Tadworth Grove Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.

Lessons were learnt to continually identify and embed good practice. For example, the registered manager told us they had to terminate a member of staff’s employment because of concerns in their care practices. They said, “[Member of staff] never spoke to the residents at all. It was not very nice. We always put our residents first.”

The registered manager understood their role under the Duty of Candour. They explained, “It’s about being honest and transparent. If we make a mistake, we look at the situation and how we can improve to avoid any other incidents.”

The provider had procedures for dealing with incidents, accidents and complaints. The management team investigated these and developed plans for improvements. These were shared with the staff. The staff confirmed the registered manager discussed adverse events with them so they could learn together. Relatives we spoke with told us they were well informed when things went wrong, and they were confident improvements were made as a result.

The provider had a learning culture which was adopted by all staff. When things happened, there were discussions and meetings to explore what had happened. Any shortfalls and systems were put in place to make improvements. The registered manager told us, “We have group supervision and managers’ meetings so we can discuss everything. We always put our residents first."

The provider worked with people and healthcare partners to establish and maintain safe systems of care. The management team made sure there was continuity of care, for example if a person required a hospital admission. They supplied summaries of key information about people’s communication and healthcare needs to help ensure everyone involved in their care had the information they needed.

The provider carried out thorough assessments of people’s needs, consulting with the person, their representatives and other professionals involved in their care.

People told us the staff were always available if they needed support. Relatives stated they were informed and involved when their family members required support or treatment from different services.

External healthcare professionals provided information and training sessions to enhance the staff’s skills and knowledge.

The service had up to date policies and procedures in place. Staff were required to read, understand and follow these.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Most staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had procedures to help safeguard people from the risk of abuse. Although most people using the service told us they felt safe, one person told us, “There’s one carer who works at night. [They are] a bit of a bully. You never know what mood [they are] going to be in. I’d rather not call if [they are] on duty.” They added, “I think it’s best not to say anything. They’re very reluctant to get you water at night. I suppose it’s extra work for them. They’re not always helpful.” Another person told us, “The carers get niggly with you when they have too much work to do. I know the times when it is best not to bother them – mornings, when they are getting people up and evenings, when they are getting people ready for bed.”

We discussed this with the registered manager, who assured us they would take immediate action to investigate these concerns. Following the inspection, they sent us evidence that they had taken appropriate action.

The provider worked with the local authority and other organisations to help investigate allegations of abuse and to keep people safe. A recent whistleblowing had been fully investigated. The registered manager told us, “Our quality assurance manager has worked with me to look at the concerns raised and what we are doing about this. My manager has done audits and has spoken to staff and residents.”

The provider had requested legal authorisations where restrictions amounted to a deprivation of liberty for people who did not have the capacity to consent. Decisions about people’s care were made in their best interests and for their safety.

The provider worked with people to understand and manage risks by considering people’s physical, emotional, and social needs together. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People said staff knew their needs and met these safely. Most people said staff were responsive and answered their call bells promptly. However, one person told us, “I don’t use the call-bell because the trouble is if you’re fiddling with things on the table, you can accidently call them by mistake, they’re not happy if you do that.” We fed this back to the registered manager who addressed this with the staff team.

Processes to help ensure risks to people were assessed and mitigated effectively. In general, we observed safe care being delivered to people. Relatives were happy with the care their family members received and felt they were safe. One relative told us, “I think it is brilliant. [Family member] has been so happy here. [They] kept having falls at home and couldn’t look after [themselves] anymore. [Their] health has improved since being here. [They] look so much better.”

The registered manager reviewed each incident or accident to establish the cause and what actions were needed to reduce the risk of re-occurrence. When people became distressed, there was guidance to inform staff how to support them to de-escalate or reduce their heightened emotions. However, the registered manager told us, “We would not take people who have very high needs, so we can ensure we meet their needs well.”

There were effective systems to review care plans and ensure they were sufficiently detailed and contained key information and guidance for staff.

