Archived: The Tudors Care Home

Below is a summary of what we found. The summary describes the number of different methods we used to help us understand the experiences of people who used the service. We looked at records; we undertook observations, we spoke with two people who used the service, two relatives of people who used the service and three staff members. We also spoke with the Acting Regional Manager, the Head of Care, Quality and Compliance, and the Quality and Compliance Officer during our inspection.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Improvements had been made since our previous inspection on 31 January 2014. During this inspection of 19 and 20 June 2014 we looked at four out of 44 people's care records. We saw that risk assessments regarding people's individual support and care needs were carried out. We saw that measures were in place to minimise those risks. The provider was also able to demonstrate to us that accurate records were now kept in line with people's current, individual, care and support needs.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The provider advised us that, at the time of our inspection, none of the people who used the service had a Deprivation of Liberty Safeguard (DoLS) in place. The provider demonstrated to us their knowledge and we saw that the provider had DoLs and Mental Capacity Act 2005 (MCA) policies and procedures in place.

A sample of staff recruitment records we looked at showed us that pre-employment safety checks to ensure that staff were of a good character and deemed suitable to work with vulnerable adults took place. However, the provider may find it useful to note that we were unable to find robust evidence to show that a risk assessment had taken place when a pre-employment safety check had shown a potential concern.

Records we looked at indicated to us that people who had chosen to be supported with their prescribed medication, was done so by staff who were trained. However, during our inspection we found concerns around the safe storage of medication. We also found that a Medication Administration Record (MARS) we looked at, showed that staff had failed to appropriately sign for the administration of a controlled drug.

Some improvements had been made since our last inspection of 31 January 2014 where we found that the provider had made some improvements to the suitability of the premises. However, during our inspection of 19 and 20 June 2014, we found that not all of the improvements necessary had been actioned. A relative we spoke with told us that the, 'Decoration could do with an update.'

We observed damaged flooring and tiles and missing tiles during our tour of the premises. This meant that these areas of damage posed an increased risk of infection control. As a result of these findings, cleanliness and infection control was added into the inspection. The Care Quality Commission have also informed the local authority Regulatory Officer of Health and Safety of our concerns.

Is the service effective?

People who used the service and their relatives made positive comments about the care and support people received. Comments ranged from, 'No complaints,' to 'Very good.'

We found evidence in three out of the four care records we looked at that people's wishes for their end stage of life care and support was discussed and documented.

Is the service caring?

One relative we spoke with told us that, "Staff are friendly and encourage (my) visits." Another relative told us that The Tudors Care Home had, "Helpful staff." A person who used the service who we spoke with said that, 'If I need assistance, I will ask and staff help quickly.'

Is the service responsive?

We looked at four people's care records and saw that their interests were recorded. We also saw that people's diverse needs had been documented. People and relatives we spoke with told us that the support and care met their or their relative's needs.

Is the service well-led?

During this inspection we found that the provider's quality monitoring systems were not robust enough to ensure that people were kept safe from the risk of unsafe and inappropriate care and support. This was because the provider's last two infection control audits did not highlight the risk around the poor maintenance of the premises. We have asked the provider to take action on this.

We found that there was a gap in the recording of a person's prescribed medication. We spoke with the provider about this during our visit and they told us that recent medication errors had resulted in the staff member's being put forward for further training.

People who used the service and their relatives told us that the home operated an 'open door' policy and that their visits to the home were encouraged by staff.

The Tudors Care Home is regulated as a care home service without nursing. During our inspection we spoke with the Acting Regional Manager about whether the home's other regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury were correct. The Acting Regional Manager agreed that they do not undertake these regulated activities and that they will amend their registration to only include the regulated activity ' Accommodation for persons requiring nursing or personal care.'

At the time of our inspection there was no registered manager in place at The Tudors Care Home and no application has been received to address the breach of the condition of the provider's registration. We spoke with the provider about this during our visit and they told us that they were taking action to address this.

We reviewed four plans of care and found that they did not always reflect the person's current individual needs, or ensured their welfare and safety. People we spoke with told us that living at the home met their expectations.

During our tour of the premises we, incidentally, found that the environment of The Tudors Care Home was not always adequately maintained.

Plans of care we reviewed were not always accurate or reflected the care and support the person required.

We spoke with two people who used the service who told us they were happy living at The Tudors Care Home. We reviewed four people's care plans which documented personal details including what they liked to be known as, this provided staff with the appropriate knowledge to provide the care according to how that person required it.

Staff we spoke with were knowledgeable about the medication process. Training and competency records showed that medication was administered by staff that understood the process and had been trained and competent to administer medication safely.

There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

From the records we reviewed we found that detailed risk assessments were in place for issues which could affect a person's health, such as a risk of falls, behaviours which challenge or dementia care.

We found that people were protected from abuse because the home had an up-to-date safeguarding policy and provided staff with training. People were provided with information within the home that enabled people to contact the correct authority should they need to report any abuse.

One person we spoke with said, "The staff really care for my mum, they have made such a difference to her".

The provider maintained the home in good decorative order and ensured people were safe. Since our previous inspection frayed carpets had been replaced and the decoration had been updated.

We also found that staff were supported with regular supervision and appraisals where areas for improvement were discussed and had been acted upon.

The provider had a complaints procedure and of the few complaints there had been in the past year we saw that these had all been responded to in a timely and sensitive manner. Complaints could also be investigated independently by another of the provider's managers if required.