This inspection took place on 18, 19 and 25 June 2018 and was unannounced. At the last inspection of the service in October 2015 we rated the provider as Good in all five of the key questions. At this inspection, we found that improvements were needed.

Tiled House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Tiled House provides an intermediate care and enablement service with accommodation and personal care for up to 47 people. The service cares for people who have been in hospital or suffered a crisis and need support to return to live at home in the community. The service provides short term support which can vary from weeks to a few months by which time people are independent or are referred to more long-term care provision. At the time of the inspection, there were 45 people living at the service.

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. 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

We saw people had to wait for support at times and staff did not always have the time to respond to people’s needs in a consistent manner. Risks to people’s safety such as falling, were identified and managed with steps taken to reduce risks. People were supported by staff who understood how to recognise and report abuse or harm. People received their medicines as prescribed. Staff understood their responsibilities in relation to hygiene and infection control.

People received care from staff that had the skills required to support them safely. Staff support and training was provided with further improvements identified. Most people liked the food, some people felt teatime and supper time choices were limited. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff gained people's consent before assisting or supporting them. People’s health care needs were supported with access to on-site and external health professionals.

People were consistently positive about the caring attitude of the staff who they described as kind and caring. People were encouraged to regain their independence. People were treated with dignity and respect. However, staff did not always ensure information about people is treated confidentially.

People were involved in discussing their care and improvements were planned to provide a more detailed care plan. People had access to some planned activities and events to encourage their interests. People knew how to make a complaint and the provider had systems in place to manage complaints.

The provider’s systems for monitoring the quality and safety of the service had not been effective in identifying shortfalls. Records held in relation to people's care were not always completed to ensure risks were managed. The analysis of falls needed to be more robust to help identify any trends or patterns such as the reasons people may be falling.

This inspection took place on 1 October 2015 and was unannounced. Tiled House provides an Intermediate Care and Reablement Service with accommodation and personal care for up to 47 people. Reablement provides personal care services to people who have been in hospital or suffered a crisis and need support to return to live at home in the community.

The service provides short term support which can vary from weeks to a few months by which time people are independent or are referred to more long term care provision. At our previous inspection in February 2013 the provider was compliant with the standards we assessed. On the day of our inspection there were 43 people living at the home.

There was a registered manager in post and she was present during 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.

People felt safe using the service and risks to their safety had been identified. People and their relatives had no concerns about their family member’s day to day safety. Staff knew how to support people safely and had training in how to recognise and report abuse.

Staff were recruited in a safe way. We found there were enough staff to support people and meet their needs in a personalised manner.

People had their medicines when they needed them and the arrangements for the management of people’s medicines was safe.

Care was focused on people’s rehabilitation and their personal goals for independence and confidence to return to their own homes. The input of a range of on-site health and social care professionals led to people receiving the right care in a coordinated way.

Staff were aware of how to support people’s rights, seek their consent, respect their choices and promote their independence.

People told us they enjoyed the meals and we saw that risks to their dietary intake were known and staff supported them to eat and drink enough. People’s health was supported by access to appropriate external and on-site healthcare professionals.

People and their relatives were positive about the care provided. Our observations confirmed that staff were attentive and caring towards people. Staff knew people well and how best to support them.

People knew how to make a complaint and were confident this would be listened to and acted upon.

People described the management of the home as friendly and approachable.  Staff felt supported by the provider. The provider had carried out audits to identify and address issues with the quality of the service and had made improvements to ensure the safety of people.

We spoke with three people who used the service, three relatives, six professional’s, five members of staff and the acting manager. On the day of our inspection 39 people were being cared for at the home. A registered manager was not in post when we visited. We have received an application from a person wishing to be considered for this position and this is currently being processed.

We saw that care plans were comprehensive and clearly identified people’s health and care needs. People’s needs had been individually assessed. Care plans contained a good level of information about how people should be supported to ensure their needs were met. One person told us, “They have sorted me out so I can go home again”.

Suitable nutritious food and drinks were available to people throughout the day or on request. We saw that people’s dietary and nutritional needs were being met.

Staff we met with were not receiving any regular supervision or appraisal. This meant that the provider was failing to provide a support structure for staff in line with their own policy.

We saw that some of the quality monitoring programmes in place were not effective. This meant that the monitoring of quality and safety of the services provided in the carrying on of the regulated activity were not robust.

Records we looked at were easily accessible, securely stored and fit for purpose.

We spoke with five people, one relative, one friend and six staff members. People and their relatives were very complimentary about the staff. One said, “It doesn’t matter what you ask for, they always help you”. Another said, “They never keep you waiting".

All people told us that they felt involved in the planning of their care and that their privacy and dignity were respected.

All people told us they were very satisfied with the service they received at the home. They all said that their needs were being met. a relative told us they were very satisfied with the care provided. Throughout the inspection, we saw that staff provided care and support in a friendly and professional manner. We did not see anybody having to wait for that support to be given.

All people we spoke with all said they felt safe. One said, “You know you are going to be looked after”. Most of the staff had been trained in safeguarding and the policy and procedure were readily accessible. We talked to staff about their understanding of safeguarding and their responsibility to report incidents, which they clearly understood.

Medicines were handled appropriately and safely stored. We saw that regular audits were taking place.

Staff received appropriate professional development and felt supported in their role by approachable management.

None of the people we spoke with had any complaints. People told us they would feel confident to raise a complaint if they needed to.

We carried out this review to check on the care and welfare of people using the service. There were 47 people living at the home at the time of this visit. There are six units in the home, one of which is for people with dementia.

There was a very friendly and pleasant atmosphere in the home. People and their relatives were complimentary about the staff. Some people told us about the recovery they had made whilst being at the home. One person told us “I would give them 10 out of 10.”

People were happy with their rooms and the facilities available. Relatives told us that staff always welcomed them. One relative said, "We can visit whenever we like." We saw that relatives could sit with people in the lounge or in people’s bedrooms, where their privacy was respected. One relative told us, “They even give us refreshments when we visit.”

The Primary Care Trust (PCT) has employed two nurses, a physiotherapist, an occupational therapist, and an occupational therapist assistant to work at the home. These professionals work together to ensure that people are given care that meets their needs.

The home recognises that some work needs to be carried out to ensure safe handling of medicines. One staff member told us, “We are always looking for ways to manage this better.”