Tweedmouth House 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 home provides accommodation and care for up to 55 people, some of whom are living with dementia. Accommodation was divided into three smaller areas. People who had general nursing and personal care needs lived in ‘Royal’ and ‘Tweedmouth.’ Those who had a dementia related condition lived in ‘Orchard House.’ There were 49 people living at the home at the time of the inspection.

We last inspected the care home in August 2017 and rated the service as requires improvement. We identified a breach of the regulation ‘fit and proper persons employed.’ One nurse’s registration with the Nursing and Midwifery Council [NMC] had lapsed. Nurses are legally required to be on the NMC register in order to practise. Following the inspection, the provider sent us an action plan which stated what they were going to do and by when to meet this regulation.

At this unannounced inspection on 25 September 2018, we found the provider had taken action to improve. An effective system was now in place to ensure nursing staff were registered with the NMC.

The provider was a husband and wife partnership. One of the partners was also the 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 and associated Regulations about how the service is run.

An assistant manager was in post; they were applying to be registered manager. The current registered manager was planning to reduce their management hours to take on a more supportive role and eventually retire from ‘hands on’ management duties. They would however, be overseeing the management of the service as the provider and owner of the home.

Checks and tests had been undertaken to ensure that the premises were safe and secure. There were safeguarding procedures in place. Staff were knowledgeable about what action they should take if abuse was suspected. They told us that they had not witnessed anything which concerned them. The local authority safeguarding team informed us there were no organisational safeguarding concerns regarding the service. Medicines were managed safely.

There were enough staff deployed to support people to stay safe and meet their needs. The skill mix ratio of registered nurses and care workers helped ensure that people’s needs were met effectively and safely.

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.

Records confirmed that training was available to ensure staff were suitably skilled. Staff were supported though an appraisal and supervision system. Many of the staff had worked at the home for a considerable number of years. This experience contributed to the skill which they carried out their duties.

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 talked about caring for people like members of their family. We asked staff if they would be happy for a friend or relative to live at the home. They confirmed they would.

There was an activities programme in place. Two activities coordinators were employed to meet people’s social needs.

There was a complaints procedure in place. No complaints had been received since our last inspection. We discussed with the assistant manager about the introduction of a central system for the recording and monitoring of any minor concerns. A central monitoring system would enable managers to have ov

Tweedmouth House provides care and accommodation for up to 55 people, some of whom are living with dementia. Accommodation was divided into two main areas. People who had general nursing and personal care needs lived in ‘Tweedmouth House.’ Those who had a dementia related condition lived in ‘Orchard House.’ There were 45 people living at the home at the time of the inspection.

There was 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 and associated Regulations about how the service is run.

We last inspected the care home in October 2016 and rated the service as requires improvement. We identified a breach of the regulation relating to the need for consent. There was a lack of evidence to demonstrate that staff followed the principles of the Mental Capacity Act 2005 [MCA].

Following the inspection, the provider sent us an action plan which stated what they were going to do to meet this regulation.

At this unannounced inspection on 22 and 29 August 2017, we found the provider had taken action to ensure records demonstrated that the principles of the Mental Capacity Act were followed. However, we identified a new breach relating to fit and proper persons employed.

We found that one nurse’s registration with the Nursing and Midwifery Council [NMC] had lapsed in October 2016. Nurses are legally required to be on the NMC register in order to practise. The NMC registers all nurses and midwives to make sure they are properly qualified and competent to work in the UK. We referred our findings to the NMC, local authority safeguarding and commissioning teams and Northumberland Clinical Commissioning Group.

There was a quality assurance system in place. We found however, that the provider did not have an effective system in place to ensure nursing staff were registered with the NMC.

Since 2012, we found the provider was breaching one or more regulations at five of our eight inspections at this service. Since 2015 we have rated the service as requires improvement on three occasions. At this inspection, we identified one breach of the regulations. This meant that compliance with the regulations was not sustained and consistency of good practice was not demonstrated.

Prior to our inspection we received information of concern about people’s safety. We checked the concerns raised during our inspection and concluded that people were cared for in a safe environment, with suitable equipment and caring staff.

Checks and tests had been undertaken to ensure that the premises were safe and secure. There were safeguarding procedures in place. Staff were knowledgeable about what action they should take if abuse was suspected. They told us that they had not witnessed any concerns. The local authority safeguarding team informed us there were no organisational safeguarding concerns regarding the service. Medicines were managed safely.

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.

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 procedu

This inspection took place on 19 October 2016 and was unannounced. A previous inspection, undertaken in 8 and 9 July 2015 found one breach of legal requirements. This related to safe care and treatment and was with regard to window restrictors at the home not meeting current guidance.

Tweedmouth House is registered to provide accommodation for up to 55 people. At the time of the inspection there were 48 older people using the service, some of whom were living with dementia. 41 People had been assessed as needing nursing care and support.

The home had a registered manager in place, who was also the registered provider, and our records showed she had been formally registered with the Care Quality Commission (CQC) since October 2010. A registered manager is a person who has registered with the 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.

At the previous inspection we had noted windows in some areas did not have window restrictors in place that met current Health and Safety Executive guidance. At this inspection we saw devices had been fitted to those windows where there was a potential risk of falls. People told us they were safe living at the home and staff understood safeguarding issues and how to recognise and report them. There was regular maintenance of the premises and fire risk and other safety checks were carried out on a regular basis. Accidents and incidents were monitored and reviewed to identify any issues or concerns.

