Thornley Leazes Care operates both a care home and domiciliary care service under their registration with the Care Quality Commission. The care home provides accommodation and personal care and support for up to 12 people, primarily with learning disabilities. Some people supported by the provider in both the care home and the domiciliary care settings, were living with dementia. In addition, some people supported with domiciliary care had physical disabilities. There were 12 people living at the care home at the time of our inspection, and a further five people in receipt of domiciliary personal care, in the local Allendale and Catton community areas.

This inspection took place on 10 and 11 November 2016 and it was unannounced. The last inspection we carried out at this service was in January 2015 when the provider was not meeting all of the regulations that we inspected which included the need for consent, safe care and treatment and good governance. The provider submitted action plans linked to each of these breached regulations, stating how and by when they would meet the requirements of these regulations. At this inspection we found improvements had been made in all three of the regulations that had been breached at our last visit.

Thornley Leazes Care does not require a registered manager to be in post under their registration with the Commission, as the registered provider is an individual in day to day charge of the service and the carrying on of the regulated activity. A registered manager is a person who has registered with the Care Quality Commission to manage the service. In this service, the provider is a ‘registered person’ who is actively involved in the service who has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Concerns identified at our last visit to this service in January 2015 related to the management of medicines and people's finances had been addressed and we were satisfied that measures had been put in place to support people to remain safe. Medicines were now managed safely and some small areas for further improvement were discussed with the assistant manager and registered provider.

Staff were aware of their personal responsibility to report matters of a safeguarding nature and they were knowledgeable about the different types of abuse. People told us they felt safe living at Thornley Leazes Care residential home or in receipt of care from the service on a domiciliary basis, and we found no evidence during our inspection that contradicted this.

Risks within the environment of the care home setting and in people's own homes had been assessed and measures put in place to mitigate these risks. Equipment used in care delivery had been appropriately serviced and checked to make sure that it remained safe for use. A business continuity plan had been drafted for staff to refer to in an emergency, for example if there was a loss of power to the building. Health and safety checks around the building were carried out regularly, including fire safety checks.

Staffing levels within the service were appropriate to meet people's needs and were adjusted depending on people's activities and their desire to access the community. Staff files revealed that recruitment processes were thorough and that staff were trained in areas relevant to the needs of the people they supported. They received appropriate supervision and appraisal and told us they felt supported to fulfil their roles by the registered provider, and the assistant and home care managers.

People received an effective service from staff who were knowledgeable about their needs, likes and dislikes. They enjoyed good relationships with each other. Staff provided person-centred care and understood people's behaviours and personality traits. People told us they were supported to live their lives in the way that they wanted to and that their general

Thornley Leazes Care operates both a care home and domiciliary care service under their registration with the Care Quality Commission. The care home provides accommodation and personal care and support for up to 12 people, primarily with learning disabilities. Some people supported by the provider in both the care home and the domiciliary care side of the business, are living with dementia. In addition, some people supported with domiciliary care have physical disabilities. There were 12 people living at the care home at the time of our inspection, and a further 12 people in receipt of domiciliary care in the community in and around the Allendale area.

This inspection took place on 15, 16 and 19 January 2015 and it was unannounced. The last inspection we carried out at this service was in May 2014 when the provider was not meeting all of the regulations that we inspected which included cleanliness and infection control, the safety and suitability of premises and records. The provider submitted action plans linked to each of the regulations they were in breach of, stating how and by when they would meet the requirements of these regulations. At this inspection we found that improvements had been made in all three of the regulations that had been breached at our last visit.

Thornley Leazes Care does not require a registered manager to be in post under their registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. In this service, the provider is a ‘registered person’ who is actively involved in the service who has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Therefore there is no requirement for them to register a separate registered person as a manager.

Systems were in place to protect people from abuse and to report any abuse to the local authority safeguarding team for investigation. Two safeguarding concerns had been raised against the provider in the last 12 months which had been investigated and not substantiated.

People’s needs and the risks they were exposed to in their daily lives had been assessed. Care records were regularly reviewed in the home, but in respect of domiciliary care we found that although some improvements in records was evident, further work was needed as there was a lack of information and instruction for staff.

Care planning and risk assessing around the administration of medicines was not sufficient in the domiciliary care service. Records related to the administration of medicines did not accurately reflect how staff supported people to take their medicines. No agreements were in place about the level of support staff provided to assist people to take their medicines. Where there were medicines care plans or risk assessments in place, these were not detailed enough.

Regular health and safety checks were carried out on the premises and on equipment. The provider rectified an issue regarding door security during our inspection. Recruitment processes included checks to ensure that staff employed were of good character. The staff team and staffing levels were consistent and people’s needs were met. Staff records showed they received training related to their role which was up to date. Staff told us they received supervisions and appraisals and they could feedback their views directly to the registered provider at any time.

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards exist to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered provider was in the process of applying for DoLS to be put in place for those people who lived at the home who needed them. We found the MCA was not always applied appropriately in that the best interest decision making process had not always been followed. Records did not fully reflect people’s capacity levels and we found the management of some people’s finances required review.

People told us, and records confirmed that their general healthcare needs were met. People’s general practitioners were called where there were concerns about their welfare as were other healthcare professionals such as dentists and chiropodists. People told us they were happy with the food they were served and they could ask for anything they liked and it was accommodated. People’s nutritional needs were met and specialist advice was sought when needed.

Our observations confirmed people experienced care and treatment that protected and promoted their privacy and dignity. Staff displayed caring and compassionate attitudes towards people, and people spoke highly of the staff team. Staff were aware of people’s individual needs. People and staff told us that regular activities took place within the home and the local community.

There was a lack of suitable quality assurance systems in place to monitor the service. For example, audits were not done in areas such as infection control, medication and health and safety. This had resulted in some shortfalls which the provider and staff team were unaware of. The registered provider had recently appointed a deputy manager whose role was to develop the administrative side of the business and introduce quality assurance measures to drive improvements within the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and their corresponding regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were; Regulation 10, Assessing and monitoring the quality of service provision which corresponds to Regulation 17, Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 13, Management of medicines, which corresponds to Regulation 12(f) & (g), Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; and Regulation 18 Consent to care and treatment which corresponds to Regulation 11, Need for consent, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.