Turner Home

Turner Home is a residential care home providing accommodation, personal and nursing care for up to 59 people. The home supports people with mental and physical health conditions, including dementia. There were 52 people living at the home at the time of this inspection.

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

At our last inspection the provider had failed to ensure medicines were safely managed, effectively manage the risks associated with people’s care and implement robust processes to monitor and improve the safety and quality of care being provided. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

People received their medicines safely and as prescribed. Changes had been made to the home’s medicines dispensing and administration processes to ensure medicines were stored securely. Quality assurance processes around medicines administration had also improved. People had personalised risk assessments which gave staff the information needed to safely manage the risks associated with people’s care. However, the consistency and quality of health and care monitoring records still required improvement. The environment was safe and well-maintained. The home was clean and effective infection prevention and control measures were in place.

People told us they felt there were enough staff at the home. One person said, “There are always plenty of staff around even at weekends and at night. If I use the buzzer, I get help quickly.” The home was reliant on some agency staff, potentially making it more challenging to deliver and sustain improvements, such as maintaining consistent and high-quality records. Staff were visible around the home and were readily available to support people when needed.

People were safeguarded from the risk of abuse. People told us they felt safe living at the home and relatives felt the same. One person said, “I feel safe here as the staff look after me well. If I need anything I just ask for their assistance.” Staff had received safeguarding training and were aware of their responsibility to report safeguarding concerns. The provider had systems in place to manage concerns of a safeguarding nature.

Quality assurance and audit processes had improved since the last inspection. However, further improvements were still needed. For example, greater clarity was needed about who was responsible for ensuring highlighted actions were completed and in what timescale they were due to be completed.

People living at the home and their relatives gave positive feedback about the staff. One person said, “The staff look after me very well they do everything for me. The staff talk to me very nicely, they are polite.” Relatives said staff kept them well-informed and involved in their relative’s care. One relative commented, “The staff often chat with me and they tell me what [Relative] has been doing. If there is a problem, they call me up.”

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 10 November 2020) and there were multiple 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

We carried out an unannounced focused inspection of this service on 29 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance at the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We also 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Turner Home on our website at www.cqc.org.uk.

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.

Turner Home is a residential care home providing personal care and nursing care for up to 59 people. There were 48 people living at the home at the time of this inspection.

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

People were placed as significant risk of harm because there was a failure to adequately assess, monitor and manage known risks. Risk assessments lacked specific details and guidance for staff as to how risks should be safely managed. The failure to mitigate risk resulted in an incident which placed a person at significant risk of harm.

Medicines were not safely managed. A medicines trolley was left in a communal area unattended and unsecured. The trolley was accessed by a person who took an overdose and was subsequently hospitalised. People did not always receive their medicines as prescribed.

Quality assurance processes at the home remained ineffective and placed people at risk of unnecessary and avoidable harm. This was a continued breach of Regulation 17 and the fourth consecutive inspection in which we have identified a breach of this regulation. This was also the provider’s fifth consecutive overall rating of requires improvement or inadequate. Clearly, this represents a sustained period of failed leadership.

People told us they felt there were enough staff at the home. Comments included, “Always seems to be enough staff” and “I like the staff, they’re fabulous and there’s always someone around.” Staff were visible around the home throughout our inspection and people who needed assistance were promptly supported by staff.

People said they felt safe living at the home. Comments included, “Yeah I feel safe, staff are friendly, and I can trust them.” Staff had received safeguarding training and safeguarding concerns were appropriately monitored and managed by staff.

We observed kind and caring interactions between staff and the people who lived at the home. The manager had a good rapport with people living at the home and staff.

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 24 July 2019) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations. We also identified an additional breach of regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management.

The service remains rated requires improvement. This will be the fifth consecutive rating of requires improvement or inadequate for this service.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27 June and 2 July 2019. Breaches of Regulations were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led. The Key Question Effective which contains the breach of Regulation 18 was not inspected at this time.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Turner Home on our website at www.cqc.org.uk.

