Tweed View House provides care and accommodation for up to 36 older people some of whom have a dementia related condition. Accommodation is split over three levels with lift access. There were 29 people living at the home at the time of the inspection.

We last inspected the service in March 2016 and rated the service as requires improvement and identified two breaches of the regulations relating to safe care and treatment and good governance. Following our inspection the provider sent us an action plan which stated what action they were going to take to improve.

At this inspection we found improvements had been made and the provider was meeting all the regulations we inspected against.

There were safeguarding procedures in place. Staff were knowledgeable about what action they should take if abuse was suspected. The local authority safeguarding team informed us that were no ongoing organisational safeguarding issues regarding the service.

The premises were clean. Checks and tests had been carried out to ensure that the premises were safe.

Recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people. There were sufficient numbers of staff deployed to meet people’s needs. Records confirmed that training was available to ensure staff were suitably skilled. Staff were supported though an appraisal and supervision system.

People's nutritional needs were met and they were supported to access healthcare services when required.

We observed positive interactions between staff and people who lived at the service. Staff promoted people's privacy and dignity. There were systems in place to ensure people were involved in their care and support.

Care plans were in place which detailed the individual care and support to be provided for people. Arrangements for social activities met people’s individual needs.

There was a complaints procedure in place. No complaints had been received since our last inspection.

Audits and checks were carried out to monitor the service. Staff were very positive about working for the provider. They said they felt valued and enjoyed working at the service. We observed that they applied this positivity in their roles when supporting people.

Further information is in the detailed findings below.

Tweed View House is situated in Berwick upon Tweed close to the Scottish border. The home is registered to care for up to 36 older people, some of whom are living with dementia. Nursing care is not provided. Care is provided over three floors, and the service was full during 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.

There were shortfalls in relation to the safety of the premises including fire safety and infection control. Some wardrobes were not secured. The home was clean and the bedrooms were nicely personalised. Attention had been paid to dementia friendly design and décor including creative use of signage and colour.

A safeguarding procedure was in place and staff had received training. They told us they knew what to do if abuse or neglect were suspected. Safe systems were in place for the management of medicines, but instructions relating to as required medicines given to support people exhibiting behavioural disturbance required more detail. Safe recruitment procedures were followed which meant that people were protected from harm.

Risk assessments were carried out in relation to the premises and individuals using the service. A number of safety checks to the premises were carried out.

There were suitable numbers of staff deployed during the inspection, and staffing levels had been increased. People were supported in a relaxed unhurried manner and staff said they had time to care. People and their relatives told us they were happy with the care provided.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The registered manager had submitted DoLS applications to the local authority for authorisation. The service worked within the principles of the mental capacity Act 2005 and the manager was in the process of further developing policies and documentation in this area to improve recording of best interests decisions for example.

We found that people were able to access a range of healthcare services and appropriate advice sought. A visiting professional spoke highly of the service and staff.

Care plans were in place and regularly reviewed. They contained all of the required information

Staff received regular training in a range of key areas and accessed additional training relevant to the people they cared for where necessary, including catheter care or training around dementia and behaviours that challenge. Staff also received regular supervision and an annual appraisal. They said they felt valued by the organisation and that morale was good.

People’s nutritional needs were met. On one day of the inspection a taster session had been arranged to enable people to try new foods, and we saw that where there were concerns about people’s dietary intake appropriate action was taken.

Staff were caring and treated people with kindness and respect. There were good examples of person centred care throughout the inspection, and some skilled and supportive interventions were observed. There were some routines and practices which were not entirely person centred in particular around the mealtime experience which needed to be improved.

An activities coordinator was in post and there were a range of activities available including physical and sensory. People had visited the local pub for meals with staff which they enjoyed.

The views of people, relatives, staff and other stakeholders were routinely sought, and the registered provider and manager monitored the quality of the s

This was an inspection to check if the provider had addressed our previous findings about record keeping. Due to their health conditions and needs, the people we spoke with were not able to share their views about arrangements for accessing and reviewing their records. During our visit we spoke with four people who used the service and two deputy managers. We inspected four people’s personal care records and information relating to complaints.

We considered all the evidence we gathered under the regulation we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found;

Is the service safe?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service effective?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service well led?

We looked at care records and found work had been completed to ensure care plans and other records relating to people’s care were more robust and reflective of individual care needs. We saw complaints had been recorded, with details of what action had been taken to investigate and respond to the concern raised. We found there was a manager in post, registered with the Commission in line with legal requirements.

