Tudor House

About the service

Tudor House is a residential care home registered to provide personal care for up to 23 people, some living with dementia. At the time of our inspection there were 19 people living at the home.

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

Since the last inspection there have been some changes to the management of the service and restructuring of its processes. We found some of the systems in place to monitor the quality within the home required improvement. The feedback we received from relatives and staff was mixed regarding how the service was managed and felt communication from the provider could be improved.

People we spoke with were happy with the care received. Relatives we spoke with were overall, satisfied with the support given to their family member.

People were protected from abuse and relatives we spoke with were assured the home environment was safe for their family members to live in. Staff knew how to report any suspicions of abuse. Risks to people were reviewed regularly and people were supported to remain as safe as possible.

On the day of inspection, there were enough staff employed to meet people's needs and there were recruitment procedures in place to check staff were safe to work with people.

People were supported to take their medicines in a safe manner. There were some minor issues with the recording and storage of medicines, however these had not posed any risk to people.

We were overall assured the provider had safe infection prevention and control procedures in place, including in relation to the management of COVID-19. The home environment was clean and tidy and no unpleasant odours.

Incidents and accidents had been reported appropriately and reviewed for any trends to mitigate future risk.

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

Rating at last inspection

The last rating for this service was good (published 10 December 2019).

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We inspected and found there was a concern with some of the provider’s infection control practices, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the 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.

The provider had taken immediate action to address some of the concerns raised with them.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified a breach in relation to the provider’s governance processes at this inspection.

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.

Tudor House provides accommodation and nursing or personal care for up to 23 people. On the day of our inspection, 21 people were living there, some of whom were living with dementia.

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

People received safe care and support as the staff team had been trained to recognise potential signs of abuse and understood what to do to safely support people.

The provider had assessed the risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

Staff members followed effective infection prevention and control procedures when supporting people. Staff members had access to, and used, appropriate personal protection equipment.

People received safe support with their medicines by trained and competent staff members.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision.

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 at Tudor House supported this practice.

People had access to additional healthcare services when required. Staff members knew people’s individual health outcomes and supported them appropriately.

People were supported to maintain a healthy diet by a staff team which knew their individual preferences.

People received help and support from a kind and compassionate staff team with whom they had developed positive relationships.

People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability.

People were provided with information in a way they could understand.

The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them.

The provider, and management team, had good links with the local communities within which people lived.

The management team and provider had systems in place to identify improvements and drive good care.

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

Rating at last inspection

The last rating for this service was ‘Good’ (published 04 May 2017).

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.

The service has a registered manager although they were absent from work at the time of the inspection. Management cover was being provided by the deputy manager who was present throughout our inspection. 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 told us they felt safe living at the home. Staff had knowledge about safeguarding procedures and action they would take should they have concerns.

People received their medicines safely. We saw staff seeking consent from people before supporting them with their medicines. Staff had received training to enable them to support people with their medicines safely.

Most of the people living at the home thought there were enough staff available to support them and we saw staff were always available in communal areas of the home.

People had the opportunity to feedback their preferences for food which were incorporated into menu planning. People told us they enjoyed the foods they were offered. People received appropriate support to have their healthcare needs met.

People were offered choices in many aspects of their care.

Some people at the home were living with dementia. Staff had some understanding of how to support people with this condition although some practice we saw did not promote good dementia care. There were limited aids or resources available to support people with dementia.

People living at the home felt cared for. People had been involved in developing a plan of care that stated how they preferred to be supported. Staff knew people well and understood people’s likes and dislikes.

People were treated with dignity and in the most part consent was sought from people before supporting them. Some people living at the home were encouraged to remain independent.

We saw that people had access to some activities that were of interest to them. We found that at times there was limited interaction or activity with people living at the home. Further plans were in place to improve the provision of activities at the home.

People and relatives felt able to raise any concerns or complaints they may have. There were systems in place for people to raise concerns or complaints.