Each person had personal emergency evacuation plans place. These plans contained detailed information about them, and the support they required to safely evacuate the building in the event of a fire or other emergency.

People were protected from the risk of avoidable harm. Where risks were identified, we saw risk assessments were in place, and these were regularly reviewed and updated.

The provider identified and mitigated potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. However, on the day of our inspection we found on the first floor, one of the shower rooms had exposed pipes. This meant people were at risk of harm, as they could injure themselves if they fell against them, or burn themselves if the pipes were hot. We reported this to the registered manager and maintenance person who took immediate action to make this safe.

People were supported in a safe and well-maintained environment that met their needs. People told us they liked the home and felt it was homely and comfortable. The home was clean and well-maintained with good fixtures and furnishings. Communal areas were light and airy which allowed people to mobilise easily. People’s bedrooms were personalised with photographs and items belonging to them.

There were effective systems in place to monitor and regularly check the safety and upkeep of the premises. There was a maintenance staff member available whenever any repairs were necessary. They also undertook regular checks of all areas of the home to ensure safe systems were in place. These included water temperatures, fire safety checks and kitchen equipment.

Equipment used to support people was suitable, well maintained and stored securely. The provider had an up-to-date plan in place to help ensure people were supported in the event of an emergency.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider’s systems helped ensure suitable staff were recruited to work at the service. The provider carried out pre-employment checks and provided an induction, assessed staff competencies at work and provided a range of training. However, 2 of the qualified nurses only had 1 reference on file. The administrator told us the company’s policy on the recruitment of nurses was obtain references for the previous 2 years employment which this covered. Following our feedback, the registered manager told us, “I have instructed my administrator to request the missing references and to review all personnel files to ensure that two references are consistently maintained going forward.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Most people we spoke with said there were enough staff to meet their needs. Their comments included, “There’s always someone who can help you if needed. I feel safe” and “There are plenty of staff around. Everyone is helpful.” The registered manager added, “The home is currently fully staffed. “We have just employed a full-time nurse and awaiting clearance. For the past 7 years, we have used the same agency nurse.”

The registered manager used a dependency tool to evaluate the number of staff required to meet people’s needs. They told us, “We use a dependency tool and this is updated monthly or more. If we needed more staff, I would speak with my manager and we would increase the number of staff. The staff are also keen to do overtime as needed."

The provider assessed and managed the risk of infection. They identified and mitigated the risk of it spreading. They also shared concerns with appropriate agencies promptly.

People told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic. One person said, “The cleaning is very good. I always have a chat with [Housekeeper]. [The staff] use the gloves and aprons when doing personal care.”

The home was clean, tidy and well-maintained. However, upstairs, the décor was a little tired and areas required re-painting, such as doors and skirting boards. Bathrooms and toilets were modern and accessible. There was a house keeping person on duty daily and cleaning schedules were in place to ensure the home was kept to a good standard.

The staff received training in infection control and followed safe guidelines. Care staff wore appropriate PPE when supporting people to help protect them from cross infection.

People received their medicines safely and as prescribed. There was a policy in place to support the safe and effective use of medicines. Staff were trained and competent to administer medicines safely.

Staff understood people’s needs and preferences with medicines and ensured these were followed. The medicines administration records showed people received their medicines in line with the prescriber’s instructions. Where people were receiving medicines covertly, which means staff had hidden the medicine in food or drink, this was done safely, and best interests decision meetings were completed and recorded.

Additional documents to support staff to give ‘when required’ (PRN) medicines were in place. However, some of these documents lacked the detail which could be found in other care documents, and some of the information in these documents did not always match. People prescribed paraffin-based skin products did not have appropriate fire risk assessments in place. However, the provider was responsive in rectifying this, and each person had the appropriate risk assessment in place by the end of the inspection process.

People’s medicines were stored safely and securely and they had access to support from a range of healthcare professionals. This included a GP, district nurses, mental health practitioners and the pharmacist.