This unannounced inspection took place on the 23 and 24 February 2017. The service was last inspected in December 2015 where we identified that the service required improvement in safe and effective. Tudor House provides accommodation for a maximum of 23 older adults some of whom are living with dementia. There were 21 people living at the home at the time of the inspection and one person was currently in hospital.

The service has a registered manager although they were absent from work at the time of the inspection. Management cover was being provided by the deputy manager who was present throughout our 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 told us they felt safe living at the home. Staff had knowledge about safeguarding procedures and action they would take should they have concerns.

People received their medicines safely. We saw staff seeking consent from people before supporting them with their medicines. Staff had received training to enable them to support people with their medicines safely.

Most of the people living at the home thought there were enough staff available to support them and we saw staff were always available in communal areas of the home.

People had the opportunity to feedback their preferences for food which were incorporated into menu planning. People told us they enjoyed the foods they were offered. People received appropriate support to have their healthcare needs met.

People were offered choices in many aspects of their care.

Some people at the home were living with dementia. Staff had some understanding of how to support people with this condition although some practice we saw did not promote good dementia care. There were limited aids or resources available to support people with dementia.

People living at the home felt cared for. People had been involved in developing a plan of care that stated how they preferred to be supported. Staff knew people well and understood people’s likes and dislikes.

People were treated with dignity and in the most part consent was sought from people before supporting them. Some people living at the home were encouraged to remain independent.

We saw that people had access to some activities that were of interest to them. We found that at times there was limited interaction or activity with people living at the home. Further plans were in place to improve the provision of activities at the home.

People and relatives felt able to raise any concerns or complaints they may have. There were systems in place for people to raise concerns or complaints.

People and their relatives were happy with how the service was managed. Staff felt supported in their roles. There were systems in place to monitor the quality of the service although we found they were not always effective or robust. We identified two safeguarding concerns that had not been identified or actioned by the management of the service. Following the inspection the management of the service contacted us to inform us of action they had taken to address these concerns.

We visited this service and talked with people to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. There were 22 people living in the home at the time of our visit.

We spoke with four members of staff, the manager and six of the people who lived in the home. We observed how people were cared for and how staff interacted with them to get a view of the care they experienced.

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed the interactions between the people who lived in the home and staff. People looked at ease in their surroundings. Staff spoke with them in a calm and friendly manner. There were enough staff on duty to meet the needs of the people who lived at the home.

We saw there were systems in place to ensure people received their medicines safely and as prescribed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. No applications had been made. The manager understood how this legislation applied to people and protected their rights.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at necessary risk.

Is the service effective?

People's care and health needs were assessed and planned for. Specialist pressure relieving, mobility and equipment needs had been identified in care plans where required.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

The people who lived in the home confirmed that they were able to visit with people in private and that visiting times were flexible.

We saw that systems for monitoring people’s weights and following up on any weight loss were not always effective. This meant that people were at risk of not having their needs adequately met.

Staff training was sufficient to meet all the needs of people using the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were available at all times, showed patience and gave encouragement when supporting people. One person told us, “I wouldn’t be able to live if I wasn’t here. If I call for them (the staff) they come.” Another person said, “I like it here.” A relative told us, “They are marvellous here, I have no concerns.”

People using the service, their relatives, friends and other people involved with the service completed regular satisfaction surveys. The suggestions and ideas voiced by people were followed up.

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

Is the service responsive?

People's needs had been assessed before they moved into the home and care plans reflected people's assessed needs. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

Records confirmed people's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to some activities and were able to maintain relationships with their friends and relatives.

Records showed that staff responded quickly to changes in people's health. We saw people had access to a variety of health care providers to ensure their needs could be met. One person told us, “I am seeing the nurses every day to dress my legs.”

Is the service well led?

The registered manager had been in post for some time. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There were systems in place so people who lived in the home could share their views about how the home was run. The manager was able to give us examples of actions taken and changes that had been made as a result of listening to the people living in the home.

There were systems in place to ensure the quality of the service was regularly assessed and monitored.

The majority of the required records for the people living in the home and the staff were available. We saw that these records were kept securely. This ensured people’s confidentiality was maintained.

On the day of our unannounced inspection, twenty one people were living at Tudor House Care Home. We subsequently spoke to six people who lived there, four of the friends and relatives, the manager and three members of care staff.

From our observations it was apparent that care staff were attentive, polite and that there were enough qualified, skilled and experienced staff on duty to meet people’s needs.

People were complimentary about the care staff who supported them. Comments included, “I like it very much living here, the staff are great and there’s plenty (of them) here to look after me” and "I wouldn’t want to be anywhere else but here."

People’s needs were assessed and care and support was planned and delivered in line with individual care plans. We found that each person had their own individual plan of care and support which included assessed needs, risk assessments and useful information about any health conditions they had.

People who lived at the home were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Comments received included, “It’s very nice to live here and I feel safe, content and well cared for by the staff.” We noted that most care staff had received training in relation to safeguarding vulnerable adults.

We found that there were good systems in place for assessing and monitoring the performance of the home and for addressing shortfalls.

On the day of our unannounced visit, 21 people were living at Tudor House. We subsequently spoke to five people who use the service, four of their relatives and three members of care staff.

We found the home to be clean, homely and comfortable. Care was provided in an environment that was safe, accessible and adequately maintained.

People were complimentary about the care staff who supported them. Comments included, ”The staff are really lovely” and “I can’t fault them”. From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support. Relatives of people who lived at the home were equally complimentary about the staff and the care being provided.

We examined care plans and found that people’s needs were properly assessed and that care and treatment was planned and delivered in line with their individual care plans. People who used services had given their consent to the care and support they received.

