Talbot House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Talbot House Nursing Home accommodates up to 25 people over three floors. On the ground floor there are three small communal lounges and a dining room that people can use. At the time of our inspection visit, 23 people (some of whom were living with dementia and others had physical care needs) were living there.

This unannounced inspection took place on 24 January 2018. At our last inspection on 21 July 2016, the overall rating of the service was Good. At that time the key question, ‘is the service well led?’ was rated as Requires Improvement. At this inspection, the overall rating of the service remains Good, and improvements were seen in the key question ‘is the service well led?’ However, the key question ‘is the service responsive?’ had deteriorated to Requires Improvement. We have recommended that the provider seeks advice and guidance about meeting the information and communication needs of people with a disability or sensory loss.

People’s communication needs had not been considered within the care planning process, and information was not available in accessible formats. Some people’s care plans did not reflect the person as a whole in relation to their life, and in places information was not as detailed as needed. People had been involved in the initial planning of their care, and were supported to take part in activities and hobbies they enjoyed. People knew how to raise issues or concerns, and these were responded to in a timely manner.

People were safe living at Talbot House Nursing Home. They were supported by staff who understood how to protect people from harm and abuse. Risks were managed and there were enough staff to meet people’s needs. People received their medicines as prescribed and were protected against the risk of infection. Lessons were learnt and improvements made when safety concerns were identified.

People’s needs were assessed and support was given in line with evidence-based guidance. Staff had the knowledge and skills needed to provide effective care for people. People’s nutritional needs were met and they were supported to access healthcare services. 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.

Staff were caring and kind to people, and supported people to make decisions about their day to day care. People’s privacy was respected, and their dignity and independence promoted. People were able to maintain relationships that were important to them and there were no restrictions as to when families and friends could visit.

There was a registered manager in post who had implemented systems to monitor quality and drive improvements within the home. Staff were supported in their roles and encouraged to share ideas to develop the service. The culture of the service was open and transparent and people were encouraged to give feedback about their experience of living or working in the home.

Further information is in the detailed findings below.

This inspection was unannounced and took place on 21 July 2016. The service was registered to provide accommodation for up to 25 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 22 people were using the service.

There was a registered manager in post, however they were not active in this role. A new manager had recently been recruited to replace them. They told us they were going to apply to register with us. 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.

Our last inspection took place on 1 April 2015, and at that time we asked the provider to make improvements to ensure that there were effective systems in place to assess, monitor and improve the quality of care people received. Some improvements had been made, but further improvements were required. Some information was being gathered, but there was limited analysis of any trends that could be used to drive continuous improvement.

Staff also told us they would benefit from further training and development opportunities to increase their understanding in certain areas. Staff supervisions, which may have identified areas where staff needed further support to develop their skills, were not consistently taking place.

At our last inspection, we had also asked the provider to make improvements to ensure that people were not being restricted unlawfully. At this inspection, we found that improvements had been made. When people who lacked capacity were restricted, the necessary authorisations were in place to do this lawfully.

People were safe and protected from harm and abuse. Staff demonstrated an awareness of how to keep people safe. Risks to individuals were assessed and managed. There were enough staff to meet people’s needs and keep them safe. The provider recruited staff in a safe way and people’s medicines were managed safely.

People were supported to make decisions. When people were not able to make certain decisions for themselves, care and support was provided in their best interests. Staff had the knowledge and skills needed to support people. People received food and drink that met their nutritional needs and were referred to other healthcare professionals to maintain their health and wellbeing.

People were treated with kindness and compassion and their dignity and privacy was promoted and respected. People were listened to and were encouraged to be independent and make decisions about their care and support. People were enabled to maintain relationships that were important to them.

People and their relatives were involved with the planning of their care, and were supported to follow their interests and take part in activities. People knew how to raise and concerns and were encouraged to share their views about the service.

There was a positive culture within the service; people and staff spoke positively about living and working there.

This inspection took place on the 1 April 2015 and was unannounced. At our previous inspection in April 2014 we found that the provider did not have systems in place to effectively monitor and assess the quality of service being delivered.

The Service provided accommodation and nursing care for up to 25 people. At the time of this inspection 20 people were using the service.

There was 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.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards are part of the MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. Some people were being restricted of their liberty through the use of bedrails and by being restricted to their rooms. Referrals had not been made to ensure that people were being restricted lawfully.

Although some improvements had been made in ensuring a quality service was maintained further improvements were required. Staff told us that they would benefit from more training and they required further personal development.

