This inspection took place on 24 November 2017 and was unannounced. At the last inspection completed on 6 December 2016 we rated the service as requires improvement. We found the provider was not meeting all the requirements of the law. The provider had not ensured people's medicines were available in sufficient quantities and pre-employment checks were not always completed before new staff started work. We asked the provider to submit an action plan outlining how they would make the necessary improvements. During this inspection we found improvements had been made and the provider was meeting the regulations.

Trentside Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Trentside Manor Care Home can accommodate 36 people in one adapted building. At the time of the inspection there were 31 people living in the care home.

There was a registered manager in post at the time of the inspection. 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 protected from avoidable abuse and harm by trained staff. Risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were managed safely and were kept clean and tidy. Staffing levels were sufficient to meet people’s needs and new staff had their suitability to work in a care setting checked before they began working with people. Medicines were managed safely. The registered manager had systems in place to learn when things went wrong.

People were supported by trained staff and received effective care in line with their support needs. Staff received regular supervision and observations of their competency. Staff meetings were organised. 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 support this practice. There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs. The environment was designed to support people effectively. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.

Staff were kind, caring and compassionate with people. Relatives visiting the home were welcomed and staff had good relationships with people and their relatives. People and their relatives were supported to express their views and encouraged to make decisions about their care. People were treated with dignity and respect.

Staff understood people and care plans were detailed and provided comprehensive information about people, their personal histories and preferences. Activities were organised by staff, however people felt more could be done to occupy their time. People’s cultural needs were considered as part of the assessment and care planning process. Where required people received support to consider their wishes and preferences and receive support at the end of their lives. Complaints were managed in line with the provider’s policy.

A registered manager was in post and was freely available to people, relatives and staff. People and their relatives were involved in discussions about the service and their feedback influenced developments. We found the registered manager had systems in place to check on the quality of the service people received and use this to make improvements. The registered manager monitored the delivery of peoples care.

Our inspection took place on 6 December 2016 and was unannounced. We last inspected this service on 6 August 2014. At our last inspection completed in August 2014 we found the provider was not meeting all of the standards we inspected. We found people were not always protected from the risks of unsafe or inappropriate care and support as care records were not being consistently maintained. We asked the provider to submit an action plan outlining how they would make the necessary improvements. During this inspection we found improvements had been made, however further improvements were still required.

Trentside Manor provides accommodation and personal care for up to 36 older people who may be living with dementia. At the time of the inspection there were 31 people living at 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.

We found the provider was not meeting all the requirements of the law. The provider had not ensured people’s medicines were available in sufficient quantities. This meant that people did not always receive their medicines as prescribed.

People were not always supported by staff who had pre-employment checks completed before they started work.

People were supported by a staff team who knew how to keep people safe from the risk of potential harm or abuse. People’s risks had been assessed and staff were working in ways to reduce these risks.

People received care and support from appropriately trained staff who received support to effectively carry out their role. People were asked for their consent to care and support and the principles of the Mental Capacity Act 2005 were understood and applied. People were provided with choices of food and drink and specific dietary requirements were met. People were supported to access healthcare services when they needed to. People were supported by a staff team who were able to recognise changes in people’s health and well-being and knew how to respond appropriately.

People were treated with kindness, and were supported by staff who maintained their privacy and independence. People were supported to maintain relationships that were important to them.

People were supported by staff who had a good understanding of people’s care and support needs and preferences. People and their relatives were encouraged to be involved in the planning and review of their care. People had opportunities to engage in activities they enjoyed.

Systems to monitor the quality and consistency of the service were not always effective at identifying concerns or required improvements. People and their relatives we spoke with told us they knew who the registered manager knew how to raise concerns or complaints. People, relatives and staff were provided with opportunities to give feedback on the service, and feedback was used to make improvements.

We found that the provider was in breach of one regulation under the HSCA 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection was unannounced. This meant that the provider did not know that we were coming. We started our inspection at 7am as we had received a concern that people who used the service were being made to get up early against their wishes. We also wanted to see whether the provider had made any improvements to the service since our last inspection.

As part of the inspection we asked the following questions we always ask:

Is the service safe?

We saw that people had risk assessments in place and staff were aware of people's individual and specific needs. Some care records were out of date and the provider will need to ensure that these records are reviewed more often to ensure that they are accurate and reflect people's current needs. Records relating to the administration of controlled medication had not always been maintained as required in order to ensure that people were protected from harm.

Is the service effective?

