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Tudor Lodge Requires improvement

The provider of this service changed - see old profile

Inspection Summary

Overall summary & rating

Requires improvement

Updated 18 May 2019

About the service: Tudor Lodge is a large detached house in a quiet residential area. It provides care and support for up to 44 older people some of whom are living with dementia. There were 34 people living at the service when we inspected.

People’s experience of using this service:

At our last inspection in November 2017 we identified that some people did not always receive the support they needed at mealtimes; we observed that people’s privacy and dignity was not always upheld; risks around some people’s safety had not been assessed. Records were not always accurate or accessible and systems for assessing and monitoring service quality were not robust. The provider told us what action they would take to improve this.

At this inspection we found that there had been progress and improvement in many areas and most of the previous breaches in regulation met. We found however that medicines were not being managed safely and have issued a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Although strengthened the system to assess, monitor and improve the service and improvements to the accuracy and completion of records had not fully met the previous breach Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 has not been fully met and further improvements are needed

Since the last inspection there was a new registered manager, she had worked hard to change the culture within the service and address previous shortfalls, as a consequence there had been a complete turnover of staff. This was enabling the registered manager to develop a new team and culture within the service. Staff thought communication was good between staff and that there were good working relationships. The provider acknowledged further work was needed and had already identified further improvements to be made from within their own service development action plans. This included for example team building, record keeping, and improving the type and range of activities and stimulation for people in the service. Overall staff told us that they enjoyed where they worked and were committed to providing people with good quality care.

People and relatives spoke positively about service quality. People told us that they felt safe and well cared for. Relatives felt reassured that their relative was living in a safe place where their needs were taken care of. Relatives told us that they had found communication from staff to be good and the registered manager approachable. People and relatives told us that staff were caring and took time to get to know people well. People and relatives told us that they had no concerns but felt able to raise them if they did and were confident these would be acted upon.

We observed that there were enough staff to support people’s needs during the day, the provider agreed to relook at morning availability of staff which had been highlighted by some staff as a particularly busy time.

A full range of checks were made of new staff to help ensure people were supported by suitable staff.

Staff were provided with an appropriate programme of training to understand and support people’s individual needs. They demonstrated a detailed knowledge of people and their routines and preferences.

People lived in a safe well-maintained environment where equipment was routinely serviced and checked that in was in safe working order.

Improvement recommendations made by the fire service were being addressed to ensure they met the required standard of fire safety.

Peoples health needs were supported. Health professionals visiting to provide routine health care support raised no concerns about the appropriateness of referrals to their service; they said staff followed advice and guidance appropriately in support of people’s health needs.

Staff felt confident of raising issues with senior staff and felt supported, they had opportunities to express their vi

Inspection areas


Requires improvement

Updated 18 May 2019

The service was not always safe

Details are in our Safe findings below.


Requires improvement

Updated 18 May 2019

The service was not always effective

Details are in our Effective findings below.



Updated 18 May 2019

The service was caring

Details are in our Caring findings below.



Updated 18 May 2019

The service was responsive

Details are in our Responsive findings below


Requires improvement

Updated 18 May 2019

The service needed further improvement and was not always well-led

Details are in our Well-Led findings below.