We carried out a review of the data available to us about Tiled House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tiled House, you can give feedback on this service.
We found the following examples of good practice.
¿ A pre-booked pod visiting system was to be implemented. If people were very unwell arrangements had been made for their relatives to visit them. Relatives were required to wear full Personal Protective Equipment (PPE) and take a COVID-19 test to ensure their visit could take place safely.
¿ Infection Prevention and Control (IPC) guidance had been followed when new people had been admitted to the home. This helped to prevent infection being brought into the home.
¿ Cohorting and zoning was used to reduce the number of staff and people in any one area. This helped to decrease the risk of infection transmission within the home.
¿ There was enough Personal Protective Equipment (PPE) available in stock and throughout the home. Staff wore PPE in line with guidance.
¿ COVID-19 test kits were plentiful. Staff were required to take a COVID-19 test three times a week and people were tested every 28 days. Where people or staff tested positive, they were required to self- isolate in line with current guidance.
¿ Changes to lounge and dining room areas had been made to allow some social distancing. The premises were adequately clean. Appropriate cleaning products were used and staff followed the provider’s cleaning schedules.
¿ The registered manager had a good insight into dealing with any infectious outbreaks. The provider's IPC policy was updated when new government guidance had been issued.
Tiled House is a residential care home providing personal care for up to 48 people aged 65 and over, some who live with dementia. There were 41 people living at the home at the time of our inspection. The care provided is aimed to be short term. People are admitted for rehabilitation with the goal of allowing them to return to their own home. To facilitate this there are physiotherapists, occupational therapists and nurses based on site but not managed by the provider. These health professionals provide a role that reflects that provided by community healthcare services, for example district nursing.
Tiled House has units over two floors and was built for purpose. All bedrooms in use are single. There are also numerous communal living areas available on each floor.
People’s experience of using this service and what we found
People were safe, and staff knew what to do to minimise risks to people as far as this was possible without infringing their rights. There was enough staff available to keep people safe and staffing levels were reviewed to reflect changes in people’s needs.
People's care plans on most occasions reflected people’s needs and preferences although there were some inconsistencies found. However, staff were able to explain how they provided appropriate safe care that reflected people’s needs and preferences. People also expressed satisfaction with the care they received.
People were supported by care staff who had the skills and knowledge to meet their needs. There was ongoing training based on the training needs identified by the registered manager and training updates were on going. People expressed confidence in staff skills and knowledge and staff understood, felt confident and well supported in their role. People's health was supported as staff worked with health care providers, whether on or off site, as needed to support people’s healthcare needs.
People were supported to have maximum choice and control of their lives and staff understood they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.
People had access to food and drink they enjoyed, and the service offered specialist or culturally appropriate diets when needed.
People were supported by care staff that were caring and expressed interest in people and the support they provided them. People received person centred care and support based on their individual needs and preferences. Staff were knowledgeable about people, their needs and preferences and used this to develop good relationships with the people. People’s privacy, dignity and independence was respected by staff.
We saw the service was responsive to information from people and relatives. People could complain, and concerns were listened and responded to by the staff. Complaints and comments were used as a tool to drive improvement of the service.
People, relatives and staff were able to share their views with staff and were involved in planning their care. People said they enjoyed staying at Tiled House and said it helped them reach better levels of independence. People were able to follow their chosen routines and had access to a range of activities.
Quality monitoring systems included audits and regular checks on people’s satisfaction with the service they received. The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.
The registered manager and staff were approachable, organised, listened and responded to people and acted on feedback they when they shared this with them. The registered manager had demonstrated they were not complacent and had improved the service since our previous inspection.
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 requires improvement (report published 02/10/2018)
Why we inspected
This was a planned inspection based on the previous rating.
Tiled House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Tiled House provides an intermediate care and enablement service with accommodation and personal care for up to 47 people. The service cares for people who have been in hospital or suffered a crisis and need support to return to live at home in the community. The service provides short term support which can vary from weeks to a few months by which time people are independent or are referred to more long-term care provision. At the time of the inspection, there were 45 people living at the service.
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
We saw people had to wait for support at times and staff did not always have the time to respond to people’s needs in a consistent manner. Risks to people’s safety such as falling, were identified and managed with steps taken to reduce risks. People were supported by staff who understood how to recognise and report abuse or harm. People received their medicines as prescribed. Staff understood their responsibilities in relation to hygiene and infection control.
People received care from staff that had the skills required to support them safely. Staff support and training was provided with further improvements identified. Most people liked the food, some people felt teatime and supper time choices were limited. 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. Staff gained people's consent before assisting or supporting them. People’s health care needs were supported with access to on-site and external health professionals.
