This unannounced inspection took place on 05,11 and 13 April 2018. Tallis House 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. A previous inspection, undertaken in June 2016, found the provider was meeting all legal requirements and rated the service as 'Good'. At this inspection, we found some improvements were required.

Tallis House is registered to accommodate up to 101 older people. At the time of the inspection, 96 people were permanently living at the service. The accommodation is spread over three floors.

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 2008 and associated Regulations about how the service is run.

On the day of inspection we saw there was sufficient, suitably recruited staff employed to keep people safe. However, when looking at the provider's falls analysis we identified concerns related to insufficient numbers of staff available to meet people’s needs. The provider responded to this shortfall immediately and increased staff. Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS).

Risks to people were identified and regularly reviewed. Written guidance was provided to staff on how to manage risks to keep people safe. We did note on some occasions additional controls to minimise risk of falls were not always updated in a consistent area within records. Staff had a good knowledge of the risks to people and knew what to do to minimise risk. There was sufficient equipment and measures in place to minimise the risk of infection.

People told us they were safe living at the home and we found safeguarding issues had been referred to the local safeguarding vulnerable adult’s team. Systems in place to reduce people being at risk of potential abuse were robust

Medicines were managed safely and the provider had procedures in place so they were stored securely, administered in line with recommended guidance and recorded.

Staff had access to regular training to support them to maintain and develop their skills and knowledge. The registered manager had planned some additional training to ensure all staff had sufficient knowledge to meet people’s needs. Staff were supported through supervision, observations and appraisals to help them develop professionally.

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. We have made a recommendation the service find out more about training for staff, based on current best practice, in relation to assessing people’s capacity in keeping with the principles of the MCA.

Staff took account of people’s individual needs and preferences and people were encouraged to be involved in making decisions about their care. People were complimentary about the way staff interacted with them. Independence, privacy and dignity was promoted and respected.

Food was of a good quality and people had enough to eat and drink. The service supported people to maintain their health and wellbeing and people were supported to access healthcare services.

The provider had systems in place to monitor the quality of the service. The management team were open and transparent throughout the inspection and sought feedback to further improve the service provided.

This inspection took place on 4 May 2016 and 9 May 2016 and was unannounced.

Tallis House provides a service for up to 101 older people. On the day of our inspection there were 99 people living at 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.

People were safe as the service had comprehensive systems in place for monitoring and managing risks to promote people's health and wellbeing. There were suitable arrangements in place for medication to be stored and administered safely.

There were sufficient numbers of staff with the relevant skills and knowledge to effectively meet people's needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had followed the MCA code of practice in relation to DoLS

People were supported to maintain their health as they had regular access to a wide range of healthcare professionals. A choice of food and drink was available that reflected people's nutritional needs, and took into account their preferences and any health requirements.

Staff had good relationships with people and were attentive to their needs. People's privacy and dignity was respected at all times. People were treated with kindness and respect by staff who knew them well and who listened and respected their views and preferences. People were encouraged to follow their interests and were supported to keep in contact with their family and friends.

The manager promoted an open culture. Staff were clear about their roles and responsibilities and they were able to express their views. The provider and management team had robust systems in place to ensure the quality and safety of the service, learn from complaints and feedback and to drive improvements.

This inspection too place on 26 November 2014 and was unannounced.

On our previous inspection in July 2014, we had concerns about how the service supported staff and with record keeping. The service sent us an action plan detailing how they would be addressing these issues. This inspection found that improvements had been made in these areas.

The service is registered to provide care and accommodation for up to 101 people. There were 98 people living at the service on the day of our inspection. The accommodation is arranged into three units spread over three floors.

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.

The service was safe. Staff were trained to recognise signs of abuse and knew what to do if they suspected abuse. Where people raised concerns about their care and support the service took appropriate action to deal with these. Relatives and/or people’s representatives were consulted where necessary.

The service ensured there were sufficient adequately trained staff to available to provide effective care and to meet people’s needs. However some staff were overdue with refresher training on the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff we spoke with could not tell us how they worked within the principles of the MCA.

The community nursing team were working with the service to reduce the number of hospital admissions by improving care plans and staff knowledge of conditions such as diabetes.

