Tudor Lodge is a residential care home for up to 56 older people, some of whom have dementia. The building offers accommodation over two floors with lift access to each floor. People have access to communal lounge and dining areas, an accessible garden and outside space. There were 52 people living at the home at the time of inspection.

Tudor Lodge is a ‘care home’. 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm because staff understood how to recognise signs of abuse and how to report any concerns. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. Staff understood the risks people faced and ther role in managing these safely. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

Pre-admission assessments included information about peoples’ physical, religious, emotional and mental health needs to ensure that these could be effectively met. There were assessments of capacity and decisions made in people’s best interests where required. Feedback about the meals and drinks available was positive and where people needed foods prepared in a certain way to eat safely, this was accommodated. Staff received support through supervision and had access to relevant training opportunities to provide them with the correct skills and knowledge for their role.

People were supported by staff who were kind and compassionate in their approach. We observed informal interactions, the use of tactile contact and staff communicating with people in ways which were meaningful for them. People were offered choices about how they spent their time and were supported with respect by staff who protected people’s dignity and promoted their independence. Visitors were welcomed whenever they wished to visit and were encouraged to feedback through informal discussions, resident and relative meetings and surveys.

People received person centred care which was responsive to their changing needs and wishes. There were regular reviews of people’s care plans and staff were kept up to date with any changes. People were supported by staff to engage in a range of social opportunities which included some group activities, one to one time with staff and a range of visits from external providers. People and relatives were aware about how to raise concerns if needed and where complaints had been received, these had been investigated and responded to. End of life care was person centred and planned with people to ensure that wishes and preferences were understood and respected.

The service had an open and positive culture. Leadership was visible and promoted good teamwork. Staff spoke highly about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below.

We previously inspected Tudor Lodge on the 29 and 30 of June 2016 and found the provider did not have robust governance systems in place to recognise and implement measures for improvement. People's records were not always updated to reflect their care needs and the requirements of the Mental Capacity Act 2005 were not consistently applied. Risks to people's health and wellbeing were not always appropriately documented. We found a breach of Regulation 17 Good governance and told the provider to improve.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tudor Lodge nursing home on our website at www.cqc.org.uk .

After our inspection the provider sent us an action plan which detailed the improvements they were going to make. We were satisfied with the content of their action plan and we returned to conduct a focused inspection on the 17 October to check they had made the improvements needed. At this inspection we were satisfied improvements had been made and they had met the requirements of the regulation.

The provider had good arrangements in place to monitor the quality or care people received. .

People's records were regularly reviewed and provided accurate information.

Effective arrangements were in place for the monitoring of the Mental Capacity Act 2005.

Staff were knowledgeable about people’s care needs.

The introduction of an electronic recording system allowed staff to document, review and assess people’s care needs more thoroughly.

This comprehensive inspection took place on 29 and 30 June 2016 and was unannounced.

Tudor Lodge Nursing Home provides accommodation, support and nursing care for up to 56 people, some of whom live with dementia. There were 54 people living in the home at the time of our visit. The home is built on three levels and there is a lift between the floors. There are three communal areas on the ground floor where people can socialise and eat their meals if they wish.

A registered manager was in place. 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.

People told us they felt safe in the home and we saw staff had a good awareness of their needs and any risks associated with these. Staff awareness of safeguarding adults at risk was good and they said they were confident the manager and provider would respond appropriately to any concerns. Safe recruitment practices were in place. Medicines were managed safely. Suitable numbers of staff were available to meet people’s needs.

People were cared for by staff who were supported in their work and encouraged to develop their own skills and knowledge. Staff demonstrated an understanding of the Mental Capacity Act 2005 (MCA), however the records of the application of the Act were not clear. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The registered manager and staff understood their responsibilities with DoLs. Some DoLS had been approved for people and staff were aware of the people who had a DoLs in place. We made a recommendation about the recording of MCA and DoLS.

People’s needs were assessed to ensure they were met. People and their representatives were encouraged to participate in care planning and review. People were able to express their views of the care they received and they were acted upon. People told us they were supported by kind and attentive staff who treated them as individuals and respected their privacy and dignity.

Staff spoke positively of the home and felt the registered manager was open, transparent and approachable. They knew the provider and felt able to approach them if needed. Feedback was sought from people and action taken to address any complaints. We have made a recommendation about recording the outcome and closure of a complaint. Systems were in place to monitor the quality of the service and drive improvement. However, records were not always accurate and clear.

We found one breach 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.