The inspection was undertaken on 13 December 2016 and was unannounced.

The provider of Tutnall Hall Care Home is registered to provide accommodation and nursing care for up to 35 people who have nursing needs. At the time of this inspection 34 people lived at the home.

There was a registered manager in post who was supported by a deputy 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.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People told us they were supported in a safe way and had their medicines as prescribed. Since our last inspection in January 2016 we found improvements in the way medicines were stored.

People and their relatives told us they were happy with the care and support provided by staff. People felt staff understood their needs and they felt safe. Staff knew how to report abuse and unsafe practices. Staff were recruited based upon their suitability to work with people who lived at the home.

People were assisted in having enough to eat and drink to stay healthy. People were given choice of meals. Where necessary they were given extra help to eat and drink to stay well. People said they had access to health professionals, and there was a weekly visit from their GP. Relatives had been informed if appropriate and were confident their family member had the support they needed.

Staff knew how to support people when specific decisions needed to be made to meet their needs in their best interests. We saw people were given choices about their care and support. This enabled people to be involved in the decisions about how they would like their care and support delivered.

People told us they were happy living at the home, supported by caring staff. People’s independence was promoted. Visitors were welcome to see their family members or friends when they wanted.

Relatives said they felt included in planning for the care their family member received and were always kept up to date with any concerns. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The registered manager had arrangements in place to ensure people were listened to and action could be taken if required.

There was an improvement in the monitoring of the quality of the care and support delivered since our last inspection in January 2016. The provider and the registered manager had introduced regular assessing and monitoring the quality of the service provided for people. The provider and registered manager took account of people’s views and suggestions to make sure planned improvements focused on people’s experiences.

The inspection took place on 26 January 2016 and was unannounced. Tutnall Hall is a care home and the provider is registered to provide personal and nursing care for up to 40 people. At the time of the inspection 33 people lived at the home.

A registered manager was in post and present during 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.

There were some arrangements in place to assess, monitor and improve the quality of the care but these were not always effective. This is because the checking systems had not identified some areas that required improvement actions to be taken. There were potential hazards which directly placed people’s safety and wellbeing at risk such as the sluice door was left open several times during our inspection. People living at the home may be living with dementia and there was a potential danger they might digest the chemicals.

People’s medicines were not always stored correctly putting people at potential risk.

People were kept safe from potential abuse and harm by staff who understood how to identify the various types of abuse and knew who to report any concerns to. Staff were trained and supported to meet the needs of people who lived at the home. We heard some examples where people’s health and physical needs had improved due to effective staff practices. Checks had been completed on new staff to make sure they were suitable to work at the home.

People were asked for their consent for care and were provided with care that protected their freedom and promoted their rights. Staff asked people for their permission before care was provided and gave people choices about their support.

People enjoyed the food they received and were supported to eat and drink enough to keep them healthy .We noted inconsistency in the records of people’s fluid intakes so it would be difficult to accurately monitor and how this may affect people’s health. When people needed it they had access to a range of healthcare professionals to make sure their nutritional needs were met and they remained healthy and well.

Staff didn’t always treat people with dignity and respect especially over meal times. People’s right to confidentiality was breached.

People were treated as individuals as staff knew people’s needs and their individual preferences. People told us staff responded to their care and support needs at times people needed it and were not kept waiting for unreasonable amounts of time.

People knew how to make a complaint and told us they felt able to discuss any concerns with staff or the registered manager. The registered manager was visible in the home so that people were able to approach them with their concerns and views of their care.

Staff respected the registered manager and felt they were part of an established team. The service benefited from a low staff turnover.

Quality Assurance systems were in place but not always effective, they had failed to identify potential hazards.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection. Tutnall Hall Nursing Home provides accommodation and nursing care for up to 40 people who have nursing or dementia care needs. There were 32 people living at the home when we visited and 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were positive about the care they received and the staff at the home. Their relatives said that they were very happy with the overall care and treatment. Our observations and the records we looked at supported this view.

People told us that they felt safe and well cared for. Staff were able to tell us about how they kept people safe. During our inspection we observed that staff were available to meet people’s care and social needs.

People told us and we saw that their privacy and dignity were respected. We saw that care provided took into account people’s views and input from their relatives. Guidance and advice from other professionals such as social workers had also been included.

The provider acted in accordance with the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. At the time of our inspection there was one person currently being assessed for DoLS.

We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People received their medicines as prescribed and at the correct time. People had access to other healthcare professionals such as a dietician and a chiropodist.

People were supported to eat and drink enough to keep them healthy. People had access to a range of snacks and drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with both internal and external training. Two of the seven staff we spoke with preferred external classroom style learning. The registered manager told us that all staff received an element of this style of training and they were happy to source more of this training.

Staff told us that they would raise concerns with the nursing staff, the duty manager or the registered manager and were confident that any concerns were dealt with.