This inspection took place on 26 January 2017 and was unannounced. At our last inspection on 12 November 2015 improvements were required with supporting people with their decision making and monitoring the quality of the service.

TNP House provides residential care for up to 12 older people. Dementia care and end of life care are provided for people who need this support. There were 12 people living in the home at the time of our inspection.

There was a registered manager in post who was also the provider. 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 prescribed medicines but the control of stock required improvement. The provider had not displayed their ratings poster in the correct format and size for people to view. People’s risks had been assessed and their care was planned to reflect this. Staff understood their responsibility to protect people from harm, poor care and abuse and how to report any concerns that arose.

There were a sufficient number of staff to meet people’s needs in a timely manner. There were recruitment processes in place to ensure staff working in the home were suitable to support people in a caring environment.

Staff understood the importance of gaining consent from people and how to support people when they needed help to make decisions. Staff received training and support to ensure they had the right skills and knowledge to care for people effectively. People were offered a choice of nutritious food and plentiful drinks to support and maintain their health and wellbeing.

People had access to healthcare professionals when they needed additional support to preserve their mental and physical health.

People were provided with kind and caring support by staff who were interested in them as individuals. Staff preserved people’s dignity and recognised their right to privacy. Relatives and visitors were welcomed into the home.

People were asked to provide information about their past lives, likes and dislikes to enable staff to provide care in the way people preferred. Staff knew people well and understood what was important to them. There were arrangements in place to provide people with opportunities to spend their time doing activities and hobbies if they wanted to. Staff encouraged people to become involved but respected their decision if they chose not to.

There were arrangements in place for people to raise any concerns, complaints or compliments they wanted to share. People felt comfortable to raise their concerns directly with the provider and were confident that action would be taken.

People and relatives were provided with meetings to discuss what happened within the home and any plans for the future. The provider distributed satisfaction surveys to people, relatives and healthcare professionals to provide them with the opportunity to feedback their opinions of the care that was provided.

There were audit arrangements in place to monitor the quality and safety of the care and home environment.

People, relatives, staff and healthcare professionals felt the home was well-led and the provider/manager was approachable and supportive to them.

This inspection took place on 12 November 2015. The inspection was unannounced and was undertaken by one inspector. At our last inspection on 27 June 2015 we found the provider needed to improve people’s choice of food, the recording of food and fluid intake and ensure people were supported to maintain a healthy weight. This was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

TNP House provides residential care for up to 12 older people who may be living with dementia. 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 were given a choice of food and drinks which met their needs and preferences. Staff did not complete records people's food, drinks and care as it was provided. The registered manager was not monitoring some aspects of care to identify what could be improved and ensure records were completed fully.

Staff understood the importance of gaining consent from people but did not record how they made decisions for people who did not have the ability to do this for themselves.

Staff understood their role in protecting people from abuse and the actions they should take if they had concerns. People who presented with behaviour that challenged their own safety and that of others were supported by staff who understood how to support them with consistency.

People were supported by staff with the skills and knowledge they needed to care for people effectively. Referrals were made to specialist health care professionals to support people’s health and well-being.

Staff were kind and polite to people. Staff recognised people’s individual needs and provided care which met their preferences. People’s dignity and privacy was promoted. People were supported to maintain the relationships which were important to them. People were supported to take part in social activities. If people or relatives were unhappy with the care or service they felt empowered to raise their concerns directly with the registered manager who kept a frequent presence in the home. People, relatives and health care professionals were encouraged to share their views about the home. The registered manager was not auditing some aspects of the care to improve the service for people. The registered manager was not assessing people's level of dependency to plan the number of staff required. Staff felt well supported by the registered manager.

We carried out this inspection in response to concerns that one or more of the essential standards of quality and safety were not being met. At the time of our visit 12 people were using the service. Below is a summary of our finding based on our observations, speaking to people who used the service and the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask:

Is the service safe?

We found there were sufficient numbers of staff on duty to meet the needs of the people using the service. People using the service told us the staff were available to them when needed. One person said; “We are only a small home, so the staff are always nearby if we need them.”

People using the service told us that they liked the staff and that they did a good job. One person said; “All of the staff here are very good, they have the skills and knowledge to look after everyone.” Another person said; “All of the staff are nice, I get on very well with them, we have a laugh and a joke together, it’s very nice here.”

Risk assessments were in place where known and potential risks had been identified, with plans of action to inform staff how risks could be minimised.

Is the service effective?

Discussions with people using the service and information in care records showed that people's needs and preferences were being met.

Everyone had a care plan which informed staff how to meet people's needs. Assessments included people's needs for specialist equipment, mobility aids and dietary requirements.

People spoken with confirmed that staff respected their wishes and supported them as needed. People confirmed that they were consulted about their care plans and involved in decisions about the support they received and records seen demonstrated this.

Where people required their diet and fluids to be monitored the records seen had not always been completed to demonstrate that people’s dietary intake was effectively monitored.

Is the service caring?

We observed positive interactions and conversations between staff and people who used the service throughout the inspection.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People using the service confirmed that staff treated them with dignity and respect.

