Archived: TNP Homecare (UK) Limited

TNP Homecare is a residential care home providing personal care to nine people aged 65 and over at the time of the inspection, although one person was residing in hospital. The service can support up to 12 people.

The home is divided over three floors, bedrooms were located on the ground and first floor. The second floor was used for the registered manager office. Two lounges, a kitchen and a dining room were situated on the ground floor. The dining room was currently being used as a staff and visitor COVID-19 testing area. A passenger lift was in place to enable people to access all floors. People had access to a paved garden, this was accessible to people who required the use of a wheelchair.

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

Some risks to people were not always monitored safely. Window restrictors were not compliant to Health and Safety Executive requirements. Quality auditing systems needed to be more robust to monitor medicines.

People felt safe living in the home and with the staff who supported them. Staff were safely recruited and inducted into the home. Risk assessments were completed and updated regularly. There were sufficient numbers of trained staff on duty and people told us they never had to wait long for support from staff.

Staff had excellent knowledge of peoples care needs and told us each person’s care and support needs, including their likes and dislikes. Staff described how they could recognise unsafe care practices and the action they would take to report poor practice.

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 were supported by caring and kind staff. They felt empowered to voice their own opinions and actively involved in daily life decision-making. People were encouraged to maintain relationships and family members told us how staff members encouraged independence skills.

The atmosphere in the home was relaxed and homily, the home was decorated to a good standard and there were festive decorations in accordance to the time of the year. There were opportunities throughout the day for people to engage in fun and interesting activities. People told us they were happy and enjoyed living in the home.

Mealtime was a positive experience for people. People enjoyed a selection of meals and both people and family members told us how they enjoyed the lovely home cooked meals.

The care provided was person centred. People were encouraged to decorate their own bedrooms and there were personalised objects such as photos of people in communal areas. People told us they could engage in their own interests and relatives told us people could take positive risks.

People could be confident their wishes for end of life care would be respected by staff. Relatives told us they were supported by compassionate staff during their family members end of life.

People felt involved in the care provided. Relatives told us they were informed following any changes and their opinions were sought. There was a culture of learning from when things went wrong.

The service worked in partnership with other professionals and the local community to achieve good outcomes for people. Professionals told us the registered manager was committed to providing a high standard of care. Staff members had confidence in the registered manager and told us they enjoyed working at the home.

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 requires improvement (published 15 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations

The last rating for this service was requires improvement (published 15 October 2019). The service has now improved to good.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the Well led section of this full report. The provider has made significant improvement from the last inspection and has taken action to address the risks identified in this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for TNP Homecare on our website at www.cqc.org.uk.

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.

TNP House is a residential care home providing personal care to 12 older people, some of whom were living with dementia, had a physical disability or sensory impairment.

The home is divided over three floors, bedrooms were located on the ground and first floor. Two lounges and a dining room were situated on the ground floor. Bathrooms/shower rooms were situated on each floor. An office was located on the second floor. A passenger lift was in place to enable people to access all floors. People had access to a paved garden, one area of the garden was accessible to people who required the use of a wheelchair.

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

The providers governance was ineffective to review, assess and monitor the quality of service provided to people. The provider worked with other agencies. However, concerns relating to people’s safety had not been shared with the local authority safeguarding team. The provider had not displayed their CQC rating on their website. The provider did not notify CQC of significant events that had occurred in the home which, they are obliged to do by law.

Identified risk to people were not always managed effectively to protect them from further harm. People were not always safeguarded from the risk of potential abuse. The management of medicines needed to be improved to reduce the risk of people receiving contaminated medicines. Systems in place to monitor hygiene standards within the home needed to be reviewed to ensure people were not placed at risk of avoidable infections. Monitoring systems were not effective to ensure lessons were learned when things went wrong.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Deprivation of Liberty Safeguards were not always reviewed to ensure they were still required. People had a choice of meals, but they were not always supported with their meal in a dignified manner. Staff had access to training. However, shortfalls identified at our inspection showed that skills learned were not always put into practice. The environment was not ‘dementia friendly’ and this could add to people’s confusion.

Staff were kind and had a gentle approach. However, the lack of understanding of safeguarding people from the risk of abuse compromised the care provided to people. There was no evidence of people’s involvement in making decisions about their care and treatment to ensure their preferences were met. People’s right to privacy and dignity was not always respected by staff. At the time of our inspection no one was receiving end of life care.

The assessment of people’s needs did not identify people’s involvement to ensure they received care and treatment the way they liked. People were not encouraged by staff to engage in meaningful activities to promote their mental wellbeing. Complaints were not always listened to or acted on.

People and staff were aware of who was running the home. The culture of the home presented as warm and friendly. The registered manager and staff were confident there were sufficient staffing levels to meet people’s needs. Although at key times people did not get prompt support. People had access to relevant healthcare services to promote their physical and mental health needs.

Rating at last inspection

The last rating for this service was good (published 4 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 reinspection programme. If we receive any concerning information we may inspect sooner

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

TNP House provides residential care for up to 12 older people. Dementia care and end of life care are provided for people who need this support. There were 12 people living in the home at the time of our inspection.

