This inspection visit was unannounced and took place on 31 October 2017. At our last inspection visit in November 2016 we asked the provider to make improvements to the staffing levels. The provider sent us an action plan in December 2016 explaining the actions they would take to make improvements. At this inspection, we found improvements had been made. The service was registered to provide accommodation for up to 24 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 21 people were using the service.

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.

People received their medicines as prescribed and had the opportunity to remain independent with their medicine. As and when required medicine was also available to support people’s pain relief. When people were at the end of their life they had been supported with medicine to ensure they received a pain free and dignified death.

People were supported to make choices and when required, assessments had been completed to ensure decisions were made in people’s best interest. The home had enough staff to support people’s needs. Any staff who had been employed had received a range of checks to ensure they were suitable to work in the home.

The registered manager completed a range of audits to support the improvements within the home. Audits had been developed to increase the responsiveness of actions following accidents and incidents. The provider was involved in a number of pilot studies with the aim of improving people’s experience of care. People had the opportunity to comment on their environment and to be part of the improvements of the home and care they received.

People felt comfortable in the atmosphere of the home and had established positive relationships with people. Staff showed respect for people’s choices. They ensured they maintained people’s privacy and dignity at all times. People were able to choose the meals they wished to eat and alternatives were provided. Referrals had been made to health care professionals and any guidance provided had been followed.

Staff had received training to support their roles. People were offered a range of stimulation and opportunities to reflect their interests and hobbies. Any complaints had been addressed and resolved in a timely manner.

We saw that the previous rating was displayed in the reception of the home and on the provider’s website as required. The registered manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

This inspection took place on 1 November 2016 and was unannounced. At our last inspection in October 2014, the service had one breach of the Health and Social Care act 2008 in relation to records. At this inspection, we found improvements had been made.

There is a requirement for Thomas Colledge House Care Home to have a registered manager and a registered manager was 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 is registered to provide residential care for up to 24 older people some who were living with dementia. At the time of our inspection 21 people were using the service.

Sufficient numbers of staff were not deployed to meet people’s needs. Some people waited for long periods of time for help and assistance from staff. Some people experienced increased risks as they required prompt attention from staff to keep them safe.

Medicines were stored securely and were mostly, but not always well managed. Staff had not always followed the system in place to ensure creams were ordered as required. Medicines were administered and records kept in line with the provider’s policy. Other risks to people’s health, for example from risks of malnutrition and pressure sores were identified and actions taken to reduce those risks.

Most, but not all people were supported to engage in the social atmosphere of the home. Events and activities were supported by family members as well as staff. The registered manager had started to consider what other activities would be of interest to stimulate other people throughout the day.

People were cared for and supported in line with the Mental Capacity Act 2005 (MCA). Applications for Deprivation of Liberty Safeguards (DoLS) had been made when required by the registered manager. However, not all staff knew which people had a DoLS either in place, or where an application had been made.

Staff were recruited in line with the provider’s policy and procedures and checks were completed to ensure staff employed were suitable to work at the service. People told us they felt safe and able to raise any worries or concerns.

People were happy with the meals they received and we saw the menu choices offered were nutritionally balanced. People were prompted by staff to drink regularly.

Other healthcare professionals were involved in supporting people’s health care needs when needed. People had access to a GP and district nurse when needed.

Care plans were developed to include people and their relatives’ views. Care plans were regularly reviewed and people and families felt involved in the process.

Staff provided care to respect people’s privacy and dignity. Staff were respectful and caring when supporting people.

Staff were supported by their line manager and found meetings with their managers useful. Staff were trained in areas relevant to people’s needs and told us they received the support and training they needed to enable them to feel confident in their role.

People were able to have their views listened to, either through meetings with staff or more formally by making a complaint. Where complaints had been made we saw the provider had a policy in place to ensure these were investigated.

The service was managed by a registered manager who was open and approachable. The provider had sent in notifications when required. Notifications are changes, events or incidents that providers must tell us about. The service was developed with the involvement of people and in response to feedback. Systems and processes, such as equipment audits helped to ensure the quality and safety of services. Other systems and processes to ensure good practice were in place, for example infection preventio

At the time of this inspection there were 21 people using the service. We spoke with two of these people and one relative, the manager and two staff working at the service. We also observed people receiving care and examined records at the service. Below is a summary of what we found.

