Tudor Gardens

About the service

Tudor Gardens is a supported living service which provides personal care and support to people living in 3 shared houses for people with learning disabilities situated in Kingsbury. At the time of our inspection 15 people were being supported by the service.

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

Right Support: People were involved in the planning of their care and told us that they received support in accordance with their individual needs and preferences. Staff demonstrated a good understanding of people’s needs, preferences, and interests. People were supported to live the life they wanted by staff who knew them well and put them at the centre of decision making. Staff supported people to access specialist health and social care support. 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.

Right Care: Staff understood how to ensure people were protected from harm or abuse. Staff worked with people to identify and reduce the likelihood of risks to their wellbeing. Staff engaged with people in a respectful and friendly way. People were supported to participate in a wide range of activities of their choosing. People spoke positively about the staff who supported them.

Right Culture: The registered manager and staff knew and understood people well and were responsive in supporting their aspirations to live a quality life of their choosing. Staff ensured risks of a closed culture were minimised so that people received support based on respect and inclusivity. People were regularly asked for their views of the service and the support they received. The registered manager ensured staff received the training, information and support they required to support people effectively.

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 the service was good (published on 25 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

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

Tudor Gardens is a care home registered for 15 people with learning disabilities situated in Kingsbury. Some of the people who live at the home have additional needs such as physical impairments, communication impairments and behaviours that could be considered ‘challenging.’. The home consists of three self-contained houses, each with a separate entrance. At the time of our inspection 15 people lived at the home.

The home been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Although this is a service for 15 people, they live in small groups of five in separate buildings with and receive support from a staff team who only work in the building where they live. The Registering the Right Support CQC policy can be found at:

https://www.cqc.org.uk/sites/default/files/20170612_registering_the_right_support_final.pdf

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, at the time of our inspection the registered manager was working at another service. The manager responsible for the home at the time of this inspection told us that they would be applying for registration with CQC.

Following our previous inspection of Tudor Gardens on 9 and 13 June 2017 the home was rated as ‘Requires Improvement.’ People’s support plans and risk assessments had not been updated to reflect their current needs. The provider’s quality assurance processes had failed to ensure that regular monitoring and review of care and support documentation had taken place.

During this inspection we found that actions had been taken to address these failures. People’s support plans and risk assessments were up to date. These contained guidance for staff members on how best to support people in accordance with their needs, wishes and preferences. We saw that care and support documents had been regularly reviewed and amended where there were any changes to people’s needs and requirements.

People spoke positively about their experience of living at the home and the staff who supported them. Family members told us that they were happy with the support that people received. We saw that staff members engaged with people in a positive and respectful way. We also observed staff communicating with people in ways that they understood and offering them a range of choices.

People were protected from the risk of harm. Staff members had received safeguarding training and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the home were well managed and safely stored. Staff members responsible for administering medicines had received appropriate training and their competency was assessed through spot checks of practice.

Staff who worked at the home received training designed to ensure that they were able to meet people’s needs and were knowledgeable about their roles and responsibilities in supporting people. All staff members received regular supervision from a manager to ensure that they were supported in their roles.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions was contained in people’s care plans. Up to date authorisations in relation to the Deprivation of Liberty Safeguards (DoLS) had been obtained from the relevant local authority. Staff members had received training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People’s nutritional needs were well met. People ate a varied and healthy diet and told us that they enjoyed the food. We saw that people were offered a choice of food at mealtimes and that drinks and snacks were offered to people throughout the day.

The home supported people to participate in a range of in-house and group activities. During our visit we saw that people were engaged in individual and group activities within the home. People also left the home to undertake community based activities supported by staff.

People and their family members that we spoke with knew what to do if they had a complaint.

The home liaised with health professionals to ensure that people received the support that they needed. during our inspection people were supported to attend health checks at a local surgery.