There was a registered manager in post who was also the provider. 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 received their prescribed medicines but the control of stock required improvement. The provider had not displayed their ratings poster in the correct format and size for people to view. People’s risks had been assessed and their care was planned to reflect this. Staff understood their responsibility to protect people from harm, poor care and abuse and how to report any concerns that arose.

There were a sufficient number of staff to meet people’s needs in a timely manner. There were recruitment processes in place to ensure staff working in the home were suitable to support people in a caring environment.

Staff understood the importance of gaining consent from people and how to support people when they needed help to make decisions. Staff received training and support to ensure they had the right skills and knowledge to care for people effectively. People were offered a choice of nutritious food and plentiful drinks to support and maintain their health and wellbeing.

People had access to healthcare professionals when they needed additional support to preserve their mental and physical health.

People were provided with kind and caring support by staff who were interested in them as individuals. Staff preserved people’s dignity and recognised their right to privacy. Relatives and visitors were welcomed into the home.

People were asked to provide information about their past lives, likes and dislikes to enable staff to provide care in the way people preferred. Staff knew people well and understood what was important to them. There were arrangements in place to provide people with opportunities to spend their time doing activities and hobbies if they wanted to. Staff encouraged people to become involved but respected their decision if they chose not to.

There were arrangements in place for people to raise any concerns, complaints or compliments they wanted to share. People felt comfortable to raise their concerns directly with the provider and were confident that action would be taken.

People and relatives were provided with meetings to discuss what happened within the home and any plans for the future. The provider distributed satisfaction surveys to people, relatives and healthcare professionals to provide them with the opportunity to feedback their opinions of the care that was provided.

There were audit arrangements in place to monitor the quality and safety of the care and home environment.

People, relatives, staff and healthcare professionals felt the home was well-led and the provider/manager was approachable and supportive to them.

Is the service safe?

We found there were sufficient numbers of staff on duty to meet the needs of the people using the service. People using the service told us the staff were available to them when needed. One person said; 'We are only a small home, so the staff are always nearby if we need them.'

People using the service told us that they liked the staff and that they did a good job. One person said; 'All of the staff here are very good, they have the skills and knowledge to look after everyone.' Another person said; 'All of the staff are nice, I get on very well with them, we have a laugh and a joke together, it's very nice here.'

Risk assessments were in place where known and potential risks had been identified, with plans of action to inform staff how risks could be minimised.

Is the service effective?

Discussions with people using the service and information in care records showed that people's needs and preferences were being met.

Everyone had a care plan which informed staff how to meet people's needs. Assessments included people's needs for specialist equipment, mobility aids and dietary requirements.

People spoken with confirmed that staff respected their wishes and supported them as needed. People confirmed that they were consulted about their care plans and involved in decisions about the support they received and records seen demonstrated this.

Where people required their diet and fluids to be monitored the records seen had not always been completed to demonstrate that people's dietary intake was effectively monitored.

Is the service caring?

We observed positive interactions and conversations between staff and people who used the service throughout the inspection.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People using the service confirmed that staff treated them with dignity and respect.

Is the service responsive?

Records demonstrated that people's health and care needs were addressed promptly and referrals were made to relevant health professionals as needed.

From our observations we saw that people using the service appeared relaxed and comfortable with the staff on duty and were able to openly express their opinions and preferences.

Is the service well-led?

Records confirmed that when issues were identified these were acted upon promptly. This meant that there were processes in place to develop and improve the service people received.

This was a follow up visit to review concerns we had when we inspected TNP House in July 2013. At that time we had found a lack of clarity about caring for some people. No 'best interest' decisions had been recorded for people who lacked capacity to make decisions about their care. At the same time, the local authority safeguarding investigation team was looking into allegations made about people's care and safety.

We returned to TNP House in October 2013 to follow up the manager's action plan for making improvements, particularly to care plans. At this inspection we had no concerns about the clarity of 'best interest' decisions made on people's behalf. We had no concerns about the planning and delivery of care and there was clear guidance for care workers to follow in order to meet people's needs at all times. We checked and found that all safeguarding enquiries had been closed by the local authority safeguarding team. None of these had been substantiated.

We spoke with people who used the service, one relative and two members of staff. We had been liaising with the local authority prior to the inspection.

We looked to see if people who used the service consented to their care, treatment and support. We had concerns that the service did not always respond appropriately when consent was required in the change of a person's care.

We had previously been informed of an accident to a person who used the service which had resulted in a serious injury. We looked to see if people's care and welfare was being maintained. We found that systems the service had in place were not effective in minimising risk of harm to people who used the service.

During our inspection we became aware of some people who used the service that had suffered abuse through the actions of another person who used the service. We had concerns that the service did not have systems in place to prevent the abuse and had not responded appropriately to the incidents.

We found that the service followed the correct recruitment procedure when employing new staff.

The service had a complaints procedure for people who used the service or their relatives if they had cause to complain.

We saw that the people who lived at TNP House were treated with consideration and respect. Their right to dignity, privacy and independence was recognised and maintained. We found that care plans were detailed and considered people's full range of needs. Staff had clear guidance to support them in promoting people's well-being and keeping them safe.

There were enough staff on duty on each shift. Care workers told us they were well supported. We saw that they had attended regular training relevant to their work, including safeguarding training. The owner of TNP House managed the care people received. She had systems in place to monitor the quality of the service she provided.