Archived: Tudor Care Home

The service does not have a Registered Manager, and has not had one for over 12 months. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. There was an acting manager in place: this person was appointed on 1 November 2015 after the previous acting manager left the service. Following this inspection visit, this new acting manager explained that they would not be putting their application in for registration with the CQC. The explanation given was that they felt that they did not have the skills to fulfil the duties of a Registered Manager.

The acting manager and senior carer supported us during our inspection visit. We found documentary evidence to show that limited risk assessments and safety plans were in place relating to different aspects of the home. For example: care planning, treatment, infection control, medication, healthcare and environmental safety. However, these were sometime incomplete, and the information contained within them was limited and unclear. Personal Emergency Evacuation Plans (PEEPs) in the event of a fire had not been drawn up for each individual living in the home. Staff were aware that they had to notify CQC of deaths at the home, but were unsure of the other types of incidents that were notifiable.

Care staff were seen to be involved in providing personal care and support, but one of the two staff were also involved in preparing, cooking and serving the meals. Staff explained that this occurred on a daily basis, and although they enjoyed providing meals for people, they acknowledged that it took them away from the caring duties. This potentially put pressure on their colleagues at busy times of the day. We noted that one person did not have any employment references on file, even though their application form had highlighted who their referees should be.

The home did not have a lift, and was cited on four floors. The home had an unusable chair lift, due to the parts needed to repair it were said to be obsolete. We found that some parts of the building were in a poor state of repair, and the 4th floor was found to be unusable as part of it needed significant attention and repair.

Although staff knew the different types of abuse that could take place, and were aware of the procedures in place that they should follow if they had safeguarding concerns, the records showed that a safeguarding referral had not taken place in one instance, when a service user was found with unexplained bruising and scars.

The processes for the safe and secure handling of medicines were found to be appropriate. The service was found to have a clear process in place for the handling of controlled drugs when necessary.

The service provided had not ensured that staff received the support, training, professional development, supervision and appraisals that was necessary for them to carry out their role and responsibilities.

We looked at people’s care records and found documentary evidence to show that their nutritional and hydration needs, and food intake monitoring took place. However, the records were found to be completed sporadically. Staff said that although there was a menu on offer at the home, this was not always followed, as staff would discuss people’s meals preferences on a day to day basis, which would be dependent on what was in stock.

People living at the home were seen to be very comfortable in the presence of the staff. People were seen to engage and interact with the staff, and conversations were relaxed and jovial. We noted that the relationships between the staff and the service users were very positive. Staff knew the people they cared for very well.

Although a home for people with dementia and associated memory problems, the service had not engaged with best practice in this area of care and support. There were no signs of dementia related activities available such as rummage boxes or reminiscence objects that could be used to promote conversation and reduce social isolation.

The home had a complaint's procedure, and this was displayed within the home. We looked at the record of complaints.

We found there to be unsatisfactory leadership from the registered provider: strategic management and guidance was lacking. Despite being committed to caring for the people living in the home, the registered provider was only in a position to undertake short term fixes to problems such as cosmetic maintenance of the building. The larger issues such as staff development, business development and on-going governance was found to be out of their grasp. The service did not have a registered manager in place.

We identified a number of breaches 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following our visit, we expressed our concerns, regarding the safety of the building and the welfare of people living at the home, to the Registered Provider. They engaged with us, and gave us details of how they intended to address some of the issues at the home. However, following discussions with their stakeholders, the Registered Provider told us that they had taken to the decision to close the home. The Registered Provider submitted an application to cancel their registration with CQC, and we accepted this application. The Registered Provider made arrangements to alert all relevant parties to the decision, and at the time of writing this report, measures were in place in secure placements for the nine people living at the home, and the home to close on 31 December 2015.

Is the service safe? People's basic care needs were met, and the service did now have better systems in place through better care planning, to meet people's dementia care related needs. Safeguarding procedures were now robustly in place and staff did have a better understanding of how safeguarding procedures should be implemented. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, and concerns. The home had proper policies and procedures in relation to the use of the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. The new manager sets the staff rotas, and staff deployment was based on the needs of people living at the home.

Is the service effective? People's health and care needs were assessed with them, and they were involved in writing their plans of care.

Is the service caring? People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I like the staff." People's preferences, interests, aspirations and diverse needs were not always recorded, and care and support was provided in accordance with people's wishes.

Is the service responsive? The new manager was looking at ways in which new and different activities could take place within the home, and outside the home. The records showed that staff training and leadership had improved, and as a result the staff team felt better equipped to provide appropriate specialised care and support to a group of individuals who experienced dementia related social and healthcare problems.

Is the service well-led? The home now has a new manager, with experience of management in other homes. A new range of audits and monitoring systems have been put in place so that the service provider and manager can have a clear overview of the quality of the services provided within the home.

Is the service safe? Although people's basic care needs were met, the service did not consistently meet people's dementia care related needs. People had limited verbal communication. One person told us they felt safe. Safeguarding procedures were not robustly in place and staff did not fully understand how safeguarding procedures should be implemented. Systems were not in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, and concerns. The home did not have proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had not been trained to understand when an application should be made, and in how to submit one. The acting manager sets the staff rotas, and staff deployment was not based on the needs of people living at the home. Staff were involved in cleaning and catering tasks, and this frequently took them away from their caring tasks.

Is the service effective? People's health and care needs were assessed with them, and they were involved in writing their brief plans of care.

Is the service caring? People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I like the staff." People's preferences, interests, aspirations and diverse needs were not always recorded, and care and support was not always provided in accordance with people's wishes, due to a lack of training, clear leadership and financial constraints.

Is the service responsive? Very few activities took place both within the home, and outside the home.The records showed that staff training and leadership was at a deficit, and as a result the staff team were not well equipped to provide appropriate specialised care and support to a group of individuals who experienced dementia related social and healthcare problems.

Is the service well-led? The home has been without a registered manager for over 9 months. The acting manager had recently submitted her application to be registered, but we later found that she had withdrawn this application. Basic audits such as medication and care plan audits took place.

You can see our judgements on the front page of this report.

The provider responded by sending the Care Quality Commission (CQC) an action plan of how they would address the findings from the previous inspection. We found evidence the manager had addressed the concerns from the previous inspection.

We spoke with Lancashire fire service who confirmed work to ensure fire doors were safe had been completed. We also spoke with the manager. She informed us most windows had restrictors fitted. She said a risk assessment had been put in place for rooms on the ground floor and this was being kept under review.

This home cares for people with a range of dementia conditions and conversation with some residents was limited. We therefore spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support with personal care. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "I like it here, like it a lot."

We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Tudor Care Home. This included speaking to the fire safety officer of the local fire and rescue service. We were told that some doors at the property do not comply with the Regulatory Reform (Fire Safety) Order 2005. An enforcement notice has been issued, with the requirement for remedial work to be completed by 31st July 2013.

We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff treated people with respect and provided support or attention as people requested it. We spoke with one person about the care and support they received. They said, "I like it here, it's like one big family.'