Mount Tryon is a care home with nursing for older people, people with a physical disability, people living with dementia and younger adults. It is registered for a maximum of 59 people. The home has a dementia care unit situated at first floor level, with people needing more general nursing or personal care on the ground floor.

Prior to the inspection, the home had undergone extensive refurbishment which included a number of bedrooms being redecorated, fitted with new furniture and the en-suite toilets renewed to a very high standard. At the time of the inspection 37 people were living at the home. However, this number was expected to rise over the coming few weeks as the newly refurbished bedrooms were now available.

The home was inspected on two occasions in 2017. In February and March 2017 a comprehensive inspection resulted in the home receiving an overall rating of ‘requires improvement’. We found improvements were required in how the home shared information about people’s nutritional needs to ensure these were fully understood by all those staff involved in people’s care. The policies and procedures relating to providing safe care had not been consistently followed by the nursing staff.

In October 2017 a focused inspection of the key question, ‘Is the service safe?’ identified improvements had been made and the home’s overall rating improved to ‘good’.

At this inspection, in May 2018, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The key question of ‘Is the service well-led?’ has an improved rating from ‘requires improvement’ to ‘good’. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

The home had a registered manager, appointed following the previous inspection in October 2017. People, relatives and staff told us the home was well managed and registered manager was supportive and approachable. Effective quality assurance systems, including care reviews, meetings and audits, ensured people received the care and support they required in a safe environment.

Sufficient numbers of well trained staff were on duty. People and relatives described staff as kind, caring and compassionate. Our observations showed staff were knowledgeable about people’s care needs, attentive to people and it was clear they had developed close relationships with them. Staff told us they were proud to work at the home.

People were protected from the risk of abuse as staff recruitment practices were safe. Staff had received training in the protection of adults. Other risks to people’s health, safety and welfare, such as the risk of falls or not eating or drinking well, were assessed and care plans provided guidance for staff about how to mitigate these risks.

Medicines were managed safety and people’s healthcare needs were monitored and guidance sought from healthcare professionals when necessary.

People were supported to make decisions about their care and to have maximum choice and control of their lives. People rights were respected and protected. Staff supported people in the least restrictive way possible; the policies and systems in the home supported this practice. Care plans provided staff with clear guidance and information about people’s specific care needs, what to be observant for to indicate a person’s health might be declining and what actions to take.

People and relatives told us they were very happy with the care and support they received. One person described this as “excellent” and another as “brilliant”. Two relatives said their relatives’ health and well-being had improved as a result of the care they received. One relative said, “She's come on leaps and bounds since she's been here.” None of the people or relatives we spoke with had any compla

We undertook this focused inspection of Mount Tryon on 19, 25 and 31 October. The first and third days of the inspection were unannounced. This inspection was undertaken in response to concerns raised with us over the safety of care provided to people living at the home, particularly in relation to two people with complex care needs. These concerns related to whether people were having their nutritional and hydration needs met; whether their pressure area care needs were being met and how the home managed people’s medicines. Concerns were also raised about the attitude of some staff, whether there were sufficient staff on duty to meet people’s care needs and whether staffing had been reduced. The team inspected the service against the Key Question of safe. We looked at the care and support provided for the two people we had received concern about, as well as the care and support received by another two people who also had complex care needs.

Through our ongoing monitoring and during our inspection activity, no risks or concerns were identified in the four remaining Key Questions, (Is the home effective, caring, responsive and well-led?), so we did not inspect. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

As a result of this inspection, we found no evidence that the safety and welfare of people was being placed at risk.

Mount Tryon is a care home with nursing. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide care for up to 59 older people, people with a physical disability, people living with dementia and younger adults. Care is provided in two separate areas of the home: a nursing unit on the ground floor and a dementia care unit on the first floor. On the first day of inspection there were 36 people living at the home: 17 people in the nursing unit and 19 people in the dementia care unit. We looked at the care given to people on both units.

The home did not have 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.

An interim manager had been in post since the previous manager left the home in August 2017. Since then a manager had been appointed and they had started to work at the home on 30 October 2017. They were available during and following the inspection and they told us it was their intention to apply to register with the Care Quality Commission.