We interviewed care staff and checked their personnel files and training records. We concluded that people who used services were safe and their health and welfare needs were being met by staff who were fit, appropriately qualified and competent.

Examination of records revealed that Tudor House had a complaints policy and that people who use services and those acting on their behalf could be confident that their comments and complaints were listened to and dealt with effectively.

When we visited Tudor House on the 10 and 13 June 2011, we found that people living in the home were at risk from receiving poor quality care due to the lack of care plan recording to meet their needs. There were also shortfalls in the quality monitoring processes in the home. We could not be confident that risks to people’s safety and wellbeing would be responded to.

Following our visit to the home in June 2011, we received action plans from the manager of the home which informed us how they were going to become compliant with the shortfalls we had found at our visit.

We visited Tudor House on the 30 August 2011 and found that work was in progress in making the required improvements. Following this visit, we returned to the home on the 21 November 2011 to check whether the improvements which we had required had now been put in to practice.

We found that improvements had been carried out to ensure people were receiving a safe standard of care to appropriately meet their needs.

We spoke with some people who live at the home who told us they were happy with the care and support they receive. A person enthusiastically shared with us the information staff follow to meet their needs. This person told us that it held details of their preferences so that they receive the right support in the right way.

Throughout the day, we observed staff supporting people with words of encouragement where needed whilst completing tasks. We also identified that time was taken to pass the time of day by general chat between both people living in the home and staff. It was evident that staff had a good rapport with people and it became evident that the manager and staff knew people’s likes and dislikes.

Comments we received from people living in the home included, ‘’It’s lovely here,’’ ‘’Food is nice,’’ and ‘’Staff are nice and friendly.’’

We identified improvements in the management of infection control risks and redecoration had taken place so that the home was a clean, comfortable and pleasant place to live.

There were improvements in providing safe quality care and support, because the systems for monitoring the quality of the service people receive in the home had improved.

We spoke with some of the people who lived at the home and their relatives, whilst we looked around the building. They all expressed their satisfaction with the care they were now receiving as it was improving due to the new manager designate who came to work at Tudor House in April 2011. Relatives told us, ‘’Staff arrange for GP, optician visits’’ and ‘’Tony (manager) always has a few minutes to spare’’.

The people who lived in the home appeared to be appropriately dressed for the time of year and their hair and nails were clean and tidy. We also found that some people were carrying their handbags around the home as they wished. We saw that people’s privacy and dignity was being maintained whilst care workers were assisting people with their daily living activities.

Care workers were seen offering encouragement and support to people who lived in the home with their meals in a respectful way. There was a menu displayed and people had two choices of meals. Care workers told us that people were made aware of the meal choices each day so that could choose what they liked. A person who lived in the home told us, ‘’The meals are good’’ and a staff member said, ‘’Meals a lot better now and people like these. Meals are more nutritious and there is a new menu everyday with the offer of two choices’’.

Care workers told us there were activities each day and a person played the organ so that people could sing along if they wished. We were told that there was a person employed to organise the activities in the home and they worked two days each week. Care workers told us on the other days they "Try and provide activities for people if they have time" and ‘’There is a bit more activities happening now’’. One person told us how they liked to listen to their radio and how their room let in a lot of light from their window which had been cleaned recently at their request. Another person was having a telephone installed and said that they liked their room. A person who lived in the home told us, ‘’Sometimes sit in the lounge area depending upon the activities on offer’’.

We spoke with some people who lived in the home and their relatives who all commented that the manager is improving the way that the home is run to ensure that people’s needs were being met. Comments that we received from relatives included:-

‘’Very nice room which had been decorated’’.

‘’Tony (manager) had tidied up the front garden and furniture has been placed in the garden’’.

‘’If any complaints would speak with Tony (manager) who is accessible’’.

This unannounced inspection took place on the 23 and 24 February 2017. The service was last inspected in December 2015 where we identified that the service required improvement in safe and effective. Tudor House provides accommodation for a maximum of 23 older adults some of whom are living with dementia. There were 21 people living at the home at the time of the inspection and one person was currently in hospital.

The service has a registered manager although they were absent from work at the time of the inspection. Management cover was being provided by the deputy manager who was present throughout our 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 told us they felt safe living at the home. Staff had knowledge about safeguarding procedures and action they would take should they have concerns.

People received their medicines safely. We saw staff seeking consent from people before supporting them with their medicines. Staff had received training to enable them to support people with their medicines safely.

Most of the people living at the home thought there were enough staff available to support them and we saw staff were always available in communal areas of the home.

People had the opportunity to feedback their preferences for food which were incorporated into menu planning. People told us they enjoyed the foods they were offered. People received appropriate support to have their healthcare needs met.

People were offered choices in many aspects of their care.

Some people at the home were living with dementia. Staff had some understanding of how to support people with this condition although some practice we saw did not promote good dementia care. There were limited aids or resources available to support people with dementia.

People living at the home felt cared for. People had been involved in developing a plan of care that stated how they preferred to be supported. Staff knew people well and understood people’s likes and dislikes.

People were treated with dignity and in the most part consent was sought from people before supporting them. Some people living at the home were encouraged to remain independent.

We saw that people had access to some activities that were of interest to them. We found that at times there was limited interaction or activity with people living at the home. Further plans were in place to improve the provision of activities at the home.

People and relatives felt able to raise any concerns or complaints they may have. There were systems in place for people to raise concerns or complaints.

People and their relatives were happy with how the service was managed. Staff felt supported in their roles. There were systems in place to monitor the quality of the service although we found they were not always effective or robust. We identified two safeguarding concerns that had not been identified or actioned by the management of the service. Following the inspection the management of the service contacted us to inform us of action they had taken to address these concerns.