This unannounced inspection was conducted on 25 July 2017.

Situated in Birkdale and located close to public transport links, leisure and shopping facilities, Tudor Bank Nursing Home is registered to provide accommodation for up to 46 younger and older adults who have mental health needs and require nursing or personal care. The location has a specialist unit for people living with dementia. It is a large three storey property which is fitted with a passenger lift. All the bedrooms are currently in use for single occupancy and have hand-basins.

At the time of inspection 18 people were using the services for younger people with mental health conditions and 24 people were using the dementia services.

A registered manager was 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.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

People and their relatives told us that the service at Tudor Bank was safe. Staff were deployed in sufficient numbers to monitor people’s safety. We asked people living in the home and their relatives about staffing levels. Everyone said they thought there were enough staff on duty to meet people’s needs and keep them safe. We saw that staff were not rushed and were available to monitor and provide care as required. Staff were recruited in accordance with a robust procedure.

We saw that people were protected from the risk of abuse or harm because staff knew people well and were vigilant in monitoring risk. Risk assessments had been regularly reviewed and changes applied where necessary.

Medicines were safely managed within the service by nursing staff and in accordance with best-practice guidance for care homes. We checked the storage, administration and record-keeping for medicines and found that stock levels were correct and records were completed correctly. We noted one stock error which had been caused by a labelling mistake at the pharmacy. This was addressed immediately by staff.

Safety checks had been completed as required. Safety certificates were up to date although there had been a slight delay in the gas safety check caused by a late cancellation by the contractor. This was addressed during the inspection and no issues were identified.

Staff were trained in subjects relevant to the needs of people living at Tudor Bank. This training was refreshed on a regular basis.

People’s capacity was assessed and consent sought in accordance with the Mental Capacity Act 2005 (MCA). This process included the use of best interest decisions for example, in relation to end of life care.

People were supported to maintain a varied and healthy diet in accordance with their preferences and healthcare needs. The service operated a menu which offered good choice.

We saw from care records that staff supported people to access a range of community based healthcare services on a regular basis. Some people were also supported to access specialist healthcare services where there was an identified need.

Part of Tudor Bank was specifically adapted to meet the needs of people living with dementia. Adaptations and décor had been developed with the support of information from Stirling University which specialises in understanding dementia and the care of people living with the condition.

Throughout the inspection we saw that staff were exceptionally caring in their approach to the provision of care. People living at Tudor Bank, their relatives and professionals were extremely complimentary about the quality of care provided and the positive impact that the service had on people’s lives. The relatives that we spoke with were equally clear

This unannounced inspection was conducted on 11 August 2015.

Situated in Birkdale and located close to public transport links, leisure and shopping facilities, Tudor Bank Nursing Home is registered to provide accommodation for up to 46 younger and older adults who have mental health needs and require nursing or personal care. The location has a specialist unit for people living with dementia. It is a large three storey property which is fitted with a passenger lift. All the bedrooms are currently in use for single occupancy and have hand-basins. Two of the bedrooms where suitable for shared occupancy.

The location offers two services:

• Services for younger people with mental health conditions.
• Services for older people requiring nursing and personal care including people living with dementia.

At the time of inspection 36 people were using the service.

A registered manager was 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. All staff spoke positively about the influence of the registered manager.

There were sufficient numbers of staff available to meet the needs of each person living at the home. There was a programme of staff training available, which included general health, social care and specialist topics relevant to the needs of the people using the service. Staff were recruited subject to satisfactory references and appropriate checks being completed.

At the time of the inspection two magnetic door closure devices were not operating. Wedges had been used to keep these doors open. The registered manager took immediate action when alerted to the matter.

Systems were in place for people living in the home, their relatives and staff to raise concerns. Evidence of appropriate and timely responses to issues raised was provided. The provider had received one formal complaint in 2015. The provider shared documents which demonstrated that they had listened to and acted on concerns and complaints. There were systems in place to engage with people using accessible communication.

The service had a system for the ordering, storage, administration and disposal of medication and conducted regular audits and checks. Medication was administered safely in accordance with this system.

Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority. Some people had a deprivation of liberty safeguard (DoLS) plan in place. Staff sought people’s consent before providing routine support or care.

Individual dietary requirements were met through the production of personalised menus. This was documented in care files.

People had access to a range of primary health care and specialist services, such as GPs, dentists and mental health teams.

People were supported with dignity and respect throughout the inspection. Staff spoke to them before providing care and checked that people understood what this meant. Staff demonstrated awareness of the needs of the people and interacted with them in a professional, caring and courteous manner. Each person had a nominated key-worker.

Each person was supported to be as independent as possible through a process of positive risk taking. Appropriately detailed risk-assessments supported this process. The service had supported people to move-on to alternative provision.

People had private space within the service and staff were respectful of this when engaging with them.

Relatives and friends were free to visit the service without any obvious restriction other than at mealtimes which were protected for the benefit of some people living in the home.

Systems were in place to encourage people to discuss any concerns with staff. Changes to care plans demonstrated that the provider had responded to people’s preferences and changing needs. The service had systems in place to monitor and support quality assurance.