Follow up:

We will meet with the provider and local authority to discuss our findings and how the provider will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using the service

At our last inspection in September and October last year the registered provider was in breach of regulations in relation to requirements in relation to safe recruitment and management of medicines. We found during this inspection that the service had taken action to meet these breaches, however we identified new breaches in relation to governance and staffing.

Records were poor in quality in most areas and not always accurate, fully completed or reviewed. The service was transitioning from paper to electronic records, and not all staff had access to these. We also saw that some audits required improving as they had not highlighted some of the concerns during our inspection, and some audits, in relation to care plans, were not taking place. There was a manager in post who had not yet registered with the Care Quality Commission. Staff had team meetings and people told us they felt engaged with and they liked the manager.

Staff training was not in date and most staff had not undergone a recent refresher update. We saw gaps in the training matrix in relation to some subjects the registered provider had deemed mandatory. Additionally, induction for agency staff was not robust and there was an over reliance on verbal information being passed over from long standing staff which might not have always been happening. There was an ongoing plan in place to improve this which the manager and the Human Resource manager have shared with us.

Care plans did not fully reflect dignity, respect or diversity. We observed mostly kind and caring interactions from long standing staff, however the recording of people’s care needs did not match what staff were doing and did impact on the caring domain in this report. People did tell us they liked the staff and felt they were kind.

Complaints were dealt with in accordance with the organisation’s complaints procedure, people said they knew how to complain.

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

The last rating for this service was requires improvement (published 20 November 2018)

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 that even though some improvements had been made in some areas enough improvement had not been made and the provider was still in breach of regulation.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the third consecutive time.

Why we inspected

The inspection was prompted in part due to concerns received about oversight, staffing and an incident which is currently being investigated by the local authority. A decision was made for us to inspect and examine those risks.

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

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.

Turner Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Turner Home is registered to provide nursing care and accommodation for up to 59 people; in an original Victorian building and in a more recently added annexe. At the time of our inspection 45 people were living at the home.

The home had a registered manager. 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. At this inspection the registered manager has been absent from the service and had been since August 2017.

During our inspection in January 2018 the trustees of the service appointed a general manager who took on the role as the nominated individual. The nominated individual is responsible for supervising the management of the regulated activity provided. Since that inspection the acting manager was in the process of applying to become registered with the CQC.

At our inspection in August 2016 the service was rated overall ‘requires improvement’. There were breaches of regulation 9 (person-centred care) and regulation 18 (staffing). This was because people were not receiving person centred care that reflected their preferences as to what time they wanted to be supported to get up out of bed; and there were not sufficient numbers of staff on duty at night to make sure that they could meet peoples care needs.

At our inspection in January 2018 the quality of the service had deteriorated. We found breaches of regulation 9, 10, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found there had been breaches of regulation 14 and 18 of Care Quality Commission (Registration) regulations 2009, as there had been a failure to notify the Commission of notifiable events. We issued the provider with a warning notice because there had been a continued breach of Regulation 9.

At this inspection there was a continued breach of Regulation 12 and a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the service had not ensured that medication was always stored safely and appropriately and the service had not consistently applied robust recruitment checks on the suitability of all applicants.

However, at this inspection we saw that in many other areas there had been significant improvements in the quality of the care and support provided to people.

Improvements had been made in the way that care planning ensured that the service met people’s needs and reflected their preferences. More information had been obtained about people’s preferences and other person-centred details; this information had been used to increase engagement with people in a way that was meaningful to them. This included information on choices and decisions people made, including the details of who a person would like to be involved in any future best interest decisions. The showed service was provided in line with the principles of the Mental Capacity Act (2005).

The home’s activity room had been refurbished and now looked interesting and inviting. Also, a previously underused room had been turned into a cinema room. The service had employed three activity co-ordinators; the times they worked were staggered so that people were able to also do things into the evening time.

There was an increase in the amount and quality of activities people got involved with both inside and outside of the home. These were both group social activities and one to one activities with people at the home having more engagement with the local community. We saw examples of and people told us how they had benefitted from this.

