We carried out a review of the data available to us about Tegfield House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tegfield House, you can give feedback on this service.
Tegfield House is a residential care home providing personal care to up to 24 in a two-storey adapted building. At the time of the inspection, there were 23 people using the service.
People’s experience of using this service and what we found
People and their relatives told us the care they received at Tegfield House was exceptionally good and we saw that people were enabled to participate in assessments and care planning and direct their care plans to ensure they could lead fulfilling lives.
People told us they felt safe. Staff had been trained and received regular updates in safeguarding and were clear about what they should do if they saw signs and symptoms of potential abuse.
People and their relatives felt that care provided was done safely and we saw that all safety monitoring was completed to a high standard to ensure this was the case.
The provider investigated all concerns thoroughly and according to relevant policies and procedures.
People were supported to remain safe through the extensive use of risk assessments.
Technology was used to minimise risks. Falls mats and movement sensors were utilised along with other equipment such as air mattresses to maintain skin integrity.
Maintenance checks and servicing of equipment was completed at set intervals. When we inspected, all checks and services were current from the daily safety ‘walkaround’ to tree surveys to ensure that trees in the grounds were in good condition.
Sufficient, safely recruited staff were deployed to meet the needs of people living at Tegfield House. Staff had recently identified a time during the day when additional staff would be beneficial. A twilight shift had been introduced which had reduced pressure on staff and improved care delivered to people.
Medicines were safely administered by staff who had been trained and checked for competency.
The registered manager and quality team reviewed all accidents and incidents and ensured that lessons learned were shared. Information was passed in a timely way to the care team through the electronic care record system.
Staff members were supported to complete an extensive induction before they worked with people. Additional support to staff through training and supervision had enabled them to progress through roles in the service and develop their careers in social care.
Assessments were thorough and completed so that people moving to the home were already known by staff who would be supporting them. The registered manager ensured the assessment process was inclusive and put people at ease and the stressful move into a care home was made as comfortable for them as possible.
Services were delivered in line with current legislation and best practice guidance. Consent was sought and documented, and outcomes were developed so that people were able to live an active life, taking positive risks in order to maximise their experiences.
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.
The provider had introduced an electronic care system which had improved care delivery and recording of interactions with people.
Food and drink were integral aspects of the service and the provider not only supplied appetising meals but provided them in a person centred way. Meals could be pureed, vegetarian, vegan, menus changed to accommodate likes and dislikes and if someone didn’t want what was offered then a different meal would be prepared.
The building had been adapted to meet the needs of people living with dementia. Toilet doors had been painted yellow as per the latest best practice guidance and items such as a dementia clock and reminiscence objects were placed about the home.
Personalised images on each person’s bedroom door offered people visual clues that this was their room and a talking point. A pilot remembered his work and a lady who had lived near to a canal could remember her previous home.
The provider had forged positive working relationships with local health and social care professionals. This enabled people to have good access to GP surgeries and social workers as needed.
The service was compliant with all aspects of the Mental Capacity Act 2005 and all Deprivation of Liberties Authorisations were applied for and updated as needed.
We heard many happy interactions between staff and people living in the home. Staff were affectionate when speaking about people they cared for and this affection was mirrored by people.
People were treated respectfully both in life and after death. Families had praised staff for the standard of care and respect shown to their relative when they had passed away.
People and their relatives were involved in the assessment and care planning process as fully as they were able or wanted to be.
People were constantly being offered choices about what they wanted to do, where they wished to sit and what they wanted to eat. Staff always asked for consent before providing care to people.
We were told about examples of exceptional care provided by staff, these were celebrated in the service however staff members did not see their exceptional practice as anything more than what should be provided.
Support was person-centred and delivered as the person wanted it to be. Staff went out of their way to make people’s lives better if they could and some simple actions such as taking someone to their home to collect belongings had a far-reaching impact on the person. The impersonal environment of the room they had moved to become their home when their own belongings had arrived.
