We carried out an inspection on the 17 April 2014 to check the provider had complied with the compliance action that we had made at the time of our inspection on the 30 January 2014. We found that the appropriate checks for staff had been promptly actioned by the provider and completed.
During our inspection on 30 January 2014, we noted that building work was being carried out on the premises. During our inspection on 5 March 2014 we saw that the building work was complete and noted that the kitchen was fully operational.
Following our inspection on 30 January 2014, we were concerned that the provider had failed to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.
The provider was given until 28 February 2014 to comply with Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010.
During the inspection on 5 March 2014, we saw that the provider had taken sufficient steps to ensure that accurate and appropriate records were maintained and therefore people were protected from the risks of unsafe or inappropriate care and treatment as a result of this.
During our inspection on 30 January 2014 we saw that the provider was undergoing building work at the premises and therefore all people in the home were moved to one side of the premises where there was no work taking place.
At our inspection on 22 October 2013, we saw that mental capacity and deprivation of liberty assessments had not been completed fully. During our inspection on 30 January 2014 we noted that the provider changed the format of their mental capacity and deprivation of liberty assessments so that it included details about people's mental capacity and ability to communicate.
At our inspection on 22 October 2013, we looked at the provider's policies and procedures and saw that the majority of these were out of date and did not reflect recent changes. During our inspection on 30 January 2014, we saw that the provider had yet to review their medication and infection control policies. We also observed that the provider had not carried out a risk assessment in respect of the building works that were taking place in the home. We also observed that some documentation we looked at was not accurate and up to date.
During this inspection on 30 January 2014, we saw that there was a lack of evidence available to confirm that appropriate checks had been carried out for a member of staff who had recently started working at the home.
The provider was given until 18 November 2013 to comply with Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010.
During our inspection on the 22 October 2013 we raised concerns as there were a lack of activities available for people who used the service. We noted that the provider had an activities timetable but we saw no evidence that activities were taking place. There was insufficient information recorded in the activities record book and therefore a lack of evidence to confirm what activities had taken place.
During our inspection on 3 December 2013 we noted that the provider had employed an activities coordinator and we saw that people who used the service were taking part in a music session which involved people playing with musical instruments, listening to music and dancing. People appeared to be enjoying themselves and there was a lively atmosphere in the home. We also saw that the provider had recorded people's activities in the activity record book and that this was up to date. We noted that an activities timetable had been implemented and was being used at the home.
During this inspection, we observed that the provider had implemented a new format of care plans. We looked at five care files and saw that they each contained care plans and risk assessments and there was evidence that they had been reviewed monthly.
We observed that the provider had taken steps to ensure that the environment was safe for people. They had replaced the carpet in the home and ensured that the carpet to the entrances of people's rooms had been secured.
We saw evidence that the provider had arranged for some of their staff to attend training course. However, there were still members of staff who had yet to attend mandatory training.
Mental capacity and deprivation of liberty assessments had not yet been completed fully and had not been signed by people's representative. It was therefore not evident that people received the care that they wanted.
We looked at the provider's policies and procedures and noted that some of these were out of date and had last been reviewed in 2010.
At our last inspections, we were concerned by the lack of activities available for people in the home. During this inspection, we observed that this was still an outstanding issue and we are therefore taking action to ensure the provider becomes compliant with the regulations.
During our inspection on the 16 July 2013 we raised concerns about food being unsuitable for consumption as it was no longer within the "use by" date, ants present in the kitchen, inappropriate storage of food, the food menu not being used and incomplete food intake records for people who used the service.
During our inspection on 29 August 2013 we checked the food in the fridge and found that all food was within their 'use by' date. There were no ants in the kitchen and the kitchen was clean and tidy. We also observed that the food menu had been updated and saw evidence that it was being used. People who used the service were being asked what they would like to eat and given a choice. We looked at the food intake records for seven people and noted that they were all up to date and contained sufficient detail.
We found that the provider had not met the compliance actions in respect of all five outcomes that we looked at.
The placing local authority had their own concerns and had made a decision to move all their clients from the home within the next few weeks.
We spoke to four people using the service. People confirmed that staff treated them with respect and ensured that their dignity and privacy was maintained. One person made the following comment, "They (staff) always ask me what I want and if I am satisfied with my care." One relative told us, "I am very happy how my (relative's) health has improved since living in Tower House."
However we found that some of the mental capacity assessments and deprivation of liberty assessments were incomplete, which could result in people's rights not being met. In addition to this the lack of appropriate regular activities did not stimulate and occupy people appropriately and did not fully meet their needs.
We found a number of food items that were unsuitable for consumption due to no longer being in date. And comments made by relatives during a visit in April 2013 and a visit by the placing authority in January 2013 were that food was not available in suitable quantities which put people at risk of malnutrition. Comments made by one person; "I like the food, but sometimes there is not enough' confirmed this.
People using the service told us they liked living at Tower House; however some of the maintenance and decoration was unsuitable and unsafe.