The inspection took place on 28 June 2017 and was unannounced. At the last inspection on 18 February 2015, the service was rated as Good. At this inspection we found the service remained Good

Trittiford Road is a residential care home providing accommodation and nursing care to up to six people. The home specialises in the care of people with a learning disability and physical disability. At the time of our inspection five people were living there.

Because people who lived at the home were unable to tell us about their experiences, we spoke with their relatives and observed staff working practices. People at the home were safe. Staff demonstrated that they were aware of the action to take should they suspect that someone was being abused. Staff knew the risks associated with people's specific conditions and their actions minimised the possibility of harm. There was enough staff to meet people's health, care and support needs. People received their medicines when they needed them and there were systems in place to ensure people’s medicines were managed safely.

People were supported by staff that were suitably trained and who sought people’s consent before providing support. The provider took action to protect people’s rights and adhered to the legal principles when depriving people of their liberty, in peoples’ best interests, where it was appropriate.

People were supported to make choices and received food and drink at regular times throughout the day. Staff provided healthy options for people to eat and involved dieticians to ensure the people’s nutritional needs were met. People were supported to access health care professionals to ensure their health care needs were met.

People were supported by staff that was kind, caring and respectful. People were treated with dignity and staff understood people's needs well. People were encouraged to be as independent as possible.

People’s health and support needs were assessed and reviewed and their relatives were invited to contribute to the review process. People were encouraged to participate in activities and interests they enjoyed. Relatives knew how to complain and felt they were listened to.

The provider had internal quality assurance systems to monitor the care and support people received, to ensure it was to a good standard.

Further information is in the detailed findings below.

The inspection took place on 18 February 2015 and was unannounced. At the last inspection on 26 October 2013, we found that the provider was meeting the requirements of the Regulations we inspected.

23 Trittiford Road is a residential care home providing accommodation and nursing care to up to six people. The home specialises in the care of people with a learning disability and physical disability. At the time of our inspection six people were living there.

A new manager was in post at the time of the visit. They were awaiting approval of their application to become 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 2008 and associated Regulations about how the service is run. CQC were completing the registration process for the new manager, who was at the home at the time of our visit.

People who lived at the home had different ways of expressing their feelings and were not able to tell us about their experiences. Although, relatives were able to tell us they felt that people were kept safe. We saw good interactions between staff and people; they smiled often and looked happy. Staff told us they thought people were safe. The provider had arrangements in place to protect people because, risks had been assessed and actions put into place, to reduce the risk of harm to people.

People had their prescribed medicines available to them and appropriate records were kept when medicines were administered by trained nursing staff.

We found that there was enough staff to keep people safe. The staff we spoke with told us there was always enough staff and extra staff could be brought in, when required, by the manager to ensure the correct levels of staff were on duty to meet people’s needs. The provider ensured staff were recruited and trained to meet people’s needs.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their care or treatment they receive. The provider had made the appropriate applications in line with the DoLS legislation.

We saw that people were supported to make choices and received food and drink at regular times throughout the day. Although people could not tell us about the choice and quality of the food, we saw that staff provided healthy options and involved dieticians to ensure the people’s nutritional needs were met.

People were supported to access other health care professionals to ensure their health care needs were met.

Relatives told us they thought the staff was caring and that they also had good relationships with them and the people they supported. We saw that staff were respectful and maintained people’s privacy and dignity.

We found that people’s health care needs were assessed and regularly reviewed. Relatives told us they were confident that if they had any concerns or complaints, they would be listened to and addressed quickly.

The provider had well established management systems to assess and monitor the quality of the service provided. This included gathering feedback from people who used the service and their relatives.

Six people lived at Trittiford Road Nursing Home on the day of our inspection.

The people who lived there had complex needs and were not able to tell us about their experiences. We used different methods to help us understand their experiences which included observation. We observed good interactions between staff and people living there. We saw that people smiled often and generally they looked happy.

We spoke with all of the four staff who were on duty and the manager by telephone. All staff told us positive things about the service provided. One staff member told us, "The care provided is good. The people living here are well looked after”. Another staff member said, "All people are well cared for and are safe".

We found that people's needs had been assessed by a range of health care professionals including doctors and specialist nurses. This meant that people's health care needs had been monitored to prevent illness and discomfort. People were supported by staff to engage in the activities that they enjoyed.

People were given choices about the food and drink provided. Risks associated with eating and drinking had been identified and managed to prevent choking and malnutrition.

We found that the premises were comfortable and safe.

We determined that staffing levels were adequate and ensured that people’s needs were met and that they were safe.

We saw that complaints processes were in place for people or their relatives to use if they were not happy with the service provided.

At the time of our visit there were five people living at the home. Most of the people living in the home were not able to tell us about their experience of care so we observed the care they received and spoke to staff, relatives and visiting professionals so that we could get an overview of the care provided.

People were treated with dignity and respect. Staff explained what they were going to do before they undertook tasks. This meant that efforts were made to keep them informed of what was happening.

People received individualised care based on their assessed needs. We saw that people were supported to eat and drink appropriate meals and drinks. This ensured their nutritional needs were met.

We saw that people were comfortable in the present of staff and relative spoke with confirmed that people always seemed to be happy when they visited.

Staff were knowledgeable about people’s needs. Staff were supported to carry out their roles safely. Staff told us they liked working in the home.

People living in the home were protected from the risks of abuse and unsafe care.

The provider ensured that there was adequate monitoring of the service to ensure that people received a good service that met people’s needs. A visiting professional told us, “I have always found the service to be good and staff responsive to people’s needs."