The inspection took place on 2, 3 and 4 May 2017. The first day of the inspection was unannounced and the second and third day was announced. This meant staff did not know we were visiting on the first day.

We last inspected the service in September 2016 to follow up concerns from the previous inspection where improvements were required in the safe domain of the report. At the inspection in September we found that improvements had been made in the areas we found previously but we found further issues that needed to be addressed so the domain remained as requiring improvement. We returned to check all areas were now meeting the regulations fully.

Ponteland Manor provides nursing and residential care for up to 52 older people, some of whom were living with dementia. At the time of this inspection there were 33 people living at the home, including 18 with nursing needs

The service did not have a registered manager. 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 manager who was in the process of registering with the Commission no longer worked for the provider.

People said they received good care from kind, caring and considerate care workers. They also confirmed they felt safe living at the home. Relatives and care workers also told us the home was safe.

Care workers knew how to report safeguarding concerns. We found the provider had dealt with previous safeguarding concerns appropriately.

Where potential risks had been identified, an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely. Only trained nurses and senior care workers administered medicines. People confirmed they received their medicines at the correct time and they were always made available to them.

We found there were sufficient care workers deployed to provide people’s care in a timely manner. However a number of people and relatives felt staffing levels were not appropriate at times. We have made a recommendation to the provider regarding review of staffing numbers.

Effective recruitment checks were in place to help ensure new care workers were suitable to be employed at the service. Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and pre planned for the future.

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 gave positive feedback about the meals they were served at the home, although some attention was required for those people with special dietary needs. People received the support they needed with eating and drinking. Some people had been referred to external healthcare professionals for additional specialist support, for example those at risk of choking. We have made a recommendation with regards to food choices for people with diabetes.

People and their relatives were positive about the kind and caring nature of staff. People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times.

People’s needs were assessed before they came to live at the service and then personalised care plans were developed and regularly reviewed to support staff in caring for people the way they preferred.

A new activity coordinator had just started work at the service in the same week as the inspection and was in the

This unannounced inspection took place on 16 September 2015. We last inspected Ponteland Manor Care Home on 4 and 9 March 2015 when we found the provider was not meeting Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the safe management of medicines.

Following our inspection in March 2015, the provider sent us an action plan to show us how they would address our concerns.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ponteland Manor Care Home on our website at www.cqc.org.uk

Ponteland Manor Care Home provides residential and nursing care for up to 52 people, some of whom are living with dementia. At the time of our inspection there were 41 people living at the service.

The service did not have a registered manager in post. However, the current manager had applied and their application had been accepted and was being processed. 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 2008 and associated Regulations about how the service is run. Following our inspection, the manager submitted an application with the CQC for processing.

The provider had taken action to improve the safe management of medicines and we were satisfied that appropriate measures were now in place to address those concerns.

We found other areas that were in need of improvement and that meant the rating for this section (safe) would remain as requires improvement. Regular checks on the premises and equipment were carried out. Additional fire drills were being undertaken for night staff since it had been identified that these had not been carried out as regularly as planned. An order for new windows had been requested since the manager explained many of the window frames were worn and in need of updating.

Single use equipment for the testing of blood sugar levels was sometimes reused for the same people.

Risk assessments had been completed in relation to providing care to people and also in connection with any risks because of people’s behaviour or habits, for example, one person had a particular way they preferred to carry their belongings which put them at risk of harm and staff had completed a risk assessment to support them and help minimise their risk.

Accidents and incidents were accurately recorded and monitored by the manager and provider for any trends forming and to ensure timely referrals were made if appropriate.

Staff were aware of safeguarding procedures and knew how to report any concerns they may have.

We found the service to be clean and odour free.

People told us they felt there was enough staff to look after them. The manager monitored staffing levels to ensure enough trained staff were available to meet people’s needs. The provider had procedures in place to ensure any staff recruited were suitable to work within the home.

In this report, the name of a registered manager appears who was not managing the regulatory activities at this location at the time of the inspection. Her name appears because she was still a registered manager on our register at the time.

We spoke with eleven people who used the service and three visiting relatives to find out their opinions. Comments from people included, "It's fine here. Everyone is nice" "Everyone is kind" and "It's comfortable here. No problems." Some relatives referred to the regular use of agency nurses and care workers and described some inconsistencies in approach and advice given to them by staff.

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

We saw that people were supported to be able to eat and drink sufficient amounts and they were protected from the risks of inadequate nutrition and dehydration. We found that there were appropriate arrangements in place to manage medicines. People told us they got their medicines when they needed them.

