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Inspection carried out on 23 March 2021

During an inspection looking at part of the service

Tenby House is a residential care home for up to 29 people. At the time of our inspection, 28 people were living at the home, the majority of whom were living with dementia. Accommodation is provided over two floors and communal areas include a sitting room, a further sitting room/conservatory and a dining room.

We found the following examples of good practice.

People were well supported by staff to maintain contact with their family and loved ones. People had been supported with video calls when visiting was not possible. The service facilitated in person visits in a manner which minimised the risk of infection spread. A dedicated visiting room was well laid out with screening in place. Relatives were required to undertake Lateral Flow Devices (LFD) COVID-19 tests before the visit commenced.

Social distancing guidelines had been put into practice by staff. Staff were encouraged to use all areas of the service while the management team had used communal spaces creatively for people to relax, spend time and dine with other residents safely.

Staff wore PPE when undertaking any personal care and around the home; this was disposed of safely. Many people who were living with dementia were unable to understand the restrictions imposed by the COVID-19 pandemic. Staff supported them sensitively and carefully to ensure social distancing guidelines were adhered to in a way that protected them and others at the home.

The management team had carefully considered zoning and cohorting in the event of a potential outbreak and demonstrated the changes that would be implemented under the provider’s contingency plan, if it was required.

The home was clean and hygienic throughout. A structured cleaning schedule was in place and cleaning regimes were adhered to so that all areas of the home were cleaned effectively.

Inspection carried out on 6 February 2018

During a routine inspection

Tenby House is a residential care home for up to 32 people, the majority of whom are living with dementia. At the time of our inspection, 25 people were living at the home. Accommodation is provided over two floors and communal areas include a sitting room, a further sitting room/conservatory and a dining room.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

People felt safe living at the home. Staff had been trained to recognise the signs of potential abuse and new what action to take. Risks to people had been identified and assessed and actions taken by staff to mitigate risks. Staffing levels were safe and checks completed on staff before they commenced employment. Medicines were managed safely and people received their medicines as prescribed. The home was clean and staff wore protective clothing such as aprons and gloves, to prevent the risk of infection. Lessons were learned when things went wrong.

People received effective care from staff who had completed a range of training and had regular supervisions. People enjoyed the food on offer at the home and had a choice of menu. Healthcare professionals and support were provided for people as needed. There were ongoing plans to improve the building and people were involved in choosing colours when redecoration took place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were looked after by kind and caring staff who knew them well. People were involved in all aspects of their care and had choices over their lives. Staff treated people with respect and compassion and were given the privacy they needed.

Personalised care was delivered to people that was responsive to their needs. Care plans provided detailed information about people, including their preferences and life histories. People’s cultural and religious needs were documented and their spiritual needs were met. Activities were organised at the home if people wished to participate. External entertainers also visited the home. People were happy at the home and had no complaints. Where complaints had been received, these were dealt with satisfactorily by the provider. People’s wishes for their end of life care were documented.

People spoke positively about the management of the home and their feedback and views were obtained in a variety of ways. Relatives’ feedback was sought and positive comments had been recorded. Staff felt valued in their roles and supported by management. Systems were effective in measuring the quality of the service and to drive improvement. The service met all relevant fundamental standards.

Further information is in the detailed findings below.

Inspection carried out on 2 and 6 October 2015

During a routine inspection

The inspection took place on 2 and 6 October 2015 and was unannounced.

Tenby House provides accommodation and personal care for up to 32 older people with a variety of mental health needs; the majority of whom have been diagnosed with some form of dementia. The home also provides a short break and respite service. At the time of our inspection, there were 26 people in residence. Parts of Tenby House date back to the Edwardian era, but the home has been extended over the years, with the addition of more bedrooms and another lounge area. Communal areas include a large sitting room, dining room and access to gardens at the rear of the property. The majority of rooms have en-suite facilities and all rooms are single occupancy. Tenby House is located close to the centre of Worthing and within easy reach of the seaside.

There was a registered manager 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.

People and their relatives felt that Tenby House provided a safe environment. Staff were trained to recognise the signs of potential abuse and protected people from harm. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. Staffing levels were sufficient to meet people’s needs and were assessed appropriately. The service followed safe recruitment practices. People’s medicines were managed safely and medicines were administered by trained staff. Staff were provided with advice and guidance on infection prevention and control.

