Tudor House

Tudor House is a residential care home providing personal and nursing care to up to 30 people aged 65 and over, some of whom who may be living with a physical disability or dementia. At the time of the inspection the service was supporting 25 people.

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

People were protected from the risk of abuse and avoidable harm. Staff had guidance about how to manage risks to people’s health and safety and they managed people’s medicines safely. Lessons were learned when things went wrong to prevent the same incidents from occurring again.

We have made a recommendation about staffing.

The home was warm and welcoming, and people benefited from person-centred care. The provider had a system in place to monitor the quality and safety of the service and identified where action was needed to make improvements.

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 Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 September 2019). The service remains rated good.

Why we inspected

We received concerns in relation to safeguarding. This was a planned inspection based on the previous rating. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 the same. This is based on the findings at this inspection.

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

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 found the following examples of good practice:

The service was hygienically clean. Cleaning schedules and regular cleaning helped make sure all areas of the service were cleaned to reduce the risk of people catching or spreading coronavirus.

Staff wore personal protective equipment (PPE) to help keep them and the people they supported safe.

Visits were organised in line with government guidance. A ‘visitor’s room’ had been set up to enable people to meet with relatives and friends in a safe way.

Tudor House provides residential and nursing care for older people who may be living with a physical disability or dementia. The service is registered to support up to 30 people, and 24 people were using the service when we inspected.

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

People received safe and effective support to meet their needs. Staff were kind, caring and respectful in their approach and people responded positively to the friendly relationships they shared with the staff who supported them.

Staff had been safely recruited and the registered manager monitored staffing levels to make sure enough staff were deployed to meet people’s needs.

Regular training, observations and competency checks were used to make sure staff had the skills and knowledge to safely meet people’s needs. Staff had been trained to recognise and respond to any safeguarding concerns.

Medicines were managed and administered safely. We made a recommendation about continuing to monitor and make sure medicines were stored at a safe temperature.

People’s needs were assessed and care plans and risk assessments guided staff on how best to support people.

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. Staff understood people’s communication needs and used accessible information when necessary to help people be involved in decisions.

The environment was suitable for people’s needs. It was clean, tidy and regular maintenance checks helped make sure it was safe and suitable for people.

Staff were caring in their approach. They treated people with dignity and respected their privacy.

Improvements had been made to the range of activities and opportunities for meaningful stimulation offered at the service. People were encouraged to raise issues, concerns or complain if needed. The provider had a policy and procedure to ensure complaints were responded to.

The provider had responded to feedback at the last inspection to improve the service. Regular audits were used to continually monitor the quality and safety of the service.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

At the last inspection service was rated requires improvement (report published 30 August 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had been made and the provider was no longer in breach of regulations.

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.

Tudor House is registered to provide residential and nursing care for up to 30 older people who may be living with a physical disability or dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service is a converted town house with accommodation provided across two floors. At the time of our inspection there were 25 mainly older people using the service.

At the time of our inspection, the previous registered manager had not yet deregistered although they were no longer managing the service. The service had a new manager who had been in charge since October 2017. They were in the process of registering with the CQC to become the 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 2008 and associated Regulations about how the service is run.

The manager was also the registered manager for another of the provider’s services and split their time between managing the two homes. They were supported by a deputy manager and nurses in the management of Tudor House.

At the last inspection in May 2017, we rated the service requires improvement overall and identified two breaches of regulation relating to safe care and treatment and the governance of the service. This was because staff training was not up-to-date and regular fire drills had not been completed. There were gaps in care records and limited activities took place when the activity co-ordinator was not at work. Quality monitoring systems had failed to identify and address these concerns. We asked the provider to take action to address our concerns.

At this inspection, we identified some improvements had been made and the provider was compliant with the regulation relating to safe care and treatment. However, we identified a number of new issues and ongoing concerns about the governance of the service.

Staff were not always effectively deployed and people were left unsupervised for long periods of time. People who used the service told us staff did not always respond quickly to their requests for assistance.

People told us there were not enough activities. The activities coordinator was not at work and the provider had not taken adequate steps to make sure regular and meaningful activities continued in their absence. We raised concerns at our last inspection about the lack of activities when the activities coordinator was not at work and found on-going concerns at this inspection.

Complete and contemporaneous records were not always in place. There were gaps in recruitment records. Profiles and induction records were not always available for agency staff. Accident and incidents records were incomplete and did not always evidence action taken to prevent similar things happening again.

The provider and manager completed a range of audits, however, these had not ensured portable appliance tests were completed in line with the provider's policies and procedures. Checks had not been consistently documented to evidence medicines were stored at a safe temperature. Annual medicine competency checks, designed to make sure staff were safe and competent administering medicines, were overdue.

Staff had not received regular supervisions at the frequency set out in the provider’s policy and procedure. Records did not evidence the support provided to new staff during their first months at the service.

There was a new breach of regulation relating to person-centred care and a continued breach of regulation relating to the governance of the service. You can see the action we have told the registered provider to take at the end of this report.

We made a recommendation about developing a more ‘dementia friendly’ environment.

Appropriate action had been taken to improve fire safety.

