This inspection took place on 3 October 2017 and was unannounced. This meant the staff and manager did not know we were coming. At our last inspection of this service we awarded an overall rating of Good.

At this inspection we found the service remained Good.

Ventress Hall is a care home for 106 people who require nursing or personal care. Some people who use the service were living with dementia. The home is set over three floors, situated in its own grounds with two enclosed garden areas. Ventress Hall has a range of communal areas for people and their relatives to use. There were 77 people using the service at the time of our inspection.

The service 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.

There were systems in place to keep people safe. Staff knew about safeguarding processes and how to raise concerns if they felt people were at risk of abuse or poor practice. Accidents and incidents were recorded and monitored as part of the manager’s audit process.

There were robust recruitment processes in place with all necessary checks completed before staff commenced employment.

The provider used a dependency tool to ascertain staffing levels. We found staffing levels to be appropriate to needs of the service, these were reviewed regularly to ensure safe levels.

Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. Medicine administration records (MAR) were completed with no gaps. Medicine audits were completed regularly.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates to reflect fire inspections, gas safety checks, and electrical wiring test had been completed.

Staff training was up to date. Staff received regular supervision and an annual appraisal.

People’s nutritional needs were assessed and we observed people enjoying a varied diet, with choices offered and alternatives available. Staff supported people with eating and drinking in a safe, dignified and respectful manner.

People were supported to maintain good health and had access to healthcare professionals when necessary and were supported with health and well-being appointments.

People were supported by kind and attentive staff, in a respectful dignified manner. Staff discussed interventions with people before providing support. Staff knew people's abilities and preferences, and were knowledgeable about how to communicate with people.

Advocacy services were advertised in the foyer of the service accessible to people and visitors.

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.

Care plans were individualised and person-centred focussing on people's assessed needs. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date. Processes and systems were in place to manage complaints.

The provider had an effective quality assurance process in place to ensure the quality of the care provided was monitored. People and relatives views and opinions were sought and used in the monitoring of the service. People, relatives and staff told us the service was well managed.

People had personal emergency evacuation plans (PEEPs) in place that were available to staff in case of an emergency.

People we spoke with and their relatives told us they were happy living at the home. They spoke positively about staff.

People were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services. We saw staff understood people’s care and support needs, were kind and thoughtful towards them, and treated them with respect.

Care plans were individual to people and were reviewed regularly. This meant that information was accurate and up to date.

Medicines were only handled by people trained to do so. Good practices were in place for the handling and storage of medication.

We saw that adequate maintenance of the premises was not carried out to maintain the safety and suitability of the premises which breached the Health and Social Care Act 2008 and associated regulations

The home regularly monitored the quality of the service. Audits were carried out to minimise the risks available to people and actions were put in place when needed, however we were not always sure if these had been addressed.

People and staff had access to forums where they could voice concerns or complaints which they had.

People and staff felt well supported at the home.

The inspection team who carried out this inspection consisted of three inspectors. During the inspection, the team worked together to answer five key questions which are outlined below.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke to understood the procedures which they needed to follow to ensure that people were safe.

Good systems were in place for medication. Staff were up to date with training and regular competency assessments were undertaken.

The security of the building was well maintained and people we spoke to told us that they felt safe living at the home. However we found that the maintenance checks needed to ensure the safety of the building we not up to date and as required by the Health and Social Care Act. This meant the provider could not demonstrate that people were protected from the risks of unsafe or inappropriate care because maintenance checks were not up to date. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. People had a copy of the fire evacuation procedure in their own rooms, however the people we spoke to were unsure of the fire evacuation procedure.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care home. Recent applications had needed to be submitted and proper policies and procedures were in place. Relevant staff had been trained to understand where an application should be made, and how to submit one.

Is the service effective?

People all had an individual care plans which set out their care needs. People we spoke with told us they had been involved in the assessment of their care needs and care planning.

It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well.

People had access to a range of health professionals. People were escorted to appointments as needed.

Is the service caring?

People were treated with dignity and respect and were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Everyone we spoke with during our inspection expressed satisfaction with the care and support which they received.

Is the service responsive?

We saw the home provided a range activities both inside the home and out in the community. The home had access to their own transport which meant that people had enjoyed many days outside.

Relatives told us they were able to visit when they wanted to and could take people out into the community. This meant people were encouraged to maintain relationships with family and friends.

Staff responded quickly when people’s needs changed and ensured that referrals to appropriate health professionals were carried out when needed.

People told us that they knew how to make a complaint if they needed to.

Is the service well-led?

The service worked well with other agencies and services to make sure people received the most appropriate care and support for their needs.

The home had a system in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed, however we were unable to see if these actions had been addressed.

Staff were dedicated to the home and had a good understanding of the ethos of the home. Staff were very clear about their roles and responsibilities and were very positive about the team they worked in.

What people said

During the inspection we spoke with five people, two relatives, one visitor and nine staff. People who were able to express their views told us that they were satisfied with the care and support they received.

People we spoke with told us, “The care couldn’t be better. The staff bend over backwards for you. I am really grateful,” and “It’s like a big happy family. The staff are really good and I believe this is the best place in town.

Relatives we spoke we told us, “We are pleased with the treatment our relative is getting here” and “Staff are nice.” One person and their relative told us, “The staff are good. I get very well looked after. They are nice.” and “I am absolutely happy with the care I receive.”

