Archived: Terrys Cross House

Terrys Cross House is a residential care home providing personal and nursing care to nine people aged 65 and over at the time of the inspection. The service can support up to 12 people. Terrys Cross House is a registered charity that provides retirement accommodation for those associated with the Church of England. Terrys Cross House is a large Victorian building set in its own grounds. The home has two floors, with kitchen, small chapel room, shared dining area and lounge on the ground floor with access to a large garden. Bedrooms are on the upper floor. The upper floor is served by stairs and a lift. Rooms are en-suite. The manager has an on-site office and there is a meeting room for staff use.

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

There were systems and processes in place to keep people safe at the home. Staff were caring and alert to notice if anything was wrong. People were independent and managed their own medication, however if they needed any help staff were trained to assist them. The home was clean, and people told us they were happy at Terry Cross House. A person told us, “I’m very content. I have a lovely room and all my meals provided, there are lovely staff and the residents are nice. It’s ideal for me.” Staff had time to sit and talk with people during the day.

People had their needs assessed before living at the home, and then regularly during their stay. Care plans were reviewed and updated frequently and staff knew people well. Staff were well trained and training was ongoing to keep staff up to date. People told us they enjoyed the food at the home. The cook planned the menus and people enjoyed the routine of morning and afternoon coffee and tea times.

People were supported by polite and caring staff. We saw positive interactions between staff, relatives and people. People and their relatives told us the care they received was good. A relative told us, “[Person] told me how happy he is here. He’s an intelligent man. If he’s happy, that endorses that it’s a smooth running home that meets his needs. Staff told us keeping people independent was very important and worked to keep people motivated.

People had personal care provided to them in a dignified way by considerate staff. Staff knew people well and enjoyed learning about their lives. Visitors were frequent at the home and were always welcomed. People were free to come and go as they wished and many people chose to go out to neighbouring towns unaccompanied. Where people asked the registered manager for trips out they were provided. People were able to take their pets with them to the home. At the time of the inspection there was a cat in residence.

The service had a positive, open culture which showed in the care staff gave to people. People and staff were happy to be at the home. Staff and people told us the registered manager had made positive changes to the running of the service. Audits and risk assessments were now carried out regularly as well as a more formal recording of staff training and supervision. A member of staff said, “I've been welcomed and I've been made aware if I need anything the office door is always open. It's a really nice place to work.” and a relative said, “Things weren't as they should have been before, but I can see she's totally different. She’s nice and friendly with everyone, but no favourites, not gushy, very practical, as it should be.”

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.

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 requires improvement (published 11 January 2019). At this inspection we found improvements had been made.

Terrys Cross House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Care is provided to up to 12 people on a permanent basis or for respite care. At the time of the inspection nine people were living in the service, but one was not present during the inspection. The service is situated in Woodmancote with easy access to local amenities and transport links.

The service had a new registered manager who had commenced working in the service in August 2018. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. One person told us of the new registered manager, “We needed someone at the helm. They were wonderful when there was not a manager. But we have found a champion a real winner. It’s made the house feel more complete.” A member of staff said, “(Person’s name) is passionate about the place and she gets things done. She is involved with the people and out and about. You could not ask for a nicer boss. It’s made such a difference. She will muck in anytime. We are like a small family.”

At our last inspection on 26 September 2017 we rated the service Requires Improvement. We found breaches in the regulations in relation to recruitment procedures and there had been a failure to establish and operate effective systems to assess, monitor and improve quality and safety. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the areas highlighted. This was the focus of this inspection. We found improvements had been made and the breaches have been met. However, we have identified further areas in need of improvement. At this inspection we found the evidence continued to support the rating of Requires Improvement.

