We inspected Tollesby Hall Nursing Home on 22 September and 3 October 2017. The first day of the inspection was unannounced which meant the provider and staff did not know we would be visiting. We informed the provider of our visit on 3 October 2017.

Tollesby Hall Nursing Home provides both personal and nursing care to a maximum of 55 people. The service supports younger adults, people who have a physical disability and older people. At the time of the inspection there were 53 people who used the service.

Tollesby Hall Nursing Home is an established service, which had been previously registered under a different provider. This is the first inspection of the service under the new provider.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a strong presence of health care professional involvement at the service, which ensured people experienced a high level of care and support that promoted their health and wellbeing. People and relatives were extremely complimentary about the care and support received. It was clear from speaking with the registered manager, staff, relatives and hearing from professionals that the registered manager and provider were committed to achieving excellence in the provision of care.

End of life care was exemplary. The registered manager worked closely with other healthcare professionals to ensure people received excellent end of life care. Relatives consistently praised end of life care.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring. Medicines were managed safely with an effective system in place. Staff competencies, around administering medicines, were regularly checked. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained.

People and relatives told us there were enough staff on duty to meet the needs of people who used the service. In general we found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people. We did note some gaps in employment history, however the registered manager and provider had resolved this by the second day of our inspection.

People were supported by a team of staff who were knowledgeable about people’s likes, dislikes and preferences. A training plan was in place and the registered manager monitored this to make sure all staff were up to date with their training requirements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received diets tailored to their specific needs and were able to choose meals of their choice. Staff supported people to maintain their health and attend routine health care appointments.

Relatives and professionals were extremely complimentary about the care provided, particularly about the care people had received at the end of their life. People’s privacy and dignity was respected.

Care plans detailed people’s needs and preferences. Care plans were reviewed on a regular basis to ensure they contained up to date information to enable staff to meet people’s care needs. People and relatives were actively involved in care planning and decision making. People who used the service had access to a range of activities and leisure opportunities. The