The home was also supported by a clinical development nurse employed by Barchester Healthcare Homes Ltd. They had the responsibility to support the nursing staff to assess, review and plan for people’s nursing care needs.

Mount Tyron was previously inspected in February and March 2017. As a result of that comprehensive inspection, the home received an overall rating of Requires Improvement as we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made, and there were no breaches of regulations.

People told us they felt safe living at Mount Tryon. One person said, “Yes, everything is fine” and another “It’s very nice.” Relatives described the care their relations received as “outstanding” and “excellent”.

Risk assessments and management plans were well documented. Actions required to keep people safe were communicated effectively throughout the staff team, including all support staff. This included catering and housekeeping staff. Each person’s care file

Mount Tryon is a care home with nursing. It is registered to provide care for up to 59 older people, people with a physical disability, people living with dementia and younger adults. On the first day of inspection there were 30 people living at the home. There were 15 people living in the ground floor nursing unit and 15 people living in the upper floor dementia care unit.

This inspection started on 1 and 2 February 2017. We revisited the home on the evening of 12 March and during the day on 29 March 2017 after we received concerns about insufficient staff on duty, particularly at weekends, whether people could have something to eat during the night and whether people were receiving safe care and support. The first and third days of the inspection were unannounced.

Mount Tryon has been inspected on five occasions since it was rated as requires improvement in all five key questions at the comprehensive inspection undertaken in January 2015. Since that time, CQC has continued to require improvements and/or made recommendations for improvement. In March 2016 CQC issued a warning notice to the provider as they had failed to ensure the nutritional and hydration needs of service users were met.

In May 2016 the provider had met the requirements of the warning notice but was in breach of a number of other regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Mount Tryon was placed in 'special measures' as it had been rated as 'Inadequate' in a key question over two consecutive inspections.

Following the inspection in May 2016 the provider sent us a detailed action plan telling us how they would resolve the issues identified at the inspection.

In September 2016 an unannounced focused inspection took place in response to concerns raised with us about whether the home was monitoring the food and fluid intake of people who may be at risk of not eating and drinking enough to maintain their health. At that inspection we found concerns relating to the monitoring of one person’s nutrition and hydration needs to be substantiated but other people’s needs in relation to their diet and fluid intake were being reviewed, monitored and met.

You can read the reports from our previous inspections, by selecting the 'all reports' link for Mount Tryon on our website at www.cqc.org.uk.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The home 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.

At our previous inspections we found improvements were required in how the home was being managed. In May 2016 we identified changes to the management and leadership within the home and at regional level and had led to weak and inconsistent management, leadership and ineffective oversight of the service. At this inspection we found improvements had been made to internal management and oversight systems. However, there had been some failing by the nursing staff to fully implement the home’s policies and procedures to review and manage risks to people’s safety. This had led to one person being left with food that had not been suitably prepared for them to eat safely.

Since coming into post the registered manager had developed an action plan relating to the improvements needed. They had involved staff and relatives in this plan and had ensured each member of staff understood

Mount Tryon is a care home with nursing. It is registered to provide care for up to 59 people with a physical disability and people living with dementia. On the day of inspection there were 31 people living at the home. There were 16 people living in the ground floor nursing unit and 15 people living in the upper floor dementia care unit.

This unannounced focused inspection took place on 21 September 2016 in response to concerns raised with us. These concerns related to whether the home was monitoring the food and fluid intakes of people who may be at risk of not eating and drinking enough to maintain their health. During this inspection we looked at whether people who were at risk of dehydration and malnutrition, were receiving safe care and treatment and whether the service was monitoring the support people received in relation to their nutritional and hydration needs.

Mount Tryon has been inspection on four previous occasions since it was rated as ‘requires improvement’ at the comprehensive inspection undertaken in January 2015. In October 2015 a comprehensive inspection continued to rate the service as ‘requires improvement’. At both these inspections the service was required to improve how it ensured people received safe care and treatment and how it monitored the quality of care and support provided. In January 2016 an unannounced focused inspection was undertaken in response to concerns regarding the number of staff on duty. As a result of that inspection we made a recommendation that the home review its staffing arrangements at mealtimes in order for people to receive their meals promptly.

