We carried out this unannounced inspection on 12 September 2017.

Tudor Care Home is registered to provide accommodation and care for up to ten older people who are living with Dementia or who have a physical disability. The home is located on two floors with a stair lift to access the first floor. There was a communal lounge, kitchen and dining room where people could spend their time. At the time of the inspection there were nine people using the service.

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 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 the risk of harm at the service because staff knew their responsibilities to keep people safe from avoidable harm and abuse. Staff knew how to report any concerns they had about people’s welfare.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where risks had been identified, measures to reduce these were in place.

There were enough staff to meet people’s needs. The provider had safe recruitment practices. Staff had been checked for their suitability before they started their employment.

People’s equipment was regularly checked and there were plans to keep people safe during significant events such as a fire. The building was well maintained and kept in a safe condition. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. Staff had been trained to administer medicines and had been assessed for their competency to do this. Liquid medicines were not always dated when they were opened. Staff had not always signed when they had given a person their medicine. There were processes in place to ensure medicines had been given.

Staff received appropriate support through a structured induction, support and guidance. There was an on-going training programme to ensure staff had the skills and up to date knowledge to meet people’s needs.

People were supported to maintain good health and nutrition. People had access to healthcare services. Follow up actions from health appointments were not always recorded.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Assessments of mental capacity had usually been completed. Staff sought people’s consent before delivering their support.

People developed positive relationships with staff who were caring and treated them with respect, kindness and compassion.

People received care and support that was responsive to their needs and preferences. Care plans provided information about people so staff knew what they liked and enjoyed.

People were encouraged to maintain and develop their independence. People took part in activities that they enjoyed.

People and their relatives knew how to make a complaint. The provider had implemented effective systems to manage any complaints they may receive.

Systems were in place which assessed and monitored the quality of the service and identified areas for improvement. These had not always been completed at the required frequency.

Policies and procedures were in place and gave staff guidance on their role. These had not always been updated to reflect current legislation.

People and staff felt the service was well managed. The service was led by a registered manager who understood most of their responsibilities under the Care Quality Commission (Registration) Regulations 2009. Staff felt supported by the registered manager.

People had been asked

This was an unannounced comprehensive inspection that took place on 12 July 2016.

Tudor Care Home is a care home registered to provide accommodation for up to ten older people who are living with Dementia, or who a physical disability. The home is located on two floors. Each person had their own room. The home had a communal lounge, kitchen and dining room where people could spend time together. At the time of inspection there were nine people using the service.

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

People’s medicines were handled safely and were given to them in accordance with their prescriptions. People’s GPs and other healthcare professionals were contacted for advice whenever necessary. Creams and liquids had not been dated when they were opened. We found that staff had not always signed when they had administered medicines. The registered manager told us that checks had been completed to make sure that medicines had not been missed.

Checks and risk assessments to make sure the building was safe had not always been completed. . Evacuation plans had been written for most people, to help support them safely in the event of an emergency.

There were enough staff to meet people’s needs. However, we found there were times when staff were not present in the communal areas. Staff were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction and regular supervision. There was an on-going training programme to provide and update staff on safe ways of working.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that appropriate assessments of mental capacity had been completed for some specific decisions. One person had not been able to consent to a decision relating to their care. We found that the MCA had not been followed for this person. DoLS applications had been made where these were needed. Staff told us that they sought people’s consent before delivering their support.

Systems were in place which assessed and monitored the quality of the service. However, we found that these had not always been completed within agreed timescales.

People were protected from the risk of harm at the service because staff had undertaken training to recognise and respond to safeguarding concerns. They had a good understanding about what safeguarding meant and how to report it.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where people displayed behaviour that may be deemed as challenging the training and guidance given to staff helped them to manage situations in a consistent and positive way that protected the person, other people using the service and staff.

People were supported to maintain a balanced diet and guidance from health professionals in relation to eating and drinking was followed. We saw that people were able to choose their meals and were involved in making them.

People were involved in decisions about their support. They told us that staff treated them with respect. Staff interacted with people in a caring, compassionate and kind manner.

People received care and support that was responsive to their needs and preferences. Care plans provided detailed information about people so staff knew what people liked and what they enjoyed. People were encouraged to maintain and develop their independence. They took part in activities that they enjoyed. People did no

At our inspection we gathered evidence that helped answer our five questions.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five of the ten people who used the service, a relative of one of those people. We spoke with three staff including the registered manager. We looked at two people's care records, staff records and other records including the most recent satisfaction survey of people who used the service.

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

Is the service safe?

People who used the service were safe from avoidable harm and abuse because the provider had effective safeguarding procedures. Staff had received training about safeguarding of vulnerable people and knew how to recognise and report signs of abuse. Senior staff had a good understanding and other staff an awareness of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. This showed that staff understood

how people's safety was respected and their best interests taken into account. The legislation had been correctly applied at the home.

The provider had responded to a recent fire safety inspection. At the time of our inspection, most of the fires safety inspection recommendations had been carried out.

