Taptonholme

Taptonholme is a care home. It can accommodate up to 19 people in an adapted older building. It provides personal care for older people, including people living with dementia. There were 13 people using the service at the time of the inspection.

People’s experience of using this service:

People told us they felt safe. Staff understood safeguarding and whistleblowing procedures. Relatives said their family members were kept safe. Staff knew people well and risks were identified. Staff told us there were enough staff on duty to meet people’s needs, people told us there were always staff available and did not wait long for assistance. There was a safe recruitment process, which ensured only staff suitable to work with vulnerable adults were employed. Accidents and incidents were effectively monitored, which ensured staff learned when things went wrong. People were protected by the prevention and control of infection. Medication systems were in place and followed by staff to ensure people received their medicines as prescribed. We identified some documentation could be improved. However, this had already been picked up by the managers quality monitoring systems and was being addressed. We were sent evidence this had been completed following our site visit.

Staff we spoke with were knowledgeable about people needs. We observed that care provided was person-centred and individualised. Staff received effective training to ensure their knowledge was up to date. Staff were supervised and supported. 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 had access to health care professionals, staff worked closely with professionals to ensure people's needs were met. We observed interactions between staff and people who used the service these were positive, inclusive, respectful, and person-centred, promoting people’s well-being.

There was a quality monitoring system in place. Audits were undertaken to ensure good quality care and support was provided and any improvements required implemented. Relatives felt listened to and said staff and management were approachable. People we spoke with told us their views were obtained to continually drive improvements. Feedback from staff was extremely positive, told us communication was very good and the registered manager and new deputy were approachable, visible, listened and took appropriate action.

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 11 November 2017).

Why we inspected:

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well led. For those key questions not inspected, we used the ratings awarded previously to calculate the overall rating.

The overall rating for the service remains good.

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.

We found the following examples of good practice.

The premises were very clean. Staff followed detailed cleaning schedules to ensure all areas of the home were regularly cleaned. Suitable cleaning products were used to control the spread of infection.

Staff had received training about how to keep people safe from the risk of infection and how to use personal protective equipment (PPE) correctly. The provider ensured there was enough PPE available for staff at all times. We observed staff wearing appropriate PPE.

Tests for COVID-19 were being carried out in line with government guidance, by both staff and people living in the home.

Appropriate checks were completed before people moved into the home, to reduce the risk of infection being introduced to other people living in the home. The service obtained evidence that any person being admitted to the service had recently tested negative for COVID-19, prior to their arrival.

The home had a suitable system in place to support relatives and friends to visit people living in the home during the COVID-19 pandemic. Government guidance was being followed and the home had supported visits to recommence safely within the home. Visits were pre-booked to ensure they were staggered and the number of visitors in the home was manageable at all times. Visitors were required to complete a COVID-19 test prior to entering the home and wear PPE during their visit.

There were clear procedures in place to help ensure staff knew what action to take if they or a person living in the home displayed symptoms of COVID-19 or received a positive test result.

There was a manager at the service who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

Our last inspection at Taptonholme took place on 22 August 2016. We found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 9: Person centred care and Regulation 17: Good governance. The registered provider sent an action plan detailing how they were going to make improvements. At this inspection, we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of Regulation 9: Person centred care, as care plans and risk assessments were found to be accurate and up to date. We also found sufficient improvements had been made to meet the requirements of Regulation 17: Good governance, as systems were in place to effectively monitor the quality and safety of the service.

This inspection took place on 16 October 2017 and was unannounced. This meant the people who lived at Taptonholme and the staff who worked there did not know we were coming. On the day of our inspection there were 15 people living at Taptonholme.

People we were able to speak with spoke positively about their experience of living at Taptonholme. They told us they felt safe and they liked the staff.

Staff were aware of safeguarding procedures and knew what to do if an allegation was made or they suspected abuse.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Staff recruitment procedures were robust and ensured people’s safety was promoted.

Sufficient numbers of staff were provided to meet people’s needs.

Staff were provided with relevant training, supervision and appraisal so they had the skills they needed to undertake their role.

Whilst the home was well maintained, there was no dedicated maintenance person working at the home. This meant that small repairs and maintenance work could take longer to address.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected. Pictures and information about the meal choices on offer were not displayed to improve access to information.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

A programme of activities was in place so people were provided with a range of leisure opportunities.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

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. The registered manager was on leave during the inspection and the deputy manager supported the visit.

We found not everyone had a full and up to date care plan and risk assessment to guide staff in how to meet the person’s needs in a person-centred way. You can see what action we have asked the registered provider to take at the back of the full version of the report.

The quality and safety of the service had not been monitored effectively and shortfalls had not been dealt with consistently or had not been identified. You can see what action we have asked the registered provider to take at the back of the full version of the report.

We found there was an inconsistency regarding the application of the Mental Capacity Act 2005. The registered provider and registered manager had not always followed best practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests. We have made a recommendation about this.

There were policies and procedures to guide staff in how to keep people safe from abuse and harm. Staff had completed safeguarding training. Records showed concerns were generally reported to the local safeguarding team and CQC; however we found one incident had not been reported appropriately which we discussed with the deputy and registered managers and received assurance that any similar concerns would always be reported to the appropriate agency.

We found the service was generally clean and tidy in communal areas and bedrooms. There were some areas of the environment and practice that could be improved in regards to good infection prevention and control. These were mentioned to the deputy manager during the inspection to address.

We found people’s health care needs were met. Health professionals were contacted to ensure people received treatment and advice when required. People received their medicines as prescribed. Staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We observed kind and caring approaches from the staff team. People’s privacy and dignity were respected and staff provided people with explanations and information so they could make choices about aspects of their lives. There were positive comments from relatives about the staff team.

People enjoyed the meals provided to them. The menus enabled people to have choice and special diets when required. We saw people’s weight, their nutritional intake and their ability to eat and drink safely was monitored and referrals to dieticians and speech and language therapists took place when required for treatment and advice. During the day, we observed people were served drinks and snacks between meals.

We saw people were encouraged to participate in a range of activities within the service and local community. They were supported to maintain their independence where possible. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.

We found staff were recruited safely with appropriate employment checks carried out to ensure staff were suitable to work in care settings. New staff received an induction and all staff had access to training, supervision and support to ensure they felt confident when supporting people who used the service. We found there were sufficient staff on duty.

The registered provider had a complaints procedure on display. Relatives told us they would feel able to complain and any concerns would be looked into and addressed.

"Absolutely superb" and "Excellent care". A relative commented " The consistency of care is commendable". We found that the staff were supported and well trained to provide care to people who use the service.

We observed that the home had a happy and relaxed atmosphere and it was clean and tidy. We found that individual preferences were catered for and that people using the service were treated with respect and dignity.

We were told by the people using the service and their relatives that they would feel comfortable in approaching staff with any concerns they had. People using the service and their relative's felt that they were involved in their care and were kept informed of any changes.