There was a period since the last inspection when there was not a registered manager on site. The trustee and registered manager acknowledged due to staff changes there had been a period when some of the systems to be followed had fallen behind or had not been fully maintained. For example, staff training, supervision and appraisal had been delayed. Some quality assurance checks had fallen behind, for example no infection control audits had been completed. Care plans and risk assessments needed updating. Some building checks for example in relation to legionella, risk assessments and fire drills had not been completed. There were records of checks of the hot water delivered. However, these records detailed the temperature was not at the recommended safe temperature of 43 degrees Celsius. There were no supporting risk assessments completed. However, senior staff had sought the advice and support of an external company to work with them. They spoke to us about the work already completed and booked to address the issues highlighted. They were aware of the shortfalls identified in the report there was a robust action plan was in place which they had been following to address this. These were areas in need of improvement.

People were protected from the risks of abuse as staff understood the signs of abuse and how to report concerns. People had information to enable them to raise any complaints or concerns they had about the service. People felt any complaints would be dealt with in a timely way. People were also regularly visited by Trustees of the charity, with whom they could raise any issues. Medicines were stored correctly and there were systems to manage medicine safely.

People told us they had continued to feel involved and listened to. The culture of the service was open and inclusive and encouraged people to be part of the running of the service. The registered manager worked with staff to develop the service with people at the heart of the service.

Staff had the knowledge and skills to provide the care and support that people needed. Staff told us they felt well supported and had received supervision and appraisal’s. They spoke of a team that worked well together. A member of staff told us, “I am really happy here. It’s such a nice place and it does not feel like work.” Another member of staff said, “We all mix in.” Infection control procedures were in place.

People lived in a service with a relaxed and homely feel. They were supported by kind and caring staff who treated them with respect and dignity. A member of staff told us, “It’s lovely here. It’s more like a family and their home. It’s very family orientated. It’s like looking after your grandparents. We are all very close. You get to know them very well. It’s like looking after your own family.” They were spoken with and supported in a sensitive, respectful and professional manner. People were supported to be independent and have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff had a good understanding of consent.

People were supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health and access healthcare professionals when needed.

People had been supported to join in a range of activities.

People, a visitor, staff and a visiting health and social care professional told us the service was well led. Staff told us the registered manager was always approachable and had an open-door policy if they required some advice or needed to discuss something. A system was in place to respond to any concerns raised. People and their relatives were regularly consulted about the care provided through reviews, residents meetings and by using quality assurance questionnaires.

Further information is in the detailed findings below.

Terrys Cross House is a care service originally registered with the Care Quality Commission (CQC) in 2015 to provide accommodation and personal care to clergy from the Anglican community, their siblings or spouses. The service will also now accept people without this link. The service is overseen by Terrys Cross House Trust which is a registered charity, and has a committee of Trustees who oversee the service. Terrys Cross House is registered for up to 12 people needing personal care. The service does not provide nursing care; this is provided by the community nursing team if needed.

Eight people were living at the service at the time of the inspection with one person staying on a short term basis. On the inspection we identified that only two of the people living at the service were receiving personal care. Most people living at the service were independent and active, and had chosen to enjoy living in a community of likeminded people with a similar spiritual background. For some of these people, although they were not yet receiving personal care, the service monitored their wellbeing discreetly and would escalate any concerns about their health or welfare to supporting agencies.

As people not receiving personal care would fall outside of CQC regulation, we have only included information relating to people receiving personal care in this report. However some information relating to the maintenance of the building, although only affecting people not receiving care at this time, had the potential to affect those receiving care in future, as they related to part of the registered premises. As a part of the inspection we also received comments from people not receiving personal care, who were keen to share their positive experiences of the service.

This was the first inspection of the service since their registration in 2015.

The service has a registered manager. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The service had quality monitoring systems in place to ensure care and support provided continued to meet the needs of people, and that they received consistent quality care. However we identified a number of instances on the inspection where improvements were needed. Not all of these had been identified by the service’s quality assurance or management systems, which told us they were not always working effectively.

People were supported by sufficient numbers of staff to meet their needs, however, improvements were needed to the staff recruitment processes to ensure decision making regarding any risks identified during the recruitment process was recorded. Photographs of staff were not all in place in their files, and the service had not ensured a full employment history was available for each staff member employed. However we did not identify any harm had occurred as a result of this. The registered manager took immediate action to resolve this while we were at the service, and confirmed they would be asking staff to complete these retrospectively.