We found people's needs were assessed and care was planned in line with their needs. One relative told us, “My relative is well cared for here. I do think the staff have a good understanding of his needs and they are able to recognise his mood. They have a sing song with him often and he enjoys this.” Care plans were regularly updated and contained clear information about individuals' care.

People told us they enjoyed the food and had a choice at each mealtime. We saw people were supported to eat and drink sufficient amounts to meet their needs.

The home was clean and staff were provided with appropriate equipment to prevent the spread of infection.

We saw there was the deputy manager, one senior care worker and three care workers available on the day of the visit. 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 were asked their views about the service provided and these were taken account of. People were aware of the complaints procedure. The provider had systems in place to monitor care delivery and ensure the health, welfare and safety of people who used the service was maintained.

People's personal records, including medical records, were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.

We spoke with four people who lived at the home and three relatives, to find out their views on the care provided at the home. One person who lived there said, “I am very happy with the home, I really like living here and everyone is very kind. The staff pop in regularly to see me because I prefer to stay in my room. The staff know what I need help with and they come quickly when I ring the bell for them.” Another person told us “I like the food and my room is very comfortable. I have been able to bring in bits and pieces from my house so it is more like home to me now. The staff are lovely; they have a joke and a laugh with you. It has been a good move for me, because I couldn’t manage at home.”

One relative told us, “I don’t think they could be looked after any better anywhere else.” Another said they were very satisfied with the care provided by the staff. They said they came in daily and staff were very good. However this person had made a complaint about the behaviour of another person who lived there that was impacting on the life of their relative. This was discussed with the manager who was aware of the situation.

At the time of the inspection there were 33 people living at the home. Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. During our visit we spoke with six people who used the service and observed their experiences. We spoke with the registered manager, six care staff and three relatives.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

The provider had in place effective systems to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls.

We found the arrangements for handling medicines were safe. All medicines were administered by staff who had received appropriate training.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and staff had received training in the Mental Capacity Act 2005 (MCA) and DoLS. The manager was aware of the recent high court judgement and was making a referral to the local authority of people who required an assessment.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in this process. We saw that particular needs were identified in some plans for example, dietary needs or dementia care in people’s plans. However some care plans did not accurately reflect changes in people’s needs such as, they were at a higher risk of falls than previously. We saw the quality of recording in care plans varied. We made a compliance action about this which required the provider to take action to address the shortfalls in recording. We spoke with staff and they were able to describe people’s care requirements and what support they needed.

Staff training was provided that took account of the needs of the people in the home. For example, we saw training in dementia and administration of medicines had been provided.

We found the provider had systems in place to protect people and others who could be at risk from the use of unsafe equipment. We saw records that confirmed regular servicing and maintenance was carried out. Records showed training had been provided to ensure staff had the competency and skills to operate equipment safely.

Is the service caring?

We saw staff responded kindly and promptly to people. Care workers were patient and encouraging to people as they assisted them.

People we spoke with were positive about the service, the staff and the care they received. One person told us, “It’s a wonderful place here. I love it. The staff are marvellous and they are all concerned to make sure all is well. It is so much better than my last placement.” A relative told us, “I am very happy with the care of Y. He always looks well cared for and I visit very regularly so I would know if something wasn’t right. The staff are very kind.”

People’s preferences, interests, aspirations and diverse needs were recorded and we saw staff were aware of these during the inspection.

Is the service responsive?

We saw the staff identified encouraged people to be involved in activities. People told us they could choose whether or not they attended arranged activities.

People told us they were aware of the complaints procedure and staff could describe how they would assist a person to make a complaint. We saw there was information available on the notice board in the home and in individual rooms about making a complaint.

There was a suggestion box in the main hallway and we found changes had been made to take account of suggestions received. These include redecoration and new carpets in the hallways, new bedroom furniture, an additional staff member early in the mornings to assist people and the appointment of an activity organiser.

Is the service well led?

The staff we spoke to were all aware of the complaints, safeguarding and whistle blowing procedures. All of the staff said they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of questionnaires from people who used the service. This meant people were able to feed back on their experience and the service was able to learn from this.

Staff had regular supervision, appraisals and staff meetings which meant they were able to feedback to the management of the home their views and suggestions. Staff told us they felt supported in their role and were confident their views were listened to and account was taken of them.

We found there was a training plan in place and staff told us they had plenty of training opportunities provided.