Tunstall Hall Care Centre

Tunstall Hall Care Centre is a care home without nursing care. The home accommodates a maximum of 31 people in one large building and two separate bungalows. At the time of our inspection 29 people lived in the home, some of whom were living with dementia. Care was provided over three floors. On the ground floor there were large communal rooms, including a lounge, dining room and a library for people to enjoy. Bedrooms were located on the first and second floor, a lift was accessible to each floor. There were large gardens surrounding the home.

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

We found risks to people were not always assessed, managed or monitored safely. People's medicines were not always stored or administered in a safe way. Medicine stocks were not closely monitored. Risk assessments were not always completed for people’s specific risks and people's weights were not always adequately monitored in line their care and support plan. Some items, which could cause significant harm if ingested, were stored in rooms where the key was located on the wall next to the locked door.

Infection prevention control policies were not always followed regarding safe hand care practices and COVID-19 safe visiting practice.

The registered managers carried out quality assurance processes, including internal audits. However, these were not always effective in identifying the concerns we identified. This meant errors were missed which could potentially cause harm.

Notifications involving safeguarding were not always reported to us, in line with regulatory responsibility.

Concerns identified on the first day of inspection which could have been actioned were found again on the second day.

During the inspection there was a COVID-19 outbreak. Most people had chosen to self-isolate in their rooms. Staff told us how they felt rushed and under pressure to support people individually in their bedrooms.

The registered manager addressed all concerns identified and put in additional measures and systems to keep people safe from harm. We will review these in the next inspection.

People felt safe living at the home and with the staff who supported them.

Staff were recruited safely, they received a detailed induction and ongoing training.

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 gained consent from people before assisting them and respected their privacy.

Staff used personal protective equipment (PPE) effectively and had attended infection prevention control training.

People’s communication needs were assessed, and people were supported to maintain relationships with others.

People told us they received care from kind and compassionate staff members.

People and relatives told us the food was well prepared and there were numerous activities for people to enjoy.

Relatives told us they felt their family members received person-centred care. They said staff respected people’s dignity and encouraged people to be independent.

Accident and incident forms were investigated by the management team. Lessons learnt were shared with the staff team.

End of life care plans were detailed and included people's preferences and wishes.

Staff told us they received regular supervisions and took part in regular team meetings.

The provider worked with other health and social care organisations to improve care and support for people using the service.

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 20 December 2018).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. The provider took effective action to mitigate some of the risks during the inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

Enforcement

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 and will take further action if needed.

We have identified breaches in relation to the way people's risks were assessed and monitored, medicines management, and governance systems at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tunstall Hall Care Centre on our website at www.cqc.org.uk

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Tunstall Hall provides accommodation and personal care for up to 33 people and at the time of our inspection, there were 26 people using the service some of who were living with dementia. The building is spread over three floors with two other separate buildings used as Independent Living Bungalows. At this inspection, only one of the bungalows was occupied.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and 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.

People, relatives and staff told us that Tunstall Hall was a safe place to live. Staff knew of people’s risks and how to manage them well. There were enough staff to meet the needs of people and the staff were suitably skilled to do so. People received their medication on time and staff knew how to reduce the risk of the spread of infection to people. The service recognised when things went wrong and the service was on a journey of improvement.

People had their needs assessed by a team who worked well with other agencies and healthcare professionals. People had enough food and drink. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People spoke positively about the staff who were described as caring. Staff knew people they were supporting well and people had their dignity upheld and respected. People and staff told us the registered manager was friendly and approachable and people knew how to make a complaint should they need to.

People had access to activities and people had their needs assessed in a way that was person-centred and were given choice and control over how their care needs were met. End of Life wishes were considered and planned for.

Further information is in the detailed findings below.

Tunstall Hall provides accommodation and care for up to 33 people, some of whom were living with dementia. On the days of our inspection 27 people were living there.

The home had a registered manager who was present for the inspection. 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 were given an annual quality assurance survey to complete and this gave them the opportunity to tell the provider about their experience of using the service. Regular meetings with staff gave them the opportunity to be involved with changes to the service. There was a clear leadership and people knew who was running the home. Governance systems were in place to promote good standards of care.

People felt safe living in the home and staff knew how to keep them safe. People felt supported because staff were always nearby to help them when needed. The provider's recruitment procedure included safety checks to ensure the suitability of people before they were employed. Safe care practices and systems in place reduced the risk of harm to people. Medicines were managed appropriately and people received them when needed.

