Tuxford Manor Care Home

We found the following examples of good practice.

The provider ensured people’s visitors provided a negative lateral flow test (LFT) result prior to entering the home. Two indoor areas of the home had been designated for visitors. These were away from communal areas. People could also see their visitors in their bedrooms and using outside spaces. This helped to reduce the risk of the spread of COVID-19.

We observed staff wearing personal protective equipment (PPE) as required. Staff wore aprons, gloves and masks when providing care for people and at other times masks were always worn. There were sufficient stocks of PPE within the home. When personal care was provided for people with COVID-19,. PPE stations were placed outside of their bedroom to enable staff to don and doff (put on and take off) their PPE safely. Staff uniforms were laundered at the home and staff arrived and left wearing their own clothes. This helped to reduce the risk of infection being brought into or taken out of the home.

People were encouraged to social distance wherever possible; however, it was acknowledged that some people, such as those living with dementia may find this difficult. Staff made allowances for this by continually cleaning touch points such as doors, handrails and tables to reduce the risk of the spread of infection. We observed the home was visibly clean and tidy.

The home had been closed to non-essential visitors following an outbreak of COVID-19. During this time, staff had worked hard to ensure the home was kept clean, people could still see visitors wherever possible and a daily testing regime was completed. Then home has now re-opened. The registered manager was proud of the work of their staff in minimising disruption to people’s lives.

The provider had processes in place that ensured the safe admission of new people to the home. The provider also assessed the impact of isolation on people’s wellbeing and measures were put in place to assist the most vulnerable, including increased time spent with staff.

Posters were placed around the home offering guidance and information for people and staff advising them how to spot the signs of COVID-19 and to help to reduce the risk of spreading it.

A consistent and stable staffing team was in place. Staff covered sickness, holidays and other absences. The registered manager was proud to have not needed to use agency staff to cover shifts during the pandemic. The provider considered staff members’ wellbeing. A variety of initiatives were in place to thank staff for their support and to offer further support for their mental and physical wellbeing.

The provider had assessed the impact of potential ‘winter pressures’ and acted accordingly. Regular COVID-19, outbreak and other related audits were carried out to help identify any areas of concern. Action plans were in place and reviewed.

Tuxford Manor is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 46 people in one adapted building.

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

People received excellent opportunities to participate in different activities. The service demonstrated how they consistently met the characteristics of providing excellent care. People were at the heart of the service and the registered manager and staff were fully committed to providing high-quality person-centred care. The staff always responded to people’s changing needs and strived to provide excellent care and support.

People were protected from risk to their health and wellbeing as comprehensive risk assessments were in place. People were protected from the risk of abuse as staff were highly skilled in the safeguarding procedure and how to recognise abuse. Safe recruitment processes were followed and people who used the service were involved in this process. Medicines were administered and stored in a safe way. Good practice was in place to protect people from the risk of infection. Lessons were learned and monitored when things went wrong.

People had their diverse needs identified and met by competent staff. People were supported to have a balanced diet. Staff collaborated with other healthcare professionals and made referrals when people required professional input. The service was adapted around people’s needs and preferences. They were encouraged to be involved in the decoration of the premises. The provider and their staff team were working in line with the principles of the mental capacity act (MCA).

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 kind and compassionate staff. People expressed their views and opinions without discrimination. The service promoted independence and respected people’s privacy at all times.

There was an open and transparent culture within the service and the providers vision and values were clearly understood and upheld. The registered manager and management team worked in partnership with others and strove to ensure the service was the best it could be. Comprehensive auditing and monitoring programmes had been completed and excellent governance was embedded within the service. There was a strong emphasis on continuous improvement and the thoughts of the people using the service, relatives, staff, stakeholders and members of the local community were continually sought and listened too.

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

Rating at last inspection

At the last inspection the service was rated as Good (published 19 August 2017).

Why we inspected

This was a planned inspection to assess if the service was still meeting the requirements of the Health and Social care Act 2014.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At the last inspection on 30 July 2015, the service was rated Good. At this inspection we found the service remained Good.

People continued to feel safe and staff continued to ensure the risks to their health and safety were reduced. There were sufficient staff to meet people’s needs in a timely way and systems were in place to ensure safely received their medicines.

People continued to receive care from staff who had received relevant training and staff felt well supported in relation to their training needs. People were asked for their consent and appropriate steps were taken to support people who lacked capacity to make particular decisions. People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people and the staff who supported them. Staff promoted people’s rights to make their own decisions and respected their choices. People were treated with dignity and respect by staff who understood the importance of this.

People’s care records were not always person centred and lacked sufficient detail on people’s differing needs. There were aspects of people’s care that were not always linked in appropriate care plans and this meant staff may not have a full picture of a person’s needs. Despite this staff showed a good knowledge of people’s needs and provided appropriate support for them. People were supported to maintain their interests and knew how to make a complaint to the service as there was a clear complaints procedure in place.

There was an open and transparent culture which enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff. There was robust quality monitoring procedures in place.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, the staff who supported them and looking at records. We also spoke with the registered manager.

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

Is the service safe?

During our visit we spoke with twelve people who used the service and also observed how staff supported people in each part of the home. We saw examples of good care and support during this time. Everyone that we spoke with said they felt safe.

