About the service
Tyspane is a residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 69 people.
Tyspane is a purpose built service with bedrooms over two floors accessed via a passenger lift. There are communal lounges and dining rooms on both floors. All bedrooms are en-suite.
People’s experience of using this service and what we found
People said they felt safe and well cared for. Some people told us that there had been times when the service appeared short staffed but no one said this had impacted on them significantly. Comments included, “I think there are enough staff to look after me day and night. There is always someone to talk to if you need them.” And, “As far as I am aware we are well looked after.” One person told us, “I think they could do with more staff. I have to wait a long time and also wait when I use the call bell. I particularly would like more time when they bath me.”
During our inspection visits we found there was sufficient staff and people were getting their needs met in a calm and caring way. The staffing rotas showed there had been some shortages due to staff ringing in sick at short notice, but the levels had not reached a stage where people’s needs or safety had been compromised.
Relatives said communication with them was good and people’s healthcare needs were being met. One said, “The staff do a remarkable job, she feels safe and is happy and thinks all the staff are friendly.” Two commented, that in their view, the service being short staffed. One said, “My relative is not happy with the staff numbers she does not think there are enough, she thinks the home is understaffed as she reports waiting for a while to have her pads changed as she needs two members of staff as she uses a hoist.
There was a strong odour in the upstairs corridor and this was also mentioned by a relative. We have asked that this be addressed as a priority as it was impacting on people’s enjoyment of their environment.
Risk assessment were being completed but where people were on pressure mattresses, it was not clear when and how staff checked this and we have made a recommendation in respect of ensuring good systems were established. This was to ensure pressure mattresses were on the right settings for the person’s weight and that these were checked daily.
Recruitment processes had not been followed in line with guidance and their own policy. Employment histories and any gaps had not been documented as fully explored. When we fed this back, we were sent documentation to show this had been followed up. We have made a recommendation in respect of ensuring future recruitment practice follows guidance and national requirements.
We had received a number of whistle blowing concerns which suggested the culture and teamwork within the service was impacting on staff and their work. Staff said there had been elements of some staff having favoured tasks. We had sent this information to the provider prior to this inspection. They had taken a number of actions to address both being short staffed and the culture and ethos with the team. This was work in progress. We found no major impact for people using the service despite being told by whistle blowers that people were at risk.
Medicines were managed safely. However, we have made a recommendation in respect of reviewing their systems for recording the application of patches and monitoring that they remain in place.
Infection control processes were embedded and staff had access to and wore appropriate personal protective equipment (PPE). People and relatives confirmed staff wore PPE at all times. However, we received information from emergency services which said not all staff on their visit were wearing PPE. We have asked the provider to respond to this.
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 training and support was done in a range of ways to ensure they had the right skills to meet people’s needs safely and effectively.
Staff showed empathy, caring and patience during our observations of interactions. Some staff were particularly skilled and assisting people with their lunch and ensuring this was a pleasant and unrushed experience.
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 31 January 2018)
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels, people’s needs not being met and records not being completed. We also heard from whistle blowers that the culture within the service was bullying and had led to staff leaving and low staff morale. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
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 changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make some improvements in other areas not identified by the information we received. Please see the safe and 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.
Following feedback, the provider had taken actions to address staff morale, monitoring of pressure relieving mattresses and deep cleaning of carpets where there was an odour issue.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tyspane on our website at www.cqc.org.uk.
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.
We have identified breaches in relation to premises and equipment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.