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Inspection carried out on 14 January 2019

During a routine inspection

We inspected this service on 14 January 2019 and this was an unannounced inspection. At our last inspection in August 2016 we rated the service, good overall and requires improvements within well led, as some quality assurance systems needed to be improved. At this inspection we found improvements had been made and the evidence continued to support the rating of good; there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service was registered to provide support for up to 27 older or younger people who may also be living with dementia or have a mental health need. There were people 19 living in the home at the time of our inspection.

Tudor Rose Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 continued to receive safe care and were protected from the risks of abuse. The staff understood where harm may have occurred and took action when people were at risk of abuse. Staff knew why people needed medicines and when these should be taken. Staffing was organised flexibly to enable people to be involved with activities and do the things they enjoyed. The home was clean and the registered manager reviewed incidents to ensure lessons were learnt.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People made decisions about their care and staff helped them to understand the information they needed to make any decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where people’s liberty was restricted, this had been done lawfully to safeguard them.

People had food and drink that they liked and specialist and cultural diets were catered for. People’s health and wellbeing needs were monitored and they were supported to attend health appointments and screening programmes as required. Staff received training and support to ensure they could understand and meet people’s needs.

People had positive relationships with the staff who were caring and treated them with respect and kindness. People liked the staff who supported them and had developed good relationships with them. People had opportunities to be involved with a variety of activities and could choose how to spend their time. People maintained relationships with their families and friends who were invited to join in activities with them.

There were plans in place which detailed people’s likes and dislikes and these were reviewed regularly. People knew how to raise a concern or make a complaint. Staff listened to people’s views about their care and they could influence the development of the service.

The registered manager and provider understood their legal responsibilities and kept up to date with relevant changes. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

Inspection carried out on 30 June 2016

During a routine inspection

This inspection took place on the 30 June and 1 July 2016. The first day of the inspection visit was unannounced, the second day was announced. We last inspected Tudor Rose on 6 and 12 January 2015 where we found the provider had breached the Health and Social Care Act 2008 in three regulations. This included ineffective systems to protect people from the risk of unsafe and inappropriate care, unsafe medication practice and not notifying us of a change in managers. At this inspection, we found there had been improvements made.

Tudor Rose is a home providing accommodation and residential care for up to 27 people. At the time of our inspection 27 people were living at the home.

At our last inspection there was no registered manager in post. At this inspection, there was a registered manager in post. 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.

At the last inspection it was found peoples’ safety was not consistent. People did not always receive their medication as prescribed. Risks within the environment were not always identified, people were at risk of cross infection and staff had not always managed people’s care in a way that would prevent people from the risk of harm. We found there had been improvements in all areas identified as previously requiring improvement.

People had received their medicines as prescribed. An effective infection control procedure had been introduced to protect people from cross infection and risks within the environment were identified and repaired in a timely way. People felt safe living at Tudor Rose. Staff understood their responsibility to take action to protect people from the risk of harm because the provider had systems in place to minimise the risk of harm and abuse.

At the last inspection it was found peoples’ rights had not always been protected. At this inspection there had been an improvement. People identified as being under a form of restricted practice to keep them safe, in their best interests, appropriate processes to protect their rights had been followed.

Improved systems were in place to monitor, audit and assess the quality and safety of the service but they had not been consistently effective and still required further improvement.

There were sufficient numbers of staff available to support people. Suitable staff had been recruited and had received training to enable them to support people with their individual needs.

People were able to choose what they ate and drank and enjoyed their meals and given the opportunity to join in different activities if they wished.

People were supported to receive care and treatment from a variety of healthcare professionals and received treatment if they were unwell.

Staff demonstrated a positive regard for the people they were supporting. People felt staff were caring and kind. Staff understood how to seek consent from people and how to involve people in their care and support.

People felt happy living at Tudor Rose. There was a complaints process in place and people could raise concerns. Feedback on the service provided at Tudor Rose was sought from people living at the home, their relatives and staff.

Inspection carried out on 6 and 12 January 2015

During a routine inspection

This inspection took place on 6 and 12 January 2015 and was unannounced. We last inspected this service on 5 and 15 May 2014 there were four breaches of legal requirements at that inspection. During this inspection we found that the provider had taken steps to comply with some of these regulations, there was one area where the provider was not fully compliant.

Tudor Rose Rest Home is registered to provide accommodation and personal care for up to 27 older people. The home is not registered to provide nursing care.

The service is required to have a registered manager. There was no registered manager in place; however the provider was taking reasonable steps to employ a 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.

Medication systems and practice was not safe and there were instances where people did not receive their medication as prescribed.

The management of the service was unstable, with no registered manager in post and several changes in managers since July 2014. The provider had not always kept us informed of these changes, as they are required to do.

People were involved in how the service was managed. Quality assurance systems put in place by the provider were not sufficiently effective to ensure people benefited from a quality service.

Everyone that lived at the home and their relatives spoken with said that people were safe. All staff spoken with knew how to keep people safe from abuse and harm and had received training to help reduce the risk of abuse to people. Whilst the provider took action when incidents relating to people’s safety occurred, staff practice did not reduce the risk of reoccurrences.

People and relatives spoken with told us they thought the environment was safe. However, we found that risks in the environment were not always identified by the provider; therefore people were at risk of living in an environment where the risks to their safety were not always identified.

We found that cleanliness of the premises and equipment was not consistently maintained, and the provider was not following the appropriate guidance in respect of infection control. This meant that people were not adequately protected from cross infections.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. People’s rights were not being fully protected in line with the legislation.

