Archived: Tiddington Court Limited

Updated 30 June 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

The service had a manager registered with the Care Quality Commission. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

Our inspection was announced. We gave the service 45 minutes notice of our visit because the service was inspected during the coronavirus pandemic and we wanted to be sure we were informed of the home's coronavirus risk assessment for visiting healthcare professionals before we entered the building.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection and recurrent themes of concerns. We sought feedback from the local authority and commissioners who may work with the service. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection visit

We spoke with three people who lived at Tiddington Court about their experiences of the care provided. We spoke with a registered manager, a duty manager and a care staff member. We also spoke with a service manager.

We reviewed three people's care records in detail. We looked at a sample of records relating to the management of the service including health and safety checks, accident and incident records, policies and procedures and a sample of records the registered manager said they checked, such as daily records and cleaning schedules.

After the inspection

We contacted four care staff but were only able to speak with two care staff via the telephone. We reviewed the additional documentation we had requested from the registered manager during the site visit. We continued to seek clarification from the provider to validate evidence found.

Updated 30 June 2021

About the service

Tiddington Court is registered to provide personal care to older people. Care and support was provided to people at pre-arranged times in a specialist ‘independent living’ service. Tiddington Court consists of 30 apartments and 12 bungalows. People living at Tiddington Court own their own home and share on-site communal facilities such as a passenger lift, lounge, dining room and the use of an on-site restaurant.

This provider is based at Tiddington Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living at Tiddington Court receives a regulated activity of personal care. At the time of this inspection visit, Tiddington Court staff supported three people, so we only looked at the care and support for those three people receiving personal care from this provider.

People's experience of using this service

At the previous inspection, provider audits needed to be improved and become embedded. At this visit we found those improvements had not been made. We asked to look at audits for incident and accidents, analysis of falls, care plan audits, risk management, staff training, complaints, medicines and survey questionnaires to see how actions had been taken to drive improvements. Some of the analysis of information was either not completed or inaccurate, so we could not be confident actions were taken when improvements were identified. This meant the registered manager and the provider had limited assurances people received a safe, effective and well led service.

We looked at infection prevention and control measures under the Safe key question. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. Infection control systems implemented during a pandemic were in place, however these were not always followed and observed. People and staff told us on some occasions, face masks were not worn when providing personal care. During our visit, the management team were based in a small office and on occasions, up to four senior staff were seen, not socially distancing and not wearing a face mask in line with government guidelines. Some of these staff could meet those people who received a regulated activity.

People’s plans of care were not detailed enough for staff to provide safe care. The registered manager was in the process of updating those plans with important information that staff needed to know. Staff’s knowledge of how to support people was inconsistent.

Risks related to people’s care were not recorded, accurate and reviewed. Some risks were scored, however there was no instructions for staff to follow to manage those identified risks. Where people were at risk of falling, records were not consistent with events and although falls analysis was completed, it failed to record all falls and incidents. In some examples, intervention by a GP or falls team was suggested. There was no evidence to show, this had been followed.

Staffing levels met people’s needs. People told us staff supported them in an unrushed manner and were able to respond to requests for support without any undue delay.

People receiving personal care, spoke positively about their experiences living at Tiddington Court and the quality of their care demonstrated by the staff team.

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 28 November 2018)

Why we inspected

The inspection was prompted in part due to information received about concerns in relation to staff supporting people with personal care, a lack of training, staff not adhering to government guidelines with PPE and a culture of staff not feeling supported. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

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

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Further information is in the detailed findings below.