Information was supplied to people in the most suitable manner for their needs, the provider offered large print and symbols / photos and could look at other methods of presentation as needed.
There was a full programme of activities that people could choose to join in. Some people preferred to make their own entertainment by, for example, doing some gardening, others enjoyed the group activities and entertainers.
The provider had supported people with end of life care. Feedback and accounts of exceptional care provided to people highlighted the importance the provider and staff gave to end of life care and the respect shown to people before and after death.
There was a registered manager in post who lead by example. We saw them helping on the floor of the service and being available to staff, people and relatives at all times.
Feedback about the management team was very positive and the registered manager and deputy manager were known to be very supportive, approachable and keen to improve people’s experiences of living at Tegfield House.
People were always at the centre of Tegfield House. If something was not positive to the people living in the home, it did not happen.
The management team were supportive and empowering to staff.
Staff turnover at the service was low and there had been no use of agency staff for more than six months. This was a proud achievement as it meant that people had received consistent care from staff they knew.
Staff, relatives and people living in the service were able to participate in monthly meetings or support groups. Feedback about meetings was positive, people could bring items for the agendas and a recent change to the relative’s group had been positively received.
Thorough auditing ensured attention to detail in recording and quality care delivery. All items identified for improvement were immediately followed up and plans made to change practice.
Engagement with stakeholders such as people, relatives, health and social care professionals and the public was good. Open days and other events were held regularly along with meetings and support groups.
The provider was constantly striving to improve. If anything went wrong, learning was taken and shared, and all improvements were embedded into the service.
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 8 November 2016).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The service had a registered manager. 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.
At our last inspection of this service on 25 and 26 August 2015 we found three breaches of legal requirements in relation to safe care and treatment, fit and proper persons employed and safeguarding. Following the inspection the provider wrote and told us they planned to meet the requirements of these regulations by the end of October 2015. At this inspection we found the requirements of these regulations had been met.
People told us they felt safe at Tegfield House. There were robust procedures in place to protect people from the risk of abuse. Allegations and concerns were acted on promptly and appropriately by the registered and deputy managers. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.
Staff were recruited safely, the provider carried out all the required pre-employment checks to protect people from the employment of unsuitable staff. These included a full employment history with an explanation of any gaps in employment. A Disclosure and Barring Service (criminal records check) was completed by staff prior to commencing work at the service and thereafter at three yearly intervals. This meant staff were subject to continued checks on their suitability for employment with vulnerable people.
Staff completed incident and accident reports when people experienced events that could or had resulted in harm to themselves or others. The registered manager reviewed and monitored all incidents and accidents to identify trends and take action to prevent a reoccurrence. We saw improvements had been made as a result of this analysis. People involved in accidents and incidents were supported to stay safe and action had been taken to prevent further injury or harm.
Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. People told us they were cared for safely and we found staff were aware of people’s risks and acted to support them safely. There were arrangements in place to keep people safe in an emergency and staff understood these and knew where to access the information. There were sufficient numbers of staff available to meet people’s needs.
Peoples’ medicines were managed and administered safely. Staff completed training in the safe administration of people’s medicines and had their competency assessed at regular intervals. Regular audits of medicine management were carried out by the deputy manager and an external pharmacist and action had been taken when improvements were identified.
People’s needs were met by staff who were trained and supported in their role. Staff completed an induction into their role and on-going training to enable them to care for people effectively. Staff received regular supervision from managers to identify and support their learning and development needs and monitor their performance in their role.
Decisions about people’s care when they lacked mental capacity were guided by the principles of the Mental Capacity Act 2005 (MCA). People’s care plans evidenced specific decisions had been made in their best interests when they lacked the capacity to make these. When people lacked the capacity to agree to their care and treatment and it was deemed to be in their best interest to restrict their freedom to keep them safe their rights were protected by an application for a Deprivation of Liberty (DoLS) safeguard. However a best interest process had not been recorded prior to submitting these applications. The registered manager took immediate steps to implement this process during our inspection. We found people’s rights under the MCA were protected.
