This inspection took place on the 28 and 30 September 2016 and was unannounced. Tegfield House is registered to provide accommodation and support without nursing for up to 24 older people, some of who were living with dementia. At the time of the inspection there were 23 people living there. The home also provided day care to four people living in the community.

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.

At our last inspection of this service on 25 and 26 August 2015 we found three breaches of legal requirements in relation to safe care and treatment, fit and proper persons employed and safeguarding. Following the inspection the provider wrote and told us they planned to meet the requirements of these regulations by the end of October 2015. At this inspection we found the requirements of these regulations had been met.

People told us they felt safe at Tegfield House. There were robust procedures in place to protect people from the risk of abuse. Allegations and concerns were acted on promptly and appropriately by the registered and deputy managers. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

Staff were recruited safely, the provider carried out all the required pre-employment checks to protect people from the employment of unsuitable staff. These included a full employment history with an explanation of any gaps in employment. A Disclosure and Barring Service (criminal records check) was completed by staff prior to commencing work at the service and thereafter at three yearly intervals. This meant staff were subject to continued checks on their suitability for employment with vulnerable people.

Staff completed incident and accident reports when people experienced events that could or had resulted in harm to themselves or others. The registered manager reviewed and monitored all incidents and accidents to identify trends and take action to prevent a reoccurrence. We saw improvements had been made as a result of this analysis. People involved in accidents and incidents were supported to stay safe and action had been taken to prevent further injury or harm.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. People told us they were cared for safely and we found staff were aware of people’s risks and acted to support them safely. There were arrangements in place to keep people safe in an emergency and staff understood these and knew where to access the information. There were sufficient numbers of staff available to meet people’s needs.

Peoples’ medicines were managed and administered safely. Staff completed training in the safe administration of people’s medicines and had their competency assessed at regular intervals. Regular audits of medicine management were carried out by the deputy manager and an external pharmacist and action had been taken when improvements were identified.

People’s needs were met by staff who were trained and supported in their role. Staff completed an induction into their role and on-going training to enable them to care for people effectively. Staff received regular supervision from managers to identify and support their learning and development needs and monitor their performance in their role.

Decisions about people’s care when they lacked mental capacity were guided by the principles of the Mental Capacity Act 2005 (MCA). People’s care plans evidenced specific decisions had been made in their best interests when they lacked the capacity to make these. When people lacked the capacity to agree to their care and treatment and it was deemed to be

We looked at staff training records which showed that all staff had received training in the Mental Capacity Act 2005 (MCA) Staff understood that people’s ability to consent was variable and that they could withdraw their consent at any time. We saw that staff asked permission from people before providing any help or support.

During our visit we spoke with five people. Everybody we spoke with was complimentary about the care and support they received. One person said: “I don’t think you would find better.” Other people said of the staff: “They come when I want them” and “I think the staff are very good”.

At this visit we looked at all areas of the home and looked at how the infection control systems were working. We saw that staff had access to personal protective equipment, for example, disposable gloves and aprons. All areas of the home that we looked at appeared clean and there were no unpleasant odours.

We looked at a selection of staff files. These records showed that Disclosure and Barring Service checks had been carried out to ensure that staff were suitable for working with vulnerable people. Records demonstrated that the staff had completed a range of training suitable to their role.

People were made aware of the complaints system. We saw there was a laminated copy of the complaints procedure available in the foyer of the home. The copy of the complaints procedure was easy to understand and in a prominent position.

We were informed that there were twenty four people living at the Tegfield House. We looked around the building which was clean and free of unpleasant odours. All the rooms were single occupancy with their own toilet and hand basin. The rooms were personalised with photographs, TV’s and pictures and some people had their own furnishings. There was a lift so people could access the first floor.

During our visit we spoke with two people who used the service and four members of staff including the registered manager, a Doctor and a visitor. We spent time observing how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

All the people we saw looked happy living at the Tegfield House. People told us that that they liked living here, and that the staff were friendly. One person told us that the home was very nice, another person told us that they were ‘quite happy’. A visitor we spoke with told us they were happy with the home, and that the staff were nice and friendly. The Doctor we spoke with said that the staff were very helpful and caring.

We saw that care plans were person centre and all aspects of people’s care needs were reviewed. People’s assessment of care needs looked at their goals and support required.

Everyone we spoke to told us they were happy with the care and support they received. One person told us “We are looked after, it’s very casual and we are well fed. It is laidback, we are carefree, we are not restricted.”

They said that they thought the staff were very well trained to do their job and were always helpful.

People we spoke with told us about the activities that are available at Tegfield House. They told us it was up to them to take up any activity they wanted to. We observed a lot of interaction between people. We were told “I have some good friends both amongst staff and residents.”

