Towerhouse Residential Home

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

At our last inspection we rated the home inadequate. At this inspection we found the provider had made a number of improvements. However, we were not fully assured these improvements could be sustained over time.

The provider had improved their staff recruitment records. However, there was only one reference for a staff member, and for another we found a reference had not been verified to ensure it was genuine. Staff had received regular training and supervision to ensure they were equipped for their roles. However, some induction training records had not been ‘signed-off’ by a manager to verify that induction had been completed.

People’s medicines were safely stored and managed. Records of people’s medicines were up to date, and stocks were regularly monitored. People had personalised risk assessments that included guidance for staff to manage and reduce identified risks. The home and its garden were clean and tidy and free from trip hazards or other environmental risks. Bathrooms, fire doors, and garden paving had been renovated to a high standard.

People told us they enjoyed the meals provided

by the home and were offered choices about their food and drink. Support had been sought to ensure people with identified risk of choking when eating were safely supported. People had received support from health professionals where there were concerns about their health and well-being.

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.

Staff supported people in a caring and friendly manner, taking their needs and preferences into consideration. People spoke positively about the support they received from staff and management at the home.

People’s care plans were up to date. These included guidance for staff about how to support people in accordance with their needs and preferences. However, the care plan for one person contained conflicting information about their communication needs. Some activities took place at the home, but these were not always recorded in people’s records. The registered manager told us they were seeking to improve the range of activities available to people.

The provider had updated their quality assurance monitoring procedures. These covered a range of care and safety issues. A range of monitoring audits had taken place. However, these had been recently introduced, and were not yet embedded in the home’s practices.

People and staff spoke positively about the management of the home. Regular meetings had taken place with staff and people.

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

This service has been in Special Measures since 15 February 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement

We have identified one breach in relation to staff recruitment at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

The provider had not ensured records of people’s medicines were accurately monitored and recorded. This meant we could not be sure people received their prescribed medicines safely.

The home was clean and tidy. However, we found concerns in relation to environmental risk and infection control. We observed gaps around fire doors and noted the provider had failed to carry out an assessment of fire doors as recommended by a fire safety inspection in February 2021. Potential trip hazards created by uneven paving in the home’s garden had not been identified as a risk.

Staff took the temperatures of people, staff and visitors to the home but had not identified that a faulty thermometer was showing temperatures as consistently low. Exposed grouting and cracked tiles were found in the home’s bathrooms. There was a failure to accurately record hot water temperatures that meant people could be at risk of scalding. Out-of-date food was found in the home’s fridge and there was no system for checking expiry dates of food items.

People’s care records had not always been updated to reflect their current needs and risks. People’s risk assessments in relation to COVID-19 were generic and had not been personalised to reflect their specific needs. Information about, and outcomes of health appointments for people had not always been recorded.

The provider had failed to verify staff references to ensure they were genuine. There was no system for ensuring that staff working visas were up to date and included in their records.

People told us they enjoyed the meals provided by the home and were offered choices about their food and drink. However, two people’s risk assessments showed they were at risk of choking when eating, but we saw staff were not following risk management guidance for one of these people. The provider had not sought specialist eating and drinking assessments for people at risk of choking.

The provider’s quality assurance systems had failed to identify risks and concerns, for example, in relation to temperature checks, medicines and environmental safety.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People said they were offered choices and our observations of staff interactions with people confirmed this.

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 on 25 June 2021).

Why we inspected

This was a planned inspection based on the previous rating. However, we brought the inspection forward as a result of concerns received from a local authority in relation to safeguarding, record keeping and infection control.

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 monitor the service.

We have identified breaches in relation to people's safety at the home, the quality of care records and the provider's quality assurance and monitoring systems at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on our findings at this inspection.

You can read the report from our last inspection, by selecting the 'all reports' link for Towerhouse Residential Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Towerhouse Residential Home is a care home providing care and support to people aged 65 and over. The home can accommodate up to eight people in one adapted building. When we inspected seven people were living at the home.

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

People’s prescribed medicines were safely stored. However, during this inspection we saw people’s medicines had been dispensed into pots and placed by their breakfast table settings and not administered individually to people directly from the packet which is good practice for medicines administration. We noted a gap in a person’s medicines record where a medicine was not recorded as having been taken.

