Tallis House

Tallis House is a care home providing accommodation for people who require nursing or personal care. The service can support up to 101 people. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 68 people using the service.

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

There were not enough staff deployed to meet people's needs. Whilst dependency tools identified there were enough staff to meet people’s needs, feedback from staff, people and relatives did not support this. There were suitable recruitment processes in place. However, these had not always been consistently followed.

People's medicine support was being managed safely. The service was hygienic and infection control measures were being manged to help prevent the spread of infection. However, some improvement was needed to ensure the service followed all best practice guidance.

Staff did not always have the necessary knowledge, skills or competencies to meet people's needs safely. We received mixed feedback about the culture of the service, with some staff saying they did not always feel well-supported or listened to by the management team.

Systems to monitor and assess the quality of the service were not robust. The provider had not identified all of the issues we found on this inspection .

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 positive about the staff that supported them.

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 17 June 2021)

Why we inspected

We received concerns in relation to the management of accidents and incidents, weight loss and people’s hydration needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Enforcement and Recommendations

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 staffing, staff training and support and governance arrangement 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 the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tallis House is a residential care home providing accommodation and personal care for up to 101 people some of whom are living with dementia. At the time of our inspection 86 people were resident at the service.

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

Staff treated people with kindness, dignity and respect and spoke with people in a friendly manner. We observed positive and friendly interactions between staff and people throughout the inspection. People we spoke with were happy at the service. One said, “It is fantastic here, staff are brilliant.”

People told us they felt safe living at Tallis House. Risks to people`s safety were identified, and risk assessments were in place to mitigate these risks. People received their prescribed medicines by trained and competent staff. Staffing levels in the service were appropriate to meet people's needs. Staff members did not start to work until satisfactory employment checks had been completed. Accidents and incidents were fully investigated, and lessons learned were discussed with staff.

Staff received appropriate induction, training and supervision to provide safe and effective care. The registered manager worked in partnership with other organisations to support people's needs.

Care plans were person centred and included guidance for staff in how people wanted to be supported. A range of activities were available for people to take part in. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

People and relatives were complimentary of the staff team and the approach of the registered manager and felt the service was well managed. Staff said they felt supported and found the management team to be very approachable. The registered manager with the assistance of the management team, ensured audits and checks were completed regularly to ensure the safety and quality of people's care.

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 support this practice.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 07 June 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 requires improvement to good. This is based on the findings at this inspection.

Follow up

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

We found the following examples of good practice.

¿ The registered manager was following the government’s guidance on whole home testing for people and staff. This included using rapid testing and weekly testing for staff.

¿ Staff had received training on working during the pandemic in relation to COVID-19 and had received training in the correct use of personal protective equipment (PPE).

¿ New admissions were assessed prior to admission and tested for COVID-19. On admission they were supported to isolate.

¿ Staff completed regular health screening on people to help identify any symptoms early.

¿ People were supported to isolate when required and the environment had been set up to encourage social distancing when people were able to meet in communal areas.

¿ There was clear guidance and signage around the service to help prompt staff to safely work whilst minimising the risk of spreading infection.

¿ The registered manager had followed guidance on zoning areas to minimise the spread of infection. Staff had been identified to work in specific areas to stop the risk of spreading infection during an outbreak.

¿ Good infection prevention control practices had been implemented such as increased cleaning and the addition of PPE stations and hand sanitisers around the service.

¿ People’s well-being was supported by video and telephone calls to relatives and staff continued to engage in activities with people of their choice.

People’s experience of using this service:

The service had made improvements since our last inspection. However, further improvements were required following this inspection.

Suitable systems and processes were not in place to ensure people consistently received the care they needed and had the right to expect. Robust arrangements had not been made to safeguard people from situations in which they may be at risk of experiencing abuse.

People had not always received care that was supportive when they became anxious. People had not always received person centred care. People were supported to take part in a range of activities inside and outside the service. However, some people felt this was an area which could be improved.

Staff received training to provide them with the knowledge to fulfil their role, however further training was required to ensure staff could meet people's individual and specific needs.

We have made a recommendation about staff training in relation to supporting people living with dementia that might display challenging behaviour.

Staff received supervision from the management team. People received support they needed to eat and drink enough. We found in one area some aspects of the meal service required improvement in order that the mealtime was a positive experience for people using the service.

Quality assurance processes were not always effective. They had not identified concerns we found during the inspection, relating to the management of behaviours or care records. The management team acted quickly to address the concerns we identified during our inspection. From our discussions we were assured they were committed to making the required improvements to ensure people experienced consistently good outcomes.

We found the provider was in breach of two regulations. These were Regulation 13 HSCA RA Regulations 2014; Safeguarding service users from abuse or improper treatment and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the back of the full version of the report.

Rating at last inspection: At the last comprehensive inspection the service was rated as 'Requires Improvement'. The last report was published 23 May 2018.

This is the second time the service has been rated as Requires Improvement.

Why we inspected: All services rated as 'Requires improvement' are re-inspected within one year of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received and the improvements made.

Enforcement: At this inspection we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and safeguarding. Details of action we have asked the provider to take can be found at the end of this report.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.

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

Tallis House is registered to accommodate up to 101 older people. At the time of the inspection, 96 people were permanently living at the service. The accommodation is spread over three floors.

There was a registered manager in post. 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.

