This unannounced comprehensive inspection took place on 28 November 2018. This was the first inspection of this service since it re-registered with the Care Quality Commission due to the provider became a limited company.

Tremethick House is a care home which offers care and support for up to 42 predominantly older people. At the time of the inspection there were 37 people living at the service. Some of these people were living with dementia.

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

The service is required to have a registered manager and at the time of the inspection there were two registered managers 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 and associated Regulations about how the service is run.

We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. People told us, "All the staff and the managers do what they can, and very willingly” and "My room is kept spotless.”

The premises were well maintained. There was no pictorial signage at the service to support some people, who were living with some early dementia and may require additional support with recognising their surroundings. The provider agreed that there was a person living at the service who was independently mobile around the building and may benefit from additional signage to help them find their own bedroom. Additional signage would be reviewed. The premises were regularly checked and maintained by the provider. Equipment and services used at Tremethick were regularly checked by competent people to ensure they were safe to use.

Care plans were held electronically and contained accurate and up to date information. However, we found that two people did not have care plans completed. Both had full pre admission assessments and daily notes had been completed by staff detailing all the care and support they had been given. One person had been living at the service for three weeks. The staff knew both people well and visiting district nurses had knowledge of one person from when they previously lived in their own home. Their nursing care needs had been met. We judged this had not impacted on people’s well-being. These care plans were created during this inspection. People told us, "The staff are very caring people," "I love it here because I never feel lonely" and "They help you with absolutely everything.”

Care plans were reviewed regularly and people’s changing needs were recorded. Care plans contained risk assessments which showed risks were identified, assessed and monitored to minimise the risk of harm whilst helping people to be as independent as possible. Relatives told us, “I am happy with the place, the staff are good and it is clean,” "The care is 10 out of 10” and "The staff have bent over backwards to help our relative settle in."

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had a vacancy for one carer at the time of this inspection.People told us, "There's always somebody around to help me” and "I know I can use my call bell in case of an emergency."

There were systems in place for the management and administration of medicines. It was clear that people had received their medicine as prescribed. Regular medicines audit