The people we spoke with felt that their needs were met very well by the staff at the home. A person said: "This is by far the best home x has been in. The care x receives here is excellent." Staff were attentive to people's needs. Another person told us: "The staff look after us very well. Nothing is too much trouble here."

Is the service responsive?

We saw that the provider responded to the needs of people and involved other health professionals where required. We met with two health professionals - a district nurse and a phlebotomist during the inspection. They were both complimentary about how the staff worked with them to support people who used the service. They said that the manager and staff made appropriate referrals where required.

Is the service caring?

People who used the service felt that staff were caring. One person told us: "The staff are lovely here they really care." Visitors also told us that they thought the staff were caring. One visitor said: "The staff are great here they are very caring and respectful with people." During the inspection we observed staff to be caring, compassionate and attentive to the needs of people. We saw that staff treated people with dignity and respect.

Is the service well-led?

We did not review the outcome relating to management and quality monitoring during this inspection. The registered manager had been in post at the home for several years. People who used the service and visitors told us they thought the manager was approachable and efficient. Staff who worked at the home said they felt supported by the manager.

During our inspection we spoke with 10 people who used the service and one person’s relative. We also spoke with three members of staff and the registered manager. People who used the service told us they were happy with the care. One person told us, “I’m very happy with everything and I can’t fault anything. You won’t get a better place than here”. Another person told us, “I think we are well looked after here and the staff are very good”. One person’s relative told us, “The girls are lovely and the care is second to none. It’s absolutely superb”.

People told us they were involved in making choices about their care and support, and we observed staff responding to and respecting people’s choices.

Staff worked with other professionals and other services to ensure that people’s health and wellbeing needs were addressed.

We saw that there were enough staff on duty to enable them to meet people’s individual needs and provide compassionate care in a responsive and timely manner.

We saw that the safety of the premises were monitored and maintained and the care environment was suitable to keep people safe.

We saw that people’s care records contained assessments and plans outlining how people’s needs needed to me met, but care records did not always contain up to date information.

In this report the name of a registered manager, Mrs Kerry Rowson appears, who was not in post at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our inspection we spoke with four people who used the service and two relatives. People told us they were happy with their care. One person said, “The staff are all very nice, helpful and polite”. Another person said, “I’ve been very comfortable here”. Relatives we spoke with told us they were happy with the care. One relative said, “Everyone is treated individually” and “It’s such a homely atmosphere”. Another relative said, “The manager has put a lot of goodness into the home. And I can see that the proprietor is putting money back into the home”.

During our inspection we saw that people were supported to make decisions and when people were unable to make decisions for themselves the provider acted in accordance with legal requirements.

We saw that people received care in a positive and caring manner by staff who had received training to enable them to meet people’s needs.

We saw that people were protected from the risks of abuse because the staff had received the necessary training to identify and report safety concerns.

We found that there was an effective system in place to manage and respond to complaints. The service demonstrated that they had learnt from complaints and had improved quality as a result of this.

We last visited this service on 22 February 2011 when we found that some improvements were needed in areas of care and welfare, management of medicines and monitoring service quality. We made three compliance actions and subsequently received an improvement plan from the provider telling us what actions would be taken to improve the service.

The purpose of this visit was to check that the improvements had been made.

Two people told us that they were happy living at Trentside Manor. One person said "The staff are really good to us and the food could not be better". Another person said "I like being in the lounge where I can talk to people, I don't like being alone in my bedroom. I have a friend and we sit together and chat".

A visiting district nurse talked positively about the improvements that had been made at Trentside Manor since our last visit in February 2011. She said that there had been considerable benefits to people in the home.

The local authority told us that the improvements they had asked for earlier in the year had all been satisfactorily completed and had improved the service for people using the service.

People told us that they were satisfied with the service and had no complaints. Comments included “yes, they look after us well here”. They told us that the doctor was called if they felt unwell one said “I know if I don’t feel well staff will call the CP, there is no hesitation”

They said that they enjoyed the food at Trentside Manor, there was a variety and choice of food and there were no dishes they did not like. They said the food was well cooked and presented by staff. People told us they could have meals delivered to their bedrooms if they wished – we saw an example of this during our visit.

People were very positive in their comments about staff.

We asked people if they felt safe at Trentside Manor, they replied that they did, one person said “Staff look after us really well”.

People told us they liked the additional communal and lounge space the new extension had provided. A person in her bedroom told us that she liked to spend a lot of time in her bedroom during the day, it was “bigger, brighter and I have my own toilet – it is a lot better for me”.