Throughout our visit we observed caring and supportive relationships between people and care staff. People were treated in a caring way that demonstrated a positive caring culture existed in the service.

The service provided group activities for people. However, these were not always tailored to an individual’s needs. We noted that two people were not supported to continue taking part in religious observance as they had prior to moving into the service.

The service demonstrated an open culture with people and staff able to discuss any problems with management. The registered manager was supported by the provider with regular visits from the provider’s representative.

The service had quality assurance systems in place. The providers representative visited the service regularly to carry out their own audits and monitor the quality of care provided.

We spoke with four people who used the service, looked at five care records and five staff files. We spoke with the operational manager, registered manager, two members of staff and a visiting community psychiatric nurse. We considered our inspection findings to answer the 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?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the administrator greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The registered manager spoke to us about The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS). They informed us that they had submitted 15 DoLS applications. This was in response to the Supreme Court Judgement of March 2014. The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We noticed from training records that not all staff had received DoLS training.

We looked at staff training records and saw that some staff were out of date with manual handling, safeguarding and infection control training.

Is the service effective?

We saw that each person’s care records were reviewed monthly. Each plan contained an assessment of need, an evaluation a care plan and a review of care. Some information was recorded twice and could cause confusion unless studied carefully. The service planned for the staff to have regular supervision and a yearly appraisal. Training sessions had been delivered but not all training was up to date for all staff.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. One person told us: “They look after me very well here I have no complaints.”

Is the service responsive?

Each person had a keyworker. We examined five care records of people who used the service and noted that the risk assessments were reviewed and updated monthly. We noted that staff recorded information regarding people’s daily fluid intake but when this was not sufficient there was not a clear plan of action for staff to follow to show how people's need would be met.

Is the service well-led?

The service had worked with other organisations and services such as health and social care professionals to make sure people received their care in a joined up way. Staff members told us the senior staff were approachable and supportive.

On the day of our visit the home was fully occupied with 101 people living at Tallis House. We spoke with 11 of the people who lived there. One person said, "It's brilliant here; I'm well looked after and I can do what I want." Another person commented, "I am very happy with the care on offer here."

Some people were not able to speak with us due to their needs. We observed the care and attention that they received from staff. All of the interactions we saw were appropriate, respectful, and friendly and we found the staff across the whole home to be attentive to the needs of the people on a moment-to-moment basis.

The accommodation was designed and adapted to meet the needs of the people who lived there and risks within the home had been assessed. The home was clean, well maintained and was personalised to the people who lived there.

We saw that support plans and risk assessments were informative and up to date. Staff were aware of their contents, which supported them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment and induction systems were robust. There were enough qualified, skilled and experienced staff to meet people’s needs.

People expressed their views and were involved in making decisions about their care and treatment. During our visit we saw that staff helped people to make choices about the way they wanted to live, how they looked, what food they ate, where they wanted to sit and what activities they wished to be involved with.

People who used the service told us they would speak with the manager or other senior staff if they had any concerns. They said the staff were approachable and they often asked them if they were happy with everything.

Most of the people who live at Tallis House told us that they liked living there but that there was very little to do during the day to occupy them. One person told us that they didn't like Tallis House and that they wanted to go home.

We found that the home was not meeting the identified needs of the people who lived in the home. We found that tasks were put before the immediate care of the people and that people had to wait a long time for their personal care needs to be me, for example, we observed that one person had to wait for an hour to be taken to the toilet because a member of staff was completing paperwork.

We found people on the top floor crowded into one room, the staff did not have sufficient space to move a hoist safely and in a manner that promoted the dignity of the people. There was a larger sitting room unoccupied on the same floor.

We also observed that the majority of people stayed in their own bedrooms with their television on or reading the newspapers. People told us they preferred to stay there because activities were not provided.

We found that there was not enough staff on duty to meet the needs of the people in a person centred manner. We observed care being provided which was led by the need to complete tasks rather than engage with the people to see what they wanted. An example of this was people were taken to the toilet before lunch. They were not asked if they wanted to go nor were they told where they were being taken.

People with whom we spoke said that they were happy living at Tallis House and had choice in their day to day lives. They also said that the staff were "Kind and caring" and that "They would do anything for you". Both the people living in the home and their relatives felt that at times the staffing of the home was an issue.