About the service: Tancred Hall Nursing Home provides support for up to 49 older people and younger adults who may be living with dementia, mental health needs, a physical disability or sensory impairment. Accommodation is provided in one adapted building separated into two areas. The 'Hall' supports people with nursing needs who may be living with dementia. The 'Cottage' supports people with nursing and mental health needs. Twenty-seven people were receiving a service at the time of this inspection.

People’s experience of using this service: The provider and registered manager had made significant improvements since our last inspection. The environment was cleaner and more welcoming. Staff were more attentive and engaged, and there were more effective systems to monitor and make sure people’s needs were met. The provider was now compliant with all legal requirements.

Although there had been significant improvements, progress was needed to show improvements could be sustained. Work was ongoing in other areas to develop and improve the service. For example, a more robust system was needed to make sure agency staff were suitably trained; progress was needed to develop a fully dementia friendly environment, and to maintain consistently high standards of cleanliness. The range of activities on offer had improved, but further improvements were needed as people were not always meaningfully engaged.

We recommend opportunities for regular, meaningful stimulation should be further explored and developed.

We recommend the provider implement a business continuity plan to help keep people safe in an emergency.

Staff were safely recruited and enough staff were deployed to meet people’s needs. Staff had been trained to respond to safeguarding concerns. The registered manager was proactive investigating and responding to concerns to keep people safe.

People received care from staff who were kind and caring. Staff worked closely with healthcare professionals and sought their advice, guidance and support on how to best meet people’s needs. Staff had completed a range of training. The registered manager was looking to source and deliver more comprehensive training for staff working with people with mental health needs and behaviours that may challenge.

People were supported to meet their personal care needs and dress according to their personal preferences. Staff supported people when needed to make sure they ate and drank enough.

People gave very positive feedback about the new registered manager and deputy manager (who was also the clinical lead) and the changes and improvements they had made. The registered manager was approachable, responsive to feedback and clearly dedicated to developing and improving the service. They used a range of audits to check quality and safety. They put in place action plans to make sure improvements were made when needed.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission's (CQC) website at www.cqc.org.uk.

Rating at last inspection: At the last inspection service was rated Inadequate (report published 11 July 2018). This is the second consecutive time the service has not achieved a Good rating overall.

Why we inspected: At the last inspection, there were seven breaches of regulation. Following the inspection, we asked the provider to take action to make improvements. They sent us a plan to show what they would do and by when to improve the service. This inspection was planned to check the provider had acted to improve the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider, local authority and clinical commissioning group to monitor progress. If any concerning information is received we may inspect sooner.

Tancred Hall Nursing Home is registered to provide residential and nursing care for up to 49 older people and younger adults who may be living with dementia, mental health needs, a physical disability or sensory impairment.

This service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in one adapted building separated into two areas. The ‘Hall’ supports people with nursing needs who may also be living with dementia. The ‘Cottage’ supports people with nursing needs, mental health needs and people living with dementia.

We inspected the service on 26 March, 5 April and 25 April 2018. The first day of our inspection was unannounced. At the time of our inspection, 32 older people with nursing needs, dementia and mental health needs were using the service.

This was the first inspection of this location since it was taken over by Tancred Hall Care Centre Limited in July 2017. Before this, the service had been in administration.

During the inspection process CQC was notified of an incident in which a person using the service died. The inspection did not examine the specific circumstances of this incident. However, the information shared with the CQC indicated potential wider concerns about the care and support provided at Tancred Hall Nursing Home and about the management of risks including the risk of choking. The inspection examined those risks.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service did not have a registered manager and had been without a registered manager since December 2017. A registered manager is a person who has registered with the CQC 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. On the first day of our inspection a manager was in post and applying to become the registered manager. However, they withdrew their application and left the service. On the second and third day of our inspection the service was being managed by a director, who was also the provider’s nominated individual, a