Tuxford Manor is a residential care home registered to provide accommodation and personal care for up to 45 people, 39 people were using the service on the day of our inspection.

At the last inspection on 30 July 2015, the service was rated Good. At this inspection we found the service remained Good.

People continued to feel safe and staff continued to ensure the risks to their health and safety were reduced. There were sufficient staff to meet people’s needs in a timely way and systems were in place to ensure safely received their medicines.

People continued to receive care from staff who had received relevant training and staff felt well supported in relation to their training needs. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make particular decisions. People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people and the staff who supported them. Staff promoted people’s rights to make their own decisions and respected their choices. People were treated with dignity and respect by staff who understood the importance of this.

People’s care records were not always person centred and lacked sufficient detail on people’s differing needs. There were aspects of people’s care that were not always linked in appropriate care plans and this meant staff may not have a full picture of a person’s needs. Despite this staff showed a good knowledge of people’s needs and provided appropriate support for them. People were supported to maintain their interests and knew how to make a complaint to the service as there was a clear complaints procedure in place.

There was an open and transparent culture which enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff. There was robust quality monitoring procedures in place.

Further information is in the detailed findings below.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; 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 used the service, the staff who supported them and looking at records. We also spoke with the registered manager.

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

Is the service safe?

During our visit we spoke with twelve people who used the service and also observed how staff supported people in each part of the home. We saw examples of good care and support during this time. Everyone that we spoke with said they felt safe.

We spoke with three relatives who told us that they were very satisfied with the service provided at the home. One relative told us, “We are quite happy with everything so far.”

The inspection was a responsive inspection following some concerns being raised with us in respect of people who used the service not getting enough fluid and nutrition.

During our inspection we saw that monitoring records were not always completed and information such as how much people had eaten or drank was difficult to gather. There was also some inconsistency in information provided. For example, one person had had a fall yet their daily record stated 'no concerns'. This could mean that staff did not know a person’s care needs.

We saw that risks to people had been assessed and actions planned to reduce those risks were in place. However staff had not always completed records to demonstrate that care and support had been given to keep people safe and well. For example, some people needed to be repositioned regularly to protect their skin and keep them comfortable. We saw some gaps in the record for one person suggesting this had not been done.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to the care and welfare of people who used the service.

Staff told us they were clear about their roles and responsibilities although some staff we spoke with were not sure which resident’s required their fluid and food intake to be monitored and recorded. This meant that the information may not be available to monitor people and ensure they were nourished and hydrated.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to meeting the nutritional needs of the people who used the service.

Is the service effective?

On the day of our inspection we saw that people received appropriate support. People told us that they were cared for in ways that they preferred. One person told us, “They do what they have got to do the way I like it.” A relative told us how the person they visited was getting better and was hoping to return to their own home. This was the person’s goal and the family were very happy that they were achieving it.

Is the service caring?

People were supported by staff who were kind and patient. We heard staff speak with people in a calm and reassuring way. They responded to requests for support in a timely manner. We saw that staff contacted family and health professionals when they had concerns about the health and welfare of the people who used the service. We saw that people were supported with their meals and encouraged to have drinks at regular intervals.

Is the service responsive?

We found that the registered manager actively sought the views and experiences of the people who used the service and their relatives. For example they organised regular coffee mornings for people who used the service, their relatives and friends. The registered manager told us that this informal approach was more effective and was well attended. Staff told us how the registered manager implemented suggestions for improvements. For example, the cook told us that a person who used the service had asked for salmon on the menu and they had provided this.

Is the service well-led?

We saw how the registered manager undertook regular reviews and audits of systems and processes. The registered manager told us that they had effective monitoring tools that reassured them that they provided a good service. They showed us the recent audits for care plans and domestic arrangements. Both identified where improvements were needed and both had an action plan detailing how the registered manager planned to address issues.

We saw how the registered manager had taken action following other internal audits. For example, we saw evidence that when people who used the service had lost weight they were monitored formally and referrals had been made to health professionals.

We used a number of different methods to help us understand the experiences of people using the service, including talking with them and an examination of their care planning documentation. We spoke with seven people who used the service, six people who were visiting friends or family members, three professional visitors to the home, the registered manager and members of the staff team.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found;

• Is the service caring?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. One person told us. "They do a really good job and things are always improving. This manager has made a big difference.”

We observed staff working with people in a professional manner whilst maintaining a happy and informal environment. During our visit we saw that people’s requests for assistance were responded to promptly and people spoken with confirmed that this was the usual practice.

• Is the service responsive?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they had recently had a meeting with the new manager and had been encouraged to express their views and opinions. They confirmed they had been listened to and as a result improvements continued to be made. Staff told us they were clear about their roles and responsibilities.

• Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

People’s needs had been assessed before they moved into the home. People told us they spoke regularly with staff to make sure their care was still appropriate. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We discussed the Mental Capacity Act (2005) with the manager. She told us that if a person appeared to lack capacity to make decisions about their care, family members would be consulted and an assessment would be carried out to ensure that any decisions made, would be in the person's best interests.

• Is the service effective?

People told us that the care that had been delivered to them had met their needs. Records we saw showed us that staff had received training to meet the needs of the people living at the home. There was information within the care plans we saw, that showed people who used the service were referred to external specialists in a timely way, to obtain assessment and treatment required to manage their health and wellbeing.

We spoke with a visiting occupational therapist and a physiotherapist. They told us that staff at Tuxford Manor worked well with them and enabled some people to return to their own home following a period of re-enablement.

• Is the service well led?

One person told us. "They do a really good job and things are always improving. This manager has made a big difference.” A staff member said, “This is now a very good place to work. The manager is always approachable and spends a lot of her time out and about around the home.” Staff told us they had been provided with good training and felt confident about their responsibilities to provide good quality care and support for people in a homely and clean environment. One care staff told us, “Things are improving all the time. I feel well supported by the management and listened to. There is a lot of good training which makes me feel more able to do a good job.”

We used a number of different methods to help us understand the experiences of people using the service, including talking with them and an examination of their care planning documentation. We also spoke with a visitor to the home, the registered manager and members of the staff team.

Records showed that people received assessment and treatment from NHS health care professionals when required.

People who used the service told us they were satisfied with the care, treatment and support they received. One person told us, "It's very good. The staff are nice and the food is lovely. I enjoy a bit of banter with people." Another person said, "I have decided I will stay here. It's wonderful. The food is better than it was. Always home made cakes and drinks for my visitor as well."

People who used the service told us that they were encouraged to undertake a range of social activities within the home and felt their social needs were being met. "The social activity is very good. I enjoy being busy."

A visitor we spoke with told us, "I stay for lunch and am always made to feel welcome."

We found that the organisation had an effective recruitment process in place which adhered to current legislative requirements. We also found that the support staff had received a training package to ensure they were competent and confident in performing their duties.

A staff member told us, "We are a happy team now and that makes the people we care for happy."

On the day of our inspection visit to Tuxford Manor there were 35 people living at the care home.

We spoke with two people who live at Tuxford Manor. They told us that: “I’m very happy here.” “The staff are lovely.” Several people who live at Tuxford Manor have some degree of dementia which made communication a little difficult. However observations of people being cared for by the staff and of the activities that people were engaged in, indicated that people who live at Tuxford Manor were treated with respect and were well cared for by the staff.

We spoke with three people who live at Tuxford Manor on an informal basis. People told us that they were very happy with the care at the home. One person said: “The staff are very nice, they work very hard.” Another person told us: “There seems to be a lot going on, and I quite like living here.” We were also told: “My family come and see me, and I’ve got a very nice bedroom on the first floor looking over the garden.”

We asked several people if they thought they were safe. They all said that they thought they were. However they were not able to give us any insight or view into staff training in vulnerable adults that had taken place at the care home.

People living in the home and their relatives told us that staff asked them what help was needed when they first arrived. One person said they liked living in the home and described the staff as “brilliant”. They added "I am very happy and settled here". "We can have a laugh together."

Most people told us they enjoyed the meals provided. People told us they had a choice, though some people did not remember what was available or what they had chosen.

People told us of other professionals who had visited the home. These included district nurses, doctors and social workers.

People had a choice of lounge areas and seating was arranged in small groups. One person told us that they like to sit in the small quiet lounge.

People we spoke with were not aware of training given to staff, but had confidence that care staff knew how to meet most of their needs.

We performed the unannounced inspection on 31 July & 5 August 2015. Tuxford Manor is run and managed by Strong Life Care Ltd. The service provides care and support for 45 people. On the day of our inspection 35 people were using the service. The service is provided across two floors with a passenger lift connecting the two floors.

The service had a registered manager in place at the time of 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 and associated Regulations about how the service is run.

When we last inspected the service on 31 July 2014 we found the provider had not taken proper steps to ensure people who used the service were protected from the risk of receiving inappropriate or unsafe care, and people were not protected from the risks of inadequate nutrition. The provider sent us an action plan telling us they would make these improvements by 24 September 2014. We found at this inspection that this had been completed and the provider had made improvements in line with the action plan.

During this inspection we found there were suitable arrangements in place to ensure people who used the service were safe. They were protected from abuse and medicines were managed safely. There were appropriate risk assessments in place and the registered manager shared information with the local authority when needed. The staffing levels were sufficient and staff underwent appropriate pre-employment checks.

People were supported by staff who had the knowledge and training to provide safe care and support. They were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. People who lived at the home did not have unnecessary restrictions placed upon them.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if needed. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care. They were cared for in a respectful manner by staff who behaved in an inclusive and open way.

People who used the service, or their representatives, were encouraged to be involved in decisions and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.