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Inspection Summary


Overall summary & rating

Requires improvement

Updated 30 August 2018

This inspection took place on 19 and 30 July 2018 and was unannounced.

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. Yo

Inspection areas

Safe

Requires improvement

Updated 30 August 2018

The service was not always safe.

There was mixed feedback about staffing levels. Staff were not always effectively deployed. Profiles and records of inductions were not in place for agency staff.

Medicine competency checks had not been completed in a timely way. Records did not evidence medicines had been consistently stored at a safe temperature.

The home environment was clean and staff followed good infection prevention and control practices.

Staff were trained to recognise and respond to safeguarding concerns.

Effective

Requires improvement

Updated 30 August 2018

The service was not always effective.

Staff had not received regular supervisions. Records did not robustly evidence the support and monitoring of new staff.

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

Staff supported people to maintain sufficient levels of nutrition and hydration.

Staff documented people’s consent to care. Appropriate applications had been made to deprive people of their liberty.

Staff sought regular advice and guidance from healthcare professionals.

Caring

Good

Updated 30 August 2018

The service was caring.

Staff were kind and treated people with compassion, dignity and respect.

People told us they had choice and control over their daily routines. Staff routinely offered people choices and respected their decisions.

Staff supported people to maintain their privacy and dignity.

Responsive

Requires improvement

Updated 30 August 2018

The service was not always responsive.

People told us there were not enough activities or things to do.

Care plans were person-centred and provided appropriate guidance to staff on how to meet people’s needs.

The provider had a system in place to manage and respond to any complaints about the service.

Well-led

Requires improvement

Updated 30 August 2018

The service was not always well-led.

Improvements had been made in some areas, but further progress was needed.

Records were not always well-maintained.

Audits had not been effective in monitoring all aspects of the service. Issues and concerns had either not been identified or not robustly addressed.