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Inspection Summary


Overall summary & rating

Good

Updated 5 March 2019

The inspection at Thomas Tawell House was undertaken on 12, 13 and 16 November 2018. The first day of the inspection was unannounced.

Thomas Tawell House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Thomas Tawell house is a care home supporting people living with visual impairments. The home was designed to support the independence of people living there. The home was a large one-story building with communal areas to allow people opportunity to have varied spaces in which they could relax, dine, undertake activities and even host events.

The home was registered to support 37 people, at the time of the inspection there were 24 people living in the home. Following the last inspection, the provider had taken the decision not to admit any further people to the home until improvements had been made. Shortly before this inspection new people had begun to be placed at the home.

Thomas Tawell had a registered manager who had been in post for approximately six months. 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 the last inspection we found six regulations to be in breach of the Health and Social Care Act (Regulated Activities) 2014. The home was found to be inadequate in the key questions of safe, responsive and well led and to require improvement in the key questions of effective and caring. The home was rated as inadequate overall. Since the last inspection there has been a change in the management structure of the home with a newly appointed registered manager and deputy in place. The nominated individual has also taken on a more proactive role in ensuring the service improved. The provider had recruited a consultancy company who had supported the service and had introduced basic and emergency plans including risk assessment and care planning to ensure people were kept safe.

Since the introduction of the new registered manager these were to develop and become a more comprehensive assessment tool which in turn would feed into more person-centred care plans. Work had begun to put this in place. We found the new management team including senior managers and the board members motivated and committed to continually drive improvement at the home.

Previous breaches had been found in regulations associated with staff and we had concerns about both the number of available staff and the training and support staff had received. We had concerns around how risks were assessed and mitigated and how restrictive practice had been assessed for people who lacked capacity. We found breaches in the regulation associated with person centred care and found people were not involved as they should be with deciding their care. We found their preferences had not been met once they had moved into the home. We also found a lack of dedicated and appropriate activities. We had concerns that complaints procedures were not accessible to people and complaints had not been handled appropriately or recorded. Lastly, we had concerns around how the provider had monitored the service delivered and the accuracy of any monitoring undertaken as it had not been effective at identifying concerns.

A consistent approach to service improvement had been adopted since the last inspection. A comprehensive action plan had been provided to the Care Quality Commission following the last inspection and we were given an up to date one at the start of the inspection This showed us ongoing systems were in place to identify, discuss and action any concerns or issues. The new registered manage

Inspection areas

Safe

Good

Updated 5 March 2019

The service was safe.

We found risk assessments were still in basic form and identified where further assessment was required. This had begun to be implemented

Safeguarding procedures were developed and staff were trained and understood their responsibilities in keeping people safe.

There were enough dedicated and competent staff to meet people’s needs.

Medicines were managed safely and people received their medicines as prescribed.

The provider had developed systems to learn from concerns. Further analysis was beginning to identify themes and trends.

There were dedicated infection prevention control procedures including audit and appropriate equipment.

Effective

Good

Updated 5 March 2019

The service was effective.

Staff were well trained and supported by their peers and management. The timeliness of some training required additional thought.

The home completed comprehensive assessment of people’s needs to ensure the home could support them effectively.

The chef took responsibility to ensure people’s nutritional needs were met.

The provider group had services designed to meet the needs of people living with a visual impairment.

Referrals were made to other services to support people in remaining as independent as possible

The home was designed to meet the occupants needs

We found the home were following the principles of the Mental Capacity Act 2005 and sought consent as required from both those with and without capacity to make decisions themselves.

Caring

Good

Updated 5 March 2019

The Service was caring.

Staff were kind and considerate to the people they supported.

We saw respectful and friendly interactions between staff and people living in the home.

People told us they felt involved in decisions around their daily activity and made plans for future activity

Responsive

Good

Updated 5 March 2019

The service was responsive.

Care assessment and planning tools were a little disjointed and work was required to pull information together in a more person-centred format. The manager had begun to act by the end of the inspection

Staff knew people well and we saw activities and support was delivered in accordance to people’s needs and preferences.

People were supported to maintain their independence where possible

There were a number of activities taking place over the inspection and we saw information for those planned both inside and outside of the home.

People told us if they needed to complain they felt they would be listened to and issues and concerns would be resolved.

Well-led

Requires improvement

Updated 5 March 2019

The service was not consistently well led

A set of comprehensive quality audits was in place. The analysis of the collated monitoring was being developed to ensure the identification of themes and trends.

There was a clear values base at the home and staff and people living in the home feel part of a positive environment.

Accountabilities and responsibilities were clear and the future direction of the home was driven by an improvement ethos

Actions from meetings and the collation of feedback helped to develop and embed a quality assurance and review system in place.

The home worked well with provider agencies and with other professionals to meet the needs of people in the home.