining area. We saw that staff offered one person the choice of additional sugar to make the food more palatable. Other people were offered another choice of dessert, rather than having to go without.

Is the service well led?

The provider had made arrangements for people to have access to a member of staff who was trained in a listening capacity. People could meet with them on a 1:1 basis and talk about any issues or matters of concern. This worked well as people had the time and space to vocalise their thoughts.

There were also opportunities for carers and relatives to meet up on a regular basis and speakers were brought in to present on a variety of topics.

Staff told us, “[It’s} quite easy going here. If you had a concern or issue, they’re open to discussions. They listen to what you have to say”.

People told us they liked living at the home and they were well treated by the staff. We saw positive interactions between the staff and the people who used the service. One person said, "There's some lovely staff." Another person said, "I'm happy enough here."

One person visiting the service told us "I'm very pleased with how my relative has settled in" and "I now get to share quality time".

Another person told us "I wouldn't stay anywhere else, it's lovely here".

We viewed records relating to staff requirements and found that the provider was operating effective recruitment procedures.

We found the lack of consistent recording systems meant that there was a risk that information may not be kept up to date and people may not be protected against the risks of unsafe or inappropriate care and treatment.

We found the provider did not have the appropriate arrangements in place to manage the administration of medicines.

During our visit we saw that people were being treated with dignity and respect and people’s independence was encouraged. People were spoken to in a respectful way. People we spoke to told us that the staff were very understanding, they always had time to listen, were approachable and helpful, and that their privacy was respected whilst they were supported to maintain their independence. One person told us “I feel very lucky here - i would recommend it to anyone.”

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas watching television and interacting with each other in the dining room. During our inspection we observed people spending time in the dining room having their nails done and participating in activities including arts and crafts and singing. We observed staff spending the majority of their time with people who used the service. They frequently checked on them to ensure they were alright when spending time on their own.

We spoke with people living in the home. We were told that people are very happy with the care in the home, that the care workers are kind and polite and that they are happy with the food. One person told us “It is very nice here" and another told us “ All meals are lovely” A further person told us “The food is very good and there are trips out all the time”

We spoke to professionals and were told that the home is organised. One mental health team told us “we have a good relationship with the home and they are very good at delivering the care we request for people”