This inspection took place on 23, 24 January and 11 February 2019 and was unannounced.
Tennyson Wharf 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.
Tennyson Wharf can accommodate 60 people in one adapted building across three floors. At the time of the inspection 51 people were resident, some of whom were living with a dementia.
The service 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 the last comprehensive inspection in January 2017 we rated the service as ‘Requires Improvement’ overall. We found the service did not consistently act in accordance with the Mental Capacity Act 2005 (MCA) and as required medicines (PRN) protocols were not consistently in place.
At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to safe care, need for consent and treatment and good governance. You can see what action we have asked the home to take at the end of this report.
Medicines were not always administered in a safe manner and in accordance with NICE (National Institute for Health and Care Excellence) guidance and the provider’s own policy. People did not always have their care needs met. Some people required repositioning to prevent skin deterioration and other people needed their fluids monitoring due to the risk of dehydration. People did not always receive safety checks and observations when they needed them. The service did not ensure people received the planned support which placed people at risk of harm.
The service was still not acting in accordance with the Mental Capacity Act 2005 (MCA). The service had a range of audits in place but these failed to identify the issues we found during this inspection. Where issues had been identified, actions plans were produced however these were not always completed as required.
People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice.
Risks were not always identified and mitigated against.
The provider used a dependency tool to calculate staffing levels. People and relatives gave mixed views when we asked if there were enough staff to support people. We observed a number of times, staff were supporting people in their rooms leaving other people unattended. Personal emergency evacuation plans (PEEP) did not accurately reflect the staffing support people needed during an evacuation.
The service supported people to gain access to healthcare professionals.
People were complimentary about the meals provided. People were encouraged to be healthy and a balanced diet was promoted.
Staff treated people with respect and dignity. Staff were knowledgeable about people, their preferences, interests and people important to them. Staff supported people to be involved in all aspects of decision making about their care and treatment. People were encouraged to be as independent as possible.
Staff spoke positively about the management team and said both the registered manager and the deputy manager were supportive and approachable.
The premises were well maintained. Regular health and safety checks were conducted for equipment and the building. The home was clean and tidy throughout, with infection control procedures followed as required.
The provider ensured systems were in place to protect people from abuse. The service conducted a robust recruitment process. Staff had completed training to ensure they were able to recognise the types of abuse and take appropriate action. Safeguarding concerns and accidents and incidents were investigated and analysed to identify any trends.
People were encouraged to take part in a range of activities and had opportunities to access the wider community.
Following the inspection the provider took immediate action to address the concerns identified. However additional concerns were raised about the safety and welfare of people. We carried out an additional day of inspection to look at these concerns. A meeting was held with the provider to gain assurances that people were safe and the issues would be addressed. The provider gave assurances and produced action plans outlined it's intended actions.
The overall rating for this service is 'Requires Improvement'.