We carried out a review of the data available to us about Tillson House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tillson House, you can give feedback on this service.
Tillson House is a residential care home providing accommodation and personal care to 30 people aged 65 and over at the time of the inspection. The service can support up to 40 people across two floors.
People’s experience of using this service and what we found
People’s individual risks were managed in a safe way and environmental risk assessments were completed appropriately.
People were supported by a staff group who had been trained in safeguarding and understood how to safeguard vulnerable adults from abuse and neglect.
The provider had enough staff with the right skills deployed to provide people with their commissioned care.
Medicines were safely managed. Medicines administration record (MAR) charts were accurately completed, medicines were safely administrated and when people received their medicines ‘as and when required’ the correct protocols were in place.
The provider demonstrated they learnt lessons when things went wrong and they encouraged continuous improvements.
Effective infection prevention and control (IPC) policies and procedures were in place and the service was following best practice and Government guidance in relation to the management of COVID-19 and other infections.
Quality control systems were effective in identifying issues within the service. When issues were identified during audits, the provider developed effective action plans to improve care and drive continuous learning.
Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.
People and their relatives were involved in developing and reviewing their care plans and risk assessments. People’s relatives and staff felt they were able to contribute to the development of the service.
The provider and management team had good links with the local communities within which people lived.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 4 June 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We received concerns in relation to staffing, staff culture and neglect of people using the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tillson House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Tillson House provides accommodation, nursing and personal care for up to 40 people who have need relating to dementia, physical disabilities, learning disabilities, mental health, and sensory impairments. At the time of our inspection there were 32 people using the service.
People’s experience of using this service and what we found
People were not always safe when being hoisted. A person had been injured and we observed poor hoisting practice. This had led to a breach in regulations.
The provider’s quality assurance audits had not identified issues with medicines records, the environment, and risk assessments.
We have made a recommendation about the provider’s quality assurance system.
Staffing levels had improved, and people received support when the needed it. The staff were kind and caring and relatives made many positive comments about them. People were encouraged to take part in activities to increase their well-being.
People and staff had the opportunity to share their views on the service and managers acted on their suggestions. Relatives said the registered manager and staff were approachable and helpful.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This was a focused inspection based on concerns we had received about the service. These were in relation to people's care and governance. As a result, we undertook this focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Tillson House on our website at www.cqc.org.uk
Tillson House is a care home registered for up to 40 older people with a range of support needs. At the time of our inspection there were 34 people using the service.
People's experience of using this service and what we found
Relatives felt their family members were safe in the service. Staff knew what to do to keep people safe and were confident any concerns would be taken seriously. Risks to people's well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively. Staffing levels were appropriately managed, and people received care from consistent, regular staff. Enough staff were employed each day to meet people's needs and keep them safe.
Staff followed infection control and prevention procedures to protect people from the risk of infections and COVID-19 as far as possible. Staff wore the recommended personal protective equipment when working in the service and providing care and support.
Effective systems were in place to check the quality and safety of the service. The environment was clean and safe and in a good state of repair and decoration. The registered manager had good oversight of the service and completed regular audits and walk arounds to monitor and improve the service. The leadership of the service promoted a positive culture that was person-centred and inclusive. The registered manager and the staff team showed a desire to improve on the service provided and in turn the quality of life experiences for the people at Tillson House.
Why we inspected
We undertook this targeted inspection to follow up on specific concerns relating to safeguarding and staffing which we had received about the service. A decision was made for us to inspect and examine those risks and to check whether appropriate action had been taken since our last inspection in relation to the breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tillson House on our website at www.cqc.org.uk.
Rating at last inspection
The last rating for this service was Requires Improvement (published February 2020).
Follow up
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Tillson House is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 40 people.
The service is provided across two floors in a purpose-built premises.
People’s experience of using this service and what we found
We found issues with staffing. The service did not always have sufficient numbers of staff on duty to meet people’s needs.
New staff did not complete relevant training before supporting people with their mobility needs.
We have made a recommendation about improving accident and incident recording.
The managers completed relevant checks which helped them monitor the quality of care at the service and made some improvements. However, they did not identify the staffing issues we found.
Risks assessment were in place to keep people safe and prevent or reduce the occurrence of risks to people. Medicines management was safe. The provider had protocols in place for safeguarding people and managing any incidents or accidents that occurred at the service.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were provided nutritious meals and snacks and drinks. They were supported to monitor their health and promptly access health care services when required.
Staff were kind and compassionate. They took steps to involve people in decisions about their care. They treated people with dignity and respect and promoted their independence.
People were supported to participate in a variety of social activities. They were also supported to follow their faith and beliefs. Care plans were comprehensive and gave staff relevant guidance and information of people’s preferences and history.
There was an enabling leadership team who supported staff to fulfil the responsibilities of their roles. The registered manager understood their regulatory responsibilities.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 6 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to staffing at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People were safe and their relatives confirmed this. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.
The care that people received continued to be effective. Staff had access to the support, supervision, training and on going professional development that they required to work effectively in their roles. People were supported to maintain their health and had access to health professionals.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People were supported to make choices and their independence was promoted.
