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We have edited the inspection report for Tabley House from 13 November 2018 in order to remove some text which should not have been included in this report. This has not affected the rating given to this service.

Inspection Summary


Overall summary & rating

Good

Updated 13 November 2018

The inspection took place on the 11, 12, 18 and 19 October 2018 and was unannounced.

Tabley House was previously inspected in March 2018. During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to: person centred care (Regulation 9); safe care and treatment (Regulation 12); safeguarding service users from abuse and improper treatment (Regulation 13); fit and proper persons employed (Regulation 19); consent (Regulation 11); good governance (Regulation 17); and staffing (Regulation 18).

Following the last inspection, the registered provider was placed into special measures by CQC. The registered provider was asked to complete an action plan to confirm what they would do and by when to improve the five key questions we ask. They are: is the service safe, effective, caring, responsive and well led. At this inspection we found that the registered provider had taken action to address the breaches identified at the last inspection and made enough improvements to be taken out of special measures.

Tabley House is a ‘care home’ run by Cygnet Health Care Limited. The care home is registered to provide accommodation to adults with nursing and personal care needs.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 59 people across two units, each of which have separate adapted facilities. One of the units specialises in providing care for up to 12 people living with dementia. At the time of the inspection 35 people lived in the care home.

The care home had a registered manager. 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.

The registered manager was present throughout the four days of our inspection and was supported by their regional operations director and deputy manager. The management team were helpful and transparent throughout the inspection process and demonstrated a commitment to ensuring the continuous improvement of the service.

There was a warm and caring environment in the care home. We observed that staff were responsive to the needs of people living in the care home and that people were treated with dignity and respect.

Information on people's assessed needs and the support they required and received from staff had been recorded on an electronic records management system. This included risk assessments and other supporting documentation. Additional records had been established to enable staff to record the delivery of care contemporaneously. For example, when recording fluid and nutritional intake or when a person had been assisted to reposition. Care plans had been fully reviewed since our last inspection and the registered manager was in the process of meeting with people living at the care home and their representatives where necessary to confirm that people had been involved and were in agreement with the information recorded.

People were supported to attend healthcare appointments and staff liaised with people's GPs and other healthcare professionals as necessary to maintain people's health or support them at the end of life. We observed that a GP visited the care home on a regular basis to ensure the healthcare needs of people were monitored and reviewed.

Policies and procedures had been developed to ensure staff were aware of their roles and responsibilities for ordering, storing and administering medication. The registered manager was in the process of reviewing staff competencies and transferring to a local pharmacist to impro

Inspection areas

Safe

Good

Updated 13 November 2018

The service was safe.

Safeguarding systems and processes were in place to help protect people from abuse and improper treatment.

Staffing levels were adequate to ensure people received appropriate levels of care and support. Plans were in place to recruit to outstanding vacancies.

Recruitment procedures provided appropriate safeguards for people using the service and a full review of staff personnel records had been undertaken. This helped to reduce the risk of unsuitable people being employed to work with vulnerable people.

Systems had been established and further initiatives were in the process of being introduced to protect people from the risks associated with unsafe medicines management.

Effective

Good

Updated 13 November 2018

The service was effective.

Staff learning and development systems and processes had been developed to ensure staff were appropriately trained and supported for their roles and responsibilities.

Managers and staff acted in accordance with the Mental Capacity Act 2005 to ensure that people received the right level of support with their decision making.

People had access to a choice of nutritious meals and systems were in place to liaise with GPs and other health and social care professionals when necessary.

Caring

Good

Updated 13 November 2018

The service was caring.

Staff engaged with people in a warm, friendly and caring manner and understood the principles of good care practice.

People were treated with dignity and respect and their privacy and human rights were safeguarded.

People's personal information was stored securely to maintain

confidentiality.

Responsive

Good

Updated 13 November 2018

The service was responsive.

Care plans and supporting documentation were in place that were subject to ongoing development and review to ensure people's needs were identified and acted upon.

There was a complaints procedure in place and any complaints were responded to appropriately.

People were encouraged to engage in a range of group and person-centred activities. However, the activities programme needed further review to demonstrate how the social, recreational and leisure needs of people living with dementia are met.

Well-led

Requires improvement

Updated 13 November 2018

The service was not always well led.

Governance and quality assurance systems were in the process of being updated to ensure improved oversight and accountability within the service. This was work in progress at the time of our inspection. The service will require time to fully embed the changes into practice and provide evidence of sustained improvement.

The service worked in partnership with other agencies and health and social professionals.