Tixover House

We found the following examples of good practice.

Changes to government guidance and important information was communicated to people's friends and family via emails and telephone calls. Staff were on hand to meet and greet visitors on arrival to the service to ensure they had all the information they required and the visit was managed in a safe way.

Government guidance for isolation periods was being followed and risk assessments were used where isolation periods were shortened following negative test results.

Additional staff competencies were used to check staff complied with the use of personal protective equipment (PPE) and used effective handwashing techniques.

Staff entered the premises by a separate entrance so they could change into their uniform and put on their PPE before having any contact with people who used the service.

Tixover House is a registered care service providing care for up to 48 older people. It is situated close the village of Tixover in Rutland. On the day of our inspection visit there were 42 people using the service.

What life is like for people using this service:

Some people used the service from time to time when they came for short stays. A person who returned to the service had not had their latest needs documented which meant staff had no care plan to follow. They had not been supported in line with their preferences.

The provider’s complaints procedure was not consistently followed. A complaint received in December 2018 had not been responded to strictly in line with the complaints procedure.

People told us that they felt safe living at Tixover House. People were cared for by enough staff who understood how to keep people safe from harm and abuse. People told us that they received their medicines on time.

People were supported by an experienced staff team who had the relevant training and support to meet people’s needs. Staff supported people with their nutritional needs and to access health services when they needed them.

People were supported to have the 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 kind and treated people with dignity and respect. People were supported to make their own choices and were encouraged to be as independent as possible. Staff understood people’s preferences and care was delivered in line with people’s wishes and needs.

The management team and staff shared the same values and aims and objectives for the service. The registered manager carried out health and safety checks of the premises and equipment. Accidents and incidents were recorded and action taken where necessary to keep people safe.

At this inspection we found the evidence continued to support the rating of good for key questions Safe, Effective, Caring and Well-led but not for Responsive which we have rated as requires improvement. The overall rating is Good.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at last inspection: Good (report published on 11 August 2016).

More Information is in the detailed findings below.

Tixover House is a care home that provides accommodation, support and care for up to 46 people. On the day of our visit there were 38 people using the service.

The service 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.

People told us they felt safe living at Tixover House. Staff expressed a thorough understanding of the principles and procedures for safeguarding people from abuse and avoidable harm.

The provider had enough suitably skilled staff to be able to meet the needs of people who used the service. The provider had effective arrangements for the safe management of medicines. People received their medicines at the correct times.

People who used the service were supported by staff who had received relevant and regularly updated training. Staff understood the needs of people that they supported. Staff understood the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff supported people with their nutritional needs by providing information about balanced diets and healthy eating. People were supported to access health services, including specialist health services, when they needed to. Staff followed any instructions or advice received from health professionals. This ensured that the healthcare needs of people who used the service were being met.

Staff were thoughtful and caring. People were able to enjoy a variety of planned activities that reflected their personal choices and interests. Staff respected people’s privacy and dignity.

People’s plans of care were centred on their specific needs, including detailed information for staff about how people had chosen to be supported. People who used the service, their visitors and relatives had access to the complaints procedure.

There were systems in place to assess and monitor the quality of the service. This included regular discussions with people who used the service. The provider issued questionnaires to gather the opinions and thoughts of people. The results were then collated and discussed with people and records showed that any actions needed had been undertaken and monitored.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We saw that the provider had made significant improvements to protect people from the risks associated with receiving care and treatment since our last visit. There had been a significant decrease in pressure sores and an improvement in the management of people at risk of malnutrition.

People were cared for in a clean and hygienic environment. We found that the environment was extremely clean and well maintained.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. At the time of our visit there was nobody using the service who required a DoLS authorisation. The majority but not all staff had received training about DoLS.

Only staff who had received the required training had responsibility for managing people’s medicines. We saw that safe and proper procedures were in place for the storage, administration and disposal of medicines.

The staff rota was decided by taking people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met. We saw that the use of agency staff was high. Staff reported that this did have a detrimental effect on people who used the service because these staff were less familiar with people’s needs and preferences and with day to day routines.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. One person told us “I get on really well with staff”. Another person said “Staff have a very good attitude and are very helpful”

Staff had received appropriate training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People who used the service appeared relaxed and at ease with the staff supporting them. One person told us that staff were flexible and would change routines to suit their preferences.

People’s health and care needs were assessed before they moved in. Each person had a care plan in place for each identified need. There was very limited evidence to show that people who used the service had been involved in the care planning and review process. Some care plans and risk assessments had not been reviewed for some time.

People’s relatives told us they were always made welcome. One relative had lunch at the home every day.

Is the service responsive?

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

People completed a range of activities in and outside the service regularly. The home has its own adapted minibus, which helped to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. People told us that staff would listen to them and take appropriate action.

The registered manager had recently held a meeting for people who used the service, their relatives and for staff. This meeting known as a ‘community meeting’ provided a forum for communication and obtaining feedback.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. The registered manager and other members of the management team were approachable and accessible to people who used the service, their relatives and to staff.

The provider’s regional manager visited the service at least once a month to carry out audits. These included speaking with people who used the service. People were consulted before changes were made.

The lunch time meal served during our visit appeared appetizing and nutritious. Staff assisted people in a sensitive and appropriate manner. Where risk was identified, assessment and management plans were in place. For example staff ensured people received fortified meals where risk of malnutrition was identified. Staff maintained records of food and fluid intake where this was required.

Staff received training and support but not all training was up to date. We issued a compliance action about this. The provider assessed and monitored the quality of service provision. This included seeking the views of people who used the service.