Teignbridge House Care Home Limited

Updated 12 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by three inspectors.

Service and service type

Teignbridge House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Teignbridge House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post, however, they had stepped back from the day to day running of the service. A consultant had been engaged to oversee the safety and quality of the service, and the day-to-day operation was overseen by 2 deputy managers.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We reviewed information we had received from the provider since the last inspection. We used all this information to plan our inspection.

During the inspection

We spoke with 14 people and 5 relatives/friends. We spoke with 11 staff including the provider, who is also the registered manager, the consultant and 2 deputy managers. We reviewed 6 people’s care records in detailed and sampled an additional 14 peoples care records. We reviewed records relating to recruitment, training, complaints, incidents and accidents, health and safety and governance.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We received feedback from 7 health professionals.

Following our site visit we contacted 19 staff by email, but did not receive any additional feedback.

Updated 12 January 2024

About the service

Teignbridge House Care Home Limited (Teignbridge House hereafter) is a residential care home providing personal care to up to 24 people, which includes people on intermediate care stays. At the time of our inspection there were 20 people using the service.

People’s experience of using this service and what we found

Concerns about the management and monitoring of risk had been identified at our last 2 inspections; at this inspection they were still not being well managed. Risks relating to pressure area care, monitoring of bowels and weight were not always effectively monitored. People’s food and fluid intake wasn’t adequately monitored, and staff didn’t always have enough information about how to manage people’s individual health risks. Staff communicated information about people’s health at daily handovers, however, because the information wasn’t written down there was a risk issues identified wouldn’t be followed up. Systems were not always effectively operated to ensure safeguarding was well managed and potential safeguarding concerns were identified.

Whilst some improvements had been made in relation to staff training, not all staff had completed the training required by the service and where they had, care was not always being provided in line with the law or best practice guidance. Only 4 staff had completed dementia training, despite several people at the service living with dementia. No one to one staff supervision had taken place.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans did not always reflect people’s needs and personal preferences and some contained inconsistencies and errors. For some people, this meant there was incorrect information about how staff should assist them. Care plans were not always regularly reviewed to ensure they met people’s current needs.

Following our last inspection, the registered manager, who is also the provider, took the decision to step back from their role. At the time of this inspection, they had not applied to deregister with CQC which meant they were still legally responsible. Quality performance, risks and regulatory requirements were not well managed. There were no systems in place to ensure senior staff and managers had oversight of daily monitoring documents. Whilst audit systems were in place, they had not identified all the areas of concern identified at this inspection, audit tools were not always comprehensive enough to identify risk and where audit systems had identified areas for improvement, action had not always been taken to address the shortfalls identified.

Improvements had been made to the environment, including the management of infection control and fire safety. New equipment had been purchased and we received positive feedback from health professionals who felt people’s health needs were well managed. People told us they felt safe. One person said, “I love it here, I feel safe.” People’s families told us they also felt people were safe. One relative said they felt their relative was “very safe” and told us, “I don’t have to worry about Mum.”

People were supported to maintain a balanced diet and their care records contained information about their likes, dislikes, and personal preferences. People were supported to access healthcare services and support, and we received positive feedback from health professionals. One said, “I’ve provided them with some extra support, and they give me good detail (about people’s needs) over the telephone.” Another health professional said, “I have full confidence that any health needs will be reported, and any plans I suggest will be actioned.”

People told us they were happy living at Teignbridge House and felt well cared for. One person said, “It’s terrific, better than a 5-star hotel.” Another person said, “It’s nice here, everyone is quite pleasant.” People’s relatives also gave positive feedback. One relative said, “They can’t do enough, I think it’s lovely, and it’s the care that counts.” Staff spoke about people fondly. One staff member said, “It’s like I’ve got 24 grandparents.”

Various opportunities were available for people to interact socially and take part in group and individual activities and hobbies. People’s families commented on an improved culture in the service. One relative said, “The staff seem more dedicated now. I’ve seen a big improvement in the last few months, their general attitude towards the residents is better.” The staff we spoke to gave positive feedback. One staff member said, “I love it here.”

Improvements relating to staffing levels, supporting people to express their views, supporting people to avoid social isolation, complaints, the culture of the service and engaging people, the public and staff had been made at this inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 14 July 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found whilst some improvements had been made, the provider remained in breach of some regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s health needs. This included concerns around urinary catheter care and the notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of people’s individual health conditions. This inspection examined those risks.

The provider has employed a consultant to address the shortfalls identified in the service and continues to work with the local authority to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Teignbridge House Care Home Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent, person-centred care, staffing, safeguarding and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.