Two people told us that the food was very good, and both cooks were excellent.

The inspection took place on 25 and 26 August 2015 and was unannounced. Tegfield House is registered to provide accommodation for up to twenty four older people who require personal care. At the time of the inspection there were 23 people living at the service, four people were receiving day care on the 25 August 2015 and two people on 26 August 2015.

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.

The registered manager had failed to respond promptly to a verbal allegation of abuse from staff in relation to another staff member. The member of staff involved had since been dismissed from the provider’s employment. The provider had made changes to staff supervision records and provided further whistle blowing training for the registered manager and the deputy manager as a result of this incident. This was to ensure they were secure in their knowledge of their role and responsibilities should such a safeguarding incident occur in the future. People had not been adequately protected; however the provider had made changes to ensure people’s future safety.

The registered manager had failed to robustly implement the provider’s recruitment policies to ensure all staff recruited were of good character. The provider’s recruitment policies did not always provide sufficient guidance for registered managers. To ensure the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014 regulations in relation to staff recruitment were met fully. As a result people had been placed at risk from the recruitment of one unsuitable member of staff who no longer works for the provider.

Risks to people had been identified and they had plans in place to manage them. However, the provider did not have an incident reporting policy. Therefore staff had only recorded and reported people’s falls and medicine errors as incidents. There was a lack of guidance for staff about other types of incident they should record, analyse and monitor in order to identify any trends in incidents and to ensure the required actions were taken to ensure people’s safety. The provider took action during the inspection to introduce an incident reporting policy. There were processes in place to gather data on the service on a weekly and monthly basis and this was used to identify areas the registered manager needed to improve. Not all data relating to incidents had been documented and reflected within the reporting system. There was  a reliance on staff to document data which created a potential risk that not all data was being recorded in order to ensure the processes for monitoring the quality of the service were fully effective.

The provider had reviewed and assessed staffing levels in accordance with people’s needs. The recruitment of additional domiciliary staff was being considered by the provider to allow staff to spend more time personally interacting with people.

People’s medicines were managed safely by competent staff who had undergone relevant training. Procedures were in place to ensure risks associated with people’s medicines were reviewed and addressed.

Staff received an induction into their role and on going supervision and support to ensure they had the knowledge and skills to carry out their role competently. Staff had undertaken dementia care training to enable them to meet the individual needs of the people they cared for effectively.

People were supported to make their own decisions. Where people lacked the mental capacity to make specific decisions staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been submitted for people where required. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

People were very satisfied with quality of the meals they received. Risks to people from malnutrition were assessed and managed effectively. For those people identified as at risk from dehydration there was a requirement for their fluid intake to be recorded on fluid charts. However, the registered manager had identified that staff had not always fully completed these charts and they were taking appropriate measures to address this with staff.

People’s healthcare needs had been identified and they were supported to access a range of health care services. People received support from staff to ensure they maintained good health.

Staff treated people with kindness and compassion and people were positive about the caring attitude of staff. Staff took account of people’s diverse needs and interests and people were supported to participate in activities that met those needs.

Staff had limited time to interact with people outside the delivery of care. However, staff used the time they spent with people to build positive relationships with them.

People were given choices and involved in decisions about their care. Staff knew about people’s decisions and preferences and respected their wishes.

Staff treated people with dignity and respect. People’s right to privacy was respected and care was arranged to promote people’s dignity and choices.

People contributed to the assessment and planning of their care, as much as they were able. Families were involved in planning and reviewing people’s care with the person’s consent. People’s needs and preferences in relation to their care were documented and this included their preferences, personal history and interests.

Staff were knowledgeable about people’s needs and delivered care to meet people’s preferences. Activities were provided based on people’s abilities to meet a range of needs and interests. The provider sought people’s and their relative’s views on the service in a variety of ways. Feedback was used to make improvements to the service people received.

Staff told us they felt able to speak out about any concerns they had about other staff and had done so. Staff said following the recent safeguarding incident they now had a better understanding of their rights under whistle blowing legislation to ensure they felt confident to report any future concerns about people’s safety. The registered manager was aware of underlying issues within the culture of the team which impacted upon staffs ability to work together effectively in the delivery of people’s care. The registered manager was taking measures to address this. Staff were undergoing training in the provider’s philosophy and values to ensure they understood these.

People, their relatives and staff all agreed the registered manager demonstrated good leadership and they felt they were approachable if they needed support. There were processes in place to ensure the registered manager had oversight of what was happening on the floor. However, feedback received was that the registered manger needed to be more visible in order for them to observe staff practice for themselves.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.