Archived: Tylecote

At the last inspection in October 2015, the service was rated Good .

At this inspection we found evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However we have made recommendations for the registered manager to improve medication procedures and ensure infection control systems improved. In addition we have recommended the provider develops a programme of refurbishment. This was so people were kept safe and lived in a healthy environment.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Tylecote 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, both of which we looked at during this inspection.

A registered manager was in place. 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.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people's safety, and balanced these against people's rights to take risks and remain independent.

Safe recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

We found PRN (as required) medicines were not stored correctly and some were missing lables, making it difficult to be sure who the medicine belonged to.

We have made a recommendation about safe medicine procedures.

Infection control measures were in place however these were not always adhered to. The kitchen was in need of some refurbishment and cleaning and parts of the communal areas also needed attention. However during the inspection visit this was being addressed. We have made recommendations in relation to infection control and refurbishment of the environment.

Any accidents/incidents or errors had been used as a learning opportunity.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People’s care and support had been planned with them. They told us they had been consulted and listened to about how their care would be delivered.

Care plans were organised and had identified care and support people required. We found they were informative about care people had received.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure that they received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

In order that people could maximise their opportunities and have their views heard the registered manager worked closely with the advocacy service to support people and to ensure they were not disadvantaged.

People's privacy and dignity was maintained at all times. Care plans were written in a person centred way and were responsive to people's needs. People were supported to follow their interests and join in activities.

Sufficient staff were on duty to meet people's needs. People told us staff responded quickly when they needed assistance. Throughout our inspection we observed there was a visible staff presence at all times.

People knew how to complain. There was a complaints procedure in place and accessible to all. No recent complaints had been received.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people living at the home, staff supporting them and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Tylecote.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required. The provider said, 'We are looking to extend the training to all staff.'

From our observations during the day, we found people were treated with respect and dignity by staff. People living at the home told us they felt safe. One person living at the home said, 'Yes I love it here, they are all lovely.'

Staff recruitment was safe with all required checks undertaken prior to people starting to work at the home. This meant suitable staff were employed who had gone through a robust selection process before commencing employment. One staff member said, 'I had a thorough induction training to go through.'

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care where possible. Relative's views were also sought to ensure people receive the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We found people's care plans were regularly reviewed for their effectiveness and changed in recognition of the persons changing circumstances. Individual risk assessments had been completed to identify the potential risk of accidents and harm.

People's assessed needs were reflected in their care records. Individual records were person centred, comprehensive and informative in identifying personal preferences and how they liked their care and support provided to them.

Is the service caring?

We spent part of the day in the lounge and dining areas talking to people and observing staff interaction with people. People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. One resident we spoke with said, 'They are very kind.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Staff we spoke with knew the people they were caring for and supporting. One staff member said, 'We are a small home run like a big family and know all the residents well. This helps to spot anything that is wrong early and act upon it.'

Is the service responsive?

People completed a range of activities in and outside the home regularly. We saw evidence of daily activities planned. One person said, 'I like to do knitting.' Staff told us people had access to education, volunteer work, and education activities that were important to them. We found the home protected people from social isolation through the community activities and systems they had in place. One staff member said, 'People had volunteer jobs and attended day centres if that was what they wanted.'

Surveys were given out to people and their relatives to give their views on the quality of care the home provided. The management would act on any information that would improve the care and support people living at the home received. They said, 'We would analyse responses and respond to any suggestions that would improve the way we deliver care and support to people.'

Is the service well-led?

We had responses from external agencies including social services .They told us they had a good working relationship with the manager and staff to make sure people received their care and support they required. The manager worked well with other agencies and services to make sure the person they supported received their care in a joined up way.

There were a range of audits and systems put in place in by the manager and provider to monitor the quality of the service being provided.

During the inspection we looked at care, medication, staff supervision and training records. We also talked to residents about the home. People told us staff were helpful, polite and supportive. One resident said, 'This is the best home I want to stay here for good.'

Staff members we spoke with had an awareness of residents care needs. We discussed with staff the individual needs of residents. Comments included, 'We are a small home like a family and are experienced to know when someone is not themselves.'

We spoke with residents living at Tylecote. They told us they were happy living at the home and that they liked the staff team and felt cared for.

Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date.

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We spoke with people about the routines within the home and were told these were being arranged around their individual and collective needs. They said they were provided with the choice of spending time on their own or following their chosen interests. One resident said, "I do work one day a week which I like to do." They told us the home had a relaxed atmosphere and the staff were kind, caring and patient with them.

Staff members we spoke with felt the training they were receiving provided them with the skills and knowledge to support people well. One staff member said, "We have a good staff team with plenty of training going on."

We spoke with staff members about individual care needs of residents. They had a good understanding of what support and care was required for each resident we discussed. One staff member said, "We get along so well and know all of the people well because we have been here a while."

All comments we received about the service were positive and included,

"I like all the staff they are helpful and kind."

"We try and make sure all residents are able to do what they choose to inside and outside the home."

"Our daughter could not be in a better place."