We were not assured that the provider was ensuring people’s safety in relation to the risk of infection. A bathroom had cracked tiles and exposed grouting which presented an infection risk to people using it. There were no records of the twice-daily temperature checks which the provider said had taken place for people and staff. Infection control audits had not been updated to include information about COVID-19 and the relevant risk assessments had not been undertaken for people. The home’s COViD-19 policy and procedure had not been updated since March 2020 and did not include more recent guidance for care homes. The home had sufficient supplies of personal protective equipment (PPE) and the provider and care staff were observed wearing masks and other PPE at all times. However, we observed a visitor entering the home and walking through communal areas without wearing a mask. Suitable cleaning materials were used. Although these were generally stored securely, we found a room containing laundry fluids had been left unlocked.

People and staff, including agency staff had been tested regularly for symptoms of COVID-19. People and permanent staff had been vaccinated. Staff had received training in infection prevention and control.

The provider had not fully ensured people were not placed at risk in the event of a fire evacuation. A fire exit was partially blocked by a chair and a fire exit sign was not placed correctly. A gate leading to the fire assembly point was locked by a padlock meaning the assembly point could not be readily accessed from the garden in case of fire. The provider said an independent fire risk assessment had been carried out the week prior to our inspection and the issues with signage and the padlocked gate had been pointed out by the assessor, but these had not yet been addressed.

The home’s quality assurance systems had failed to ensure that risks associated with infection control, fire safety and external building works that were taken place during our inspection had been identified and addressed. Regular audits of safety and systems had taken place. However, weekly tests of, for example, the fire alarm system had not been carried out for two weeks prior to our inspection. The provider told us the deputy manager who usually carried out the checks was away from work and acknowledged that no arrangements were in place to undertake checks and audits in their absence.

Staff were safely recruited and checks of their suitability had been carried out before appointment to their roles. The provider had sought evidence of appropriate checks having taken place for agency staff working at the home.

Staff had received training in safeguarding adults and understood their responsibilities in ensuring people were safe from harm or abuse. There had been no safeguarding concerns about the home during the past year.

People and family members told us they were satisfied with the care and support provided at the home. A staff member said they felt well supported by the provider and received the information they required to do their work effectively. People and staff were asked for their views about the home at regular meetings.

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 12 November 2019).

Why we inspected

We received concerns in relation to environmental safety and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 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 Towerhouse Residential Home 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 monitor the service.

We have identified breaches in relation to people’s safety at the home and the provider’s quality assurance and monitoring systems at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan 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.

Towerhouse Residential Home is a residential care home providing personal care to people aged 65 and over. The home can accommodate up to eight people in one adapted building. When we inspected seven people were living at the home.

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

The provider had acted to address failures that we had identified at our last inspection. People’s risk assessments had been reviewed and these were accurate and up to date. Emergency first aid boxes were complete and their contents were regularly monitored. The home was secure with no potential unsecured entry points.

There was a system in place to ensure that people were safe and protected from abuse and harm. Staff knew how to recognise abuse and how to report allegations and incidents of abuse. Risks to people had been identified, assessed and reviewed. Regular safety checks were carried out to ensure the premises and equipment were safe for people. There here were systems in place to protect people and staff from infection. Medicines were stored, administered, recorded and disposed of safely.

Recruitment of staff was safe and robust. Pre-employment checks had been carried before staff could commence work. There were sufficient numbers of staff to support people to stay safe.

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 at the home supported this practice.

There were arrangements to ensure that people’s nutritional needs were met. We also saw that people’s dietary requirements, likes and dislikes were assessed and known to staff. People were able to choose what they ate and drank.

Staff members received regular training and supervision to ensure that they were able to carry out their roles effectively. Observations of staff care practice had also been carried out.

People’s privacy and dignity were respected. Staff understood the need to protect and respect people's human rights. People’s spiritual or cultural wishes were respected. Faith representatives visited the home regularly to provide pastoral support.

People received personalised care. Their care plans had been regularly reviewed and updated to ensure they reflected people's changing needs and wishes. They were supported to take part in activities that were relevant and appropriate to them.