We spoke with three relatives who told us that they were very satisfied with the service provided at the home. One relative told us, 'We are quite happy with everything so far.'

The inspection was a responsive inspection following some concerns being raised with us in respect of people who used the service not getting enough fluid and nutrition.

During our inspection we saw that monitoring records were not always completed and information such as how much people had eaten or drank was difficult to gather. There was also some inconsistency in information provided. For example, one person had had a fall yet their daily record stated 'no concerns'. This could mean that staff did not know a person's care needs.

We saw that risks to people had been assessed and actions planned to reduce those risks were in place. However staff had not always completed records to demonstrate that care and support had been given to keep people safe and well. For example, some people needed to be repositioned regularly to protect their skin and keep them comfortable. We saw some gaps in the record for one person suggesting this had not been done.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to the care and welfare of people who used the service.

Staff told us they were clear about their roles and responsibilities although some staff we spoke with were not sure which resident's required their fluid and food intake to be monitored and recorded. This meant that the information may not be available to monitor people and ensure they were nourished and hydrated.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to meeting the nutritional needs of the people who used the service.

Is the service effective?

On the day of our inspection we saw that people received appropriate support. People told us that they were cared for in ways that they preferred. One person told us, 'They do what they have got to do the way I like it.' A relative told us how the person they visited was getting better and was hoping to return to their own home. This was the person's goal and the family were very happy that they were achieving it.

Is the service caring?

People were supported by staff who were kind and patient. We heard staff speak with people in a calm and reassuring way. They responded to requests for support in a timely manner. We saw that staff contacted family and health professionals when they had concerns about the health and welfare of the people who used the service. We saw that people were supported with their meals and encouraged to have drinks at regular intervals.

Is the service responsive?

We found that the registered manager actively sought the views and experiences of the people who used the service and their relatives. For example they organised regular coffee mornings for people who used the service, their relatives and friends. The registered manager told us that this informal approach was more effective and was well attended. Staff told us how the registered manager implemented suggestions for improvements. For example, the cook told us that a person who used the service had asked for salmon on the menu and they had provided this.

Is the service well-led?

We saw how the registered manager undertook regular reviews and audits of systems and processes. The registered manager told us that they had effective monitoring tools that reassured them that they provided a good service. They showed us the recent audits for care plans and domestic arrangements. Both identified where improvements were needed and both had an action plan detailing how the registered manager planned to address issues.

We saw how the registered manager had taken action following other internal audits. For example, we saw evidence that when people who used the service had lost weight they were monitored formally and referrals had been made to health professionals.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found;

' Is the service caring?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us. "They do a really good job and things are always improving. This manager has made a big difference.'

We observed staff working with people in a professional manner whilst maintaining a happy and informal environment. During our visit we saw that people's requests for assistance were responded to promptly and people spoken with confirmed that this was the usual practice.

' Is the service responsive?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they had recently had a meeting with the new manager and had been encouraged to express their views and opinions. They confirmed they had been listened to and as a result improvements continued to be made. Staff told us they were clear about their roles and responsibilities.

' Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

People's needs had been assessed before they moved into the home. People told us they spoke regularly with staff to make sure their care was still appropriate. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We discussed the Mental Capacity Act (2005) with the manager. She told us that if a person appeared to lack capacity to make decisions about their care, family members would be consulted and an assessment would be carried out to ensure that any decisions made, would be in the person's best interests.

' Is the service effective?

People told us that the care that had been delivered to them had met their needs. Records we saw showed us that staff had received training to meet the needs of the people living at the home. There was information within the care plans we saw, that showed people who used the service were referred to external specialists in a timely way, to obtain assessment and treatment required to manage their health and wellbeing.

We spoke with a visiting occupational therapist and a physiotherapist. They told us that staff at Tuxford Manor worked well with them and enabled some people to return to their own home following a period of re-enablement.

' Is the service well led?

One person told us. "They do a really good job and things are always improving. This manager has made a big difference.' A staff member said, 'This is now a very good place to work. The manager is always approachable and spends a lot of her time out and about around the home.' Staff told us they had been provided with good training and felt confident about their responsibilities to provide good quality care and support for people in a homely and clean environment. One care staff told us, 'Things are improving all the time. I feel well supported by the management and listened to. There is a lot of good training which makes me feel more able to do a good job.'

Records showed that people received assessment and treatment from NHS health care professionals when required.

People who used the service told us they were satisfied with the care, treatment and support they received. One person told us, "It's very good. The staff are nice and the food is lovely. I enjoy a bit of banter with people." Another person said, "I have decided I will stay here. It's wonderful. The food is better than it was. Always home made cakes and drinks for my visitor as well."

People who used the service told us that they were encouraged to undertake a range of social activities within the home and felt their social needs were being met. "The social activity is very good. I enjoy being busy."

A visitor we spoke with told us, "I stay for lunch and am always made to feel welcome."

We found that the organisation had an effective recruitment process in place which adhered to current legislative requirements. We also found that the support staff had received a training package to ensure they were competent and confident in performing their duties.

A staff member told us, "We are a happy team now and that makes the people we care for happy."