There were enough numbers of qualified, skilled and experienced staff to meet people’s needs, although we noted there was significant staff turnover and low staff morale. Input from agency staff was required most days and nights of the week.

We found that the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We spoke with four people who lived at the home, and the relatives of two people to find out their views on the care provided at the home. People were generally satisfied with the care and support they received. One person said, “I am quite satisfied with the care and support. The staff are kind and helpful. I can make choices about my routines and where I spend my time.“ Another person said “I would prefer to live in my own home, but I know that I can’t manage to live there because I need more support. I find it like living in a hotel here, with the staff there to support me when I need it. If I have any concerns I would feel able to discuss them with the manager or one of the staff.

Two people said the garden needed attention and were concerned that shrubs were blocking light and their view. This was discussed with the manager who agreed to get the handyman to address this.

One relative said “I am very satisfied with the care X receives. X is only here because of the very good nursing care they received. Staff are wonderful, they are kind and caring.” X nodded in agreement with this. This relative was aware of X’s care plan and had been consulted about it. Another relative said they were happy with the care provided, but had some concerns about the deterioration in the person’s mobility since they came to live at Ponteland Manor. They said they were concerned that staff could not insist on Y walking to the dining room because they did not choose to. However staff had explained that they were unable to make people do things against their wishes. We spoke to staff who were aware of this and said they encouraged people to mobilise as much as possible and gave an example of Y being taken part of the way to the dining room in a wheelchair and of giving encouragement to Y to walk the rest of the way.

The unannounced inspection took place on 4 and 9 March 2015. We last inspected Ponteland Manor on 18 August 2014. At that inspection we found the service was not meeting all the regulations that we inspected. We asked the provider to take action to make improvements to the way care was planned and delivered and how staff were supported to deliver care and treatment safely. These actions had been completed.

Ponteland Manor provides residential care for up to 52 people, some of whom are living with dementia. At the time of our inspection there were 43 people living at the home.

The service did not have a registered manager in post. While they were recruiting to the post, an interim manager was in position. The last registered manager left their employment at the end of November 2014. 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 the management of medicines required improvement. For example, people had not always received their medicines as prescribed, unauthorised people had access to the medicines room and people were not appropriately monitored while they took their medicines.

Risk assessments related to people’s care were completed accurately, which meant people were kept safe. Care records were reviewed regularly. Accidents and incidents were recorded and monitored to ensure lessons were learnt.

People were respected and cared for individually. People told us they felt safe. One person said, “Of course I feel safe, I wouldn’t stay here if I didn’t feel safe.”

Staff understood safeguarding procedures and told us about what they would do if an incident of concern happened. We felt satisfied staff would have no hesitation in reporting any safeguarding issues that may arise at the home.

We found the service to be clean, tidy and odour free with maintenance kept to a good standard.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and DoLS. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. Applications to the local authority had been made where a DoLS was required.

People told us they felt there was enough staff to look after them. The manager monitored staffing levels to ensure enough trained staff were available to meet people’s needs. The manager had procedures in place to ensure any staff recruited were suitable to work within the home. There was a training programme in place and staff development was monitored by the manager to ensure they had up to date knowledge and any training needs were met.

People were offered a selection of food types and told us they enjoyed what was offered. People told us they had a choice and we saw evidence of that on the day we inspected. One person told us, “I am more than happy with the meals prepared.”

We saw people being offered support if it was required and care staff did this in a way which retained the dignity of the people they were caring for. Care staff were seen to be kind and considerate. They also respected the views of the people they cared for. One person told us, “It’s lovely living here, so pleasant and staff are most caring.” A relative told us, “They [staff] are absolutely fabulous, they have taken the worry away for me.” We found a positive attitude to caring from all the staff we had contact with during our inspection.

People told us they had choice. We saw people choosing what meals and drinks they would like. One person said, “I like to get up late, I should be able to at my age.”

People were able to participate in activities. The manager told us a new activity coordinator had just been employed and was devising a new programme of activities and events for people to participate in.

People and their relatives knew how to complain. They told us they were able to meet with the manager and staff at any time and were able to give feedback about the home. People and relatives thought staff listened to them and helped them bring about positive change.

The provider had systems in place to monitor the quality of the service provided. When issues or shortfalls were identified, we saw actions had been taken.

There was information on display around the service, including information on dementia, advocacy, and other general information.

We found one breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 12 (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach is in connection with medicines. You can see what action we told the provider to take at the back of the full version of this report.