There were systems in place to review and monitor the quality of the service provides at the home. People were asked for their views on a regular basis and concerns were immediately addressed. Regular monitoring of, for example, records, health and safety, medicines and people’s monies had taken place.

Tudor Gardens is a care home registered for 15 people with learning disabilities situated in Kingsbury. Some of the people who live at the home have additional needs such as physical impairments, communication impairments and behaviours considered challenging. The home consists of three self-contained houses, each with a separate entrance. At the time of our inspection 14 people lived at the home.

During our previous comprehensive inspection of 8, 23 and 30 March 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, staffing and good governance. We returned to the home on 13 July 2016 and found that actions had been taken to meet legal requirements. At this inspection we rated the service as requires improvement in the areas of safe and well led as we required to provider to evidence a track record of continuous improvement.

At the time of our inspection the home did not have a registered manager on site. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been appointed to the home and at the time of our inspection they had commenced the process of applying for registration with CQC.

People spoke positively about their experience of living at the home. Staff members engaged with them in a positive and respectful way and supported them to engage in a range of activities. We observed that staff communicated with people in ways that they understood and offered them a range of choices.

People had support plans that identified their needs and preferences and provided guidance on how care and support should be delivered. However these were out of date for some people and we could not be sure that they reflected people’s current needs. New support plans were being developed for people but this process had only recently commenced. People’s risk assessments had been recently reviewed and updated and included guidance on how to manage risk. However these did not always correspond with information contained within people’s support records.

People were protected from the risk of abuse. Staff members had received safeguarding training and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the home were well managed. Staff members responsible for administering medicines had received appropriate training and their competency was assessed through spot check of practice.

Staff who worked at the home received training designed to ensure that they were able to meet people’s needs and were knowledgeable about their roles and responsibilities. All staff members received regular supervision from a manager to ensure that they were supported in their roles.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions was contained in people’s care plans. Up to date authorisations in relation to the Deprivation of Liberty Safeguards (DoLS) had been obtained from the relevant local authority. Staff members had received training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People’s nutritional needs were well met. People ate a varied and healthy diet and told us that they enjoyed the food. We saw that alternatives were offered, and drinks and snacks were offered to people throughout the day.

The home supported people to participate in a range of in-house and group activities. During our visit people came and went from the home to undertake activities supported by staff.

People and their family members that we spoke with knew what to do if they had a complaint.

The home liaised with health professionals to ensure that people received the support that they needed. during our inspection people were supported to attend health checks at a local surgery.

There were systems in place to review and monitor the quality of the service. People were asked for their views on a regular basis and concerns were immediately addressed. However these were limited. Regular monitoring of, for example, health and safety, medicines and people’s monies took place. However, there were no quality assurance measures and audits in relation to people’s care and support documentation.

We found one 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 back of the full version of the report.

During our previous comprehensive inspection of the home which took place on 8, 23 and 30 March 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, staffing and good governance.

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 13 July 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. 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 Tudor Gardens on our website at www.cqc.org.uk.

Tudor Gardens is a care home registered for 15 people with learning disabilities situated in Kingsbury. Some of the people who live at the home have additional needs such as physical impairments, communication impairments and behaviours considered challenging. The home consists of three separate self-contained units, each with a separate door. At the time of our inspection there was one vacancy at the home.

At the time of our inspection the home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager had recently taken over the management of another service managed by the provider. A new manager had been appointed to the home and at the time of our inspection they had commenced the process of applying for registration with CQC. Although the current registered manager was no longer based at the home, they visited regularly and covered for the new manager when they were on leave.

At our focused inspection on the 13 July 2016, we found that the provider had followed their action plan and put in place a range of systems to address the breaches of service identified at our previous inspection. Improvements had been made in relation to the storage and recording of medicines. We saw that medicines audits were properly completed and that identified actions had been addressed.