People and family members told us that they had no complaints, but they knew who to speak to if they did.

People, family members and staff told us that the home was well managed. Quality assurance monitoring had taken place and this had been used to maintain improvements.

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 (published 25 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The last inspection was carried out in July 2017. The overall rating for the service was inadequate. We found the provider was in breach of Regulations 12 (safe care and treatment), 9 (person-centred care) and 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During our comprehensive inspection in April 2018 the service demonstrated to us that improvements had been made and no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. There were four people at the service, the majority of whom were living with dementia.

A registered manager was not 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.

The service had made some improvements. However, further improvements were required. This is because, the systems and processes for monitoring and improving the service were not consistently effective and had failed to identify some concerns about quality and safety of the service. We also found that peoples' risk assessments did not always contain detail required to support them. Risks had sometimes been assessed as higher than they were in practice. The mechanisms in place to monitor and improve the service had not been effective as they had failed to highlight this. Where improvements had been made, it was too early for the provider to be able to demonstrate that these processes were fully embedded and that these improvements could be sustained over time.

Overall there was a system to ensure that people were safe and protected from abuse. Staff knew how to recognise abuse and how to report allegations and incidents of abuse. There was evidence risks to people had been identified, assessed and reviewed. Recruitment of staff was safe and robust. We saw that pre-employment checks had been completed before staff could commence work. There were sufficient numbers of staff to support people to stay safe. Regular safety checks were carried out to ensure the premises and equipment were safe for people. We also saw there were systems in place to protect people and staff from infection. There were suitable arrangements for the recording, administration and disposal of medicines.

Improvements had been made to ensure people were supported to have choice and control of their lives. Their care records showed relevant health and social care professionals were involved in their care. The service was working within the principles of the Mental Capacity Act 2005 (MCA). Care records held best interest decisions including details of people's relatives who were involved in the decision-making process. The service also followed the requirements of Deprivation of Liberty Safeguards (DoLS), which meant that people were not deprived of their liberty unlawfully.

There were arrangements to ensure that people’s nutritional needs were met. We also saw that people’s dietary requirements, likes and dislikes were assessed and known to staff.

People’s privacy and dignity were respected. Staff understood the need to protect and respect people's human rights. We saw they had received training in equality and diversity. People’s spiritual or cultural wishes were respected. Representatives of local churches visited the service regularly for prayers with people.

Improvements had also been made to ensure people received personalised care. Their care plans had been regularly reviewed and updated to ensure they reflected people's changing needs and wishes. Care plans also reflected their social needs. They were supported to take part in meaningful activities that were relevant and appropriate to them.

Following this inspection we imposed conditions of registration on this provider to stop new admissions and to provide us with quality audit information each month.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. There were five people living at the home, the majority of whom were living with dementia.

The manager at the home is the registered provider. Registered providers 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 carried out this inspection to check whether the provider had made improvements to quality of care provided. We found that the provider had made some improvements. Staff training was up to date and in accordance with national training standards for staff working in health and social care services. Staff members were receiving regular supervision from a manager to ensure that they were supported in their roles. Improvements had been made to the environment of the home to ensure that people were safe. A range of quality monitoring processes had been put in place. However these had failed to identify and address some issues in relation to the quality of care and support to people living at the home.

At our previous inspection of the home in October 2016 we found that that the provider had failed to take action to ensure that people were always safe. The safety of the home environment had not been assessed and we found a number of trip hazards that had that had not been identified and remedied. Window restrictors did not meet the Health and Safety Executive's (HSE) guidance on window restrictors in care homes. A fire exit had not been alarmed or otherwise secured to ensure that staff members were alerted when a vulnerable person tried to leave the home.

During this inspection we found that a health and safety risk assessment had been put in place. Improvements to the home environment had been made. New flooring had been put in place to reduce the risk of trips and falls. New window restrictors had been put in place which met HSE guidance. The provider showed us a copy of a recent independent fire risk assessment. However, when we examined the fire exit we found that the locks had been changed but no alarm or other security system had been installed. This meant that people could still leave the home undetected by staff and therefore be put at risk.