People were cared for by staff who were trained and received regular one to one [supervision] sessions by the registered manager. Staff were aware of the Mental Capacity Act 2005 and when a Deprivation of Liberty Safeguard application should be applied for to protect people’s human rights. Where people were unable to make a decision about their care a best interest decisions was made on their behalf. People had access to healthcare services to ensure their physical and mental health needs were met. Staff were aware of people’s dietary needs and people were supported to eat and drink sufficient amounts.

People were treated with kindness, compassion and were supported to be involved in planning their care. People’s diverse needs with regards to their race and religion were respected and staff ensured people’s privacy and dignity were maintained.

People were encouraged to be involved in their assessment and were supported to pursue their hobbies and interests. People felt confident to share their concerns with the registered manager or staff and complaints were well managed.

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.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We spoke with three people who used the service who told us that they were happy living at the home and that staff cared for them well. We saw that people were able to wander around their home without any restrictions. Risk assessments were in place to promote people's independence and ensured their safety.

The staff recruitment procedure ensured that appropriate safety checks were carried out to ensure that all staff were suitable to work with vulnerable people. One person who used the service said, 'The staff here are brilliant.'

People who used the service had access to the complaints procedure. Three people told us that if they had any complaints they would share this with the staff who always addressed their concerns. This meant that people could be confident that their concerns would be listened to and acted on.

Is the service effective?

Discussions with the acting manager and the care records we looked at confirmed that a needs assessment was carried out before people were offered a placement at the home. This assessment enabled the provider to find out whether they could meet the person's needs on admission.

A number of people who used the service had mental health needs. Discussions with one person who lived there confirmed that they had access to relevant healthcare professionals, such as community psychiatric nurse to assist them with their mental health.

Is the service caring?

We saw that people were well cared for and that staff were attentive to people's needs. For example, one person disliked the meal offered on the daily menu and they were offered an alternative. One person was agitated and we observed a care staff approach them in a caring manner and reassured them.

Discussions with the acting manager confirmed that one person who used the service had a history of falls. We saw that this information was contained in their care plan and that staff had access to a falls risk assessment to tell them how to reduce the risk of further falls.

One person told us about the assistance they required to meet their personal care needs and confirmed that staff did provide them with the appropriate support.

People had access to various social activities during the day, some people chose to stay in their bedroom and their choice was respected.

Is the service responsive?

At our previous inspection on 23 December 2013, we found that the provider was non-compliant with the regulation relating to the care and welfare of people who used the service. At this inspection the people we spoke with confirmed that they were satisfied with the care and treatment they had received. Although the people we spoke with were unaware of their care plan. People told us that staff did ask them how they would like to be cared for and asked their permission before this was carried out.

Discussions with the acting manager and the care records we looked at confirmed that shortfalls identified at the last inspection had been addressed. This ensured that people received an effective service.

Is the service well led?

We found that the acting manager and the care staff had a good understanding of people's needs. The people we spoke with who used the service were very complimentary about the care and treatment they had received.

We found that the provider had a quality assurance auditing system in place. This ensured that people received safe and effective care and treatment.

The acting manager said that meetings were carried out with people who used the service and this was confirmed by the people we spoke with. This meant that people were actively involved in the running of the home.

Discussions with the acting manager, staff and the records we looked at confirmed that staff had access to on-going training. Access to training meant that staff had the skills and competence to care for people appropriately.

People were encouraged to make everyday decisions. Where they were unable to make more complex decisions the provider acted in accordance with the legal requirements of the Mental Capacity Act.

Care record systems had been improved and updated over the past year. They contained detailed information about people's needs. Diagnosed conditions had been recorded together with treatment plans. Nutritional needs had been assessed and monitored closely. There were no pressure sores. The GP spoke positively about staff cooperation.

There was inadequate information for a person recently admitted and although people were weighed regularly records were inaccurate. Improvements were needed in these two areas.

Minimum staffing levels had been in place to meet the needs of 31 people.

There was a clear and concise complaints procedure in place. No complaints had been received since our last inspection.

We found that the service was recovering from a difficult period but that good progress had been made in ensuring that people's needs were met in an appropriate way.

People told us that they were happy with the service they received. They said that the staff were, 'Kind' and that they, 'Do their best'. Everyone we spoke with said that they felt safe in the home.

People told us that they were able to express their views and were involved in making decisions about their care and treatment.

We saw that new furniture was being installed in every bedroom. One person had asked to keep their existing furniture and this had been respected.

We saw that staff respected people's privacy and supported their independence.

The manager was in the process of reviewing and rewriting all care plans using a standard format.

The staff told us that there had been lots of recent improvements at the home. One staff member said, 'It's back to what it should be.'