Staff were trained to recognise and respond to safeguarding concerns to keep people safe. People told us they felt safe living at Tudor House. The environment was clean and staff followed good infection prevention and control practices.

Staff supported people to make sure they ate and drank enough. They worked closely with healthcare professionals to promote people’s health and wellbeing.

Staff completed regular training to equip them with the skills and knowledge to meet people’s needs. They sought people’s consent and made appropriate applications when necessary to deprive people of their liberty.

Staff were kind, caring and respectful. People had choice and control over the support they received. Staff helped people to maintain their dignity. People had positive caring relationships with staff and enjoyed their company.

Care plans contained person-centred information about what was important to people and about how their needs should be met. This helped staff to get to know people and provide responsive care.

The manager investigated and responded to any complaints about the service.

Staff gave positive feedback about the support, advice and guidance available to them. They told us there was good communication and effective teamwork.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a further comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements.

We inspected the service again on 23 May 2017. This was an unannounced inspection, which meant that the staff and provider did not know that we would be visiting. At this inspection we found the provider had followed their plan and legal requirements had been met. However, we identified different breaches of legal requirements and rated the service as ‘Requires Improvement’.

The home had a registered manager. 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.

Tudor House provides accommodation and nursing care to accommodate a maximum number of 30 older people, some of whom were living with a dementia.

Not all staff had not taken part in fire drills. Staff had not been provided with the training to ensure a person’s safe evacuation from the service in the event of fire.

Staff were not up to date with their training in fire safety, equality and diversity and emergency first aid. There were insufficient staff trained in emergency first aid to ensure that a trained staff member was on duty on all shifts.

There were systems in place to monitor and improve the quality of the service provided. However, this quality monitoring system had not detected the further areas we identified as requiring improvement.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Risks to people's safety had been assessed by staff.

There were sufficient staff on duty to meet the needs of people who used the service. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

Staff had an understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards and acted in the best interest of people they supported. However, best interest decisions did not always record the views of family and professionals.

Menus provided people with a choice of healthy food and drinks, which helped to ensure that their nutritional needs were met. We received mixed feedback from people on the food provided.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were kind and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for. People’s independence was encouraged.

An activity co-ordinator was employed four days a week to plan outings and activities for people who used the service. However, limited activities took place when the activity co-ordinator was on holiday.

People’s needs were assessed and their care needs planned in a person centred way. Care plans were reviewed on a regular basis to ensure they reflected people’s current support needs.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Tudor House, which is owned by Roche Healthcare Limited, is a care home registered to provide personal and nursing care for up to 30 people. Tudor House is a detached home with disabled access, a passenger lift to the first floor and car parking facilities. The service has three communal lounges on the ground floor, some bedrooms have ensuite access.

At the time of our inspection 25 people lived at the service.

The service has a registered manager. 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.

Parts of the service were not clean and there were areas where germs could collect, this meant that people who used the service were not being cared for in a pleasant environment and they were not protected from the risk of infections being acquired and spread. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although people told us they received a good standard of care we saw some gaps in care records which meant people were at risk of receiving care which was not planned or based on their current needs. We saw some out of date information in care plans. Some other associated care records were not up to date and the audits the service used had not identified these issues and so they had not been rectified. This was a breach of Regulation 17 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 the report.

The service had an up to date safeguarding policy and staff understood how to identify types of abuse and who they should report their concerns to. Risks assessments and risk management plans were in place to support people to remain safe. People were supported to take their medicines safely. The service sought support from relevant health care professionals when required.

The registered manager told us the service did not use a staff dependency tool but they assessed staffing levels on a regular basis. Overall we found there were sufficient staff. However, there was a period of time when people were not provided with supervision and they were unable to summon assistance from staff. This meant people were at risk of injury as staff were not available to assist people nor did they have a safe means of seeking assistance. We have made a recommendation about the deployment of staff.

People told us the food was good and we saw people’s individual dietary needs were met. For example some people needed support to eat and this was provided in a compassionate way.

Staff were well supported by the registered manager and had access to a variety of training.

The principles of the Mental Capacity Act 2005 were being followed. The registered manager explained updated assessment paperwork was being introduced. Staff consistently demonstrated they sought consent from people.

The service sought the views of people, relatives, staff and other relevant stakeholders. They used the feedback to make improvements to the service. People knew how to make complaints and the complaints policy was accessible. The registered manager told us they had an ‘open door’ policy and welcomed people’s feedback.

Activity and stimulation for people within the service was limited. Although the service employed an activity co-ordinator four days a week the rest of there was limited interaction for people. We have made a recommendation about ensuring activity and stimulation meets people’s individual needs.

Despite the shortfalls in records and audits, we found the registered manager was committed to delivering a good standard of care to people and we received positive feedback from people and relatives about how approachable the registered manager was.

We saw from people's care plans that people were supported to live as they chose to, within their limitations. Staff at the home had carried out an assessment of the needs of each person, and kept this under review. This helped to make sure appropriate care and support was given.

We looked at people's care records and saw arrangements were in place to identify and monitor those people at a greater risk of poor nutrition and dehydration.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff we spoke with told us they received training which helped them to deliver care and support people safely.

The home had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.