People were supported to have a meal of their choice by attentive staff. People spoke positively about the food served in the home and we saw people’s dietary and nutritional needs were met. People were consulted about their food preferences and these were catered for.
People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals. People had been supported to maintain their health and achieve positive improvements in their wellbeing.
People and their relatives told us the staff were caring and compassionate. Staff demonstrated they knew people well including their personal histories and preferences. We observed that staff were caring in their approach and respected people’s decisions, privacy and dignity. People at the end of their life received person centred care based on their known wishes.
People’s needs were assessed prior to their admission, their care plans were personalised and contained information about the person’s likes, dislikes and what was important to them. Staff were knowledgeable about people’s needs and acted in accordance with their care plans. Care plans were regularly reviewed and updated and we saw staff communicated effectively about people’s changed needs.
People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest others they would like to complete. In addition to group events people were able to have individual support from activities staff to develop or maintain hobbies and interests. People told us they enjoyed the activities on offer at the home and we saw people participating in a variety of activities during our inspection.
People’s concerns and complaints were investigated and responded to in good time.
People, their relatives and staff spoke positively about the leadership in the home. The registered manager and deputy manager worked effectively as a management team to address day to day concerns and service developments. Staff were aware of the responsibilities of their role and were held accountable for their actions when they had not met the required standards.
There was a positive atmosphere in the home and comments from people and their relatives about the home included ‘homely, safe and happy’. Feedback from people, their relatives and staff was used to make improvements in the home. An effective quality assurance system was in place which enabled the provider and registered manager to assess, monitor and improve the quality and safety of the service people received.
The inspection took place on 25 and 26 August 2015 and was unannounced. Tegfield House is registered to provide accommodation for up to twenty four older people who require personal care. At the time of the inspection there were 23 people living at the service, four people were receiving day care on the 25 August 2015 and two people on 26 August 2015.
The service had a registered manager. 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.
The registered manager had failed to respond promptly to a verbal allegation of abuse from staff in relation to another staff member. The member of staff involved had since been dismissed from the provider’s employment. The provider had made changes to staff supervision records and provided further whistle blowing training for the registered manager and the deputy manager as a result of this incident. This was to ensure they were secure in their knowledge of their role and responsibilities should such a safeguarding incident occur in the future. People had not been adequately protected; however the provider had made changes to ensure people’s future safety.
The registered manager had failed to robustly implement the provider’s recruitment policies to ensure all staff recruited were of good character. The provider’s recruitment policies did not always provide sufficient guidance for registered managers. To ensure the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014 regulations in relation to staff recruitment were met fully. As a result people had been placed at risk from the recruitment of one unsuitable member of staff who no longer works for the provider.
Risks to people had been identified and they had plans in place to manage them. However, the provider did not have an incident reporting policy. Therefore staff had only recorded and reported people’s falls and medicine errors as incidents. There was a lack of guidance for staff about other types of incident they should record, analyse and monitor in order to identify any trends in incidents and to ensure the required actions were taken to ensure people’s safety. The provider took action during the inspection to introduce an incident reporting policy. There were processes in place to gather data on the service on a weekly and monthly basis and this was used to identify areas the registered manager needed to improve. Not all data relating to incidents had been documented and reflected within the reporting system. There was a reliance on staff to document data which created a potential risk that not all data was being recorded in order to ensure the processes for monitoring the quality of the service were fully effective.
The provider had reviewed and assessed staffing levels in accordance with people’s needs. The recruitment of additional domiciliary staff was being considered by the provider to allow staff to spend more time personally interacting with people.
People’s medicines were managed safely by competent staff who had undergone relevant training. Procedures were in place to ensure risks associated with people’s medicines were reviewed and addressed.
Staff received an induction into their role and on going supervision and support to ensure they had the knowledge and skills to carry out their role competently. Staff had undertaken dementia care training to enable them to meet the individual needs of the people they cared for effectively.
