We carried out an unannounced comprehensive inspection of Turret Villa Retirement Home in September 2015. We identified a breach of regulation 12, safe care and treatment in relation to the management of medicines. We rated the service as good.

Turret Villa Retirement Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 35 people. There were 24 people living at the home at the time of the inspection.

A registered manager was in post. 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 continuing shortfalls in the management of medicines. Risks relating to the premises and equipment had not always been assessed.

Safeguarding procedures were in place. No one raised any safeguarding concerns. Systems to monitor people’s monies however, were not always documented.

There were sufficient staff deployed. Staff carried out their duties in a calm unhurried manner. Recruitment checks were carried out prior to staff working at the home to ensure they were suitable to work with vulnerable people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found omissions in the maintenance of records relating to the MCA. People told us consent was sought before care was carried out. However, records were not always maintained to evidence this or to demonstrate that staff had followed the principles of the MCA.

There were omissions and shortfalls in the maintenance of records relating to people’s care. We did not identify any major impact of these omissions and shortfalls upon people’s health, safety and wellbeing. People told us they received good care. However, we considered that an effective system was not fully in place to ensure people’s care plans were accurate and reflected their needs.

People told us they were generally satisfied with the meals at the home. Some of the gentlemen told us that larger portions would be appreciated. We observed the lunchtime experience and saw that staff were attentive to people’s needs.

Staff worked with various agencies and accessed other services when people's needs had changed, for example, consultants, GPs, speech and language therapist, dietitians, the chiropodist and dentist.

We found that not all aspects of the environment met best practice guidance relating to supportive environments for people living with dementia. We have made a recommendation about this.

People, relatives and health and social care professionals told us that staff were caring. Many of the staff had worked at the home for a considerable number of years. This meant that people were supported by staff who knew them well and could respond in a person centred way.

People living at the home had formed friendships with each other. Staff supported these friendships.

People told us they were encouraged to be as independent as possible and were able to move around the home freely. Several people self- administered some of their medicines. One person enjoyed getting a taxi to visit their relative in Berwick.

People and relatives told us that staff promoted people's privacy and dignity. We observed that staff knocked on people's doors before they entered and spoke with people respectfully.

We found shortfalls in certain aspects of the service. This included omissions in the monitoring of health and safety, medicines, people’s monies, the MCA, training and care plans. These issues had not been highlighted by the provider’s quality assuranc

We found people's needs were assessed and care was planned in line with their needs. A person told us, “This is a really good place to live. I get the care and support I need and the staff are lovely. It has been a good move for me as I was very anxious when I lived at home. Here there is always someone around to help you.”

People told us the food was well cooked and they enjoyed their meals. One person said, “The food is very good and I can have something different if I don’t like what is on the menu.” We saw people were supported to be able to eat and drink sufficient amounts to meet their needs.

We found the home was comfortably furnished and well maintained. People told us they liked the accommodation and were warm enough. One person said, “I am really pleased to have my own toilet and that is one of the reasons I chose this home.”

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance.

People's personal records were updated to reflect people's changing needs. Other records were fit for purpose and all records were held securely. Staff records were kept in an appropriate format.

We spoke with four people about their experiences of the care and support they had received. People spoke positively about the support they received from the manager and staff. One person said the manager and staff, “Were excellent.” They said “Staff are very nice and considerate.”

We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us staff asked them for their consent before they provided their care.

People’s needs were assessed and care and treatment delivered in line with their individual care plan.

There were effective systems in place to reduce the risk and spread of infection.

Appropriate checks were carried out before staff started work.

People who use the service, their representatives and staff were asked about their views about the care and support provided and these were acted upon.

People were made aware of the complaints system. Their comments and complaints were listened to and acted upon.

We did not ask people who use the service about this on this occasion because we were following up on the actions taken by the provider following the last inspection of the service.

We spoke with five people who said that they were satisfied with the service they received. One person said “the staff are very kind and helpful. They are quite busy and I try not to ring for them very often, but they come very promptly when I do.” Another person said “I am very happy with my room it is the best room in the house I think. I spend most of my time here, but I go to the dining room for my meals. The care is very good and the staff know what I need help with. They remember the things I like and I don’t always have to remind them.” Another person said they could speak to the manager or any of the staff if they had any concerns. They said “the staff are very helpful and will always make sure that I am comfortable and have everything I need.”

Most people said they liked the food, although one person said there had been a problem recently when the cook was off and staff had prepared the meal. They said that this had not happened before and the staff were concerned to do their best for people. They said they were able to make choices about their routines.

The unannounced inspection took place on 23 and 30 September 2015. We last inspected Turret Villa Retirement Home in December 2013. At that inspection we found the service was meeting all the regulations that we inspected.

Turret Villa Retirement home provides residential care for up to 33 people, some of whom are living with dementia. At the time of our inspection there were 29 people living at the service.

The service had a registered manager in post. 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, ‘as required’ medicines did not have detailed information in place and the medicines audits were not robust. People’s medicines care plans were not always in place.

People told us they felt safe. One person said, “I feel as safe as houses here.” We also found the service clean and tidy.

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 issues were identified and appropriate action taken, including onward referral if necessary, to healthcare professionals.

Staff were aware of whistleblowing and safeguarding procedures and told us about what they would do if they were concerned about any safeguarding matters. We felt satisfied staff would have no hesitation in reporting any safeguarding issues that may arise at the service.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Staff followed the requirements of the 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.

There were enough trained and skilled staff at the service and staff told us they felt supported to complete their job to the best of their ability. The registered manager was monitoring closely recent admissions to the service to ensure that people’s needs continued to be met.

People’s dietary needs were met and staff supported them with any additional nutritional needs they had. People told us they enjoyed the food that was prepared for them at the service and one said, “The meals are excellent and the staff are very attentive.”

Where people needed support, this was given by carers who received consent before beginning any activity with the person. People were respected and treated with dignity, compassion, warmth and kindness and every person that we spoke with highlighted the quality of care provided by staff at the home.

People had choice. We saw individual personal items decorating people’s bedrooms and people choosing to smoke a cigarette if they wanted. The provider had catered for people to be treated as individuals.

People were able to participate in activities although the registered manager was going to review the provision of day to day events in order to stimulate people’s interests by looking at providing additional activities.

People and their relatives knew how to complain if they needed to. Meetings were held to allow people and their relatives to give feedback on the service and offer an opportunity to bring about any changes required.

There were systems in place to audit and check the quality of the service.

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

We found one breach of Regulation 12 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.