Tudor House

Tudor House is a residential care home providing personal and nursing care to 13 people aged 65 and over, some of whom may have been living with dementia, at the time of the inspection. The service can support up to 18 people. Tudor house is an adapted building consisting of three floors. People have their own rooms and share communal facilities such as the kitchen, lounges, the dining room and the garden.

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

People were positive about the care they received. One person told us, ‘‘Everything runs smoothly at Tudor House and there are never any problems. I am as happy as I can be.’’

People were supported with kindness, respect and compassion by a staff team that took the time to get to know their likes, dislikes and preferences well. People were able to make choices about their care and staff promoted people’s independence by encouraging them to be in control of their own lives.

People’s support was tailored to meet their individual needs and communication methods. People took part in a variety of activities which they enjoyed. People were encouraged to make and maintain social relationships with family and friends.

People were kept safe from harm and abuse in all areas including medicines. People were supported by well trained and competent staff and there were enough staff to meet people’s needs safely. The service was well-maintained and kept clean to promote good infection control. Plans were in place to further improve facilities at the service for people living with dementia.

People’s needs were assessed before they began using the service and were re-assessed if people’s needs changed. People were offered a wide variety of food and drink and were supported with a healthy and balanced diet. People were supported to see health professionals when they needed support.

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.

People had access to a complaints policy and procedure. People’s complaints were taken seriously and responded to promptly. People were treated with dignity and respect at the end of their lives.

People, relatives and the staff team were very positive about the management of the service. The registered manager and the provider promoted a positive culture that put people at the centre of their care and support. Audits were completed to monitor the quality of the service and improvements were put in place where necessary.

The registered manager and staff team had a passion for involving people in the local community and supporting people to access various events and activities available to them. This had a positive impact and achieved good outcomes for people.

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

Rating at last inspection (and update):

The last rating for this service was Good (report published 04 March 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.

During this comprehensive inspection we found that improvements had been made in all areas that we had previously identified.

Tudor House provides accommodation, care and support for up to 18 people with a variety of care needs including chronic conditions and physical disabilities. Some people may be living with dementia. At the time of our inspection there were 13 people living at the service.

A new manager had been appointed and was in the process of applying to the Commission to register. The nominated individual from the provider organisation had also applied to become a registered manager and was awaiting the outcome of their application. A registered manager is a person who has registered with the Care Quality Commission (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.

People felt safe. Staff were knowledgeable with regards to safeguarding people and understood their responsibilities to report concerns. There were effective safeguarding procedures in place and staff had received safeguarding training.

Potential risks to people’s health, safety and wellbeing had been identified and personalised risk assessments were in place. The assessments gave clear guidance to staff on how individual risks to people could be minimised. Incident and accidents were recorded and analysed by management to ensure that action was taken to reduce the risk of reoccurrence.

People received their medicines as prescribed. There were effective systems in place for the safe storage and management of medicine and regular audits were completed.

There were sufficient numbers of staff on duty to meet people's needs. Staff recruitment was managed safely and robust procedures were followed to ensure that staff were suitable for the role they had been appointed to, prior to commencing work.

Staff received regular supervisions and appraisals and felt supported in their roles. A full induction was completed by staff when they commenced work at the service followed by an ongoing programme of training and development. Staff were positive about the training they received.

People were supported to make decisions about their care and support. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent was gained from people before any care or support was provided.

A varied, balanced diet was offered at the service and people were very complimentary about the meals provided to them. People were supported to access the services of health and care professionals to maintain their health and wellbeing. Care plans detailed people’s support needs in relation to their health and the support required from the service.

People and their relatives spoke positively about staff. They told us that staff were caring, kind and friendly. Staff engaged people in social conversation and understood their needs and preferences. People felt staff were respectful and their privacy and dignity was maintained and promoted throughout their care

People felt involved in deciding the care there were to receive and how this was to be given. People's needs had been assessed prior to admission at the service and individualised care plans took account of their needs, preferences and choices. Care plans and risk assessments had been regularly reviewed and updated to ensure that they were reflective of people's current needs.

People were encouraged and supported to participate in a range of activities and received relevant information regarding the services available to them.

People we spoke with were aware of the complaints procedure and knew who they could raise concerns with. People and their relatives also spoke positively about ‘resident and relative’ meetings. People felt listened to by the management team and that they were responsive to any concerns or complaints that they may have.

The service was led two managers. People, relatives and staff spoke highly of the managers, their ability to manage the service and the improvements that had been made.

The service had an open culture and staff were committed to delivering high quality care. People and their relatives were asked for their feedback on the service and comments were encouraged. Robust quality monitoring systems and processes were used effectively to drive improvements in the service and identify where action needed to be taken.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with four people who lived at the home. They told us that they were happy with the care that they received. One person told us, "The staff are okay. They understand me and know what I want." Another person said, "People know what they are doing. They know what people need, what they like and don't like." They went on to tell us that they, "...feel safe..." at the home.

We noted that the home had been awarded level three of five by the Food Hygiene Inspector. We found that the walls in the kitchen had chipped and broken tiles. These could not be cleaned effectively.

The cook advised that they wore a clean apron and uniform every day. They did not use disposable aprons but removed their apron before they left the kitchen area. We observed that they had followed this practice when they went to the food store on the second floor.

Outside of the kitchen was a coat rack from which hung three cloth aprons. Care workers wore these aprons when they went into the kitchen to collect people's food and when they assisted people to eat. The aprons were selected at random and were worn by different care workers when they assisted different people who lived in the home. Guidance on the prevention and control of infection in care homes, provided by the Department of Health, is that disposable plastic aprons should be worn by care workers when providing direct care to people. These should be stored so that they do not accumulate dust that may act as a reservoir for micro-organisms, such as bacteria and viruses. Cloth aprons may act as reservoirs for these micro-organisms.