People and relatives we spoke with told us the service was safe. They told us they knew they could raise any concerns if a situation arose where they felt they needed to.

People's care plans included risk assessments associated with people's care and support. This meant that the provider had plans in place to protect people from injury when they received care and support.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how people were supported with their needs. Care plans and records we looked at that showed that people had received the support they required.

Relatives were able to visit the home at times they wanted.

Staff had been alert to changes in people's health and had accessed relevant health services when people needed them.

Is the service caring?

People told us they were well looked after. They told us staff were kind and caring. Our observations of how staff cared for and supported people confirmed what people had told us. We saw that staff engaged with people in a caring and compassionate manner.

People's preferences, interests and diverse needs were respected. People were able to spend their time how they wanted. Staff provided people with meaningful and stimulating activities.

People who used the service had opportunities to be involved in discussions and decisions about their care and support. People were encouraged to give their views about their care and support and their views were respected.

Is the service responsive?

People were supported to be involved, as much as they were able, in the assessment of their needs and their care and support. People's care plans were person centred. People's care plans had been regularly reviewed. People who were able were involved in meaningful activities such as cleaning, laundry and cooking.

People who used the service and their relatives were encouraged to share their views about the service. People's views had been acted upon.

Is the service well-led?

The registered manager had a system for monitoring the quality of service. This included observations of how care staff supported people, unannounced night time spot checks that ensured night staff completed their duties and reviews of care records. The registered manager also carried out environmental checks of the home, for example whether the home had was clean and tidy and free of hazards that could case accidents.

The service had procedures for reporting of accidents and injuries. Reports were reviewed and analysed and action had been taken to reduce the risk of the same type of accident occurring again.

The provider regularly sought the views of people who used the service and their relatives. Their views had been acted on. Staff were able to give their views at supervision meetings and at any time because the registered manager promoted staff feedback.

Throughout our inspection visit we saw staff ask people if they wanted help and assisted when given permission. People told us they were satisfied that staff acted on their requests promptly. They were confident that the staff that supported them understood their needs and provided the care and support that they needed.

People were offered a choice of meals and drinks that suited their preferences and any special diets. Meal times were an enjoyable experience and staff sensitively assisted those who needed help with their meals. One person said: “I’m happy with the meals but I can only speak for myself.” Records showed people’s care and health needs were met by the staff and health professionals.

The service had equipment available to ensure people’s care needs were met and their independence promoted. All equipment within the service was maintained and kept in good working order and staff were trained to use it.

People were supported by staff who underwent a recruitment process, which included pre-employment checks to ensure they were suitably qualified. All staff received training to carry out their job role.

People had opportunities to make a comment and given information on how to make a complaint about the service. People said they were confident to raise concerns with the manager or staff on duty. One person said: “I’d speak to the manager if I had any complaints.”

People who use the service were complimentary about the care and support they received. People told us about the daily lifestyle and interests that they were supported with. One person said “We love the singing café where we do lots of singing and dancing.” Another person said they enjoyed gardening and had spent time potting plants and the hanging baskets.

People had a range of assessments and care plans which detailed the care and support they needed. People were supported to access health care services when required and their health was monitored by staff

People we spoke with were positive about their experiences. People said “I’m very happy here”, “it’s a lovely home” and “I don’t get to see the GP but then I’m alright.”

People were supported by staff that received regularly training, support and supervision.

The provider had an effective quality assurance system, which monitored the day to day running of the service. These included audits and checks on the environment, health and safety. People using the service and their relatives had opportunities to comments and give their views about the quality of services experienced.

We spoke with three people who use the service and a visiting relative. Everyone told us that they were happy with the care and support they received. People said they liked the variety of meals provided and the homely environment they lived in.

People were given information about the home before they moved in and were assessed to make sure their individual care, support and health needs would be met. Care plans are developed with individuals and with their relatives to ensure daily routines and interests are accommodated and respected.

Staff ensure people receive their medication on time. Health needs are met by visiting health professionals. The visiting district nurse was complimentary about the quality of care provided to people who use the service.

Staff encourage and listen to the views and requests made by those using the service and support people in making decisions about their day to day lives.

Staff were observed interacting with people well and providing the care and supported based in individual needs. People are supported to continue their interests and hobbies including smoking in the designated smoking area. Staff encouraged people to engage in social or leisure activities and walks.

People using the service receive visitors at any time and can choose to go out with them.

People who use the service are supported by staff who are qualified to care and meet individual’s care needs.

Some of the comments we received from people who use the service, a visiting relative and the district nurse included:

“Could do what they wanted to”

“I like doing nothing”.

“The staff do respect me and what I want to do”

“The food is quite good”

“I like to have my breakfast when I’m ready”

“Staff are knowledgeable about the people they look after and confident to call us”

“The manager contacted us for training before people moved in, which is really good”

“It’s a nice small home and liked having the shops and park near by”

“Have seen staff encouraging and supporting people, which was good”

“I’ve got no concerns in fact I know he’s happy and cared for here”