Terry’s Cross House is a period property set in extensive grounds. The building has large and gracious rooms; however this came with challenges for the Trust in keeping on top of repairs and renovations. We were told new boilers had been installed in the last year to heat the whole building. We were informed there were currently some issues with the roof. The registered manager and a trustee confirmed this work was due to be done but had been held up because of a bat colony in the roof that had been identified during an ecological survey. This was protected by law. We were told there was a small leak "only when it rains very hard and the wind is in a certain direction" in one person's room. This repair was due to be completed as soon as legally allowed.

Some areas within the service, such as the respite room were in need of additional cleaning and refurbishment. The registered manager told us this was due to commence after the inspection when the room being used for a weeks stay became vacant, and later sent us evidence to show this had been carried out. We have made a recommendation about ensuring accommodation is kept clean and well maintained in future. The environment was adapted to enable people with physical challenges to move as freely as possible around the service and the grounds, and there was a passenger lift to access the first floor.

People received their medicines as prescribed. The systems in place for the management of medicines protected people who lived in the service from harm. This included the use of Oxygen for one person.

Risks to people’s health or well-being had been identified and action had been taken to minimise these risks. These included those in relation to long term health conditions. People’s assessments and care plans were personalised with their individual preferences and wishes taken into account. Staff were responsive to people’s individual needs and these were regularly reviewed. For example staff were flexible in their routines to ensure people were supported to get up when they wished. Staff told us they enjoyed working in a service where they had time to support people in ways they felt demonstrated good individualised care.

People were protected from the risks of abuse as staff understood the signs of abuse and how to report concerns. People or their supporters had information to enable them to raise any complaints or concerns they had about the service. The registered manager agreed to add to this document additional information about resources who could review complaints from outside of the service’s management structures. People felt any complaints would be dealt with in a timely way, and told us they would have no concerns about raising any concerns, either to staff or relatives. People were also regularly visited by Trustees of the charity, with whom they could raise any issues.

People’s rights were respected. Staff had clear understanding of the Mental Capacity Act 2005, and issues regarding capacity and consent, which were reflected in the service’s polices and care plans. Staff ensured people were encouraged to make informed decisions where they were able. Where people’s capacity was limited, staff understood who to speak with as the person’s representative, and of the need to undertake ‘best interest’ decisions. Staff displayed caring attitudes towards people and spoke about people with affection and respect. Staff knew people’s histories, and likes and dislikes and told us they were respected.

Staff had completed training to give them the skills they needed to meet people’s individual care needs, and received the support they needed from the registered manager and Trustees. Staff told us they were confident in delivering care and support; those we spoke with were experienced in care work and could speak confidently about people’s needs and how they liked to be supported.

People were supported to have enough to eat and drink, and no-one at the service was identified as being at risk of poor nutrition. Meals could be taken communally or in people’s rooms. Meals were home cooked and people told us they ate well.

People told us they enjoyed living in a community with a shared faith. People were encouraged to remain involved in the local community, including attending services either at the chapel in the service or at local churches and maintaining contact with family and friends. For those people whose needs were greater, staff ensured they spent time with them individually, as in one instance when we saw staff supporting the person to go outside and enjoy the garden. People could participate in activities which reflected their interests, and visitors were encouraged.

People were treated with dignity and respect. All care was delivered in private in people’s rooms and there were policies in use about maintaining confidentiality of people’s information. Records were written respectfully and were well maintained. Some policies and procedures were due to be reviewed.

People and staff were positive about the registered manager, the Trustees and the overall management of the service. Trustees had an active involvement and oversight of the service, and were recruiting additional members to increase their management skills with regard to social care. The service cultivated a warm, welcoming and inclusive culture and atmosphere. People were encouraged to have a say about the operation of the service, through regular meetings and questionnaires.

We found a number of 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 this report.