Is the service responsive?

Records demonstrated that people's health and care needs were addressed promptly and referrals were made to relevant health professionals as needed.

From our observations we saw that people using the service appeared relaxed and comfortable with the staff on duty and were able to openly express their opinions and preferences.

Is the service well-led?

Records confirmed that when issues were identified these were acted upon promptly. This meant that there were processes in place to develop and improve the service people received.

When we visited TNP House in October 2013, we observed that the people who lived there were relaxed and comfortable. Several people had had birthdays and we saw that these were celebrated with the other people in the home, families and staff. Two people spoke with us about their care. One person told us that TNP House was: “Wonderful”. They described the care workers as: “Lovely, kind people”. Another person said that the care workers “Loved them all”. They told us they felt very settled.

This was a follow up visit to review concerns we had when we inspected TNP House in July 2013. At that time we had found a lack of clarity about caring for some people. No ‘best interest’ decisions had been recorded for people who lacked capacity to make decisions about their care. At the same time, the local authority safeguarding investigation team was looking into allegations made about people’s care and safety.

We returned to TNP House in October 2013 to follow up the manager’s action plan for making improvements, particularly to care plans. At this inspection we had no concerns about the clarity of ‘best interest’ decisions made on people’s behalf. We had no concerns about the planning and delivery of care and there was clear guidance for care workers to follow in order to meet people’s needs at all times. We checked and found that all safeguarding enquiries had been closed by the local authority safeguarding team. None of these had been substantiated.

We inspected TNP homecare on a planned, responsive inspection. We had previously received information of concern. The inspection was unannounced which meant the service did not know we were coming. We were supported throughout the inspection by the registered manager.

We spoke with people who used the service, one relative and two members of staff. We had been liaising with the local authority prior to the inspection.

We looked to see if people who used the service consented to their care, treatment and support. We had concerns that the service did not always respond appropriately when consent was required in the change of a person’s care.

We had previously been informed of an accident to a person who used the service which had resulted in a serious injury. We looked to see if people’s care and welfare was being maintained. We found that systems the service had in place were not effective in minimising risk of harm to people who used the service.

During our inspection we became aware of some people who used the service that had suffered abuse through the actions of another person who used the service. We had concerns that the service did not have systems in place to prevent the abuse and had not responded appropriately to the incidents.

We found that the service followed the correct recruitment procedure when employing new staff.

The service had a complaints procedure for people who used the service or their relatives if they had cause to complain.

When we inspected TNP House in November 2012, there were ten people living there. We spoke with the people who lived there and with two people’s relatives who were visiting that day. One person described their growing sense of contentment at TNP House. People’s relatives told us about “the homely atmosphere” at TNP House. They said the staff were “very friendly and very caring”.

We saw that the people who lived at TNP House were treated with consideration and respect. Their right to dignity, privacy and independence was recognised and maintained. We found that care plans were detailed and considered people’s full range of needs. Staff had clear guidance to support them in promoting people’s well-being and keeping them safe.

There were enough staff on duty on each shift. Care workers told us they were well supported. We saw that they had attended regular training relevant to their work, including safeguarding training. The owner of TNP House managed the care people received. She had systems in place to monitor the quality of the service she provided.

People who used the service were able to speak freely to staff and there was a relaxed atmosphere; people laughed, joked and shared humorous events with each other. Staff had developed good relationships with people and spent time talking and taking an interest in people's lives and adventures.

Staff had a good knowledge of the care needed and what people wanted. People who used the service told us the staff knew how to care for them safely and that they felt comfortable when being supported. People said staff were pleasant and treated them with kindness and respect.

People felt they were listened to and staff acted on what they said if they raised any concerns, and were confident their issues would be addressed.

There were two lounge areas and people liked to sit together with their friends. People said they were able to decide which programme to watch, though most people had their own television in their room if they preferred to watch a specific programme alone. People who use the service were able to speak freely to staff and there was a relaxed atmosphere; people laughed, joked and shared humorous events with each other. Staff had developed good relationships with people and spent time talking and taking an interest in people's lives and adventures.

The staff had a good knowledge of the care needed and what people wanted. People who used the service told us the staff knew how to care for them safely and that they felt comfortable when being supported. People said staff were pleasant and treated them with kindness and respect, and told us,

“The staff are very caring and approachable and they know everybody,”

“There always seems to be enough staff on duty, there are always two or three staff here and they are very caring”

“You can always tell them [staff] things, they always sort it out,”

Family and friends could visit the home whenever they wanted to, and family members were able to continue to provide care for a relative and spend time in the home. People told us that they go out to family homes and continue to enjoy family events. There were activities arranged during the week and individuals could choose whether to be involved.

People dressed in their own style and if they needed support, staff helped individuals to apply make-up or to have a manicure. People were encouraged to continue to take pride in their appearance. Staff provided any personal care where required and people in the home were well-presented.

People felt they were listened to and staff acted on what they said if they raised any concerns, and were confident their issues would be addressed.