At our inspection in October 2016 we found that two people did not have care plans or risk assessments in place. Other people’s care plans and risk assessments had not always been updated to reflect changes in their needs. During this inspection we saw that care plans and risk assessments were in place for all five people living at the home. However, these did not always contain any information for staff members about how they should provide care or manage risk to people. Actions to reduce risks in relation to likelihood of pressure ulcers were not always being followed or recorded.

Staff members supported people in a caring and respectful way. They were able to describe their roles and responsibilities in ensuring that the people whom they supported were safe from harm.

At our inspection of the home in October 2016 we had found that there were no formal records of recent safeguarding concerns and these had not been notified to CQC. During this inspection we looked again at the provider’s system for notifying us of events such as safeguarding matters. We found that no safeguarding concerns had arisen since October 2016. However, the provider had failed to notify CQC about the death of a person living at the home. It is a legal requirement that notifications are made to CQC in relation to incidents such as safeguarding concerns, injuries or deaths. .

The majority of people at the home were living with dementia and subject to the requirements of the Mental Capacity Act 2005 (MCA). During our last inspection we found that applications for authorisations under the Deprivation of Liberty Safeguards (DoLS) which are part of the MCA had not been made for three people who met the DoLS criteria of being under constant supervision and unable to leave the home unaccompanied. At this inspection we found that DoLS applications had been made for all people living at the home. However, we found that mental capacity assessments were generalised to all activities and not specific activities as required by the MCA.

Staff members told us that they were well supported by the provider/manager. Regular training, supervision and spot checks in relation to competency had been put in place.

We did not see any structured activities taking place during our inspection. However the activities record book and people's care notes showed that activities such as walks, bingo and exercise sessions took place at the home. Three people had recently started to attend a local day service on three days each week.

People's religious, cultural and relationship needs were supported. Faith representatives visited the home on a weekly basis and family members were welcomed when they visited.

Staff managed people's medicines effectively. We saw that the home liaised with healthcare professionals. However, the records that we viewed failed to show that guidance from healthcare professionals was always followed or recorded.

People and staff members told us that they were happy with the management of the home. However, at our previous inspection we had found that there had been limited action in relation to quality assurance and management monitoring of the care and support provided to people. Monitoring and audit processes were incomplete or out of date, and we were not shown how the provider had used these to assess and improve the quality of care.

During this inspection we found that a range of quality assurance processes had been put in place. However, these did not always identify or address potential concerns in relation to people’s care and support. We found failings in relation to infection control. Mould in a communal bathroom had not been identified, Exposed chipboard in the kitchen had not been corrected four weeks after it was identified by an independent consultant engaged by the home. There was no regular monitoring of hot water temperature valves which meant that people were at risk of scalding.

Our concerns in relation to the lack of guidance for staff contained in risk assessments and care plans had not been identified by the provider.. We also found that there had been a failure to record some information, for example in relation to people’s nutrition and hydration and significant appointments.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what action to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We carried out this inspection to check the Warning Notices and also to respond to a serious incident at the home which had been reported to us by a local authority. At this inspection we found that the provider had taken action to address some of our concerns about medicines. However, we identified further issues and we found that staff members had not always received training and supervision.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. At the time of our inspection there were eight people living at the home, the majority of whom were living with dementia.

The manager at the home is the registered provider. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection, although people told us that they felt safe, we identified parts of the home which were not safe. The provider had partially addressed concerns about medicines identified in our focused inspection in June 2016. However, we found that there was no internal monitoring of medicines. Medicines were not always given in accordance with the information contained in people’s prescriptions and some prescribed creams and laxatives were not recorded as given when we were told by the registered manager and staff that they had been.

The safety of the home environment had not been assessed and managed. Window restrictors had been put in place but these did not meet the Health and Safety Executive’s guidance on window restrictors in care homes. Actions had not been put in place to address risk to people living with dementia who were at risk of leaving the home. We also found that risk assessments and management plans were not in place in relation to refurbishment of a bathroom at the home and that people were at risk of trips and falls.

People living at the home told us that they were well cared for. However, we found that two people did not have care plans or risk assessments in place, despite the fact that risks associated with behaviour had been recorded in their care notes. Although care plans and risk assessments were in place for other people, they had not always been updated to reflect changes in their care and support needs.