On the day of inspection we saw there was sufficient, suitably recruited staff employed to keep people safe. However, when looking at the provider's falls analysis we identified concerns related to insufficient numbers of staff available to meet people’s needs. The provider responded to this shortfall immediately and increased staff. Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS).

Risks to people were identified and regularly reviewed. Written guidance was provided to staff on how to manage risks to keep people safe. We did note on some occasions additional controls to minimise risk of falls were not always updated in a consistent area within records. Staff had a good knowledge of the risks to people and knew what to do to minimise risk. There was sufficient equipment and measures in place to minimise the risk of infection.

People told us they were safe living at the home and we found safeguarding issues had been referred to the local safeguarding vulnerable adult’s team. Systems in place to reduce people being at risk of potential abuse were robust

Medicines were managed safely and the provider had procedures in place so they were stored securely, administered in line with recommended guidance and recorded.

Staff had access to regular training to support them to maintain and develop their skills and knowledge. The registered manager had planned some additional training to ensure all staff had sufficient knowledge to meet people’s needs. Staff were supported through supervision, observations and appraisals to help them develop professionally.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We have made a recommendation the service find out more about training for staff, based on current best practice, in relation to assessing people’s capacity in keeping with the principles of the MCA.

Staff took account of people’s individual needs and preferences and people were encouraged to be involved in making decisions about their care. People were complimentary about the way staff interacted with them. Independence, privacy and dignity was promoted and respected.

Food was of a good quality and people had enough to eat and drink. The service supported people to maintain their health and wellbeing and people were supported to access healthcare services.

The provider had systems in place to monitor the quality of the service. The management team were open and transparent throughout the inspection and sought feedback to further improve the service provided.

Tallis House provides a service for up to 101 older people. On the day of our inspection there were 99 people living at the service.

There was a registered manager in place. 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 safe as the service had comprehensive systems in place for monitoring and managing risks to promote people's health and wellbeing. There were suitable arrangements in place for medication to be stored and administered safely.

There were sufficient numbers of staff with the relevant skills and knowledge to effectively meet people's needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had followed the MCA code of practice in relation to DoLS

People were supported to maintain their health as they had regular access to a wide range of healthcare professionals. A choice of food and drink was available that reflected people's nutritional needs, and took into account their preferences and any health requirements.

Staff had good relationships with people and were attentive to their needs. People's privacy and dignity was respected at all times. People were treated with kindness and respect by staff who knew them well and who listened and respected their views and preferences. People were encouraged to follow their interests and were supported to keep in contact with their family and friends.

The manager promoted an open culture. Staff were clear about their roles and responsibilities and they were able to express their views. The provider and management team had robust systems in place to ensure the quality and safety of the service, learn from complaints and feedback and to drive improvements.

This is a summary of what we found;

Is the service safe?

When we arrived at the service the administrator greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The registered manager spoke to us about The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS). They informed us that they had submitted 15 DoLS applications. This was in response to the Supreme Court Judgement of March 2014. The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We noticed from training records that not all staff had received DoLS training.

We looked at staff training records and saw that some staff were out of date with manual handling, safeguarding and infection control training.

Is the service effective?

We saw that each person’s care records were reviewed monthly. Each plan contained an assessment of need, an evaluation a care plan and a review of care. Some information was recorded twice and could cause confusion unless studied carefully. The service planned for the staff to have regular supervision and a yearly appraisal. Training sessions had been delivered but not all training was up to date for all staff.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. One person told us: “They look after me very well here I have no complaints.”

Is the service responsive?

Each person had a keyworker. We examined five care records of people who used the service and noted that the risk assessments were reviewed and updated monthly. We noted that staff recorded information regarding people’s daily fluid intake but when this was not sufficient there was not a clear plan of action for staff to follow to show how people's need would be met.

Is the service well-led?

The service had worked with other organisations and services such as health and social care professionals to make sure people received their care in a joined up way. Staff members told us the senior staff were approachable and supportive.

Some people were not able to speak with us due to their needs. We observed the care and attention that they received from staff. All of the interactions we saw were appropriate, respectful, and friendly and we found the staff across the whole home to be attentive to the needs of the people on a moment-to-moment basis.

The accommodation was designed and adapted to meet the needs of the people who lived there and risks within the home had been assessed. The home was clean, well maintained and was personalised to the people who lived there.

We saw that support plans and risk assessments were informative and up to date. Staff were aware of their contents, which supported them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment and induction systems were robust. There were enough qualified, skilled and experienced staff to meet people’s needs.

People who used the service told us they would speak with the manager or other senior staff if they had any concerns. They said the staff were approachable and they often asked them if they were happy with everything.

We found that the home was not meeting the identified needs of the people who lived in the home. We found that tasks were put before the immediate care of the people and that people had to wait a long time for their personal care needs to be me, for example, we observed that one person had to wait for an hour to be taken to the toilet because a member of staff was completing paperwork.

We found people on the top floor crowded into one room, the staff did not have sufficient space to move a hoist safely and in a manner that promoted the dignity of the people. There was a larger sitting room unoccupied on the same floor.

We also observed that the majority of people stayed in their own bedrooms with their television on or reading the newspapers. People told us they preferred to stay there because activities were not provided.

We found that there was not enough staff on duty to meet the needs of the people in a person centred manner. We observed care being provided which was led by the need to complete tasks rather than engage with the people to see what they wanted. An example of this was people were taken to the toilet before lunch. They were not asked if they wanted to go nor were they told where they were being taken.