Suitable recruitment procedures and checks continued to be in place, to ensure staff had the right skills. Checks were carried out to ensure nurses were appropriately registered. Medicines were managed effectively and stored appropriately. Some plans to support people with “as required” medicines needed to be put in place.

People were happy with the quality and range of meals and drinks provided at the home. People told us they could request alternative items, if they wished, and special diets were catered for. Kitchen staff had knowledge of people’s individual dietary requirements and likes and dislikes.

Staff confirmed they had access to a range of training and updating. The home had a dedicated training co-ordinator, who oversaw all training delivery and carried out checks and supervision to ensure that learning was put into practice. Staff told us, and records confirmed that regular supervision took place and they received annual appraisals.

People’s health and wellbeing was monitored, with regular access to general practitioners, dentists, district nurses and other specialist health staff. There was evidence staff had responded appropriately to any health concerns.

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 people are looked after in a way that does not inappropriately restrict their freedom. The deputy manager confirmed that action had been taken to make applications to the local authority safeguarding adults team, where people may have their liberty restricted. At the previous inspection it was not always clear from records that decisions about people’s care and health had been taken in line with best interests guidance. At this inspection we found records relating to this matter still lacked clarity to demonstrate they met the legal requirements of the MCA.

Some improvements had been made to the environment on the Orchard Unit, which supported people living with dementia. The deputy manager told us she was looking at ways to further improve the homely feel of the unit.

People told us they were happy with the care provided. We observed staff treated people patiently and with appropriate care and consideration. Staff demonstrated an understanding of people’s indiv

This was an inspection to check if the provider had addressed our previous findings about cleanliness and infection control. Due to their health conditions and needs, most of the people we spoke with were not able to share their views about arrangements for cleaning the home. During our visit we spoke with five people who used the service a visiting relative and external professional and two domestic staff. We spoke with the registered manager, the deputy manager and inspected the home.

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?

We saw the infection control issues identified at our last inspection had been addressed and necessary refurbishments and changes in practice made. Additional domestic staff hours had been put in place.

When we asked about cleaning arrangements, one person using the service said, “Yes it’s fine that way.” The relative we spoke with confirmed their satisfaction with cleaning arrangements, and referring to the domestic staff said, “They’re always in.” A visiting professional told us they had seen an improvement since our last inspection.

We found people living at the home were now protected against the risk associated with inadequate infection control practice and the provider had taken steps to provide care in a clean environment.

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 found there was a manager in post who was registered with the Commission in line with legal requirements.

We spoke with eight people who lived at the home, and three relatives, to find out their thoughts on the care provided at the home. One person who lived there said, “I’ve been here a year now and I just love every minute of it” and “I’m just so happy here.”

Other comments included, “It’s as good as they can possibly make it. The food is good, everything is good,” “I’m fine here, it’s like being at home” and “It’s absolutely wonderful here. We’ve got no complaints at all. The people who work here are always delightful. There is always someone looking after you. The care is good.” One relative told us, “I don’t think he could be looked after any better anywhere else.”

This inspection took place on 8 and 9 July 2015 and was unannounced. A previous inspection, undertaken in October 2014, found there were no breaches of legal requirements.

Tweedmouth House is registered to provide accommodation for up to 55 people. At the time of the inspection there were 48 older people using the service, some of whom were living with dementia.

The home had a registered manager in place, who was also the registered provider, and our records showed she had been formally registered with the Care Quality Commission (CQC) since October 2010. A registered manager is a person who has registered with the 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.

People said they were safe living at the home and felt the staff treated them well. Staff understood safeguarding issues and demonstrated they could recognise potential abuse. They told us they would report any concerns to the registered manager. There were processes in place to support the maintenance of the premises and fire systems and other safety checks were carried out on a regular basis. However, we found that some windows did not have restrictors that met with current Health and Safety Executive guidance for care homes and a risk assessment was not in place. Accidents and incidents were monitored and reviewed to identify and issues or concerns.

The registered manager had a system to review people’s needs and levels of dependency. This information was used to determine appropriate staffing levels. Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home. Medicines were handled safely and effectively and stored securely.

Most people told us they were happy with the standard and range of food and drink provided at the home. Some people told us the choice was sometimes limited and they would like more variety. The assistant manager told us people could request alternative dishes, if they wished. Kitchen staff had knowledge of specialist dietary requirements.

People told us they felt the staff had the right skills and experience to look after them. Staff confirmed they had access to a range of training and updating. The assistant manager told us the home had introduced a system of learning events throughout the year, when they would concentrate on particular subjects; such as food and nutrition. Staff told us, and records confirmed that regular supervision took place and they received annual appraisals.

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 people are looked after in a way that does not inappropriately restrict their freedom. The assistant manager confirmed that action had been taken to make applications to the local authority safeguarding adults team, where people may have their liberty restricted. It was not always clear from records that decisions about people’s care and health had been taken in line with best interests guidance.

People told us they were happy with the care provided. We observed the majority of staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with regular access to general practitioners, dentists, district nurses and other specialist health staff. People said they were treated with respect and their dignity maintained during the provision of personal care.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care. A range of activities were offered for people to participate in including; entertainers visiting the home and trips out. On the day of the inspection a Hawaiian party was taking place, with some staff dressed up. People and relatives told us they would speak to the registered manager if they had any concerns. The assistant manager explained how she was dealing with a current complaint.

The registered manager told us she carried out regular checks on people’s care and the environment of the home. Staff felt well supported and were positive about the culture of the home. They said the management were approachable and supportive. People and their relatives told us there were regular meetings at which they could express their views or make suggestions to improve their care. Records were well maintained and up to date.