People were supported to make their own decisions. Where people lacked the mental capacity to make specific decisions staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been submitted for people where required. The service was meeting the requirements of the Deprivation of Liberty Safeguards.
People were very satisfied with quality of the meals they received. Risks to people from malnutrition were assessed and managed effectively. For those people identified as at risk from dehydration there was a requirement for their fluid intake to be recorded on fluid charts. However, the registered manager had identified that staff had not always fully completed these charts and they were taking appropriate measures to address this with staff.
People’s healthcare needs had been identified and they were supported to access a range of health care services. People received support from staff to ensure they maintained good health.
Staff treated people with kindness and compassion and people were positive about the caring attitude of staff. Staff took account of people’s diverse needs and interests and people were supported to participate in activities that met those needs.
Staff had limited time to interact with people outside the delivery of care. However, staff used the time they spent with people to build positive relationships with them.
People were given choices and involved in decisions about their care. Staff knew about people’s decisions and preferences and respected their wishes.
Staff treated people with dignity and respect. People’s right to privacy was respected and care was arranged to promote people’s dignity and choices.
People contributed to the assessment and planning of their care, as much as they were able. Families were involved in planning and reviewing people’s care with the person’s consent. People’s needs and preferences in relation to their care were documented and this included their preferences, personal history and interests.
Staff were knowledgeable about people’s needs and delivered care to meet people’s preferences. Activities were provided based on people’s abilities to meet a range of needs and interests. The provider sought people’s and their relative’s views on the service in a variety of ways. Feedback was used to make improvements to the service people received.
Staff told us they felt able to speak out about any concerns they had about other staff and had done so. Staff said following the recent safeguarding incident they now had a better understanding of their rights under whistle blowing legislation to ensure they felt confident to report any future concerns about people’s safety. The registered manager was aware of underlying issues within the culture of the team which impacted upon staffs ability to work together effectively in the delivery of people’s care. The registered manager was taking measures to address this. Staff were undergoing training in the provider’s philosophy and values to ensure they understood these.
People, their relatives and staff all agreed the registered manager demonstrated good leadership and they felt they were approachable if they needed support. There were processes in place to ensure the registered manager had oversight of what was happening on the floor. However, feedback received was that the registered manger needed to be more visible in order for them to observe staff practice for themselves.
We found breaches 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.
During our visit we spoke with five people. Everybody we spoke with was complimentary about the care and support they received. One person said: 'I don't think you would find better.' Other people said of the staff: 'They come when I want them' and 'I think the staff are very good'.
At this visit we looked at all areas of the home and looked at how the infection control systems were working. We saw that staff had access to personal protective equipment, for example, disposable gloves and aprons. All areas of the home that we looked at appeared clean and there were no unpleasant odours.
We looked at a selection of staff files. These records showed that Disclosure and Barring Service checks had been carried out to ensure that staff were suitable for working with vulnerable people. Records demonstrated that the staff had completed a range of training suitable to their role.
People were made aware of the complaints system. We saw there was a laminated copy of the complaints procedure available in the foyer of the home. The copy of the complaints procedure was easy to understand and in a prominent position.
During our visit we spoke with two people who used the service and four members of staff including the registered manager, a Doctor and a visitor. We spent time observing how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.
All the people we saw looked happy living at the Tegfield House. People told us that that they liked living here, and that the staff were friendly. One person told us that the home was very nice, another person told us that they were 'quite happy'. A visitor we spoke with told us they were happy with the home, and that the staff were nice and friendly. The Doctor we spoke with said that the staff were very helpful and caring.
We saw that care plans were person centre and all aspects of people's care needs were reviewed. People's assessment of care needs looked at their goals and support required.
They said that they thought the staff were very well trained to do their job and were always helpful.
People we spoke with told us about the activities that are available at Tegfield House. They told us it was up to them to take up any activity they wanted to. We observed a lot of interaction between people. We were told 'I have some good friends both amongst staff and residents.'
Two people told us that the food was very good, and both cooks were excellent.