Staff members supported people in a caring and respectful way. They were able to describe their roles and responsibilities in ensuring that the people whom they supported were safe from harm. However, we found that that there were no formal records of two recent safeguarding concerns and these had not been notified to CQC.

The majority of people at the home were living with dementia and were subject to the requirements of the Mental Capacity Act 2005 (MCA). We found that applications for authorisations under the Deprivation of Liberty Safeguards (DoLS) which are part of the MCA had not been made for three people who met the DoLS criteria of being under constant supervision and unable to leave the home unaccompanied.

Staff members told us that they were well supported by the provider/manager. However, a staff member who had been in post for more than a year had not received core mandatory training and only one staff member had received supervision from the provider/manager since February 2016.

The home provided some activities for people and they were planning to increase the range of these. People’s religious, cultural and relationship needs were supported. Faith representatives visited the home and family members were welcomed when they visited.

People had received appropriate support in relation to their health needs. We saw that the home liaised with healthcare professions to address these.

People living at the home and staff members told us that they were happy with the management. However, we found that there had been limited action in relation to quality assurance and management monitoring of the care and support provided by the home. Monitoring and audit processes were incomplete or out of date, and we were not shown how the provider had used these to assess and improve the quality of care.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what action to take. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During our previous comprehensive inspection of the home on 30 November 2015 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safeguarding service users from abuse and improper treatment and staffing. The provider had also breached Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.by not providing CQC with a notification in relation to a safeguarding concern. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 3 and 10 June 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. We also looked at medicines at the home following a concern that the provider was not meeting requirements in relation to safe administration of medicines. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Towerhouse Residential Home on our website at www.cqc.org.uk.

Towerhouse Residential Home is a care home situated in Willesden which is registered to provide care to up to eight older people. At the time of our inspection there were seven people living at the home, most of whom were living with dementia..

The home is owned and managed by Mrs Mary Mundy who is registered with us as an individual provider. As she has taken on the role of manager in day to day charge of how the regulated activity accommodation and personal care is provided there is no requirement for a separate manager to be registered with us.

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During our focused inspection on 3 and 10 June we found a continuing breach of regulation in relation to staffing. The provider had failed to take action to improve the level of training and support that was provided to staff members. One staff member had not received training in essential skills including food hygiene, basic first aid, safeguarding and moving and handling. Staff members had not received regular periodic supervision from a manager. This meant that the provider was failing to ensure that all staff members received the training and support that they required to carry out their duties effectively.

There had been no safeguarding concerns at the home since our previous inspection on 30 November 2015. We saw, however, that a notification had been sent to CQC in relation to a minor injury that was sustained by a person that lived at the home.

The administration and disposal of medicines were not safely managed. At our visit on 3 June 2016 we found that medicines were not directly administered to people from the pharmacy-provided packs, but had been placed in unlabelled pots prior to the time when people were due to receive them. The medicines administration record (MAR) was not completed immediately each person had taken their medicines. The manager was about to give a person medicines from a packet that had been prescribed for another person, but did not do so when we intervened.

Medicines were only administered by the registered manager who came into the home when not otherwise working in order to undertake this task. There were no arrangements in place to ensure that people received their medicines if she was ill or otherwise away. Neither the registered manager nor other staff members had received up to date training in the safe administration of medicines.

Unused and out of date medicines were stored at the home. These had not been disposed of, and there was no record in relation to any previous disposals of medicines.

When we returned to the home on 10 June 2016 we saw that medicines were administered to people directly from their pharmacy provided packs. People's MAR charts were completed immediately after they had taken their medicines. However, we had concerns about infection control procedures in relation to administration of medicines.

We saw evidence that the registered manager had attended safe administration of medicines training on 8 June 2016. Two staff members had been booked to attend the same training during the following month so that they could administer medicines in the registered manager’s absence.

The unused and out of date medicines that we identified at our visit on 3 June 2016 had been disposed of. However, there was no record to show that they had been returned to the pharmacy.

There was no record of regular medicines audits having taken place at the home. Medicines maintained by the home were not checked or counted and MAR charts were not monitored to ensure that they were accurate. Our findings showed that, although some immediate improvements had been made, we could not be sure that people at the home were protected by the safe management of medicines.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what further action to take. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.