Tudor Rose

At our last inspection we rated the service good overall, but requires improvement in the key area of effective, with no breaches of the regulations. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

Processes, training and systems were in place and operated effectively to ensure people were kept safe from the risk of abuse. Risks to people had been assessed and measures taken to manage any potential risks to people.

There had been issues with staff recruitment, but the provider had taken appropriate action to address this for people and there were sufficient staff rostered to meet people’s needs. The provider operated robust recruitment procedures.

People’s medicines were safely managed by trained staff. There were processes in place to protect people from the risk of acquiring an infection. Incidents were reviewed, and any required improvements were made to reduce the risk of re-occurrence for people.

People’s needs were assessed, and the delivery of their care was underpinned by relevant guidance. Technology was used to enhance people’s experience of the care provided. Staff had the skills, knowledge and experience to deliver people’s care.

People were supported by staff to make choices about their meals. Staff worked both within and across organisations to ensure people received effective care. Staff supported people to meet their healthcare needs. People’s needs were met by the design of the premises. People were supported to make their own decisions and, where people lacked the capacity to make a decision, legal requirements were met.

People were treated with kindness, respect and compassion by the staff who provided their care. People were supported to express their views and to be actively involved in making decisions about their care. People were supported to maximise their independence.

People contributed to the planning of their care. Staff supported people to undertake activities that were socially and culturally relevant to them. People had access to a wide range of opportunities including voluntary work. Processes were in place to enable people or their representatives to raise any issues or concerns about the service.

The provider had a clear set of values which underpinned the delivery of people’s care by staff. These included; empowering, together, honesty, outstanding, and supportive. There was an experienced registered manager in post to run the service.

The views of people, relatives and staff about the service had been sought and used to improve the service. Processes were in place to monitor the quality of the service provided and to identify areas for improvement which were acted upon for people. The service worked in partnership with relevant agencies for the benefit of people.

Further information is in the detailed findings below.

The service had a registered manager. However, the registered manager had been absent from the service since 13 November 2015 due to unforeseen circumstances. 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. An interim manager was in place to cover the absence of the registered manager.

People’s relatives told us people were cared for safely at all times. Staff had completed training in safeguarding people from abuse and records showed any concerns raised were acted on appropriately. Details about how staff, people and others could report any concerns about people’s safety directly to the provider were displayed in the home.

Staff knew about the risks to people’s safety and wellbeing and these were recorded in their care plans. Risk management plans provided guidance for staff on supporting people safely and minimising risks to them and others. Information was available to staff and others as required to support people in an emergency situation. Some of this information required updating and the manager assured us this would be completed without delay. People practised fire drills so they knew how to act in the event of an emergency evacuation due to a fire.

Sufficient staff were deployed to meet people’s needs and care for them safely. When agency staff were used they completed an induction into the home and people’s needs. Wherever possible the same agency staff were used. This provided a consistency of care for people. Staff were recruited safely. The provider carried out the required pre-employment checks to protect people from the employment of unsuitable staff.

People’s medicines were managed safely. Staff were trained and assessed as competent to administer people’s medicines.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (2005). The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS).

DoLS Applications for all people living at Tudor Rose had been made in October 2014. The outcome of these was not evident in the care plans we reviewed. A mental capacity assessment and best interest decision making process had not been followed prior to the submission of the DoLS applications. This meant there was a lack of written evidence as required to demonstrate how the decision to submit DoLS applications for people had been made and whether the applications made had been authorised.

Staff completed an induction into their role and completed training to enable them to meet people’s needs. All staff were trained to use Makaton which is a language programme using signs and symbols to help people to communicate. This meant people were supported by staff who could use their preferred method of communication.

People were supported to maintain good nutrition. People’s needs in relation to nutrition were assessed and monitored to identify any additional support required. People chose the food they ate and were supported to maintain a healthy and balanced diet.

Staff acted promptly to ensure people’s healthcare needs were met. People records included information about their healthcare appointments and any follow up treatment required. People were supported to maintain their health.

There was good continuity of staff who had been in post for some time. This meant people had established relationships with staff who knew them well. People’s relatives told us this was important and that the staff were caring in their approach to people, enabling them to build positive relationships.

The provider and staff were committed to ensuring any new person coming into the home would be compatible with the existing residents people and share their communication methods. This meant people’s needs were considered and respected.

People were supported by staff who knew their interests and preferences. Staff were aware of how people preferred to be supported if they became distressed and spoke about people with warmth and compassion. People were supported to communicate their views, decisions and feelings. People were treated with dignity and respect and enabled to enjoy private relationships with friends and family.

People were supported to engage in a range of activities to meet their needs and interests. People enjoyed doing activities together and when they preferred to do different activities this was accommodated.

People’s care plans were person-centred and included information about their needs, preferences and abilities. Monthly meetings with their keyworkers enabled people to be involved in the review and planning of their care. Where people’s needs changed these were updated on their care plans so they continued to receive appropriate care.

Staff acted promptly to ensure where people’s need changed they received the appropriate support. This included support from other professionals to assess people’s needs and provide guidance for staff on how to support people effectively. This helped people to maintain and improve their quality of life.

A complaints procedure was in place and available to people in an accessible format, such as easy read and pictorial. No complaints had been received, however people’s relatives told us they were able to raise concerns and these were responded to.

The provider had ensured adequate management support was in place for people and staff in the absence of the registered manager. Staff spoke positively about managers and team work in the home. Relatives told us the home had an ‘open’ culture and the registered manager responded to their feedback and concerns. Some relatives felt communication had fallen short over the proposed building works and occupancy changes. This had been responded to by the provider.

Staff demonstrated the provider’s values in their work with people and managers worked alongside staff to monitor this in practice. People and their relatives were asked for their feedback on the service and this was acted on. A quality assurance system was in place to drive continuous improvement to the service people received.