People were protected from the risk of abuse from sufficient numbers of staff. The manager and staff knew what constituted abuse and who to report it to.

People had access to a range of health care professionals and were supported by staff to attend health care appointments. Nutritional needs were catered for. People were supported to maintain a healthy diet that met their individual assessed dietary needs.

Assessments were carried out prior to a person being admitted into the service to ensure their individual needs could be met. If a person’s needs changed the manager acted to ensure the appropriate support was gained and that the service still met the person’s needs.

People were encouraged to engage in their chosen hobby or interest. People were happy with the opportunities available to them and were asked their opinion of them. People knew how and to whom they should complain. They had confidence that the manager would act to investigate their concerns.

We visited Talbot House on a planned unannounced inspection, which meant the service did not know we were coming.

We are changing how we inspect services in the future and also making changes in how we report our findings. Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service and their relatives told us they felt safe at Talbot House. One relative told us: “I have booked a holiday, the first for a long time; I know my mother is safe here".

Most staff had received training in safeguarding procedures but we were made aware of some staff who had not received training.

We saw that the home was clean and well maintained. All the people we spoke with told us that this was always the case.

Recruitment procedures were rigorous and thorough.

Is the service effective?

People had access to a range of health care professionals some of which visited the home.

Everyone had a care plan which informed staff how to meet their needs. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

Is the service caring?

Staff treated people with dignity and respect. People’s individual needs and preferences were upheld.

People who used the service told us the staff at Talbot House were caring. One person told us: “They (staff) are very good, very kind”.

Is the service responsive?

People were engaged in meaningful activities if they chose to participate.

Short term care plans were put in place when people’s needs changed.

Regular reviews of people’s care took place, but people that used the service or their relatives were not always involved.

Is the service well led?

Talbot House worked closely with other agencies to ensure people received care in a joined up way.

The service did not have a system to assure the quality service they provided. The way the service was run was not regularly reviewed. We have asked the service to make improvements in this area.

Staff training and supervision was not up to date.

We inspected Talbot House Nursing home on a follow up inspection. At our previous inspection in August 2013 we found that the service did not have suitable bathing facilities. The manager had contacted us to inform us that bathing facilities were now in place so we returned to check. The inspection was unannounced which meant the service did not know we would be coming. We spoke with the manager and people who used the service.

We found that the service had installed a new bath and had redecorated the bathroom.

We inspected Talbot House on a planned unannounced inspection which meant that the service did not know we were coming.

We spoke with people who used the service, staff, two visiting relatives and the manager.

We looked to see if people who used the service consented to their care, treatment and support. We found that the service had systems in place to show that people had consented to their care.

We looked at care records, spoke to people who used the service and observed their care being delivered and found that the service was meeting the care and welfare needs of people who used the service. One person who use the service told us; “They (staff) more or less saved my life”.

We found that most of the equipment used to support people in Talbot House was properly maintained and suitable for its purpose.

We found that the service was following the correct recruitment procedures when they employed new staff.

The service had a complaints procedure for people who used the service or their relatives to use if they felt the need to complain about the service.

We visited Talbot House on a planned unannounced inspection, which meant the service did not know we were coming.

When we arrived people who used the service were getting up or were up and having their breakfast in the dining room or their bedrooms. The dining room was being redecorated and we were told this would be completed in the next two weeks.

People who used the service told us they were happy at Talbot House and that the staff were good.

Relatives of people who used the service said they were happy with the care they received. One person told us they would like staff to have more time to spend with their relative as this person was being cared for in their bedroom.

Staff were observed to generally be kind and caring, although we saw at times staff were supporting people without interacting with them and informing them what they were going to do before doing it.

We had minor concerns about the care and welfare of people who used the service.

People said they liked living at the service and that they liked the staff. People said that they made choices about their life including when to get up, where and what to eat and how to spend their time. A variety of activities were available including individual support for people who spent time in their bedrooms.

People said that staff discussed their care with them and they made decisions about their care. Discussions took place with people who were receiving end of life care to make sure their wishes were known and acted upon.

People were having person centred care. Staff knew about people's needs and how they wanted their care providing. Doctors and specialist nurses visited to provide medical support. People were having eye and dental checks. People were treated with respect and dignity and had their privacy promoted.

Staff received training to undertake their role but records needed to be better kept. Aspects of the care provided were being monitored and checked but this must be further developed to make sure that any areas for improvement are quickly identified and acted upon.