Staff underwent an induction programme which included shadowing experienced staff. New staff followed the Care Certificate, a universally recognised qualification. Staff then went on to follow additional training and were encouraged to pursue additional qualifications relating to care. Staff received regular supervisions and annual appraisals. Group supervisions and team meetings were in place. Staff understood the requirements under the Mental Capacity Act 2005 and about people’s capacity to make decisions. They also understood the associated legislation under Deprivation of Liberty Safeguards and restrictions to people’s freedom. People had sufficient to eat, drink and maintain a healthy lifestyle. They had access to a range of health professionals and services. The design of the home met people’s individual needs.

Care was provided to people by kind and caring staff who knew them well. People’s spiritual and cultural needs were taken account of and they were supported to follow their religious preferences. People were encouraged to express their views and to be involved in all aspects of their care and treatment and staff supported them in this. People were treated with dignity and respect. At the end of their lives, people were supported to have a comfortable, dignified and pain-free death.

People received personalised care and care plans contained information about people’s lives, including their personal histories. Relatives were involved in reviewing care plans with senior staff. There was a range of activities on offer to people, including quizzes, music, gentle exercises and arts and crafts. Other activities included visits from a therapy dog and musical entertainment. People could access the community with staff or were supported by their families or friends. There was a complaints policy in place and all complaints were dealt with in line with this policy. No complaints had been received recently.

People’s views about the quality of the service were obtained informally, either from care staff or through the involvement of an independent consultant. Their views were fed back to the management and acted upon. Relatives were also asked for their feedback and overall this was positive. Staff were asked how they felt about the service through an annual survey. Staff felt supported by the management team and there was an open-door policy. A range of robust, quality audit processes were in place to measure the care and overall quality of the service provided.

Inspection carried out on 13 November 2013

During a routine inspection

We visited Tenby House to look at the care and welfare of people who used the service. We spoke with five members of staff, including the registered manager and observed the interactions between staff and the people who used the service. Observing these interactions was particularly valuable as the people using the service had complex needs which meant they were not all able to tell us their experience.

We observed people being treated with respect and kindness and the atmosphere was a happy and relaxed one. All those we spoke to said they liked living there. All staff we spoke to said they were happy working there.

We looked in people�s care records and found that comprehensive assessments and care plans were in place. We saw risk plans documented and evidence of specialist interventions where appropriate. We also observed that their cultural, religious and language needs had been addressed.

We saw evidence that relatives were asked for their views on standards of care at Tenby House and that they were involved in their relative�s on gong care.

We found that the provider had safeguarding procedures in place and that all staff spoken to were able to describe these procedures and had received appropriate training. We saw a training data base and training certificates to evidence this.

We looked at staff records that were all well organised. All demonstrated that suitable checks and references had been made prior to commencing and that all had received a comprehensive induction programme. Rotas demonstrated appropriate numbers of staff on duty and the staff we spoke to all stated they felt confident and supported in carrying out their role.

Inspection carried out on 5 March 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

We read in people's care plans that their likes and dislikes were taken into account. We spoke to carers, who told us that they had been involved in people's assessments and care plans. We looked at a carers' survey and found that relatives were involved in people's care. In cases where people lacked mental capacity, we found that appropriate arrangements had been made to protect their rights and interests.

We read people's case records and saw that there were appropriate and personalised care plans in place and specialist services were included in people's care. We saw evidence that people's diverse cultural, religious and language needs had been addressed.

We saw that the provider had suitable safeguarding procedures in place and that these had been used when needed. We saw that staff had been trained in safeguarding and this was confirmed to us by staff we spoke to. We spoke to carers and they said that their relatives were safe.

We saw that staff had received training appropriate to their roles, including specialist training such as dementia, and that this was updated as necessary.

We saw a range of quality assurance audits and found that service improvements were being made as a result.

Inspection carried out on 1 November 2011

During a routine inspection

The people that live at Tenby House had dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We spent 50 minutes watching people in one of the lounges and found that overall people had positive experiences. The staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own. The support that we saw being given to people matched what their care plan said they needed.

All people who we were able to have a conversation with said they were happy with staff and the care they received.