People received enough to eat and drink. People received support to access health care services, when they were unwell and as necessary. People’s privacy, dignity and independence was promoted and respected. People were supported by staff that were caring.

People received care that met their needs and a range of social activities were available to suit people’s needs and choices. There were procedures in place for people and relatives to raise concerns about their care, should they feel their needs were not being met.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 8, 15 May 2014

During a routine inspection

This inspection was conducted over a two day period. One inspector carried out this inspection on the first day and two inspectors inspected the home on the second day. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with the five people who use the service, a relative, the deputy manager, the registered provider, a business consultant employed by the provider and three care staff.

We also reviewed records relating to the management of the home which included, six care plans, daily care records, accident /incident records, complaints records, audits, safeguarding files, staff records and notification records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

All of the people and their relatives spoken with told us that they felt that the care provided was safe. A person that lived at the home told us, �The staff are alright, they are caring for me.� A relative told us, �I have no major concerns about the care at the moment.�

Systems were not in place to make sure that managers and the staff team learnt from events such as accidents and incidents, complaints and concerns. This was because managers were not always aware of incidents that had occurred in the home. Therefore the appropriate actions were not always taken.

Safeguarding procedures were in place, but staff did not always report and act on incidents that were classified as safeguarding.

There were sufficient staff to meet the needs of people that currently lived at the home.

Records were not maintained to show that people�s needs were appropriately considered.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted recently. Staff currently managing the home has not been trained to understand when an application should be made, and how to submit one.

Is the service effective?

All of the people and their relatives spoken with told us that they were receiving the care that they needed.

Care plans that we saw lacked detail and contained conflicting information about people�s care.

Improved systems were in place to ensure staff had the supervision, training and personal development plans that they needed.

Is the service caring?

All of the people and their relatives spoken with told us that they felt that the service was caring. A person that lived at the home told us, �I don�t find anybody unpleasant.� Another person told us, I like it here and the people are all pleasant.�

During the two days that we inspected the home we saw good interactions with people that lived at the home and staff.

Is the service responsive?

All the people and their relatives that we spoke with told us that they had no complaints about the care provided. A relative told us, I made a complaint a long time ago and they dealt with it. I think they would address complaints.�

We saw that the provider had introduced new activities and community involvement for people, so that their social needs were met.

Records looked at did not contain a pre-admission assessment and an audit trail was not available to show if an assessment had been undertaken prior to admission or that care needs were being reviewed.

Procedures were in place to ensure that people�s lifestyle and preferences were recorded, but these were not completed on the records that we saw.

Is the service well led?

Whilst people and relatives spoken with had no concerns about the service they received. We found that effective systems were not in place to monitor the quality of the service. This has led to shortfalls in a number of the regulations that we assessed.

The registered manager was absent from the home for an indefinite period of time. The deputy manager was designated to be in charge of the home and we have been kept informed of the changes by the provider.

During a check to make sure that the improvements required had been made

At our inspection in June 2013 we found that medication practice within the home was not always safe. We undertook this review to check that the provider had put systems in place to improve the safe administration of medication. During the review we asked the provider to send us documented evidence to show that they had taken actions to improve the medication systems. We assessed the information and we found that the actions taken by the provider should ensure safer administration of people�s medicines.

Inspection carried out on 19 June 2013

During a routine inspection

There were 25 people living at the home at the time of our inspection, we spoke with eight people, a relative three staff, the deputy manager and the manager. We also spent time observing how people were being cared for.

All the people that we spoke with told us that they were receiving the care that they needed. One person told us, �I get the support that I need and both day and night staff are pretty good.�

All the people that we spoke with told us that they felt safe living at the home. We saw that systems were in place to ensure that people living at the home were safeguarded from abuse.

All the people that we spoke with told us that they were treated well by the staff that supported them. We found that there were sufficient staff to meet the needs of people living at the home.

All the people that we spoke with said that they had no concerns about living at the home. One person told us, �The head lady is very good, no complaints whatsoever.� We found that systems were in place to monitor and assess the service that people received.

Inspection carried out on 9 October 2012

During a routine inspection

We visited Tudor Rose Rest Home on 9 October 2012 to carry out a scheduled inspection visit. During this time we also checked to see if the home had made improvements to the service since our last visit. There were minor concerns around staffing which were now addressed. There were moderate concerns around care plan documentation which were being addressed. However, we have identified further work that needs to be done to enable the service to be complaint with regulations.

We spoke to people in the home and three members of staff. People living in the home told us "Nothing could be improved here, the staff are lovely". Staff told us that they had meetings and monthly reviews to highlight any concerns. Staff had appropriate training including safeguarding training that was covered as part of their induction.

We witnessed an incident involving residents and asked the home to raise a safeguarding alert with the local authority. We reviewed four care plans of people living in the home and identified further improvements for Tudor Rose Rest Home.

Inspection carried out on 9 February 2012

During a routine inspection

We spoke with nine people who live in the home. We observed the care that people received. People were positive about their experiences of living at the home and the care they received. Three people told us that they are �Very happy here."

People told us that if they had any concerns they would speak to a member of staff. Some people said they would speak to the manager calling her by name. People felt confident that they would be listened to. One person told us that "I don�t have to put my complaint in writing. If I have a problem the staff sort it out straight away."

When we looked around the home we saw that most bedrooms were clean and suitably furnished. Some people with the support of their family had personalised their bedrooms and had brought in small items of their own furniture.

We saw that care staff treated each person as an individual. There was a good atmosphere in the home. There was good interaction and a positive relationship between people living in the home and staff working in the home. People who had good mobility were seen to move around the home freely.

Reports under our old system of regulation (including those from before CQC was created)