People were consistently positive about the caring attitude of the staff who they described as kind and caring. People were encouraged to regain their independence. People were treated with dignity and respect. However, staff did not always ensure information about people is treated confidentially.
People were involved in discussing their care and improvements were planned to provide a more detailed care plan. People had access to some planned activities and events to encourage their interests. People knew how to make a complaint and the provider had systems in place to manage complaints.
The provider’s systems for monitoring the quality and safety of the service had not been effective in identifying shortfalls. Records held in relation to people's care were not always completed to ensure risks were managed. The analysis of falls needed to be more robust to help identify any trends or patterns such as the reasons people may be falling.
This inspection took place on 1 October 2015 and was unannounced. Tiled House provides an Intermediate Care and Reablement Service with accommodation and personal care for up to 47 people. Reablement provides personal care services to people who have been in hospital or suffered a crisis and need support to return to live at home in the community.
The service provides short term support which can vary from weeks to a few months by which time people are independent or are referred to more long term care provision. At our previous inspection in February 2013 the provider was compliant with the standards we assessed. On the day of our inspection there were 43 people living at the home.
There was a registered manager in post and she was present during our inspection. 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 and associated Regulations about how the service is run.
People felt safe using the service and risks to their safety had been identified. People and their relatives had no concerns about their family member’s day to day safety. Staff knew how to support people safely and had training in how to recognise and report abuse.
Staff were recruited in a safe way. We found there were enough staff to support people and meet their needs in a personalised manner.
People had their medicines when they needed them and the arrangements for the management of people’s medicines was safe.
Care was focused on people’s rehabilitation and their personal goals for independence and confidence to return to their own homes. The input of a range of on-site health and social care professionals led to people receiving the right care in a coordinated way.
Staff were aware of how to support people’s rights, seek their consent, respect their choices and promote their independence.
People told us they enjoyed the meals and we saw that risks to their dietary intake were known and staff supported them to eat and drink enough. People’s health was supported by access to appropriate external and on-site healthcare professionals.
People and their relatives were positive about the care provided. Our observations confirmed that staff were attentive and caring towards people. Staff knew people well and how best to support them.
People knew how to make a complaint and were confident this would be listened to and acted upon.
People described the management of the home as friendly and approachable. Staff felt supported by the provider. The provider had carried out audits to identify and address issues with the quality of the service and had made improvements to ensure the safety of people.
We saw that care plans were comprehensive and clearly identified people's health and care needs. People's needs had been individually assessed. Care plans contained a good level of information about how people should be supported to ensure their needs were met. One person told us, 'They have sorted me out so I can go home again'.
Suitable nutritious food and drinks were available to people throughout the day or on request. We saw that people's dietary and nutritional needs were being met.
Staff we met with were not receiving any regular supervision or appraisal. This meant that the provider was failing to provide a support structure for staff in line with their own policy.
We saw that some of the quality monitoring programmes in place were not effective. This meant that the monitoring of quality and safety of the services provided in the carrying on of the regulated activity were not robust.
Records we looked at were easily accessible, securely stored and fit for purpose.
All people told us that they felt involved in the planning of their care and that their privacy and dignity were respected.
All people told us they were very satisfied with the service they received at the home. They all said that their needs were being met. a relative told us they were very satisfied with the care provided. Throughout the inspection, we saw that staff provided care and support in a friendly and professional manner. We did not see anybody having to wait for that support to be given.
All people we spoke with all said they felt safe. One said, 'You know you are going to be looked after'. Most of the staff had been trained in safeguarding and the policy and procedure were readily accessible. We talked to staff about their understanding of safeguarding and their responsibility to report incidents, which they clearly understood.
Medicines were handled appropriately and safely stored. We saw that regular audits were taking place.
Staff received appropriate professional development and felt supported in their role by approachable management.
None of the people we spoke with had any complaints. People told us they would feel confident to raise a complaint if they needed to.
There was a very friendly and pleasant atmosphere in the home. People and their relatives were complimentary about the staff. Some people told us about the recovery they had made whilst being at the home. One person told us 'I would give them 10 out of 10.'
People were happy with their rooms and the facilities available. Relatives told us that staff always welcomed them. One relative said, "We can visit whenever we like." We saw that relatives could sit with people in the lounge or in people's bedrooms, where their privacy was respected. One relative told us, 'They even give us refreshments when we visit.'
The Primary Care Trust (PCT) has employed two nurses, a physiotherapist, an occupational therapist, and an occupational therapist assistant to work at the home. These professionals work together to ensure that people are given care that meets their needs.
The home recognises that some work needs to be carried out to ensure safe handling of medicines. One staff member told us, 'We are always looking for ways to manage this better.'