Is the service safe?

People told us that they felt safe living at the service. One person told us, “[Staff] will talk with me while supporting me.” People’s personal files included a range of risk assessments and these included procedures to safely manage risks.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted.

People said they thought that staff were recruited safely and they felt comfortable with them. We read documents that showed appropriate checks being undertaken before staff began work at the service.

Is the service effective?

People told us that staff encouraged them to be as independent as possible. One person said, “[Staff] leave me to dress myself.”

People were involved in planning their care. One person told us, “I attend [care review] meetings.” Staff also confirmed this involvement and one staff member told us, “A manager and key worker will talk to people before their review meeting.” We saw people’s signatures on their personal files, showing their involvement.

We found that people’s personal records had not always been accurate and fit for purpose. We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to ensuring that accurate records are maintained at all times.

Is the service caring?

People’s privacy and dignity were respected. One person told us, “[Staff] knock on my door and wait to be asked in. I have my own [bedroom] door key.”

People told us that staff respected their personal preferences and interests and thought that their needs were being met. One person said, “I go to church every month, with a friend.” Staff confirmed that people’s interests were considered

Is the service responsive?

People told us they felt listened to by staff and there were meetings for the people who used the service. One person told us, “We can speak up at residents’ meetings. We’ve asked for Bingo three times a week rather than twice.” Staff told us they felt listened to by management. One staff member said, “If we think something could be done better, management will listen.”

Staff told us that people’s interests were considered. One member of staff told us, “A female gardener comes in every other week for the gardening club.”

Is the service well-led?

Staff described a sound set of values upon which the service was based. These included providing people who used the service with choice, dignity, ‘friendly care’ and loyalty.

The service had a quality assurance system which identified, assessed and managed risks to people’s health, safety and welfare.

The people we spoke with told us that staff talked things over with them before carrying out their care and asked for their consent before decisions regarding their treatment. One person told us, “I signed a consent form for the ‘flu jab.”

People told us they received their medicines as needed and felt safe and confident with staff administering them. Records confirmed that safe practice was followed.

People thought that staff were well trained to meet their needs. One person told us that the staff had, “good attitudes…[and were] competent. I’d have them through any crisis.” Records showed that most staff were up to date with relevant training.

We saw staff interacting with people and responding to their needs. People we spoke to told us they were treated well and spoke highly of the staff in the home.

Two relatives told us they had chosen the home because of their experience of using the home for respite care. One relative told us his mother had been there for almost three years and that he visited once or twice a week and found the home clean and comfortable with good food. The same person told us that they had attended six monthly review meetings to discuss his mother's care and had agreed how to reduce her risk of falling. He found this reassuring and wanted to attend the meetings to contribute to the discussions about her care.

We met with a community nurse who was visiting the home on the day of our inspection and she told us she thought people were treated with dignity and respect. She described how the home involved her and other healthcare professionals in caring for people.

All of the comments we received from people living at the home and from the relatives we spoke to were very favourable about all aspects of the home’s operation and the comforts and facilities provided through living there.

People gave us very positive reports about the caring qualities of the staff and that they had enough staff to support and meet their needs. A relative, who told us they had been involved in reviews of care, reported very good communication from the home's management team and told us that they were confident that their relative was well cared for.

We observed that a lot of people still retained high levels of independence and they told us were encouraged by staff to continue doing things for themselves where it was safe. They also expressed strong views about being involved in choosing to live at the home and a continued ability to speak out and express themselves. People that we spoke to expressed a high level of satisfaction with the physical standards of the home and that heating, lighting and ventilation were good, as was the provision of furniture and space to move around in. We were told us that various aspects of the building's design encouraged independence and assisted people who had mobility problems to get around.

People living at the home said that they were confident that if they had any problems they knew who how to get something done and were confident that they would be listened to; nobody had made any formal expressions of complaint and described a very open style of management that was there to help them as much as possible.