In March 2016 an unannounced focused inspection was undertaken in response to concerns that people were not being supported to eat or drink enough to maintain their health. At that inspection we found records were either not maintained or were incomplete and the arrangements to ensure people were supported to have a meal in a timely way still required improvement. We found there was insufficient oversight by nursing staff and management to ensure people received safe care and treatment. As a result we issued a warning notice to the provider as they had failed to ensure the nutritional and hydration needs of service users were met.

In May 2016 we undertook an unannounced comprehensive inspection as we had received concerns regarding staffing levels and whether staff were receiving the training they needed to carry put their roles; poor record keeping, particularly in relation to people’s food and fluid intake, and the manner in which the service responded to complaints. At that inspection we found the provider had met the requirements of the warning notice issued in March 2016 but was in breach of a number of other regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to people not receiving care that met their needs and reflected their preferences; the unsafe management of medicines; poor management of complaints; ineffective systems to monitor the quality of care provided by the service and staff not receiving an induction that prepared them for their role.

As a result of the inspection in May 2016, the service received an overall rating of 'Requires Improvement'. Mount Tryon was placed in 'special measures' as it had been rated as 'Inadequate' in a key question over two consecutive inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of prevent

Mount Tryon is a care home with nursing. It is registered to provide care for up to 59 older people, people with a physical disability, people with dementia and younger adults. On the day of inspection there were 37 people living at the home. There were 20 people on the ground floor nursing unit and 17 people on the upper floor dementia care unit. The registered providers told us they were not admitting people to the service until improvements had been made.

This inspection in May 2016 took place over three days. The first visit started at 9pm on a Saturday evening.

There had been a number of management changes at Mount Tryon which had negatively impacted on the care and support people had received. These changes had occurred both at service level and at regional level. Actions to address risk had either not been taken or taken and not sustained through those changes.

Mount Tryon did not have 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. A new manager had been appointed and had applied to CQC to register as manager.

Since January 2015 Mount Tryon had been inspected on five occasions. Each of those inspections had resulted in CQC telling Mount Tryon that improvements were needed to ensure people received a safe, responsive, effective, caring and well led service.

The service was last inspected in March 2016 in response to concerns we had received about whether people had enough to eat and drink in order to maintain their health. That focussed inspection found the service could not demonstrate people were being supported to eat and drink enough. We issued a warning notice telling the provider they must take action by 18 April 2016. During that inspection we also found people were not receiving safe care and quality assurance systems failed to identify and address risk.

During this inspection in May 2016 we found the warning notice had been complied with. However, whilst people were receiving enough to eat and drink, records were not always up to date or accurate. Records kept in relation to what people eat and drink are an essential part of any risk management strategy and must be up to date and accurate.

In January 2016 we carried out a focused inspection in response to concerns about staffing levels, the high use of agency staff and staff lacking the knowledge to meet people’s needs safely. We found no evidence to support those concerns. However, we made a recommendation that the level of staffing at mealtimes be looked at in order for people’s nutritional needs to be met promptly. In response to this, we were told Mount Tryon had set up two meal time sittings to ensure there were always enough staff on duty. We found at this inspection in May 2016 that this had not continued, and there were not enough staff to support people with eating at all times in a person centred way.

We carried out comprehensive inspections in January 2015 and October 2015. These resulted in an overall rating of ‘requires improvement’ on both occasions. Our main concerns were that people were not receiving safe care and treatment and the service was not well led.

Prior to carrying out this comprehensive inspection in May 2016 we had received concerns relating to: insufficient staff, particularly at night, to meet people’s needs; staff not having the skills or knowledge to meet people’s needs, especially in relation to people living with dementia; Induction for new staff was insufficient; people were still up at 1am or 2am due to lack of staff to help them to bed; people being funded for individual staffing were not receiving this; there were no snacks on the drinks trolleys for people on soft diets; no beakers were left in people’s r

Mount Tryon provides nursing care for older people, people with a physical disability, people with dementia and younger adults. It is registered for a maximum of 59 people. The home has a dementia care unit situated on the first floor level, with people needing more general nursing or personal care on the ground floor. At the time of our inspection there were 46 people living at Mount Tryon.

