Peregrine House 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.

Peregrine House is situation in Whitby. The home accommodates up to 40 older people or people living with dementia in one adapted building. They do not provide nursing care.

Inspection site visits took place on 24 and 25 July and 8 August 2018. At the time of this inspection, the service was providing support to 39 people.

At the last comprehensive inspection in October 2015 we found the service was meeting requirements and awarded a rating of outstanding. At this inspection we found the registered manager and staff team had continued to develop the service but some areas required improvements to be made. We have awarded a rating of requires improvement.

There was a manager in post who had registered with the Care Quality Commission. They assisted throughout the inspection process. 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 some quality assurance systems were in place but these had not always been effective in identifying shortfalls in relation to medicine management and care planning. We also found shortfalls in relation to the recordings on re-positioning charts, weight management and call bell checks. We found no evidence that these areas were monitored by management to highlight where improvements were required.

The principles of the Mental Capacity Act 2005 had not always been followed. Best interest decisions had not been recorded and consent forms had been signed by relatives that did not have legal authority to do so.

Risk assessments were in place but they did not always identify current risks and how these should be managed.

Medicine had been stored safely. We found that staff had not always accurately recorded when medicines had been administered, offered or refused.

Safe recruitment procedures had been followed. These procedures had been further developed to ensure people were fully included in recruitment decision. Staff had a thorough understanding of safeguarding and how to report any concerns. Servicing certificates were in place where required and regular maintenance checks were in carried out to ensure the service was safe. We did find that call bells and bed safety rails were not always included in these checks.

There was enough staff on duty to ensure people received the support they required. The registered manager and provider had a flexible approach to staffing to ensure people’s needs were met at all times.

A through induction process was in place to ensure new staff were familiar and followed the services core values. Staff were supported through a regular system of supervision and appraisal which focused on performance and personal development. Training had been delivered at regular intervals to ensure all staff had the appropriate skills and knowledge.

Staff were familiar with people who required specialist diets. We found people had not always been weighed in accordance with the directions within their care plans. Professionals we spoke with were confident staff would raise any concerns with them. The service had excellent relationships with health professionals who visited the service on a regular basis.

People and relatives spoke positively about the meals on offer and we observed the dining experience to be calm, relaxed and enjoyable. Food was presented beautifully and people were able to eat where they preferred.

Respect for privacy and dignity was at the heart of the service’s culture and values. Life history book had

This inspection took place on 14 October 2015 and was unannounced. There were no breaches of the regulations in force at the time of the last inspection on 11 September 2013.

Peregrine House is registered to provide personal care and accommodation for up to 37 older people. There is a passenger lift to assist people to the upper floor and the home is set in pleasant grounds. The home has a light and airy extension for people to enjoy. The outdoor spaces are made attractive with lawns, raised beds, a summer house and courtyards visible from within the home. These add interest and provide a pleasant aspect.

The home had 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.

People told us they felt physically and emotionally secure at the home. The home had a safeguarding champion who ensured that risks to people were well managed. People were supported to live a full and stimulating life, to do what they chose and staff had safeguards in place to allow outings and activities to go ahead. For example, they made sure that people were accompanied by sufficient staff. Risk assessments were kept under close review and the staff approach was very flexible to allow for changes in circumstances.

Staff were trained in safeguarding adults and understood how to recognise and report any abuse. They had regular updates, received talks from the safeguarding champion and held discussions between training sessions so that they could apply their learning to individual people’s care needs.

Staffing ratios were excellent and responsive to people’s changing needs and preferences. This allowed for people to make full use of all of the facilities the home had to offer, to go out on trips, both as a group and individually, and to experience well-paced and attentive care.

The home had a medicine champion who ensured that people received the right medicines at the right time and that these were handled safely. The medicine champion regularly reviewed and audited medicines to ensure they met people’s current needs and the home was proactive in involving heath care professionals whenever they felt that changes may be required.

People told us that staff understood their individual care needs extremely well. People were supported by staff who were well trained. All staff received what one member of staff referred to as a “fantastic” induction, which introduced them to what excellent care meant for each individual person who lived at the home. Staff received mandatory training in addition to specific training for people’s individual needs. The home had a health and wellbeing champion who ensured that people’s changing needs and preferences were clearly understood and that training was well researched and sourced when this was not readily available. The home had strong links with specialists and professional advisors who gave staff high praise for their dedication and care. Staff consistently expressed an enthusiastic commitment to providing excellent care. The home was proactive in seeking professional advice and acting on this.