A visitor told us, “The staff are always busy and always on the move. I have no concerns about the home.” One staff member told us, “It’s a good place to work.” Another told us, “We give people lots of choice.”

One staff member told us, “It’s a good place to work.”

We spoke with people and their relatives throughout the day both individually and in small groups sitting in the lounge. They told us they were happy with the service provided by the staff. One person said "Things are alright and I like it here". Another said “The staff are what makes this home, they are really pleasant and supportive". Staff members were seen to interact well with people and knew them by their first name. There was a choice in what people wanted to do and the privacy and dignity of residents was respected as we observed care interventions being carried out. Staff spoke to people in a pleasant and respected manner.

People had been individually assessed to see if they could make their own decisions. Care records had enough information so staff would be able to know how to support each person in the right way. We saw on the day of our visit, there were sufficient qualified, skilled and experienced staff to meet people’s needs. The provider had a system for checking the quality and safety of the service and records were maintained and held securely.

Because some of the people using the service had complex needs which meant they were not able to tell give us their views we used a number of different methods to help us understand their experiences.

Those people living in the home we spoke with, said that they were happy with the service provided by the staff. One person told us “Things are really good here” and that they “Trusted the staff” which made them feel “safe”. another said “The staff are really good” and told us that “They do things with a smile”. While we asked a relative of a person living in Ventress Hall what they thought of the service the person told said to her visitor “They are very kind to us”.

One visitor told us she that she thought the service was “Everything that they wanted” and she was “Really pleased” and that it was “All down to the staff”. Another visitor, when asked about the care being given to their relative, said “The staff asked about me about the kind of things that my relative liked to do and the kind of food she likes”. All of the relatives we spoke with had been involved in developing the care plan intitially and were happy with the content of the documents.

A visiting General Practitioner told us that they had “no concerns” about the way that people were being cared for. They said that they visited the home regularly (about once a week or fortnight) and the staff were always helpful and had followed any instructions given to them about peoples care.

We spoke with a small group of people who were sitting in one the lounges. They told us they were very happy with the service and how much they appreciated the staff and the manager. The told us the food was “Excellent” and one suggested that “If I get the chance I should have lunch as it’s really nice”.

At the last unannounced, comprehensive inspection on 4, 5, 6 and 12 February 2015, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Safety and Suitability of Premises. We asked the registered provider to take action to make improvements. We asked the registered provider to ensure they were preventing the risk of cross infection by having the appropriate equipment and policies in place and by taking action to the premises to ensure people were safe.

The registered provider wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We undertook this comprehensive inspection to check that the registered provider had followed their plan and to confirm that they now met legal requirements.

Ventress Hall care home provides nursing and personal care to 106 people with medical and nursing care needs, including people living with a dementia. The home is located in a residential area close to Darlington town centre, with local amenities and public transport. At the time of our visit, 64 people were receiving care at the service.

The service had a registered manager in place. 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.

At the last inspection we saw that there were risks to people’s safety in the premises. On this visit we saw that storage had improved by converting a bedroom into a hoist storing area which meant hoists and slings were stored safely and cleanly. An area of the home previously referred to as Thornville where one person previously resided had been de-commissioned. We saw that access to areas of risk such as maintenance areas, sluices and other storage areas had now been secured with key code locks meaning that people using the service could not accidentally access them.

We found the premises to be clean and tidy. Areas had been re-decorated and some new furniture had been purchased. There was an ongoing plan for re-decoration. There were no obvious signs of dirt or odours in any areas of the service that we visited.

At our last inspection we saw that electronic records were not always completed and staffing deployment meant there were times when there was not always enough staff to meet the needs of the service. On this visit we saw that both electronic records, recording charts and care plans were well completed.

There were systems and processes in place to protect people from the risk of harm. The care staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the right action to take if they were concerned that abuse had taken place.

Staff told us that they felt supported and had regular and productive meetings with their line manager. Staff told us that they were up to date with their mandatory training and had completed training that was relevant to the service

Staff and management had an understanding of the Mental Capacity Act (MCA) 2005. The senior management had a good knowledge of the principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions. We saw that appropriate documentation was in place for those people who lacked capacity to make best interest decisions in relation to their care. We saw that a multidisciplinary team and their relatives were involved in making such a decision and that this was recorded within the person’s care plan.

We looked at the arrangements that were in place to ensure that staff were recruited safely and people were protected from unsuitable staff. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. We saw that medicines had been given as prescribed.

There were positive interactions between people and staff. We saw that people were supported by staff who respected their privacy and dignity. Staff were attentive, showed compassion, were encouraging and caring.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People told us they had good access to their GP, dentist and optician. Staff at the service had good links with healthcare services and people told us they were involved in decisions about their healthcare. This meant that people who used the service were supported to obtain the appropriate health and social care that they needed.

Assessments were undertaken to identify people’s health and support needs. People’s independence was encouraged and there was activities taking place in the service.

The provider had a system in place for responding to people’s concerns and complaints. People and the relatives that we spoke with during the inspection told us they knew how to complain and felt confident that staff and manager would respond and take action to support them.

Records looked at during the inspection informed that audits were in place to monitor and improve the quality of the service provided. The service had responded to requirements and recommendations from the previous CQC visit in February 2015 and a clear record of actions was recorded and reviewed on a weekly basis by the manager and regional manager.