We looked in the en-suite in one bedroom and discovered that the tiling behind the toilet, which formed a wall between the toilet and the windowsill, had been damaged. The top surface of the wall had come away and we saw gaps filled with a white substance. This surface was not able to be cleaned effectively. Behind this wall was an accumulation of dirt and decomposing insect bodies on the window sill.

We noted that throughout the home most of the radiators were covered with decorative grilles. Each one of these had a build up of dust on each of the cut outs on the grilles. The cut outs meant that they had not been cleaned effectively and therefore presented an infection risk as people touched the grilles as they passed by.

On three of the chairs in the quiet lounge that people were using the vinyl covering on the arms and seats had split and there were areas of it that were missing. This had exposed the foam filling of the arms which had become dirty and stained. These presented a cross infection hazard to people who lived at the home, and any staff members or visitors who sat on them, as the foam could not be cleaned.

The recruitment system had not been robust for one new employee. They had provided only one reference and this had been from a friend and not a previous employer, even though they had previously worked in a care setting for a three months period. This employment had been terminated by the care setting as evidenced on their application form. The manager told us that no enquiries had been made of the previous care setting around the circumstances in which this employment had ended, nor had it been explored at the interview stage of the process.

Is the service effective?

One person we spoke with described the home as, "...smashing." They went on to say, "I like it here. The staff are smashing. I love them to bits."

We looked at a survey that had been completed by relatives of people who lived at the home. One relative had commented, "I am very happy that Tudor House has given a comfortable, friendly and safe environment for my relative."

People we spoke with told us that they were satisfied with the food that they received. We saw that there was a menu planned on a four weekly basis. The cook told us that this was a flexible plan and was amended from time to time following consultation with the people who lived at the home and observation of the foods they found enjoyable and those that about which they were less keen. The cook told us that all the food was freshly cooked. We saw that there was a menu of alternative meals available for people to choose from. These included fish fingers, fish cakes, omelette and ham, egg and chips. The cook told us that they were happy to provide an alternative meal if people wanted something different.

Is the service caring?

We observed care workers as they interacted with people in the quiet lounge and in their rooms. We noted that the care workers were patient and caring as they involved people in activities and they demonstrated, through their interactions, that they were aware of people's likes and dislikes. The care workers spent time chatting with people in the quiet lounge as they enjoyed a cup of tea and encouraged them to talk with each other.

During a survey of people's relatives one person commented, "I am pleased with the care that my [relative] is given and it is like one big happy family. This helps [them] to feel at home and secure."

Is the service responsive?

We saw that the manager held regular meetings with people who lived at the home. The minutes of the meeting held in February 2014 showed that people had discussed menus, activities, outings and fund raising. People were also given the opportunity to make any comments or raise any complaints that they had. We noted that people had requested that scotch eggs be removed from the tea time menu. The manager told us that these were no longer offered. People had also requested that a fish tank be provided in the quiet lounge instead of another pond in the garden to replace the fish pond which had been removed when the garden was recently remodelled. People told us that they enjoyed watching the fish in the tank when they were relaxing in this lounge.

We noted that following the manager's audit of accident and incident reports they had instigated a monthly monitoring of falls experienced within the home. This had identified that the majority of falls were experienced by a minority of people who lived at the home. The care plans and risk assessments in respect of falls for these people had been revised to reduce the risk of them falling.

Is the service well-led?

We saw that the manager completed monthly 'spot checks'. Checks completed had included care plans. cleanliness of the home, laundry and bedding, medicines, training and infection control. Records also showed that the manager carried out regular audits of areas such as health and safety, accidents and incident reports, confidentiality and access to records, staff grievance, key working and management of aggressive behaviour.

We spoke with five people living at the service. People told us that they were very happy at the home. One person told us they felt safe. Another told us "Nothing is too much trouble. If you're upset you don't need to worry, they will sort it. I would recommend it to everyone. We have such a good laugh."

We looked at the systems in place for people consenting to their care and treatment and found that people were given the opportunity to sign to consent to their care. Care plans were in place that assessed people's needs and managed any potential risks that may be present.

The provider had a policy on complaints with information on the processes the service would follow and timescales for the service to respond. The service was investigating one complaint on staffing levels at the time of our visit. We saw that the process had been followed and the letter of response was nearing completion which advised that staffing had been increased.

There was a relaxed atmosphere in the home, and we observed people were offered support at a level which encouraged independence and ensured their individual needs were met. The staff were friendly and courteous in their approach to people and responded swiftly and confidently when people required assistance. One person said, "I've been here a while now and I'm very happy. It's very clean, my medication is always on time and my mind is peaceful and busy. It's very nice, they do everything for me."

There were sufficient staff on duty and we observed they were competent in their work. They told us there were occasions where they were short of staff, however confirmed that although people may sometimes have to wait a little longer than usual for assistance, their care was not compromised and their safety was not put at risk. This was reflected in the comments from everyone we spoke with.

During our visit we found peoples' contribution to discussions and decision making about their care was documented in their care plans. We saw that people received an assessment of their needs and these were updated in most cases we looked at. Staff were completing a program of mandatory training and were knowledgeable in such things as protecting people from the risk of abuse. However, we saw that with the absence of a dedicated cook and the presence of two people with considerable care worker needs the available staff team was overstretched.

We found that the service had quality monitoring systems in place and people could attend residents' meetings to share their views and opinions about the service. We noted that where actions to prevent the recurrence of incidents or changes to improve the service were required these were completed.

One person summarised what people told us by saying: "I like living here and the staff are lovely but there aren't enough of them".