People’s nutritional needs were met, closely monitored and they received the health care support they required. People were regularly consulted about their food and drink choices and were supported to express their preferences for meals and snacks. The cook made sure these preferences appeared on the menu. When people needed specialist diets these were well prepared and presented. Meals were seen as a special event, the tables were set attractively and people sat in social groups they felt comfortable in. Special meals, themed meals and celebration meals featured regularly on the menu. People also had frequent opportunities to eat out in local cafes and restaurants to vary their dining experience.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care.

Staff had developed positive, respectful relationships with people and were extremely kind and caring in their approach. People’s privacy and dignity were respected. People were supported and empowered to be as independent as possible in all aspects of their lives. Staff anticipated people’s care needs and attended to people quickly, politely and with warmth.

People had informed staff about the areas of their care they considered most important and care plans reflected their particular wishes, though the details in written plans did not always reflect the high level of responsive service people actually received. People told us that staff concentrated on what was most important to them and made sure that they received the care they needed and preferred.

People were supported to take part in activities and daily occupations which they found both meaningful and fulfilling. People told us that they appreciated how staff had thought of ways to make sure they could continue with daily routines they enjoyed. Staff had also been responsible for encouraging and supporting people with new interests which they enjoyed. The home made a particular effort to make sure that those people whose voices were not always easily heard were consulted and that their views were acted on.

People were very well cared for in their final days. Many families and friends had made comments about the outstanding compassionate care and support they and their relatives had received at this difficult time.

People were encouraged to complain or raise concerns, the home supported them to do this and concerns were resolved quickly. The home used lessons learned to improve the quality of care.

People were placed at the heart of the service by strong, caring leadership which promoted an open culture. Since the last inspection the registered manager had achieved the National Care Manager of the Year award at the Great British Care Awards. They had impressed the judges with their dedicated work to improve people’s lives in their care. The home was also recognised by other schemes which reward quality practice, for example, achieving Investors in People Gold Award, and the Excellence in Care Standards award (EICS). The management team respected, supported and listened to staff at all levels to improve the quality of service. There were a number of champions within the staff team who each took enthusiastic responsibility to improve the quality of service in their chosen area. The service acted on staff and people’s views and regularly consulted with them about how to improve. Communication at all levels was clear and encouraged mutual respect. The manager had a strong quality assurance system in place. They understood the home’s strengths, where improvements were needed and had plans in place to achieve these with timescales in place.

We spoke with four people who lived at the service, five members of staff, one visitor and one visiting mental health professional.

One person told us “I love it here. The staff go out of their way to talk and make everyone happy.”

A visitor told us “I can’t fault them. They are always looking for ways to make things better”

We found that people were involved in their care, they contributed to decisions about their lives and were enabled to have a voice. We saw that people’s care needs were assessed and that care was planned and delivered according to people’s needs, including needs related to dementia. We found that people had agreed to the care plans and where this was not possible the home had sought an advocate to agree on their behalf. We saw that specialist health services were consulted when necessary and that risks to well- being were assessed and minimised.

We found the home supported people when they moved to or from hospital or other care facilities.

The building was suitable for purpose, safe and was a pleasant environment for people to live in. People were pleased with how the recent work to extend the property had turned out. One person told us “I love the new lounge and all the space. It’s really good to be here.”

People were protected by well recruited staff and the service had an effective quality assurance system. This meant it could identify any shortfalls and put improvements in place for the benefit of people living at the home.

We spoke with three people who lived at the service and two visitors. Everyone we spoke with told us that the staff were knowledgeable and kind. They trusted the staff to give them the correct care and told us that their preferences, complaints and concerns were listened to and acted upon.

People said they were consulted about their care, treatment and support options. They told us their views were sought and acted upon about every aspect of how the home was operated so they felt they were central to all the decisions being made. One person said ‘I have signed to say I agreed to the care and support that I receive’. Another person said ‘The proprietor and manager ask for my views regularly. They look after me well’.

The people we spoke to said that they received the help and support they needed when they wanted it. One person said ‘The staff are marvellous. The care staff really do look after me. If I need help, they say that is alright it is no trouble at all’. Another person said ‘The staff are very good. The staff know what I need a hand with. I can do what I want to maintain my independence’.

People we spoke to said they knew how to raise issues if they had any concerns. One person said ‘I would feel happy to raise any issue. I feel safe here’. Another person told us ‘The staff are gentle and kind. I know if I had any concerns they would be dealt with straight away’.

People said that there was enough staff available to help them. One person said ‘The staff have the skills they need to be able to look after me’. Another person said ‘I am very happy with how things are. The staff take good care of me’.

People told us that they could speak to the manager, deputy manager or proprietors. They said their views were actively sought about all aspects of how the home was run. One person said ‘The proprietor’s talk to me. They work hard to see that everything is just right. I cannot find fault with this service at all. I really appreciate living here’. Another person said ‘The quality of the service is very good, nothing is too much trouble’.