Tithebarn is registered to provide personal care and accommodation for up to 42 adults. The home is run by The Royal Masonic Benevolent Institution Care Company. The home is fully accessible to people with restricted mobility. Accommodation is provided over two floors, with bedrooms located on the ground and first floor. There is a separate unit specialising for people living with dementia.

This inspection was carried out over two days on 20 and 21 September 2017 and was unannounced. This was the first inspection since the service was registered in 2016.

We found consistently good standards were maintained in the home with many areas of good practice evidenced. This was particularly evidenced with the support for people living with dementia who experienced exceptionally high levels of individualised care which reflected best practice in this area.

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.

We found medicines were being safely managed. The administration records for some medicines such as external applications [creams] and medicines to be given ‘when needed’ [PRN] could be further improved by including more detail.

We looked at how staff were recruited and the processes to ensure staff were suitable to work at The home. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

We found there was sufficient staff on duty to meet people’s care needs.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training in-house. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified.

The home was clean and we there were systems in place to manage the control of infection.

Staff said they were supported through induction, appraisal and the home’s training programme.

People we spoke with and their relatives felt staff had the skills and approach needed to ensure people were receiving the right care. Staff leading in support for people with dementia had been trained to a high level.

There were examples of good practice such as the attention to positive principals of care for people living with dementia. This meant people living with dementia experienced an exceptionally high level of wellbeing and quality of life.

We found the home supported people very well to provide effective outcomes for their health and wellbeing. We saw there was regular and effective referral and liaison with health care professionals when needed to support people. Feedback from visiting health care professionals we spoke with was positive.

People we spoke with said they were happy living at Tithebarn. Staff interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people. We found a caring ethos throughout the home.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made.

When necessary, referrals had been made to support peo