People and their relatives were happy with how the service was managed. Staff felt supported in their roles. There were systems in place to monitor the quality of the service although we found they were not always effective or robust. We identified two safeguarding concerns that had not been identified or actioned by the management of the service. Following the inspection the management of the service contacted us to inform us of action they had taken to address these concerns.

We spoke with four members of staff, the manager and six of the people who lived in the home. We observed how people were cared for and how staff interacted with them to get a view of the care they experienced.

We considered all of the evidence we had gathered under the outcomes that we inspected. Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed the interactions between the people who lived in the home and staff. People looked at ease in their surroundings. Staff spoke with them in a calm and friendly manner. There were enough staff on duty to meet the needs of the people who lived at the home.

We saw there were systems in place to ensure people received their medicines safely and as prescribed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. No applications had been made. The manager understood how this legislation applied to people and protected their rights.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at necessary risk.

Is the service effective?

People's care and health needs were assessed and planned for. Specialist pressure relieving, mobility and equipment needs had been identified in care plans where required.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

The people who lived in the home confirmed that they were able to visit with people in private and that visiting times were flexible.

We saw that systems for monitoring people's weights and following up on any weight loss were not always effective. This meant that people were at risk of not having their needs adequately met.

Staff training was sufficient to meet all the needs of people using the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were available at all times, showed patience and gave encouragement when supporting people. One person told us, 'I wouldn't be able to live if I wasn't here. If I call for them (the staff) they come.' Another person said, 'I like it here.' A relative told us, 'They are marvellous here, I have no concerns.'

People using the service, their relatives, friends and other people involved with the service completed regular satisfaction surveys. The suggestions and ideas voiced by people were followed up.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's needs had been assessed before they moved into the home and care plans reflected people's assessed needs. We saw people's care plans and risk assessments were reviewed on a regular basis to ensure their changing needs were planned for.

Records confirmed people's preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to some activities and were able to maintain relationships with their friends and relatives.

Records showed that staff responded quickly to changes in people's health. We saw people had access to a variety of health care providers to ensure their needs could be met. One person told us, 'I am seeing the nurses every day to dress my legs.'

Is the service well led?

The registered manager had been in post for some time. The manager was experienced and caring and provided good leadership based on how best to meet the needs of people in an individualised way.

There were systems in place so people who lived in the home could share their views about how the home was run. The manager was able to give us examples of actions taken and changes that had been made as a result of listening to the people living in the home.

There were systems in place to ensure the quality of the service was regularly assessed and monitored.

The majority of the required records for the people living in the home and the staff were available. We saw that these records were kept securely. This ensured people's confidentiality was maintained.

From our observations it was apparent that care staff were attentive, polite and that there were enough qualified, skilled and experienced staff on duty to meet people's needs.

People were complimentary about the care staff who supported them. Comments included, 'I like it very much living here, the staff are great and there's plenty (of them) here to look after me' and "I wouldn't want to be anywhere else but here."

People's needs were assessed and care and support was planned and delivered in line with individual care plans. We found that each person had their own individual plan of care and support which included assessed needs, risk assessments and useful information about any health conditions they had.

People who lived at the home were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Comments received included, 'It's very nice to live here and I feel safe, content and well cared for by the staff.' We noted that most care staff had received training in relation to safeguarding vulnerable adults.

We found that there were good systems in place for assessing and monitoring the performance of the home and for addressing shortfalls.

We found the home to be clean, homely and comfortable. Care was provided in an environment that was safe, accessible and adequately maintained.

People were complimentary about the care staff who supported them. Comments included, 'The staff are really lovely' and 'I can't fault them'. From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support. Relatives of people who lived at the home were equally complimentary about the staff and the care being provided.

We examined care plans and found that people's needs were properly assessed and that care and treatment was planned and delivered in line with their individual care plans. People who used services had given their consent to the care and support they received.

We interviewed care staff and checked their personnel files and training records. We concluded that people who used services were safe and their health and welfare needs were being met by staff who were fit, appropriately qualified and competent.

Examination of records revealed that Tudor House had a complaints policy and that people who use services and those acting on their behalf could be confident that their comments and complaints were listened to and dealt with effectively.