There was a registered manager in post however they were not available at the time of this inspection. 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.

This unannounced inspection took place on 2 March 2016. The inspection was a focused inspection in response to concerns we had received about whether people were receiving enough to eat and drink to maintain their health. We therefore only looked at how well people were supported with their nutritional and hydration needs.

At our last comprehensive inspection of Mount Tryon in October 2015, the home was rated as ‘requires improvement’ with breaches of the Health and Social Care Act 2008 Regulations 2014 identified in Regulation 12, safe care and treatment and Regulation 17, good governance. The provider sent us an action plan which said the actions to address the issues would be completed by 1 March 2016.

The home was also inspected on 20 and 22 January 2016 in response to concerns raised with us about staffing levels and the high use of agency staff as well as staff lacking the knowledge to meet people’s needs safely. Following that inspection, we made a recommendation that the deployment of staff at mealtimes was reviewed in order for people’s nutritional needs to be met promptly and to improve the mealtime experience.

At this inspection, in March 2016, we found sufficient action had not been taken to ensure people received sufficient food and fluid to maintain their health, or in relation to the deployment and availability of staff to ensure people were supported to eat their meals in a timely manner. The home’s overall rating of Requires Improvement made at the October 2015 inspection remains unchanged following this inspection.

While some people’s nutritional needs were being well met, others were not. Care plans identified people’s risk in relation to poor nutritional and hydration. Management and support plans identified the actions required to mitigate these risks. However we found these actions and plans were not always being implemented. For example, where a care plan identified a person should have their food and fluid intake monitored and their weight checked weekly, these actions were not occurring. Some people had not been weighed for several weeks and food and fluid charts were either not being completed or were not completed in full.

Some people had been prescribed nutritional supplements. Their medicine administration records showed these had been given to people, however records were not maintained of how much people had been able to drink of these. It was therefore not possible to ascertain if people were receiving the supplements as prescribed.

At the inspection in October 2015 we were told mealtimes were protected with staff not taking their own breaks to ensure people were supported with their meals. At this inspection we found some staff were taking their breaks during the lunchtime period and some people were not being assisted to eat their meals in a timely manner. For example, we saw one member of staff place a bowl of soup in front of one person and then leave. After 20 minutes another member of staff assisted this person with their soup. There was also a delay in people receiving their main meal as they had to wait until everyone else had received their starter before

We inspected Mount Tryon Nursing Home as a part of our scheduled inspection programme. We had also received a concern over a member of staff. We found that the home had managed this appropriately.

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

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found:

Is the service caring?

People we spoke with who lived at the home told us that staff were caring and looked after them well. One person told us ”They are very kind here – all the nurses couldn’t be better”. A relative we spoke with said “I could not imagine anywhere better for (my relative). The staff give her lots of genuine love and affection. “

We observed people being supported to eat their lunch in the dementia unit. We saw people were treated with respect and affection. As an example, we saw one person had been given their meal but were reluctant to eat. We saw a member of staff watch them from a distance and then approach them and encourage them to eat independently. When they did not do this after several prompts the staff member supported and encouraged the person to eat by filling their fork and guiding it to their mouth. We saw the staff member sat with them and made good eye contact while keeping the person’s focus on eating. We saw the person responded well to the member of staff who was patient and supported them at their own pace.

This demonstrated to us that the staff were patient and caring towards the people who lived at the home.

On the day of our inspection we saw that it was the birthday of one person who lived at the home. We saw the home’s chef had prepared a cake and staff gathered together with the person’s family to sing “Happy Birthday” to them. We saw celebrations were also in hand to celebrate one other person’s 40th birthday with them. This told us the home respected and celebrated significant and personal events with people.

Is the service responsive?

We saw that the home responded quickly to changes in people’s needs. We saw for example that care plans and assessments were reviewed regularly to identify changes in people’s condition. We saw that a GP was called on the day of our inspection to support people who had been unwell overnight.