The provider had taken action to address our concerns about staffing. We saw that staff members had received recent supervisions from a manager. We also saw that actions had been taken to reduce staffing shortfalls through recruitment of agency staff who were working full time at the home. Appropriate recruitment, induction and training processes had been put in place for these staff. During our previous inspection we had been concerned that people had been required to move to another house within the home when there were staff shortages. The importance of not doing this had been discussed at a staff meeting in June 2016, and we observed that people remained where they wished to be during this inspection.

However one person had been diagnosed with a progressive condition and we were told that, although the additional support that they required could be managed within current staffing levels, this was putting a strain on the staff team. We saw that an application had been submitted to the local authority for additional funding to meet the person’s support needs. At the time of this inspection this had not been agreed.

We also saw that quality assurance processes in place and that actions had been taken to address concerns that we had raised at our previous inspection. The provider had consulted with family members and made applications to the Court of Protection in order to establish deputyships that would enable people to have full access to their monies. The provider was awaiting a response, so at the time of this inspection, people still had monies in dormant accounts that they could not access.

Tudor Gardens is a care home registered for 15 people with learning disabilities situated in Kingsbury. Some of the people who live at the home have additional needs such as physical impairments, communication impairments and behaviours considered challenging. The home consists of three separate self-contained units, each with a separate door numbered (27, 29 and 31). At the time of our inspection there was one vacancy at the home. We last inspected Tudor Gardens on 18 August 2014 when we found that the home met the regulations that we assessed.

At the time of our inspection the home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager had recently taken over the management of another service managed by the provider. A new manager had been appointed to the home and at the time of our inspection they had commenced the process of applying for registration with CQC. Although the current registered manager was no longer based at the home, they visited regularly and covered for the new manager when they were on leave.

People who lived at the home told us that they felt safe, and this was confirmed by the family members and friends that we spoke with.

People were protected from the risk of abuse. Staff members had received safeguarding training and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the home were generally well managed. Staff members responsible for administering medicines had received appropriate training. However, the PRN (as required) medicine for one person was stored in a locked filing cabinet and information that it had been moved from the medicines cabinet had not been shared with a staff member responsible for medicines in that unit. We were subsequently told that the medicines were no longer used, but the person's medicines administration record and care plan contained no record of this fact.

Our observations of staff at the home showed that people were generally supported in a caring and respectful way, and responded promptly to meet their needs and requests. However, we observed that a minority of staff members did not engage people in discussion and activities. We saw evidence that this was being addressed. However, we noted that people who lived at the home were required to move to another unit on two occasions during our inspection, due to staff supporting people on planned and unplanned activities outside the home. Therefore we could not be sure that the provider was able to ensure that sufficient staffing was available to support people at all times.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. However, the records that we viewed showed that a number of staff members had not always received regular supervision from a manager.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about people’s capacity to make decisions was contained in people’s care plans. Applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. The majority of staff had received training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People’s nutritional needs were well met. People told us that they enjoyed the food. We saw that alternatives were offered where required, and drinks and snacks were offered to people throughout the day. We saw good practice from staff members regarding offering choice and supporting a person with swallowing difficulties to eat and drink. However, during our first visit to the home, we observed that this was not always the case. This was raised with the manager, and we noted that improvements had been made when we returned to the home.

The physical environment of the home was suitable for the needs of the people who lived there.

Care plans and risk assessments were person centred and provided guidance for staff. We saw that these had been regularly updated and reflected any changes in people’s needs.

The home supported people to participate in a range of in-house and group activities for people to participate in throughout the week. During our inspection we saw that two people had gone out to lunch supported by a staff member. We also noted that a local self-advocacy service had facilitated a well-attended meeting at the home.

People and their family members that we spoke with knew what to do if they had a complaint.

Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

There were some systems in place to review and monitor the quality of the service. However these were limited. We noted that there was a regular monitoring process for health and safety and medicines. However, there were no quality assurance measures and audits of, for example, care plans, staffing records and infection control.

