Archived: Tudor Lodge Nursing Home

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, caring, responsive, effective and well led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe in the home and we saw staff had a good awareness of their needs. People were cared for by staff who were supported in their work and encouraged to develop their own skills and knowledge in care provision. Risk assessments and plans of care held information to ensure staff were able to support people in a way which ensured their safety and welfare.

The home was developing more robust procedures to support people who could not make decisions about their care and treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We saw the home was in the process of applying for DoLS for several people following the assessment of people's capacity. The registered manager and provider told us they were working with the support of the local authority on identifying the needs of other people who may be vulnerable and unable to make informed decisions.

We saw the home had appropriate policies and procedures in place to ensure the safety and welfare of people who were supported with their medicines.

Is the service caring?

People told us they were supported by kind and attentive staff. Staff treated people as individuals and provided care which was in line with needs. People told us staff were responsive to their needs at all times. We saw that people's needs were supported in a calm, dignified and respectful way. This meant people were cared for in a kind and respectful manner.

Is the service responsive?

People's needs were assessed to ensure they were met. People and their representatives were encouraged to participate in care planning and review. People were able to express their views of the care they received and have them acted upon.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People told us they received the care they needed to maintain their independence and dignity. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is the service well-led?

People told us the registered manager and provider in this home were very approachable and responded to their views effectively. People told us the staff team worked well together and were very responsive to any concerns or issues they raised. Staff received appropriate training for their roles and were supported by the registered manager and provider to ensure any concerns they might have were heard. Records we looked at showed people's views and concerns were listened to by the management team and addressed in a timely way.

At the time of our visits 54 people lived at the home. During our night time visit we spoke with the registered provider, the deputy manager, and nine members of staff including carers and registered nurses. We spoke with five people who lived at the home through the night and in the morning.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring, responsive, safe, effective and well led?

This is a summary of what we found-

Is the service caring?

People told us staff were kind and responsive to their needs and we saw that people's needs were supported in a calm, dignified and respectful way. Two people we spoke with were positive about the care they received. One said, 'The girls come when I need them, they are lovely.' This meant people were cared for in a kind and respectful manner.

Is the service responsive?

During our inspection at night time we found staff were responsive to people's immediate needs. We found night time care plans did not always show clear information for staff to follow. Two staff we spoke with had not looked at any people's care plans, however they knew where they could be found. We could find no evidence to show people and their representatives were encouraged to participate in care planning and review. The deputy manager told us night staff were responsible for the review and update of night care plans with people to ensure their needs were being met. We were unable to see if people had been involved in this process. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people are allowed to express their views and be involved in making decisions about their care and treatment.

Is the service safe?

People were cared for by people who had the appropriate skills and experience to ensure their safety and welfare. Staff had a good awareness of the needs of people who lived at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. We did not review this information during this responsive inspection and were not made aware of any DOLS which were in place at the time.

We saw the home did not have in place policies and procedures to monitor the administration and effectiveness of some medicines such as 'as required' medicines. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the administration of medicines.

Is the service effective?

We saw that people did not receive care which was individualised and planned in line with their needs at night time. We found staff provided care in the same way every night and this did not allow people to maintain their independence, in particular with their continence needs and in their support to get up from bed in the morning. Staff told us people were not always offered choice of when they got up from bed and some people were woken early every day by staff. We have asked the provider to tell us what they are going to do to meet the requirements of the law to ensure people's independence is respected.

Is the service well-led?

Staff told us the registered manager, their deputy and the registered provider for this service gave regular information to support the care being given for people at night. We saw that regular meetings with night staff ensured they were able to alert managers to any concerns or issues they may wish to raise.

Staff told us they had received appropriate support through supervision sessions or discussions with the registered manager or their deputy. This meant staff were clear about their roles and responsibilities and management were supportive of their roles.

Care needs had been assessed with a personalised care plan devised with guidance for staff on how to support people.

The home was clean and well maintained. People had personalised their rooms with their own possessions including their own furniture. There were risk assessments for all equipment used to support people.

We spoke with two staff who told us they were able to speak openly with senior staff about any concerns. We observed staff being respectful when asking people if they needed support and respecting their privacy and dignity when carrying out personal care.

We found that records such as medicine records, were not always signed or dated to indicate that personal care or lotions/creams medicines had been given or applied.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The care staff we spoke to had a good knowledge of people's histories and needs. This showed that they had read the care plans.

We spoke to staff and reviewed records which showed us that people were protected from abuse and that their care was planned and delivered in a respectful and safe way. All care staff were able to articulate the different types of abuse people may experience, signs of possible abuse and information about the whistleblowing policy.

There were processes in place to monitor the quality of service being provided and we saw that people were involved in providing feedback to help improve the service.