We carried out an unannounced comprehensive inspection of Primrose House Care Home on 8, 10 and 11 May 2018. Primrose House is a 'care home' located in Gateshead. 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. The home can accommodate 63 people in one adapted building and on the date of this inspection there were 55 people living at the home.

During this inspection we found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations: Safe care and treatment, regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations: Good governance, regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notification of other incidents and regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. This was because the provider had not adequately assessed the risks to the health and safety of people using the service, the management of medicines was not safe, renewal applications for the deprivation of liberty safeguards were not notified to the Commission and the provider did not display the previous rating within the home clearly or on the website. In addition to this provider did not operate robust governance arrangements to monitor and improve the service provision they provided to people. You can see the action that we have asked the provider to take at the back of the full version of this report.

There was a registered manager in post who has been registered with the Care Quality Commission (CQC) to provide regulated activities since November 2015. 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 that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults. Staff were safely recruited and they were provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required but not all staff had attended refresher courses. Staff had received training in end of life care and the service worked closely with partnership agencies to deliver this when required.

Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. We observed that there were enough staff on duty to support people appropriately in line with their assessed needs.

During our inspection we found that the premises were not always safe for people living at the home. We found the main conservatory doors open, sluices unlocked, fire doors stating, “keep locked” were open, the laundry room was open for people to access, clinical waste bins were open and bathroom pull cords were propped out of reach.

Regular checks of the premises, equipment and utilities were carried out and documented. Infection control measures were in place and the service was clean. We saw domestic staff cleaning the home regularly during inspection.

The home did not always provide safe medicine management. During the inspection we observed an unattended and unlocked medicines trolley left in front of the open conservatory door. Procedures were in place to ensure the safe receipt, storage, administration and disposal of medicines. There were records regarding other professionals involved in people's care. People’s medicine care p

This inspection took place on 4, 6 and 11 January 2016. The first day was unannounced.

This was the first inspection of this newly registered service. The service was called St Oswald’s Care Home at the time of this inspection but has since been renamed Primrose House.

Primrose House is a care home for older people, some of whom have a dementia-related condition. It provides nursing care. It has 65 beds and had 43 people living there at the time of this inspection.

The service had 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.

People told us they felt the staff kept them safe and well-protected. People’s relatives confirmed this. No-one expressed any concerns regarding people’s safety. Risks to people were regularly assessed and appropriate measures were put in place to minimise any risks identified. There was a low level of accidents in the home. People were supported to take their medicines safely.

Staff had been trained to recognise and respond quickly to any abuse, neglect or poor practice. Safeguarding issues were reported to the appropriate authorities.

Regular checks were undertaken to ensure the building was safe. Systems and equipment were regularly serviced, and repairs were completed promptly. Plans were in place for dealing with any building or other emergencies.

Staffing levels were sufficient to meet people’s needs safely and appropriately. People told us staff responded quickly when they needed them. Extra staff were provided when people’s needs changed. Systems for recruiting new staff were robust and ensured only people fit to work with vulnerable people were employed. Staff were given the support they needed to perform their roles effectively, by means of regular supervision, training and annual appraisal.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Where it was deemed necessary, written applications had been submitted to the local authority for authorisation to restrict people’s liberty.

Appropriate assessments had been undertaken of people’s capacity to make particular decisions. Where people lacked such capacity, appropriate ‘best interest’ decisions had been taken, with the involvement of the person’s family, and these were clearly recorded. People were asked for their consent before staff members carried out any care tasks or other interventions.

People’s health care needs were closely monitored and were met using the support of a wide range of external health professionals. People’s nutritional needs were assessed and they were supported to enjoy a varied and healthy diet.

People and their relatives told us the staff team was very caring, and treated them with sensitivity and respect at all times. We observed staff were attentive and responsive to people’s needs, and affectionate in their approach. Staff were careful to protect people’s privacy and dignity, and encouraged them to be as independent as they were able.

People were provided with information about their care and about the running of the home, were asked their views and could access advocacy services if needed.

When assessing people’s needs, the views and preferences of the person and their family were sought and were included in the care plan drawn up to meet those needs. Care plans were kept under constant review and were updated as required. Meetings were held with people to discuss their care.

A range of social activities were available to people, and there were plans to increase the range of a