The accommodation was decorated and furnished to a high standard. People had chosen to decorate some areas according to their personal preference. Shared areas were bright, clean and uncluttered.

The provider had appointed an activities coordinator who had successfully developed a range of individual and group activities for people to access.

This was an unannounced inspection of Tudor Bank Nursing home. The inspection set out to answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found there was sufficient staff on duty to meet the needs of the people who were living at the home. Systems were in place to check the environment was safe. Arrangements were in place to monitor accidents and incidents on a monthly basis.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection one of the people who lived at the home was on a Deprivation of Liberty Safeguards (DoLS) plan. The manager and staff had a good understanding of the Mental Capacity Act (2005). Some people were receiving their medication without their knowledge and these best interest decisions had been agreed with each person’s doctor.

Is the service effective?

People were satisfied with the care they received and said their needs were being met. Everybody we spoke with was pleased with the care and support they received. They said staff supported them if they needed to see a health professional, such as a doctor or dentist. Comprehensive and personalised care plans were in place for each person. Care plans were reviewed each week to ensure they were current.

People told us they were satisfied with the food and menus. Any suggestions about changes to the menu were listened to and acted upon.

Is the service caring?

People told us the staff were approachable and responsive if they needed support with a task or activity. One of the people living there said, “The staff are nice. They help with anything you need.” Throughout the day of the inspection we observed care staff engaging with people in a positive, respectful and individualised way. Staff had a good knowledge of each person’s needs.

Is the service responsive?

People were involved in decisions about their care and they received a copy of their care plan. They told us they had access to recreational and social activities, including activities within the home and trips out to the local community.

Is the service well-led?

The home had systems in place to regularly monitor the quality and safety of the service provided. People who lived at the home and their relatives had the opportunity to provide feedback about the home by completing an annual questionnaire. Meetings were held each week at the home so people could mention any concerns they had and suggest how the service could be improved.

Staff we spoke with said they felt well supported by management. They told us they received good quality training and had an annual appraisal.

People we spoke with said they were looked after well and felt safe living at Tudor Bank. Some people were unable to verbally communicate with us; however we observed members staff being sensitive, respectful and attentive to peoples needs. One person living at Tudor Bank said, “I have no complaints and I feel safe living here” and “The staff are very good.”

One visiting relative told us, “I can’t fault it here. The staff are helpful and very nice” and “I feel that (name) is safe here.”

The care records we observed were well organised and included detailed assessments of individual’s needs, risk assessments and strategies to manage those risks.

During our visit to Tudor Bank a pharmacist inspector carried out a medicines inspection. It was found that the home had systems in place for the safe administration of medication. The pharmacist inspector looked at the personal care and treatment records of eight people who use the service, spoke with Registered Nurses, care workers and people living in the home.

We saw that staff had been provided with up to date and relevant training, which helped to ensure that members of staff were suitably trained and skilled to meet people's needs.

People who lived in the service told us that they made choices their day to day lives. One person told us he regularly went out into the community, to the local supermarket, café or the pub for lunch. Relatives spoken with told us that they were happy with the care and support their relatives received. They told us that they were always made to feel “welcome” in the service and were kept up to date about their relative’s needs.

On checking medication management we found that people received their medicines as prescribed. Records regarding medication were completed correctly.

We observed staff interacting with people who lived in the service during our visit. We observed some examples of where staff supported people well, such as acknowledging anxieties and attempting to reassure them. We spoke with two relatives of people living in the home during our visit who told us, “You only have to ask staff for something for your relative and it gets done” and “My relative receives good care here.”

When we arrived at the home we were pleased to be greeted at the front door by a resident. The resident showed us where to sign in and introduced us to the manager. We told the resident about our inspection and he said, ‘’You will not find any problems here!’’

Throughout our visit we saw residents moving freely around the home and coming and going. One resident told us he was on his way out to meet a friend, he said that this was something he liked to do regularly.

We found the atmosphere of the home was very relaxed and homely and residents appeared to be content and comfortable. We spoke to a number of residents during our visit and received some extremely positive feedback about the service provided at Tudor Bank. People expressed satisfaction with all aspects of life at the home and were happy with the standard of care they received. Comments included;

‘’They (the staff) are always good to me.’’

‘’We are lucky here – everyone is really nice.’’

‘’The carers are ever so good. They bring me a nice cup of tea to cheer me up.’’

‘’I like the food we have some nice things.’’

‘’We have a lot of activities – they are all on the board so we know what’s happening.’’

‘’The cleaners keep it nice, it’s always nice and tidy.’’

We were also fortunate enough to speak to some visiting relatives during our inspection. Again, we received some very positive feedback and relatives expressed satisfaction with all aspects of their loved ones’ care. One relative commented ‘’They cannot do enough for you here – and there is always someone to speak with if you have any concerns.’’

Another relative told us he was delighted with his loved one’s care. He told us that his relative was very settled and content at the home. He went on to explain that the home had supported her to reduce her medication and that she had benefited from this greatly. ‘’She seems so much brighter now, but really calm as well,’’ he said.