Talbot House Care Home

Talbot House Care Home is a care home providing personal care for up to 25 people. At the time of our inspection 11 people were living in the home. Since our last inspection the home has changed from a nursing home to a care home. People have access to their own bedroom along with communal spaces including lounges and gardens.

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Although the system in place to monitor the home had improvements, further improvements were needed to ensure they were more robust.

Although we saw there were enough staff available, both people and staff felt they could benefit from some more. Further details were needed to ‘when required’ protocols to ensure staff had all the information needed.

The home was also tired and dated and some areas were in need of refurbishment.

We saw an improving picture in the home and people felt safe living there. Staff had received training since our last inspection and had the skills and knowledge to support people. Individual risks to people were considered and reviewed. There were systems in place to ensure safeguarding concerns were investigated and reported appropriately.

There were procedures in place to manage infection control and staff ensured all personal protective equipment was worn correctly.

People were supported by health professionals when needed and the advice given was followed by the staff in the home. People enjoyed the food and were offered a choice. When needed they were offered support and received a diet in line with their individual needs.

There was evidence that lessons were learned when things went wrong, there were now more audits taking place and the environment was also monitored. An incident and accident analysis had also been introduced to help drive improvements.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 22 December 2021) and there were breaches of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 19 January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Talbot House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 11 (Need for consent).

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Talbot House Nursing Home is a care home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 25 people.

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

The environment was not always safe. Environmental risks had not been appropriately managed to keep people safe from harm. Staff did not always have the information they needed to keep people safe. Medicines were not managed safely to ensure that people’s rights were protected, and that people got the medicine they needed, when they needed it.

There was enough staff to meet people’s needs. However, improvements were needed to the recruitment, induction and training processes.

Improvements had been made to infection prevention and control practices. However, improvements were still required to ensure safe admission processes were implemented.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The environment was not always suitable for people living with dementia and the mealtime experience needed improvement.

There was a new registered manager since the last inspection. However, good governance systems were still not in place to ensure to ensure that areas for improvement were identified and acted upon. This continued to leave people at risk of receiving unsafe or poor quality care.

Staff felt the registered manager was approachable and supportive.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 23 April 2021) and there were four breaches of regulation. We imposed conditions on the providers registration and the provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made in all areas, and the provider was still in breach of two regulations, with one new breach identified.

Why we inspected

We received concerns about a lack of improvement since the last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we identified concerns about the effectiveness of the service, so we inspected the effective key question also.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Talbot House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care, need for consent and governance at this inspection.

We have issued three warning notices to the provider, one for each of the breaches of regulation we found. We will inspect the service again to check whether these warning notices have been met.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Talbot House Nursing Home can accommodate up to 25 older people with nursing care needs. There were 14 people using the service at the time of our inspection. They accommodate people over three floors. One room is shared occupancy.

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

People who lived at Talbot House did not receive a safe or well led service. The provider was unable to demonstrate the safe and effective running of the service.

People were not safeguarded from the risk of abuse because the provider could not demonstrate they had acted to protect people from harm and not investigated concerns appropriately. Their lack of action placed people at risk of actual harm.

Fire safety arrangements within the home were unsatisfactory and unsafe. We took immediate regulatory action to ensure changes were made to ensure people’s ongoing safety.

Risks had not always been assessed or safely managed meaning people may receive unsafe care and treatment.

Infection control measures had not kept people safe during the pandemic and a high number of people and staff had been adversely affected. The provider was working with health protection agencies to improve practice.

There was a lack of sufficiently trained staff at a senior level in order to oversee the ongoing monitoring and auditing of the service to ensure its effectivity and safety. The provider did not regularly visit the home but remained in contact with the deputy manager via regular video calls. However, the provider had not established that audits and safety checks were not being carried out suggesting communication was not effective. This lack of oversight had led to issues being mismanaged and had impacted upon the safety of the service.

Although we appreciate the recent Covid 19 outbreak had impacted upon the service, some issues were historic.

Quality and safety had not been monitored or managed and this had led to poor and unsafe practice.

Rating at last inspection

The last rating for this service was good (published 6 March 2018).

Why we inspected

We had received information of a recent outbreak of Covid 19 within the home which had affected a high number of people who used the service and staff. This triggered an inspection where we looked at infection control practices as well as the safety and leadership within the home.

Enforcement

We have identified breaches in relation to safeguarding people from abuse, assessing and managing risks, safe care and treatment, staffing, and in the governance of the service at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as

inadequate for any of the five key questions it will no longer be in special measures.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Talbot House on our website at www.cqc.org.uk.

This unannounced inspection took place on 24 January 2018. At our last inspection on 21 July 2016, the overall rating of the service was Good. At that time the key question, ‘is the service well led?’ was rated as Requires Improvement. At this inspection, the overall rating of the service remains Good, and improvements were seen in the key question ‘is the service well led?’ However, the key question ‘is the service responsive?’ had deteriorated to Requires Improvement. We have recommended that the provider seeks advice and guidance about meeting the information and communication needs of people with a disability or sensory loss.

People’s communication needs had not been considered within the care planning process, and information was not available in accessible formats. Some people’s care plans did not reflect the person as a whole in relation to their life, and in places information was not as detailed as needed. People had been involved in the initial planning of their care, and were supported to take part in activities and hobbies they enjoyed. People knew how to raise issues or concerns, and these were responded to in a timely manner.

