The inspection took place on 17, 18 January 2018, and 5 February 2018 and was unannounced.

Tenterden 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.

Tenterden House Care Home is registered to provide accommodation for up to 40 people who require nursing care. At the time of our inspection, 33 people were living at the service.

The service had a registered manager who was also registered with CQC to manage another service within the same grounds as Tenterden House. 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.

When we last inspected the service on 16 January 2016, we found that the provider was meeting the standards assessed at that time. At this inspection, we found that the provider had made significant improvements, which were innovative and created opportunities to improve people’s quality of lives. The service was not only meeting the standards, but regularly exceeded people’s expectations. We found the management of the service was excellent.

People were kept safe by staff who knew how to identify and report risks and help keep people safe.

Staff received appropriate training and had on-going support from managers to understand and carry out their roles effectively.

People had personalised care plans in place with comprehensive guidance and risk assessments for staff to understand how to deliver care and support to people in a safe and effective way.

Medicines were managed safely by staff who were trained and followed best practice guidance when administering people`s medicines.

People were protected from the risk of infections by staff who ensured the environment people lived in was clean and infection control measures were followed.

There were enough staff to meet people`s needs. Recruitment processes were robust and ensured that staff employed were suitable to work in this type service.

People were central to everything that happened at the service and had a real voice.

People and their relatives were involved in planning and reviewing their care and where possible they signed to agree their care plan. People consented to the care and support they received.

People were able to plan their days as they wished and were supported and encouraged by staff to pursue their hobbies and interests. The management and staff regularly went the extra mile to make things happen for people.

People were asked for their feedback about the service they received in regular meetings and surveys so they could positively influence how the home operated and improved.

People and staff told us they were happy with how the home was managed and they felt managers were approachable and listened to them.

The registered manager and the provider carried out regular audits to ensure they were able to check on the quality of the service people received. The registered manager used innovative ways to make improvements and was continually trying new things to see if it improved people’s experiences.

This inspection took place on 19 January 2016 and was unannounced. Our previous inspection was carried out on 3 February 2015 and we found that the provider was meeting the required standards at that time. At this inspection we found the provider continued to meet the standards.

Tenterden House Nursing Home is registered to provide accommodation for up to 40 older people who require nursing care. At the time of our inspection 35 people were living at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The registered manager is supported by service and assistant service managers responsible for the day-to-day operation of each location where people live and receive care and support.

People were protected from the risk of abuse, because staff had been trained in how to recognise and report potential abuse. Risks were assessed and reviewed and actions were put in place to reduce risks where possible.

People were supported by appropriate levels of staff, and people’s needs were met in a timely way. Staff were recruited through a robust recruitment process and were supported in their roles. They received an induction and ongoing training and had regular supervision with their line managers.

People were supported to eat a varied and nutritious diet and to drink sufficient amounts to maintain their health. People were able to access health care professionals, such as GP’s as and when required. Care was personalised, and people’s individual bedrooms reflected their individuality. People were supported to participate in a range of varied group and individual activities.

The management team demonstrated strong leadership in the home and staff were motivated and valued. There were systems and processes in place to monitor the quality of the service and to make continual improvements.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. At the time of our inspection we found that the provider was working within the principles of the MCA where it was necessary and appropriate to the needs of the people they supported. and the manager submitted DoLS applications which were pending an outcome.

People looked happy and relaxed and we observed positive interactions between people and staff. People were treated with kindness and in a way that respected their privacy and maintained their dignity. People were complimentary about all aspects of the service and in particular the staff who supported them.

There was a positive culture at the home and the ethos was one of an open and transparent approach. The manager was supported by a deputy manager and a clinical services manager and were all seen to be ‘hands on’ having a visible presence throughout the home.  People were supported to give feedback about their experiences and to raise concerns if they were not happy with any aspects of the service. There were various quality monitoring systems in place which were kept under constant review to help with identifying improvements in the home.

This inspection was undertaken on 03 February 2015 and was unannounced. Our previous inspection was undertaken on 19 November 2013, during which we found that all of the regulations were met.

Tenterden House Nursing Home is registered to provide accommodation for up to 40 older people who require nursing care. At the time of our inspection 37 people lived at the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no applications had been made to the local authority in relation to people who lived at Tenterden House Nursing Home.

Where people lacked capacity to make decisions staff had been provided with guidance to ensure their rights were protected in accordance with the MCA 2005. Staff followed guidance and were knowledgeable about submitting applications to the appropriate agencies.

People were happy at the home and staff treated them with kindness, dignity and respect. Relatives were positive about the care and support provided and said that people received safe and effective care that protected their dignity. Staff members were safely recruited and had received the necessary training to give them the skills and knowledge to care for people safely. People had access to healthcare professionals such as GP’s, dentists and chiropodists and were provided appropriate levels of support to help them eat and drink where necessary. Staff helped and supported people patiently and worked at a pace that best suited their individual needs.

There was a calm peaceful atmosphere in the home and staff related to people in a relaxed and positive way. People were supported to follow their own interests and there was a variety of activities offered to provide stimulation and social interaction. We received many positive comments about the management team from people who used the service, their relatives and the staff team. The manager was approachable and communicated well with them. People were encouraged and supported to raise concerns and the manager closely monitored and sought feedback about the services provided to identify areas for improvement and drive forward improvements in the home. There was a positive culture at the home with clear values and philosophies based on person centred care.

People looked well cared for and were appropriately groomed. We noted that people were able to choose where they wanted to be and what they wanted to do. We were shown the policy on “consent” and noted people had been asked to their consent to care treatment and support and this had been documented.

We reviewed a sample of care plans for people who used the service and found that they contained detailed information that informed care staff how to support them. We reviewed the policy for medication and found that the provider had appropriate systems in place to ensure people received their medicines when they needed them.

We were shown maintenance and monitoring records for equipment which was in use at Tenterton house and noted that it had been regularly services and maintained. We reviewed quality monitoring procedure within the home and found that there were several different methods in use to monitor the service and to obtain feedback form people who used the service. Information that was fed back was evaluated and used as a means to improving the quality of care people received.

The people we spoke with told us that they and their relatives had been involved in deciding how they should be cared for and supported in meeting their needs. They also said that their privacy and dignity were respected and that staff were helpful and supportive. The people we spoke with told us that they felt safe and that their welfare was protected. They also said that they were happy with the support, quality of service they received and that they would not hesitate to raise any concerns that they may have.