Tandy Court

Tandy Court is a care home providing personal and nursing care to up to 40 people. The

service provides support to adults of all ages, some of whom may have dementia or physical disabilities. At the time of our inspection there were 39 people using the service.

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

Medicines were not always administered safely and appropriately.

Quality assurance systems were effective in identifying concerns, however, this was not always translated into good practice for people living at Tandy Court with regards to the management of medicines.

People were not always supported according to care plans and identified needs. Systems to ensure the home was clean and hygienic were not always followed.

People were supported to have maximum choice and control of their lives and staff supported them in the

least restrictive way possible and in their best interests; the policies and systems in the service supported

this practice.

Most people, relatives and staff spoke positively about the management of the service and systems were in place to seek people's feedback and drive continuous improvements.

People’s physical, mental and social needs were assessed and documented in their care plans and risk assessments.

There was evidence that staff were adapting communication techniques to achieve best results with people.

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

Rating at last inspection

The last rating for this service was good (published on 19/06/2019).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all

care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to regulation 12 Safe Care and treatment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next

inspect.

We found the following examples of good practice.

¿ On their arrival at the home, visitors were screened for symptoms of Covid-19 and were required to completed a lateral flow test to ensure their visit could take place safely in line with current guidance.

¿ People were supported to maintain contact with others who were important to them in a variety of ways including video calls. Social media was used to share updates and photographs of what had been happening within the home with people's family members and the community.

¿ A ‘visiting pod’ partitioned by a glass screen was in use. Use of the area meant visits took place safely which reduced the risk of cross infection.

¿ Some furniture in communal areas had been replaced to encourage people to socially distance. For example, sofas had been replaced with armchairs.

¿ Social activities had been adapted to keep people active during the pandemic. People took part in ‘dance to health’ sessions. The sessions are part of a nationwide falls prevention programme which aims to boost strength and balance to prevent falls in older people.

¿ The service had been nominated for a national award within the sector for their commitment and hard work during the pandemic. Staff felt valued and their contribution had been recognised and rewarded in a variety of ways by the provider.

¿ Wellbeing sessions had also been held with staff. This included signposting staff to a confidential helpline for advice during the pandemic.

¿ Staff did not wear their uniforms outside of the home which reduced the risk of transmission of infection. ¿ An extra staff room had been created and staff breaks were staggered. That meant staff could appropriately socially distance during their breaks.

¿ Cleaning schedules had been increased to monitor cleanliness of the environment. Staff compliance with the provider's infection control policy was monitored by the infection prevention lead and the registered manager.

People’s experience of using this service:

People said they felt safe at Tandy Court. Personalised care was provided by staff who understood people’s needs and were available at the times people needed. Individual and environmental risks were assessed and regularly reviewed. Risk management plans ensured staff had the up to date information they needed to keep people safe. Medicines were managed in line with regulatory requirements and best practice guidelines.

Staff were recruited safely and received the support and on-going training they needed to be effective in their roles. People had access to health and social care professionals and their nutrition and hydration needs were met. 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 home supported this practice.

People and relatives spoke highly of the staff who provided their care and support. Staff practice demonstrated their commitment to providing individualised care which showed the provider’s values were embedded within the service. People’s privacy and dignity was upheld, and their independence promoted.

People’s needs were assessed prior to moving into the home to ensure these could be met. Detailed care plans provided staff with the up to date information they needed to provide care in line with people’s wishes and preferences. Complaints were managed in line with the provider’s policy and procedure. Individual and group activities were driven by people’s interests and feedback.

The provider used a variety of effective methods to monitor and improve the quality of the service provided. People and relatives were positive about the way the home was managed and the quality of service they received. The management team and staff worked in partnership with other professionals to improve outcomes for people and were committed to working towards achieving an outstanding rating.

Rating at last inspection: Good (report published November 2016). At that inspection we found the service required improvement within the safe domain, but remained good overall.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Tandy Court is registered to provide care and support for up to 40 older people who have needs relating to their age or dementia. Nursing care is not provided. On the day of our inspection there were 37 people at the home.

The home had a registered manager but they had moved into the role of district manager. A new manager was in post who was not yet registered with us. Both were available throughout 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 2008 and associated Regulations about how the service is run.

We observed people looking relaxed and at ease within the home, and with the staff who were supporting them. People and their relatives told us they felt safe at the home. Staff were aware of the provider’s processes for reporting any concerns. Staff understood their responsibilities to keep people safe from harm. Most risks of harm to people receiving the service had been assessed and recorded but improvement was needed to ensure people could be confident all risks were well managed.

There were enough staff to support people safely. Staff told us they had recently had to work extra shifts to cover staff vacancies. Recruitment had taken place and additional staff had been employed. Satisfactory recruitment checks were in place to help ensure staff that were employed were safe to work with people. Staff had been trained to support people effectively. This included learning about the specific needs the person lived with. Staff told us that they received regular supervision and felt supported.

People’s medicines were safely managed, stored and administered by staff who had received training and had been assessed as competent to administer medicines.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions.

People we spoke with told us they were happy at the home. People told us that they were supported by staff who were kind, caring, attentive and compassionate. People were able to make decisions about how they wanted their care provided. Staff maintained people's privacy and dignity whilst encouraging them to remain as independent as possible.

People told us they were offered meals which they enjoyed. People were supported to eat enough food and drink by staff who understood their nutritional needs. People's health was supported by access to a variety of health professionals.

People told us that they played an active part in contributing to the planning and reviewing of their care to ensure it was delivered how they wished . A variety of activities were provided to meet the interests of individual people. We saw people were engaged and were consulted about the activities programme.

People who lived at the home, their relatives and staff were encouraged to share their opinions about the quality of the service and there were effective systems in place if people wished to make a complaint. The new manager was in the process of applying to us to be registered and was able to tell us about their future plans for the development of the home. Support was available to the manager to develop and drive improvement and a system of internal auditing of the quality of the service was in place.

There were 37 people living at the home at time of our visit. Some people were not able to share their views of the service so we used a number of different methods to help us understand the experience of people using the service.

During our visit we spoke with six people who lived at the home and three of their relatives. We also spoke with the registered manager, care manager and six members of staff. The provider's district manager and care and dementia advisor were also present for part of the inspection.

People we spoke with were complimentary about the home and told us that they were happy with the care they received. One person told us, 'It's nice here, the staff are nice, there is nothing wrong here.' A relative told us, 'I cannot praise the home enough, staff are feeling and thoughtful.'

We found that care and support was not always planned and delivered in a way that ensured people's safety and welfare.

Improvements were needed to ensure there were enough staff available at all times to meet people's needs.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

We spoke with eight people living in the home, three relatives and five members of staff including the manager. People we spoke with were complimentary about the home. People told us that they were happy with the care they received. One person told us, 'I definitely feel safe here, it is much better than being in a flat on my own.'

A new care planning system had been implemented but the information in place did not properly reflect people's needs and how they were to be met.

People were protected against the risks associated with medicines because the provider had the appropriate arrangements for managing medicines safely.

An effective system to regularly assess and monitor the quality of service that people received was in place.

At our last inspection in June 2012 we found that where improvements had been identified as needed, these had not been completed in a timely manner. At this visit, we found that improvements had taken place and the majority of improvements identified by the home had been completed in line with their own time scales.