We saw the home reacted positively to comments and suggestions. At our last inspection in February 2014 we had commented in our inspection report that the main double doors were difficult for a wheelchair user to operate independently. We saw in the home’s development plan that this was being actioned with new doors. The home also had regular residents meetings. We saw the minutes of the last meeting where people had identified they would like pasties as an evening meal choice. We saw that this had been actioned. This told us the home responded to people’s requests about their care and treatment.

Is the service safe?

People told us they felt safe at the home. One person told us “Of course I feel safe here. If I didn’t I would leave”. Another person told us “I do feel safe. The staff are lovely and there is always someone here to help if I need it”. A relative we spoke with told us their relation had settled well at the home and had told them they were “happy and content here. I don’t think that would be the case if they were worried about anything. I am sure they would tell me or the staff if they were”.

We saw that risks to people who lived at the home, visitors and staff were assessed regularly. We saw there were regular audits of practice and the competency of the nursing team was assessed by the Registered Manager, for example with medication. Spot checks were carried out by the management out of hours to ensure standards were maintained at all times.

CQC is responsible for monitoring the deprivation of liberty safeguards which applies to care homes. No-one at the home was subject to an authorisation by the Court of Protection, or a Supervisory Body under the Deprivation of Liberty Safeguards. However the home manager was aware that following a recent Supreme Court judgement applications would need to be made to ensure that where people had been deprived of their liberty, through for example locked doors on the dementia unit, this was lawful. Each person had been assessed by the home to see if the new legislation affected them. The Registered Manager had sought advice from the local care trust in relation to how to manage the applications that would be needed and was preparing to make applications. This meant that the provider was acting to ensure that people’s rights were protected and that where people were being deprived of their liberty this was in accordance with legislation.

Is the service effective?

We saw that people received effective support to maintain or support their health and wellbeing. As an example, we followed through one person’s care plan in relation to nutritional support. We saw that the plan had been actioned with specialist support from the speech and language therapy services. The person had gained weight. This told us the care plan and support had been effective.

A relative we spoke with told us “I am very happy with (my relative’s) care. She is putting on weight, and her face is filling out – she looks so much better since she came in. She is having her hair done regularly and she always looks well groomed. Sometimes she is up and down, but she is now interacting with people. And she enjoys joining in the singing.”

Another person said of the staff “They are very good. I need hoisting and help with getting about. They know what they are doing when they help me to move – I have no complaints”.

Is the service well led?

We saw the Registered Manager of the home was experienced and knowledgeable. Staff we spoke with told us they enjoyed working at the home, and felt they were well supported. They understood who was in charge and their individual roles. Staff told us “The staff here get access to good training. It’s very important for us to work well as a team and we do”. Another staff member said “I feel very supported, there is always someone here to ask. (Staff member’s name) is my mentor and I can ask them anything, I am so very happy to be working here. I really love my job”.

We found that management systems were effective and gave a clear picture of the quality of the service that people experienced.

On this inspection we looked at the way that people were asked for their consent to the care they received, how their needs were met, medication systems, cleanliness and infection control practices and records.

People we spoke with or their relatives told us they received good care. We saw people being supported well by workers, and engaging in positive relationships. People said “Nobody really wants to be here. But if they have to come into residential care this is the best place - they couldn’t be in a better place than here”. Other people told us Mount Tryon was “the best home” they had seen, and said “we are always happy to visit and are always made welcome”.

One person said “I get out and about quite often and sometimes go swimming”, and another that “I very rarely get bored. There’s always a lot going on”. Sensory objects and reminders were situated in the dementia care unit, including objects to touch and hold as well as those to provoke memories.

We found that overall people's medication was managed well, and the home's records were kept up to date and secure. We found that the home was clean and workers understood cleaning and maintenance schedules to keep it so. They had access to equipment to control the risks of cross infection.

However we found we had some concerns over the way people with impaired capacity were involved in making decisions around their care or how other people made decisions on their behalf regarding their care.

