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Peacock Manor Nursing Home Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 3 February 2020

During a routine inspection

About the service

Tancred Hall Nursing Home provides residential and nursing care for younger adults and older people who may be living with a physical disability, sensory impairment, mental health needs or dementia. The service is split into two areas. The 'Hall' provides residential and nursing care for people who may also be living with dementia. The 'Cottage' provides support for people with more advanced dementia or complex mental health needs. The service is registered to support up to 49 people, and 28 people were using the service when we inspected.

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

People benefited from a more welcoming and homely environment, but further improvements were needed to make sure all areas of the service were thoroughly and regularly cleaned.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. We made a recommendation about record keeping in relation to the Mental Capacity Act 2005.

People’s care plans were being reviewed and updated to make sure they consistently contained person-centred information about their needs, preferences and any risks to their safety.

People were supported to eat and drink enough, but their dietary requirements were not always clearly recorded to guide staff and help make sure they received consistent support. We spoke with the manager about the importance of reviewing records to make sure actions were recorded and handed over where people had not had a lot to drink.

The manager had made significant and widespread improvements to the quality and safety of the service. Whilst this work was ongoing and further improvements were needed in some areas, they were aware of what was needed and work was ongoing to deliver the planned improvements. Systems had been put in place and were being embedded to help deliver sustained improvements. The provider had appointed a new nominated individual and arranged for audits to help monitor progress and support improvements.

Improvements had been made to the way medicines were managed and administered. People received safe support to take their prescribed medicines.

The provider had improved their recruitment process. Safe systems were in place to make sure enough suitable staff were deployed. People benefited from patient and unrushed support when they needed it.

People were supported to stay safe by staff trained to identify and report any safeguarding concerns. Risks relating to the environment and fire safety had been addressed and the provider continued to make significant improvements to the quality and safety of the service.

People benefited from a more comfortable, stimulating and homely environment. Work was ongoing to continue redecorating and renovating the service.

Improvements had been made to help make sure suitably trained and supervised staff were deployed. New staff received an induction to the service. Existing staff, including nurses, completed a range of training and received supervisions to monitor their performance and support them to develop in the role. Plans were in place to complete annual appraisals.

Staff worked with professionals to make sure people’s complex needs were met and they received medical attention if required.

Improvements had been made to the range of activities on offer. People benefited from more regular and meaningful activities to help avoid social isolation. There was a relaxed, happy and friendly atmosphere within the service and people shared friendly interactions with staff throughout our visit.

Staff were kind and caring. Interactions were more person-centred and less task orientated. People’s personal care needs were met and they were supported to have regular baths or showers. People were supported to maintain their privacy and dignity.

People felt able to speak with staff or management if they were unhappy or needed to complain. The manager was approac

Inspection carried out on 19 August 2019

During an inspection looking at part of the service

About the service

Tancred Hall Nursing Home provides residential and nursing care for younger adults and older people who may be living with a physical disability, sensory impairment, mental health needs or dementia. The service is split into two areas. The ‘Hall’ provides residential and nursing care for people who may also be living with dementia. The ‘Cottage’ provides support for people with more advanced dementia or complex mental health needs.

The service is registered to support up to 49 people, and 36 people were using the service when we inspected.

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

People received inconsistent care, which did not always meet their needs. The provider’s approach to managing the service put people at risk of avoidable harm as they had failed to adequately monitor the quality and safety of the service. Risks were not always identified or addressed in a timely way.

There were significant and widespread issues and concerns in relation to the decoration, maintenance and cleanliness of the environment. The environment did not promote people’s wellbeing and support the delivery of high-quality care. People had not been protected from risks associated with a fire occurring; North Yorkshire Fire Service were due to revisit the service to make sure appropriate action had been taken in response to these concerns.

People were put at risk of harm because the provider had not followed a robust process to make sure suitable staff were employed and deployed. There was a high use of agency staff and suitable checks had not always been completed before they worked at the service. Staff lacked organisation and leadership, particularly at mealtimes. There were gaps in staff’s training and supervisions and appraisals had not always been completed in line with the provider’s policy and procedures.

Improvements were needed to make sure medicines were managed safely. Care plans and risk assessments varied in quality and detail. They did not consistently provide enough information about people’s needs, risks and how to safely support them. People did not always benefit from the support of skilled and experienced staff when they became anxious or distressed. The provider had not developed an evidenced based approach to supporting people with mental health needs or dementia. Care plans did not support good practice and clear information was not recorded in relation to periods of anxiety and medicines used to reduce distress.

People told us staff were generally kind and friendly, but interactions were brief and often task focussed. There were limited activities and people spent long periods of time socially isolated or without meaningful stimulation.

