Tunbridge Wells Care Centre

We found the following examples of good practice.

People were well supported by staff to have telephone and internet contact with their family and friends. The service facilitated in person visits in a manner which minimised the risk of infection spread, including outside visits, and visits using a screened area through a separate door on the ground floor.

Plans were in place to isolate people with COVID-19 to minimise transmission. The service had good supplies of personal protective equipment (PPE) that were readily available at stations throughout the service. PPE was ordered on a weekly basis and there was a central store managed by the provider that the registered manager could access.

Visitors were asked screening questions and to wash their hands with soap and water when they arrived. Lateral flow tests were carried out on arrival and visitors were allowed into the home once a negative test had been confirmed.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and residents were regularly tested for COVID-19. The building was clean and free from clutter. High touch areas were cleaned several times a day, including visitor areas that were cleaned between use.

Staff ensured people’s welfare had been maintained and they had sufficient stimulation, such as staff supported activities. Daily activities were recorded on the electronic care system and could be viewed by relatives as a way of keeping them in touch with activities and care within the home.

Tunbridge Wells Care Centre is a nursing home providing accommodation, personal and nursing care for up to 70 older people, including those living with dementia. Accommodation is located over three floors with a lift available to access each floor. One of the floors specialises in providing care to people living with dementia. At this inspection, there were 63 people living in the service.

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

People and their relatives were positive in their feedback. Comments from people included, “The staff are very attentive, and I have not had any worries about my care or feeling unsafe” and “The staff are all very kind and lovely.” Comments from relatives included, “It’s wonderful here. I have no worries about the care and the staff keep me up to date with any changes” and “I looked at a number of homes and was impressed that it was clean, staff were smiling and everywhere was fresh.”

Observation showed that staff had developed trusting relationships with people where they felt comfortable in staff’s presence and approach them with any concerns they had. Staff knew what their responsibilities were in relation to keeping people safe from harm and potential abuse.

Medicines were stored and administered safely by registered nurses. Staff were trained to meet people’s needs and registered nurses were supported to keep their registration with the Nursing and Midwifery Council (NMC). Nurses and care staff received continuous support and supervision from the management team.

Staffing levels were based on people’s needs. There were enough care staff and nurses to meet people’s needs, call bells were answered promptly. Staff continued to be recruited safely.

People received support to maintain their health and access health care professionals as required. Daily meetings were held to discuss any changes in people’s needs and referral to relevant health care professionals were promptly made.

People’s care plans were person-centred and informed staff how the person wanted to be supported. 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 staff were caring, and knew people, their preferences, likes and dislikes well. Staff encouraged people to maintain their independence using aids to support independence. Staff understood the importance of protecting people privacy whilst promoting their dignity.

People’s, relatives and staff’s feedback was sought and acted on. People were supported to access a range of activities within the service and in the local community.

Staff worked in partnership with the local hospice team to support people to have a dignified death they have chosen.

The management team were committed to improving the quality of the service people received. Audits highlighted any areas for development or improvement, which were acted on quickly.

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 3 January 2017).

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.

We carried out this unannounced inspection of the home on 2 November 2016.

At the time of our inspection there was a registered manager in place. They had been registered since January 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were kept safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service.

People were supported to take their medicines as prescribed.

People were supported to eat and drink sufficient amounts of food and drink. They were provided with choices of food and drink to meet their individual dietary preferences and requirements. People were helped to access health care services. This was to ensure that their individual health needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA 2005] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. People's mental capacity was assessed and people were able to make decisions about their day-to-day care. Staff were knowledgeable about the application of the MCA.

People were looked after by staff who were trained and supported to do their job. The registered manager ensured that people received individual supervision that supported them to undertake their roles.

People were looked after by kind staff who treated them with respect and dignity. They and their relatives were given opportunities to be involved in the setting up and review of people's individual care plans.

There was a warm and welcoming atmosphere in the home and staff worked closely with people and their families. This was to ensure each person was supported to maintain their individual interests and to have a meaningful and enjoyable life. In addition, staff provided a varied programme of communal activities for those who wished to participate in them.

Care was provided based on people's individual needs and helped to reduce the risk of social isolation. There was a process in place so that people's concerns and complaints were listened to and action was taken to address them.

The registered manager was supported by a team of management staff, ancillary staff and a team of nursing and care staff. Staff were supported to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action was taken where improvements were identified.

People had their capacity to make decisions about their care assessed. They were offered choices, and where they had the capacity made decisions about their care. Where they were unable to consent, relatives were involved in making choices for them.

The people we spoke with and their relatives were positive about the service and the care provided. One person told us 'the care's excellent' and 'I can't fault anything'; another said that it was 'reasonably good'. A relative told us that the home were good at communicating, and told them what had happened with their relative. They said they were very happy with the care provided, and thought that their relatives care needs had been met.

There were safeguarding processes in place.

Staff received the necessary training and appraisal and to support them to meet people's needs.

All but one of the people we spoke with were complimentary about the food saying it was 'super' and they 'get all they need'.

The people we spoke with were positive about the staff and the care they provided. One person said 'the carers are wonderful' and 'there were a 'few blips, but the girls are good.' Another person said there had been a lot of agency staff 'but they are all very good' and 'there's nothing you can blame them for.' A relative told us 'all the staff were wonderful, right up to the cleaners.' However, not all staff had completed what the service set out as its minimum training requirements.

People told us they were asked for their opinions about the service, and that the manager asked them if there were any problems.

The service had processes in place for safely administering people's medication.

One person told us they felt able to complain if they needed to, and a relative told us that they felt able to say anything to the staff as 'they seem to be on your side.' The relatives we spoke with confirmed that the manager and her deputy were approachable and available.