The home looked after people’s money and we saw that there was regular and effective monitoring. However, we had concerns about the fact that people had not been able to access significant sums of monies held in bank accounts, in some cases for a number of years. The provider showed evidence that recent actions had been taken to address this. ,

Policies and procedures reflected regulatory requirements and good practice.

People who used the service, their relatives and staff members spoke positively about the home.

We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have taken enforcement action against the provider, and will report further on this when it is completed. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we spoke with seven people who used the service. We spent time observing staff interactions whilst carrying out their duties. We spoke with six care workers and the registered manager.

Following the inspection we spoke with two relatives of people who used the service. Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe and staff were friendly. We saw staff interact with people who used the service in a respectful manner. The relative of the person who used the service told us they were confident that people were safe.

The home had systems in place to identify assess and manage risks relating to the health, welfare and safety of people who used the service. Staff understood their role in safeguarding the people whom they supported and they understood the whistleblowing policy. Staff were clear about their roles and responsibilities and felt supported by management staff.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager knew when an application for deprivation of liberty would need to be submitted for authorisation.

Is the service effective?

People told us they were happy living in the home and received the care and support that they wanted and needed. Comments from people about the home included that it was 'good' and a relative we spoke to described the staff as 'working together hand in glove.'

Staff told us there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

People's care needs had been assessed and care and treatment were planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed with involvement from people and those who were important to them.

Is the service caring?

We saw that people were supported by kind, attentive staff who approached people in a friendly manner. We saw those using the service had a good rapport with those who were caring for them. Relatives we spoke to felt that people were well cared for by dedicated staff.

Staff were knowledgeable regarding the specific care needs of people and respected the choices that people made. Staff had an understanding of people's cultural and religious needs and where appropriate, arrangements had been made to meet these needs.People's privacy and dignity was respected. People took part in a variety of activities of their choice.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. People told us they were listened to and felt involved in decisions about their care. People's care and health were monitored closely. Written notes about people's health and care were completed by staff.

People's health, safety and welfare were protected as they received the advice and treatment they needed from a range of health and social care professionals. People who used the service told us that if they had any concerns or complaints, they would feel comfortable raising them with staff. People had the opportunity to provide feedback about the service. We found those managing the service were responsive to the suggestions made and changed practice and policy where required.

Is the service well-led?

The home had an experienced registered manager and monitoring checks of the quality of the service were carried out. These included checks of the care provided to people and the quality of their environment. Improvements were made when needed. Staff meetings took place regularly so staff views about the service were taken into account.

The care we observed was compassionate and ensured people's safety and welfare.

We found that people were cared for and their needs were met. The provider acted in accordance with legal requirements to seek consent for care and treatment. People were offered choices whenever possible.

Care plans were up to date and people using the service and significant others were involved in the review process.

Meals provided were well balanced, nutritious and culturally appropriate. People who used the service were involved in the planning of the menu and shopping of the ingredients.

Robust medicines administration procedures ensured that people who used the service were protected from inappropriate administration of medicines.

People who used the service told us that staff were available to them and enabled them to undertake community based and in-house activities. A longstanding staff team ensured consistency in the provision of care.

People who used the service had no complaints about the treatment and care provided and staff were confident in the registered manager that all complaints raised would be dealt with.

People had been involved in the assessment of their needs and their recorded plan of care. We saw people were central to their care plan and took a lead in how their care was delivered. People's preferences and goals were considered in relation to the care and support that they received.

People told us they made decisions about their lives. We saw people make a number of choices. These included deciding what they wanted to eat, when they wanted to get up and what they wanted to do.

People spoke about the activities they participated in and enjoyed. We saw people took part in a range of leisure activities. People's independence and skills were promoted and supported by staff.

People told us they felt safe and knew who to talk to if they had any worries or concerns. Policies and training received by staff protected people from abuse. Staff received the training they needed to meet people's varied needs. There were systems in place to monitor and make improvements to the service provided to people.