Tillson House is a residential home that provides care for up to 40 older people, many of whom are living with dementia. At the time of our inspection, there were 38 people living in the home. At the last inspection, in March 2015, the service was rated good. At this inspection we found that the service remained good.

People were safe and their relatives confirmed this. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on going professional development that they required to work effectively in their roles. People were supported to maintain their health and had access to health professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People were supported to make choices and their independence was promoted.

People had detailed care plans in place to enable staff to provide consistent care and support in line with their personal preferences.

The provider's had a complaints procedure, which was followed when a concerns were raised. People felt able to make a complaint if they needed to.

Staff felt supported by a registered manager who was visible in the service. They were clear on their role and the expectations of them as they had received training, guidance and support.

People and their relatives told us that they had confidence in the registered manager’s ability to provide a well-led service. Systems were in place to monitor the quality of the service being provided and to drive improvement.

This inspection was carried out to see if improvements had been made following our inspection of 1 November 2013.

We spoke with eight people using the service and nine members of staff.

We found people experienced care and support that met their needs and protected their rights. One person using the service told us: “It’s nice living here. The staff are looking after me well.” Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found that there were sufficient numbers of staff on duty to ensure people were safe and their needs were being met. One member of staff told us: “There’s generally enough staff on duty and the home runs well. I would recommend Tillson House for a family member to live at.”

We spoke with three people using the service and three relatives visiting their family members. We also spoke with nine members of staff.

We found people were able to make informed decisions about their care and support. One person told us: “The staff always ask for my consent before doing anything with me.” One relative told us that: “The staff are respectful and I am happy with my [family member’s] care.”

We found that care and support may not always be delivered in a way that met people’s needs. Whilst we found people’s care needs had been assessed, we saw some monthly reviews had not taken place. We found that most people using the service had no opportunity to take part in any social or leisure activities.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had systems in place relating to the management of medicines.

Although there was a recruitment and selection process in place, we found that gaps in a person’s employment history were not fully explained.

We found that there were not always sufficient numbers of staff on duty to ensure people were safe and their health and welfare needs were met at all times.

We found the provider had a complaints policy in place. People using the service, and their relatives, told us they were aware of the provider’s complaints policy and how to make a complaint.

We spoke with six people who used the service and seven members of staff. We also looked at four care plans and three staff files.

All the care records had a care and support plan in place. The care records contained risk assessments related to people’s individual needs. All the care records we saw were agreed and signed by the person or a representative. One person told us:” I was visited prior to coming here and I signed the care plan to agree with my care. I had a choice of room and my mobility issues were catered for”.

All the staff we spoke with had a good understanding of the different types of abuse and were able to explain what they would do if they suspected someone was being abused and who they would report to, both within the service and external agencies.

We saw evidence of staff supervision. However we saw that the personal development review (PDR) meetings were out of date. The registered manager had identified a gap in the appraisal process and showed us evidence of an annual planner for 2013, where all supervisions and appraisals were identified throughout the coming year.

We saw evidence of weekly completed quality assurance listening forms. The registered manager explained the people who used the service were asked to comment on aspects of personal care and general feelings about living in the home.

The inspection took place on 5 March and was unannounced. We returned on 28 March, unannounced, because we had received information of concern about staffing levels at the home.

Tillson House provides care and support for up to 40 older adults, including people with dementia care needs. At the time of our inspection there were 38 people using the service. The home is a two storey purpose built building with a number of communal areas and gardens.

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.

Our previous inspection of 13 March 2014 found the provider had met all the regulations we inspected.

People we spoke with told us they were satisfied with the care and support provided and all felt their needs were being met. People had developed good relationships with their care workers and told us they were treated with kindness and respect and felt safe using the service. Relatives we spoke with confirmed this. People told us staff took the time to interact with them and had a good understanding of their individual needs.

Staff were knowledgeable, friendly and accommodating. They understood people’s care and support needs and had taken the time to get to know people’s personal preferences, likes and dislikes. We observed that staff were friendly, kind and treated people with respect.

Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Staff received a thorough induction and on-going training to ensure they had up to date knowledge and skills to provide the right support for people. They also received regular support through the use of staff meetings and supervisions. Staff had confidence in the registered manager.

There were sufficient numbers of staff available to meet the needs of people who lived at the home. Staff responded to people promptly and call bells were answered without delay. People, their relatives and the vast majority of the staff team told us that staffing levels were appropriate at the home. The registered manager was clear that staffing levels were flexible and dependent on people’s needs.

Staff had received training on how to keep people safe from harm and we observed care being provided in a safe way. The registered manager had a good understanding of the local procedures in responding to and reporting allegations of abuse and had ensured that these processes had been followed when required.

The premises and equipment were well-maintained and safe for people who lived there.

Medication was safely stored and administered by trained staff. We found that one persons’ pain relief medication had been missed on the first day or our inspection but appropriate action was taken by the staff team to respond to this.

People’s needs were assessed and plans were in place to meet those needs. Staff understood what people’s individual needs were and acted accordingly. Risks to people’s health and well-being were identified and plans were in place to manage those risks. People were supported to access healthcare professionals whenever they needed to. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided.

The registered manager was clear about the values and aims of the home and was committed to improving the quality of service provided. We saw evidence of improvements they had already made to develop the service. Staff, relatives and people who used the service told us the registered manager was approachable and were confident that any concerns or issues they raised would be dealt with appropriately.

There were effective systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service and monitoring the quality of service provided.

Requirements of the Mental Capacity Act 2005 had been met.