People were safe living at Talbot House Nursing Home. They were supported by staff who understood how to protect people from harm and abuse. Risks were managed and there were enough staff to meet people’s needs. People received their medicines as prescribed and were protected against the risk of infection. Lessons were learnt and improvements made when safety concerns were identified.

People’s needs were assessed and support was given in line with evidence-based guidance. Staff had the knowledge and skills needed to provide effective care for people. People’s nutritional needs were met and they were supported to access healthcare services. 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 service supported this practice.

Staff were caring and kind to people, and supported people to make decisions about their day to day care. People’s privacy was respected, and their dignity and independence promoted. People were able to maintain relationships that were important to them and there were no restrictions as to when families and friends could visit.

There was a registered manager in post who had implemented systems to monitor quality and drive improvements within the home. Staff were supported in their roles and encouraged to share ideas to develop the service. The culture of the service was open and transparent and people were encouraged to give feedback about their experience of living or working in the home.

Further information is in the detailed findings below.

There was a registered manager in post, however they were not active in this role. A new manager had recently been recruited to replace them. They told us they were going to apply to register with us. 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.

Our last inspection took place on 1 April 2015, and at that time we asked the provider to make improvements to ensure that there were effective systems in place to assess, monitor and improve the quality of care people received. Some improvements had been made, but further improvements were required. Some information was being gathered, but there was limited analysis of any trends that could be used to drive continuous improvement.

Staff also told us they would benefit from further training and development opportunities to increase their understanding in certain areas. Staff supervisions, which may have identified areas where staff needed further support to develop their skills, were not consistently taking place.

At our last inspection, we had also asked the provider to make improvements to ensure that people were not being restricted unlawfully. At this inspection, we found that improvements had been made. When people who lacked capacity were restricted, the necessary authorisations were in place to do this lawfully.

People were safe and protected from harm and abuse. Staff demonstrated an awareness of how to keep people safe. Risks to individuals were assessed and managed. There were enough staff to meet people’s needs and keep them safe. The provider recruited staff in a safe way and people’s medicines were managed safely.

People were supported to make decisions. When people were not able to make certain decisions for themselves, care and support was provided in their best interests. Staff had the knowledge and skills needed to support people. People received food and drink that met their nutritional needs and were referred to other healthcare professionals to maintain their health and wellbeing.

People were treated with kindness and compassion and their dignity and privacy was promoted and respected. People were listened to and were encouraged to be independent and make decisions about their care and support. People were enabled to maintain relationships that were important to them.

People and their relatives were involved with the planning of their care, and were supported to follow their interests and take part in activities. People knew how to raise and concerns and were encouraged to share their views about the service.

There was a positive culture within the service; people and staff spoke positively about living and working there.

We are changing how we inspect services in the future and also making changes in how we report our findings. Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service and their relatives told us they felt safe at Talbot House. One relative told us: 'I have booked a holiday, the first for a long time; I know my mother is safe here".

Most staff had received training in safeguarding procedures but we were made aware of some staff who had not received training.

We saw that the home was clean and well maintained. All the people we spoke with told us that this was always the case.

Recruitment procedures were rigorous and thorough.

Is the service effective?

People had access to a range of health care professionals some of which visited the home.

Everyone had a care plan which informed staff how to meet their needs. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

Is the service caring?

Staff treated people with dignity and respect. People's individual needs and preferences were upheld.

People who used the service told us the staff at Talbot House were caring. One person told us: 'They (staff) are very good, very kind'.

Is the service responsive?

People were engaged in meaningful activities if they chose to participate.

Short term care plans were put in place when people's needs changed.

Regular reviews of people's care took place, but people that used the service or their relatives were not always involved.

Is the service well led?

Talbot House worked closely with other agencies to ensure people received care in a joined up way.

The service did not have a system to assure the quality service they provided. The way the service was run was not regularly reviewed. We have asked the service to make improvements in this area.

Staff training and supervision was not up to date.

We found that the service had installed a new bath and had redecorated the bathroom.

We spoke with people who used the service, staff, two visiting relatives and the manager.

We looked to see if people who used the service consented to their care, treatment and support. We found that the service had systems in place to show that people had consented to their care.

We looked at care records, spoke to people who used the service and observed their care being delivered and found that the service was meeting the care and welfare needs of people who used the service. One person who use the service told us; 'They (staff) more or less saved my life'.

We found that most of the equipment used to support people in Talbot House was properly maintained and suitable for its purpose.

We found that the service was following the correct recruitment procedures when they employed new staff.

The service had a complaints procedure for people who used the service or their relatives to use if they felt the need to complain about the service.

We saw that staff were using hoists and slings with people without having been formally trained in their use. We observed one person being assisted from sitting to standing by staff who used an under arm hold which is now no longer used to support people. We looked at staff files and could see no evidence of moving and handling training. This meant that the care being delivered wasn't safe and people's welfare wasn't being protected.

The manager has since sent us evidence of staff training in moving and handling. The manager has received training to train the staff at Talbot House and has completed this training with all care and nursing staff.

When we arrived people who used the service were getting up or were up and having their breakfast in the dining room or their bedrooms. The dining room was being redecorated and we were told this would be completed in the next two weeks.

People who used the service told us they were happy at Talbot House and that the staff were good.

Relatives of people who used the service said they were happy with the care they received. One person told us they would like staff to have more time to spend with their relative as this person was being cared for in their bedroom.

Staff were observed to generally be kind and caring, although we saw at times staff were supporting people without interacting with them and informing them what they were going to do before doing it.

We had minor concerns about the care and welfare of people who used the service.