Archived: Tewkesbury Fields

People’s experience of using this service:

• Services that provide health and social care to people are required to inform the Care Quality. Commission (CQC), of important events that happen in the service. Provider checks had not identified this did not always happen promptly, and this had led to delays in CQC being advised of some important events.

•A registered manager was not in place at the time of the inspection, but a new manager had been appointed and was in the process of applying to become the registered manager for the home.

• People saw the manager regularly and found them approachable.

•People told us Tewkesbury Field was managed so the care they wanted was made available to them. People told us although there had been some changes in the staff running the home, and the care staff supporting them, they enjoyed living at the home, and would recommend living at Tewkesbury Fields to other people.

• Further meetings were planned by the manager with people, their relatives and staff, to ensure there were on-going opportunities to communicate information regarding the development of care and the business.

• Staff knew how to recognise the signs of abuse and understood risks to individual people’s safety and supported them to stay as safe as possible. Staff were confident if they raised any concerns these would be promptly dealt with by senior staff.

• There were sufficient staff to care for people at times people wanted assistance, but staff experienced busy periods. The manager advised us they would review the current deployment of staff to address this.

• People were supported to have their medicines safely and checks were undertaken to ensure these were administered as prescribed.

• The risk of infections and accidental harm was reduced, as staff had received training and used the knowledge and equipment provided to do this.

• People told us they had opportunities to discuss the care they wanted. Staff explained how they assessed people’s needs, and incorporated people’s, their relatives’ and other health professionals’ views into their findings. This helped to ensure people were offered appropriate care, based on their preferences.

• Training had been provided to staff and people told us staff knew how to look after them. The manager had planned further training for staff, so they would develop the knowledge and skills needed to support people.

• People were very positive about their meal time experiences and told us they enjoyed making their own decisions about dining and snacks. Where staff had any concerns about people having enough to eat and drink action was taken to support them, so they would remain well.

• Staff knew people’s health and well-being needs well, and ensured people had prompt access to the healthcare they needed from other health and social care professionals. This helped to ensure people’s health and well-being needs were met.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

• People had developed good bonds with the staff who cared for them and told us they enjoyed sharing a joke with staff, and found staff caring.

• People were confident to ask for assistance and reassurance from staff when they wanted this, and staff took time to support people as people preferred.

• Staff knew what was important to the people they cared for and ensured they promoted people’s rights to dignity, independence and privacy.

• People made their own decisions about their lives and care. Where people needed support to make some decisions staff assisted them, using people’s preferred ways of communicating.

• The views of people and other health and social care professionals were considered when people’s care was assessed, planned and reviewed, so people’s needs continued to be met.

• Staff ensured people had a wide range of opportunities to do things which they enjoyed, and which responded to their individual needs, including their sensory needs. This enabled people to be fully involved in life at the home, and to maintain links which were important to them in the local community.

• Systems were in place to take any learning from complaints and accidents and incidents, and to further improve people’s care.

• Staff established people’s wishes for their care at the end of their lives by talking to people and by consulting with their relatives and other health and social care professionals.

• The manager and provider checked the quality of the care provided and developed the service and took action to develop the home further.

• We found the service met the characteristics of a “Requires Improvement” overall.

Rating at last inspection: Good. The last report for Tewkesbury Fields was published on 30 September 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Full information about CQC's regulatory response to concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook a further comprehensive inspection on 26 and 27 July 2016 which was unannounced. This was to check the provider had followed their plan and to confirm that they now met legal requirements and to review the ratings of the service. We found that the provider was now meeting the legal requirements in relation to both breaches. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Tewkesbury Fields provides accommodation and nursing care for up to 74 older people. There were 61 people who were living at the home on the day of our inspection. There was no registered manager in place at the time of our inspection. There were two regional support managers working at the home at the time of our inspection. We spoke with the area manager who explained that one of the recently appointed regional support managers would register with the CQC while they recruited a permanent manager into post. 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.

People lived in a safe environment as staff knew how to protect people from harm. We found staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks.

There were sufficient staff on duty to meet people’s needs. People told us that staff helped them when they needed assistance. Regular reviews of people’s care and deployment of staff meant staffing levels were reflected the needs of people who lived at the home. People’s medicines were administered and managed in a safe way.

The regional support managers supported staff by arranging training so staff developed the skills to provide care and support to people which was in-line with best practice. People and relatives told us of the positive benefits this had on the care and support received. We found that staff provided people’s care with their consent and agreement.

We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals, such as the dentist and their doctor when they required them and where supported to attend hospital appointments.

We saw people were involved in the planning around their care. People’s views and decisions they had made about their care were listened and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected.

We found people knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last four months, since the regional support manager had been in post. We found seven complaints had been received, all of which had been responded to with satisfactory outcomes for the complainants.

The area manager had placed two regional support managers into the home to improve the standards of care as the provider had recognised further improvement was required to the care people received. One regional support manager had been in place since April 2016 while the second since July 2016. The area manager explained they were actively sourcing a new manager for the home; however until this time a regional support manager would become the registered manager with CQC, to fulfil their legal requirement.

The regional support managers demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, which meant that people received care and support in-line with their needs and wishes.

We found the checks the provider completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure lessons were learnt and used to improve staff practice.