At our previous inspection we did observe staff being kind and personable in their interactions with people. However, we also observed times when staff did not treat people with respect. At this inspection it was clear that there had been a renewed focus on the experience of people who lived at the home. The home had a very different culture and atmosphere, it was much more positive and although the building looked somewhat like an institution the care provided was much less institutionalised and more focused on people as individuals.

We saw many positive, happy interactions between people living at the home and staff.

People told us they felt safe living at the home and when they needed help with something it was available for them. People told us they received their medication when they needed it. We saw that there were sufficient nursing and care staff on duty to meet people’s needs in a timely manner. One person told us, “You know you can always get someone when you need them.” We also saw that people received effective support with any healthcare needs that they may have.

At this inspection we saw that the home had a new accident and incident policy in place. There was an improvement in the way accidents, incidents and near misses were recorded by staff and analysed by the management team. The information was now used to inform people’s risk assessments and other actions were taken to minimise future risks.

The building was now safe for its intended purpose. Improvements had been made to a number of areas since our previous inspection, particularly with regards to the electrical supplies and fire safety. The home now had appropriate checks and audits of the building and environment in place.

The home is a large Victorian building and was in a good state of repair. The environment was clean and free of odours, staff followed good infection control practices and there had been improvements to the laundry service. There had been improvements to the décor of the building. Adaptations had been made to the building to make it more interesting and easier for people with dementia and other health conditions to orientate themselves. The home was also part way a number of further improvements regarding the use of technology to increase people’s autonomy and independence.

There had been an improvement in the training provided to staff members and there was an ongoing program to ensure that all staff received mandatory training was in place. Staff told us that they thought they had received appropriate training and support for them to be effective in their roles, and they felt supported by the trustees and the management team.

There were appropriate arrangements in place for the leadership of the home. People living at the home and staff members told us that they had confidence in management and there was good teamwork amongst staff. One person told us, “The managers come in to speak to us and see how we are.” One staff member told us, “The management are supportive, they listen to ideas.” Another staff member described the management team as, “Positive and proactive.”

The service is no longer in special measures.

Turner Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Turner Home is registered to provide nursing care and accommodation for up to 59 people; in an original Victorian building and in a more recently added annexe. At the time of our inspection 48 people were living at the home.

The home had a registered manager. 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. During our inspection we became aware that the registered manager had been absent from the service since August 2017. The registered manager was also the nominated individual for the service. The nominated individual is responsible for supervising the management of the regulated activity provided.

There was an acting manager at the home and an acting deputy manager. During our inspection the trustees of the service appointed a general manager to support the management of the home.

At our previous inspection in August 2016 the service was rated overall ‘requires improvement’. There were breaches of regulation 9 (person-centred care) and regulation 18 (staffing). This was because people were not receiving person centred care that reflected their preferences as to what time they wanted to be supported to get up out of bed; and there were not sufficient numbers of staff on duty at night to make sure that they could meet peoples care needs.

At this inspection we found breaches of regulation 9, 10, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found there had been breaches of regulation 14 and 18 of Care Quality Commission (Registration) regulations 2009, as there had been a failure to notify the Commission of notifiable events.

We observed times when staff did not protect people’s dignity or privacy, showed a lack of respect or were overly focused on the task at hand and not the person and any impact their actions may have. We also saw a lack of dignity in how people’s daily notes and records were written.

We saw in people’s care files that there was insufficient information on risk assessments and they had not always been updated to reflect current risks. Some risk assessments were missing background information which would be needed to assess a risk and at times a necessary risk assessment was not in place.

The service provided was not in line with the principles of the Mental Capacity Act (2005). People’s consent had not always been sought for the support they received. Care planning often did not demonstrate how decisions had been made in people’s best interests. People’s care plans lacked sufficient guidance for staff and did not give information on people’s history, lifestyle choices and preferences.

The acting manager and deputy manager were unable to show us the system for reporting, reviewing and learning from incidents and how this information was used to inform the risk assessment process.

The administration and recording of medication was not always safe. The nursing staff did not have protected time when administering medication and they experienced distractions. Some administration records and the stocks and balances of some medication had not been consistently recorded; at times it had been recorded and the figures were inaccurate. This made it impossible to work out if the stocks were correct and therefore to be assured that the correct medication had been given to people. Audits of the medication system had not been effective.