The home was last inspected by the Care Quality Commission (CQC) in April 2012 and action was required relating to standards of staffing and management. We followed up on the improvements made by the provider at this inspection. We (the CQC) spoke with two people, two relatives, the manager and four staff. We also observed the lunch time period.

We spoke with one person and two relatives about staffing levels. One relative said there “could always be more staff” in any care setting but there were enough staff “most of the time”. The person we spoke with agreed with this opinion and added “95% of the time they’re alright”. Another relative said that at the majority of time there were enough staff. They added that “Things are a lot better.”

At our last inspection in April 2012, 50% (30 of the 60 staff) were up to date with mandatory training. At this inspection we were shown a report which showed that 67% of staff were up to date with mandatory training. We were told that, as part of the New Year budget, training hours had been increased from 14 to 30 hours per week. The manager gave an assurance that the 85% target for training would be met by the end of March 2013.

We reviewed the complaints records and saw that both formal and informal comments and complaints had been recorded. Records clearly showed the action taken. One relative said “Things have improved greatly.” One person said they took any “concerns” to the senior nurse and they were “sorted”.

We (the Care Quality Commission) spoke to seven people, three relatives and seven staff. We also used the Short Observational Framework for Inspection (SOFI). SOFI was a specific way of observing care to help us understand the experience of people who could not talk with us. We also looked at seven care plans.

A person’s relative told us that the co-ordination of their family member's move from hospital to the home had been “excellent” and that the home had responded very well to day to day changes in their condition.

One relative said “The nurse who has just gone in is terrific; my mother trusts her implicitly and she is so committed. All the staff are OK, but some are less committed.”

Two people told us that although the care in the home was generally very good they had specific concerns re maintenance of oral hygiene, with dentures not being properly cleaned or relatives taken to the dining room without teeth in. They stated that when they brought this to the home’s attention things improved temporarily, but that it was not sustained. Two relatives said they regularly had to raise the same concerns.

Two relatives who were helping at lunch time were not confident that their relative would be helped to eat if they were not present.

One person when asked if there were enough staff to meet their needs said “the staff are short at times” and “they take a long time to answer the call bell, sometimes”.

A good standard of cleanliness was seen throughout the home and the premises were well maintained. The maintenance person had won an award given by the organisation for the best standard of maintenance in the south west in 2012. People benefited from suitable premises and grounds.

Staff were not up to date with mandatory training.

This unannounced inspection took place on 20 and 22 January 2016. We arrived at the service at 6.20am on 22 January 2016 to ensure we could inspect the night shift. The inspection was a focused inspection in response to receiving concerns about staffing levels and the high use of agency staff and staff lacking the knowledge to meet people’s needs safely. At our last inspection in October 2015 Mount Tryon was rated as ‘requires improvement’ with breaches of safe care and treatment and governance arrangements. The provider sent us an action plan which said the actions would be completed by March 2016. The rating for this service has not changed as a result of this inspection.

Mount Tryon is a care home with nursing for older people, people with a physical disability, people with dementia and younger adults. It is registered for a maximum of 59 people. The home has a dementia care unit situated on the first floor level, with people needing more general nursing or personal care on the ground floor. At the time of our inspection there were 41 people living at Mount Tryon.

There was not a registered manager in post at the time of our inspection. However, the manager who took up their position in October 2015, had recently had their fit person interview with the Care Quality Commission and would be registered. 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.

Staff working at Mount Tryon were supported by agency staff, whilst recruitment of permanent staff was on-going, and to cover sickness. Agency staff identity checks and inductions were not always robust. However, these staff always worked alongside regular staff. Health and safety inductions were being implemented by the second day of our inspection and improvements had been made to system for checking the identity of agency care staff coming into the service.

People using the service and their relatives felt people’s needs were met by staff. We observed people’s needs were met promptly when assistance was required. Staffing levels had been increased to meet people’s needs and further changes were due to be implemented around mealtimes to ensure people received the support they needed in a timely and person centred way.

Risk management was robust to ensure people’s needs were met safely.

We recommend the deployment of staff at mealtimes is reviewed in order for people’s nutritional needs to be met promptly and to improve the mealtime experience.