The Gardens is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during the inspection.

The Gardens accommodates up to 60 older people in one building. People are accommodated over one ground floor. The service provides residential care. On the day of our inspection there were 52 people using the service.

The inspection took place on 12 April 2018 and was unannounced. This meant staff did not know we were visiting.

We last inspected The Gardens in February 2016 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

The service had a registered manager who was on duty during the course of our visit. They had worked at the service for many years. 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 and the management team understood their responsibilities with regards to safeguarding and staff had been trained in safeguarding adults. People we spoke with and their relatives told us they felt safe at the home. We saw the registered manager had shared learning within the staff team from safeguarding occurrences that occurred at the service.

People’s needs were assessed before they came to live at the service. We saw care plans were in the process of being changed to a new more personalised format. Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Health and safety checks were completed and procedures were in place to deal with emergency situations.

The home was clean, and we saw staff followed good practice in relation to wearing personal protective equipment when providing people with care and support. The environment was homely, clean and accessible.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way. People confirmed they received their medicines at the correct time and they were always made available to them.

We found there were sufficient care staff deployed to provide people’s support in a timely manner. We saw that recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people. People told us their needs were attended to promptly.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date.

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. Some records were lacking regarding best interest decisions but these were immediately updated by the registered manager following our visit.

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking by the kitchen team who were trained in the support of people with nutritional needs.

We saw people’s healthcare needs were well monitored and records in relation to the monitoring of people’s health, nutrition and pressure care were recorded.

People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times.

An activities coordinator provided a range of activities within the home and support for people to access the community.

People and staff were very positive about the management of the home. Many staff had worked at the service for a number of years and this added to the feeling of a caring, well-run home.

The provider had an effective complaints procedure in place. People w

The inspection took place on 11 and 12 February 2016. The inspection was unannounced.

The Gardens is a residential care home based in Darlington, County Durham. The home provides personal care to older people and people with dementia. It is situated close to local amenities and transport links. On the day of our inspection there were 53 people using the service.

The home 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.

We spoke with a range of different team members; care staff, senior care staff, kitchen staff and housekeeping staff who told us they felt well supported and that the registered manager was caring, supportive and approachable. Throughout the day we saw that people who used the service and staff were comfortable, relaxed and had a positive rapport with the registered manager and with each other. The atmosphere was welcoming, homely and relaxed. We saw that staff interacted with each other and the people who used the service in a friendly, supportive, positive and respectful manner.

From looking at people’s detailed care plans we saw they were written in plain English and in a person centred way and they also included a ‘one page profile’ that made good use of pictures, personal history and described individuals care, treatment and support needs. These were regularly reviewed and updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, continence advisor or chiropodist.

Our observations during the inspection showed us that people who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

When we looked at the staff training records they showed us staff were supported and able to maintain and develop their skills through training. The staff we spoke with confirmed they attended a range of learning opportunities. They told us they had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. We also viewed records that showed us there were robust recruitment processes in place.

We observed how the service administered medicines and how they did this safely. We looked at how records were kept and spoke with the senior staff that was trained to administer medication and we found that the medication administering process was safe.

During the inspection we witnessed the staff rapport with the people who used the service and the positive interactions that took place. The staff were caring, positive, encouraging and attentive when communicating and supporting people.

People were actively encouraged to participate in activities that were well thought out, organised, and included outings, baking and regular entertainers. We saw staff spending their time positively engaging with people as a group and on a one to one basis in activities. We saw evidence that people were supported to go out and be active in their local community.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a varied selection of drinks and snacks. The daily menu that we saw offered choices and it was not an issue if people wanted something different.

We saw a complaints and compliments procedure was in place. This provided inform

The Gardens is a care home for older people. The home has accommodation for 58 people, most with an ensuite facility. The home accommodates people living with a dementia and people requiring personal care.

Our inspection team was made up of one inspector and this helped answer our five questions; 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 were treated with respect and dignity by the staff. People told us they felt safe. One person told us they sometimes had to wait some time when they rang for assistance, but that they were happy with the staff who worked at the home and felt the care provided was good. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and appropriate applications had been submitted and records held accordingly. We discussed the implication of a recent court judgement in relation to Deprivation of Liberty Safeguards and the manager had sought advice from the local authority into its relevance for The Gardens residents.

Is the service effective? - People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring? - People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented that the staff; “Were all lovely” and “You get very well looked after here”. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes including end of life care. One staff member who had worked at the service for nine months and was new to the care sector told us; “This is a vocation, it’s not a job where you can just clock in and clock out, if someone needs you, you stay with them”.

Is the service responsive? –The service also regularly sought views of people using the service and visitors via questionnaires and meetings. The home had a complaints policy and procedure that was accessible and people and visitors to the home told us they could raise any issue with the managers or staff. We saw that the quality assurance officer carried out a range of audits right across the service and developed action plans for any issues that were found.