We asked the general manager to undertake an audit of the system used to record and administer medication and the stocks on hand; and to report their findings to the Care Quality Commission within three days. This was completed.

The building was not always safe. Upstairs windows were not appropriately restricted. This was acted upon during our inspection to reduce risks. We also saw that a fire risk assessment had been completed and appropriate actions on known risks had not been taken in a reasonable timeframe. The general manager told us that action was now being taken.

Staff members had not received adequate training appropriate to their roles and people’s care and support needs.

Some areas of the environment and practices at the home were institutionalised and detracted from creating a homely atmosphere. People told us that there were limited activities at the home.

In the absence of the registered manager who was also the nominated individual an appropriate alternative management structure had not been put in place. The home was not adhering to its own policies and there was insufficient oversight of the quality of the service provided to people.

People told us that the staff were nice. People’s relatives told us that the staff were nice and had been supportive during difficult times. We observed some interactions between staff and people that were kind and personable.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We went to The Turner Home at 6:00 am as the CQC had received concerning information regarding people being got up out of bed by the night staff from 5:30 am.

The manager was registered with the Care Quality Commission. 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. The registered manager was not available for this inspection, we spent time with two senior nursing staff and the deputy manager.

At this inspection we found breaches relating to people not being provided with person centred care as people were being got up very early and moved into the main lounge areas by the night staff. The staffing levels at night were not at all times adequate to meet the care of the 52 people. Also people were not receiving activities for stimulation during the daytime to support their wellbeing. You can see what action we told the provider to take at the back of the full version of the report.

People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided had been checked. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that care plans and risk assessment monthly reviews records were all up to date in the six files we looked at however there was not a lot of information recorded by staff that reflected the changes of people’s health in the monthly reviews.

People were not having enough person centred activities provided by the service to promote their wellbeing.

People told us they felt safe with staff. The deputy manager had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required. However two recent incidents that had occurred in The Turner Home had been reported to the local authority but not to the CQC.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We found that medicines were managed safely and records confirmed that people received the medication prescribed by their doctor.

The staffing levels were seen to be adequate on the day shifts however the staffing levels at night fluctuated from six to four staff which was not adequate at times to support people, meet their needs and undertake the tasks required. Day staff did not have time to provided activities or one to one stimulus to promote people’s wellbeing.

The home used safe systems for recruiting new staff. These included using DBS checks and annual self-disclosure checks made with the manager. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home. Senior staff told us they did feel supported by the registered manager however there were staff who told us they did not feel supported.

We observed that there was good rapport and interaction between the people who used the service and staff. People who used the service told us that they received the appropriate care and support that they needed. They also told us they had choices in what they wanted to do such as when to get up, meals and activities.

Some people who used the service had limited verbal communication but could communicate in a number of other ways. They were supported by staff who knew the appropriate way to communicate with them when decisions needed to be made about their care and welfare.

All residents had an individual care record. One person told us, "They are very good (the Staff) nothing is any bother for them".

There were enough qualified and skilled staff on duty to meet the needs of the people who used the service. People told us they had no concerns about the staff and had no complaints about the care home.

We saw evidence that the Turner Home had acted on recommendations in the previous inspection report regarding work that was needed to ensure that any risks of receiving care or treatment that was inappropriate or unsafe were identified and acted upon in a timely manner.

People told us they had been well cared for by staff at the home and that staff had supported them to attend appointments such as with their GP, chiropodist and at hospital. People knew about their care plan and said they thought staff knew their needs well. People said they had enjoyed organised trips out with staff and others said they had enjoyed getting out and about locally on their own.

People told us they knew how to complain and would do if they needed to. They said they knew they would be listened to and were confident that their complaint would be properly dealt with.

People using the service and a person's relative told us they had had no concerns about the way people had been treated. They told us they would report an incident of abuse right away.

People said staff were good at their jobs and they felt confident in their care. They said they thought staff were well trained and properly supervised.

People told us that the manager had regularly approached them and had asked how things had been and if they had any concerns or other comments about the service they received.