People’s personal care needs had not always been met and their dignity had been compromised by issues with the cleanliness and care shown in maintaining a welcoming and homely environment.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always offered choices or appropriately supported to make decisions. A lack of management oversight had led to delays seeking applications to deprive people of their liberty; mental capacity assessments and best interest decisions were not always recorded.

Records did not support staff to appropriately monitor and make sure people’s needs were met. The new manager had begun working more closely with professionals and reviewing people’s needs to ensure the support provided was appropriate and based on up-to-date clinical advice.

People generally told us they felt able to speak with management if they had any issues or concerns. One complaint had been recorded, but the provider had not followed their complaints procedure in responding to this concern.

The new manager had been responsive to feedback and

Inspection carried out on 10 January 2019

During a routine inspection

About the service: Tancred Hall Nursing Home provides support for up to 49 older people and younger adults who may be living with dementia, mental health needs, a physical disability or sensory impairment. Accommodation is provided in one adapted building separated into two areas. The 'Hall' supports people with nursing needs who may be living with dementia. The 'Cottage' supports people with nursing and mental health needs. Twenty-seven people were receiving a service at the time of this inspection.

People’s experience of using this service: The provider and registered manager had made significant improvements since our last inspection. The environment was cleaner and more welcoming. Staff were more attentive and engaged, and there were more effective systems to monitor and make sure people’s needs were met. The provider was now compliant with all legal requirements.

Although there had been significant improvements, progress was needed to show improvements could be sustained. Work was ongoing in other areas to develop and improve the service. For example, a more robust system was needed to make sure agency staff were suitably trained; progress was needed to develop a fully dementia friendly environment, and to maintain consistently high standards of cleanliness. The range of activities on offer had improved, but further improvements were needed as people were not always meaningfully engaged.

We recommend opportunities for regular, meaningful stimulation should be further explored and developed.

We recommend the provider implement a business continuity plan to help keep people safe in an emergency.

Staff were safely recruited and enough staff were deployed to meet people’s needs. Staff had been trained to respond to safeguarding concerns. The registered manager was proactive investigating and responding to concerns to keep people safe.

People received care from staff who were kind and caring. Staff worked closely with healthcare professionals and sought their advice, guidance and support on how to best meet people’s needs. Staff had completed a range of training. The registered manager was looking to source and deliver more comprehensive training for staff working with people with mental health needs and behaviours that may challenge.

People were supported to meet their personal care needs and dress according to their personal preferences. Staff supported people when needed to make sure they ate and drank enough.

People gave very positive feedback about the new registered manager and deputy manager (who was also the clinical lead) and the changes and improvements they had made. The registered manager was approachable, responsive to feedback and clearly dedicated to developing and improving the service. They used a range of audits to check quality and safety. They put in place action plans to make sure improvements were made when needed.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission's (CQC) website at www.cqc.org.uk.

Rating at last inspection: At the last inspection service was rated Inadequate (report published 11 July 2018). This is the second consecutive time the service has not achieved a Good rating overall.

Why we inspected: At the last inspection, there were seven breaches of regulation. Following the inspection, we asked the provider to take action to make improvements. They sent us a plan to show what they would do and by when to improve the service. This inspection was planned to check the provider had acted to improve the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider, local authority and clinical commissioning group to monitor progress. If any concerning information is received we may inspect sooner.

Inspection carried out on 26 March 2018

During a routine inspection

Tancred Hall Nursing Home is registered to provide residential and nursing care for up to 49 older people and younger adults who may be living with dementia, mental health needs, a physical disability or sensory impairment.

This service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in one adapted building separated into two areas. The ‘Hall’ supports people with nursing needs who may also be living with dementia. The ‘Cottage’ supports people with nursing needs, mental health needs and people living with dementia.

We inspected the service on 26 March, 5 April and 25 April 2018. The first day of our inspection was unannounced. At the time of our inspection, 32 older people with nursing needs, dementia and mental health needs were using the service.

This was the first inspection of this location since it was taken over by Tancred Hall Care Centre Limited in July 2017. Before this, the service had been in administration.

During the inspection process CQC was notified of an incident in which a person using the service died. The inspection did not examine the specific circumstances of this incident. However, the information shared with the CQC indicated potential wider concerns about the care and support provided at Tancred Hall Nursing Home and about the management of risks including the risk of choking. The inspection examined those risks.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service did not have a registered manager and had been without a registered manager since December 2017. A registered manager is a person who has registered with the 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. On the first day of our inspection a manager was in post and applying to become the registered manager. However, they withdrew their application and left the service. On the second and third day of our inspection the service was being managed by a director, who was also the provider’s nominated individual, a