Archived: Tiled House

Updated 17 May 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 April 2017 and was unannounced. The inspection team comprised two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On this occasion the expert by experience had professional expertise in nursing and managing health and social care services, and had experience of caring for a family member who used regulated services.

Before the inspection we reviewed information we had about the service, including previous inspection reports, enforcement notices, and notifications the provider sent to us. A notification is information about important events which the provider is required to tell us about by law.

Before the inspection, the provider completed a Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider had also sent us action plans and other records to show how they had responded to enforcement notices we issued following our last inspection, including a report commissioned from an independent consultant. We also spoke with a social care professional who had been closely involved with the service since our last inspection.

During the inspection we spoke with the provider’s general manager, the home manager, the deputy manager, a registered nurse, three care assistants (one who also worked as a domestic assistant), and the cook. We spoke with or observed the care and support of 13 people who were living at the home. We also spoke with a visitor to one of them.

We reviewed records relating to the care and support of five people. We looked at how medicines were managed, including the medicines records for all the people living at the home. We looked at the staff duty rota for a recent four week period, four staff files, an overview of staff training, and documentation related to the safety and suitability of the premises. We looked at audits conducted by the provider. Other records reviewed included complaints and compliments, accident and incident reports, current action plans and records associated with the Mental Capacity Act 2005.

Updated 17 May 2017

The inspection took place on 10 April 2017. It was unannounced. At our previous inspection in August 2016 we found breaches of six of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were to do with providing care and treatment in a safe way, operating effective systems to manage risk and quality, maintaining sufficient staffing levels, providing care and support that met people’s needs, meeting the requirements of the Mental Capacity Act 2005, treating people with dignity and respect, managing risks to people’s safety and welfare, and treating people with dignity and respect. The provider sent us an action plan and other records describing how they intended to meet the requirements of these regulations. At this inspection we found the provider had made sufficient improvements in some areas to meet the requirements of the regulations, but there were still concerns in other areas.

This service has been in special measures. Services that are in special measures are kept under review and inspected again within six months or soon after. We expect services to make significant improvements within this time frame. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Tiled House is registered to provide accommodation, personal care and nursing care for up to 29 older people who may be living with dementia or a learning disability. At the time of our inspection there were 14 people living at the home.

Accommodation was on two floors, both of which were partly occupied. Shared areas included two shared lounges and a dining room. Access to a decked area and the secure garden was from the dining room.

There was no registered manager in post at the time of this 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 2008 and associated regulations about how the service is run. Following this inspection we received an application to register from the manager in post.

Although improvements had been made with respect to the safety, maintenance and cleanliness of the home, we found some examples where appropriate standards of hygiene and cleanliness were not maintained in relation to fixtures and fittings in shared bathrooms. When we pointed these out to the manager they took action to resolve them on the day.

The provider had arrangements in place to protect people from other risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to store medicines safely and administer them safely and in accordance with people’s preferences.

Staff were aware of the importance of consent but the provider did not always put into practice the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards where people were unable to consent.

Staff received appropriate training and adequate supervision to maintain and develop their skills and knowledge to support people according to their needs. People were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and specialist nurses.

Care workers had developed caring relationships with people they supported. People were able to take part in decisions about their care and support and their choices were respected. Staff respected people’s independence, privacy, and dignity.

Care and treatment were based on plans which took into account people’s needs and preferences. People were able to take part in a variety of group and individual leisure activities. The provider listened to people’s experiences and concerns, and acted on them. There had been no recent complaints.

There was a warm, welcoming atmosphere in the home, and people were supported to express their views of the service they received. The provider had systems in place to manage the service and to monitor, assess and improve the quality of service people received. Although the service had improved, these systems were not yet fully effective or embedded in practice.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of this report.