Is the service well-led? - The manager and deputy manager had clear roles along with senior care staff. Together they met regularly to plan how the service should be managed. The service has a quality assurance system and a dedicated quality assurance and training officer; records we saw showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times. The service had increased the level of senior care staff to two per shift and feedback to this was very positive and it helped manage the home more effectively.

We spoke with eight people who used the service, two relatives and three members of staff as well as the manager and deputy manager and one senior carer.

One visitor to the home told us; “The calibre of staff here is excellent, they are gentle, pleasant and courteous all the time”. One person living at the home told us they had been sitting outside with the warmer weather over the last couple of days which they had enjoyed. Another person told us; “You get very well looked after here, every single staff are alright, any problems are sorted out as soon as you tell the staff”. We saw there was an activities coordinator and a new activities assistant. One person told us; “They bend over backwards to put on something that everybody likes and they are always coming up with new ideas”.

We spoke with two members of staff who were relatively new to the service. One told us “I gave them some feedback about having a consistent mentor when you are doing your induction as I felt this would have helped me more but I love learning and am enjoying all the training”. The other new starter told us; “There has been lots of training and I’m booked on lots more to come, I’m able to ask anybody if I have any problems”.

Three people who we spoke with were satisfied with the support they received with their medicines. People told us:

“The girls look after them [the tablets] fine”.

“I get them [the tablets] on time”.

“The girls always stay with me while I take them [the tablets]”.

“I just take what I am given, I don’t always know what they are for”.

“I get tablets everyday and there is one I take once a week before breakfast. I get it every week”.

“I count how many tablets I get and it is always right.

“I get all my tablets regularly including all my vitamins”.

Overall, we found that medicines were managed in a safe way.

Two people who we spoke to were happy with the support they received with their medication. People told us “I get my painkillers if I need them”, “if I am going out and don’t want my tablets I tell them and it is OK” and “they cater for my needs”.

Overall, we found that medicines were not consistently managed in a safe way.

We arrived at the home at 06.00am and was greeted by a senior member of care staff who explained there were seven staff on duty for the 47 people who lived at the home. There had been five staff on overnight and two further staff started their shift at 6am to help support people with getting up.

We saw the home had a comprehensive quality assurance process which was managed by a full-time officer. There were regular checks and audits in place as well as consultations with people living at the home to ask if they were happy with the service.

Care records were up to date and showed people had been involved in their development.

People told us; "Every whim is catered for" and "The staff are good and friendly".

We spoke with both the senior carer responsible for medication and the registered manager during our visit.

We spoke with eight people. They told us:

“I like to stay in my room”,

“I have no complaints about the people”,

“I have a lady who comes every week and does my speech therapy”,

“ I like to join in the quizzes”,

“I’ll be here till I’m carried out in a box”,

“The staff have been wonderful”,

“They do everything they can for you”,

“Its supposed to be your own home but you can’t always do as you like”,

“You get a menu to look at before mealtimes”.

“I can talk to the manager if I want to, she is very easy to talk to”,

“I’m here on re-enablement. I’ve put on weight since I’ve been here. The staff look after the older people very well, they give them lots of reassurance and love which is nice”, and

“We go out in the minibus every week, usually for a pub lunch”.

This inspection took place on 17 and 19 March 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting. The Gardens Care Home was last inspected by CQC on 20 May 2014 and was compliant.

The home had a registered manager in place. 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.

The Gardens Care Home is a care home for older people. The home has accommodation for 58 people, 52 with en-suite facilities. The home is in a quiet residential area of Darlington. On the day of our inspection there were 43 people using the service.

There were insufficient numbers of staff on duty in order to meet the needs of people using the service.

The provider had a recruitment and selection procedure in place but did not always carry out relevant checks when they employed staff.

Training records were up to date however staff did not always show they understood what care people needed to keep them safe and comfortable.

Staff received regular supervisions and appraisals.

People who used the service and their relatives had conflicting views about the standard of care at The Gardens Care Home.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and was suitably designed for people with dementia type conditions.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) is part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the manager and looked at records. We saw there were DoLS in place and in the process of being applied for. We found the provider was following the requirements of DoLS.

People were protected against the risks associated with the unsafe use and management of medicines.

We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible.

People had access to food and drink throughout the day and we saw staff supporting people in the dining room at lunch time when required.

The home had a programme of activities in place for people who used the service.

Care records were not always person-centred and reflective of people’s needs.

We saw staff completed a range of assessment tools but they were not always up to date.

We saw people who used the service had access to healthcare services and received ongoing healthcare support. Care records contained evidence of visits from external specialists.

People using the service, their relatives, visitors and stakeholders were asked about the quality of the service provided.