People had detailed care plans in place to enable staff to provide consistent care and support in line with their personal preferences.
The provider's had a complaints procedure, which was followed when a concerns were raised. People felt able to make a complaint if they needed to.
Staff felt supported by a registered manager who was visible in the service. They were clear on their role and the expectations of them as they had received training, guidance and support.
People and their relatives told us that they had confidence in the registered manager’s ability to provide a well-led service. Systems were in place to monitor the quality of the service being provided and to drive improvement.
The inspection took place on 5 March and was unannounced. We returned on 28 March, unannounced, because we had received information of concern about staffing levels at the home.
Tillson House provides care and support for up to 40 older adults, including people with dementia care needs. At the time of our inspection there were 38 people using the service. The home is a two storey purpose built building with a number of communal areas and gardens.
There was a registered manager in 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.
Our previous inspection of 13 March 2014 found the provider had met all the regulations we inspected.
People we spoke with told us they were satisfied with the care and support provided and all felt their needs were being met. People had developed good relationships with their care workers and told us they were treated with kindness and respect and felt safe using the service. Relatives we spoke with confirmed this. People told us staff took the time to interact with them and had a good understanding of their individual needs.
Staff were knowledgeable, friendly and accommodating. They understood people’s care and support needs and had taken the time to get to know people’s personal preferences, likes and dislikes. We observed that staff were friendly, kind and treated people with respect.
Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Staff received a thorough induction and on-going training to ensure they had up to date knowledge and skills to provide the right support for people. They also received regular support through the use of staff meetings and supervisions. Staff had confidence in the registered manager.
There were sufficient numbers of staff available to meet the needs of people who lived at the home. Staff responded to people promptly and call bells were answered without delay. People, their relatives and the vast majority of the staff team told us that staffing levels were appropriate at the home. The registered manager was clear that staffing levels were flexible and dependent on people’s needs.
Staff had received training on how to keep people safe from harm and we observed care being provided in a safe way. The registered manager had a good understanding of the local procedures in responding to and reporting allegations of abuse and had ensured that these processes had been followed when required.
The premises and equipment were well-maintained and safe for people who lived there.
Medication was safely stored and administered by trained staff. We found that one persons’ pain relief medication had been missed on the first day or our inspection but appropriate action was taken by the staff team to respond to this.
People’s needs were assessed and plans were in place to meet those needs. Staff understood what people’s individual needs were and acted accordingly. Risks to people’s health and well-being were identified and plans were in place to manage those risks. People were supported to access healthcare professionals whenever they needed to. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided.
The registered manager was clear about the values and aims of the home and was committed to improving the quality of service provided. We saw evidence of improvements they had already made to develop the service. Staff, relatives and people who used the service told us the registered manager was approachable and were confident that any concerns or issues they raised would be dealt with appropriately.
There were effective systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service and monitoring the quality of service provided.
Requirements of the Mental Capacity Act 2005 had been met.
We spoke with eight people using the service and nine members of staff.
We found people experienced care and support that met their needs and protected their rights. One person using the service told us: 'It's nice living here. The staff are looking after me well.' Care and support was delivered in a way that met people's needs and ensured their safety and welfare.
We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.
We found that there were sufficient numbers of staff on duty to ensure people were safe and their needs were being met. One member of staff told us: 'There's generally enough staff on duty and the home runs well. I would recommend Tillson House for a family member to live at.'
We found people were able to make informed decisions about their care and support. One person told us: 'The staff always ask for my consent before doing anything with me.' One relative told us that: 'The staff are respectful and I am happy with my [family member's] care.'
We found that care and support may not always be delivered in a way that met people's needs. Whilst we found people's care needs had been assessed, we saw some monthly reviews had not taken place. We found that most people using the service had no opportunity to take part in any social or leisure activities.
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had systems in place relating to the management of medicines.
Although there was a recruitment and selection process in place, we found that gaps in a person's employment history were not fully explained.
We found that there were not always sufficient numbers of staff on duty to ensure people were safe and their health and welfare needs were met at all times.
We found the provider had a complaints policy in place. People using the service, and their relatives, told us they were aware of the provider's complaints policy and how to make a complaint.
All the care records had a care and support plan in place. The care records contained risk assessments related to people's individual needs. All the care records we saw were agreed and signed by the person or a representative. One person told us:' I was visited prior to coming here and I signed the care plan to agree with my care. I had a choice of room and my mobility issues were catered for'.
All the staff we spoke with had a good understanding of the different types of abuse and were able to explain what they would do if they suspected someone was being abused and who they would report to, both within the service and external agencies.
We saw evidence of staff supervision. However we saw that the personal development review (PDR) meetings were out of date. The registered manager had identified a gap in the appraisal process and showed us evidence of an annual planner for 2013, where all supervisions and appraisals were identified throughout the coming year.
We saw evidence of weekly completed quality assurance listening forms. The registered manager explained the people who used the service were asked to comment on aspects of personal care and general feelings about living in the home.