Archived: Tunnicliffe House

Tunnicliffe House is a residential care home that provides accommodation and personal care for up to 16 people. Tunnicliffe House is a small domestic style building in a quiet cul-de-sac that offers accommodation over two storeys. At the time of our inspection there were 10 people using the service.

People’s experience of using this service and what we found

Some lessons had been learnt since the last inspection and improvements had been made to health and safety systems. All required environmental and smoking risk assessments were now in place.

Risks to people were not always managed effectively to protect them from potential harm. Additional risk assessments needed to be in place to mitigate risks around skin integrity and continence care for one person and another person who required blended foods. The provider had learnt lessons following incidents and accidents but had not recorded them.

People told us they received support from a consistent team of staff that knew them well. Staff were safely recruited and received training. There were enough staff to ensure people’s needs were met.

Medicines were managed safely by trained and competent staff. Infection controls procedures were in place and followed by staff.

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 told us they felt involved, listened to and consulted. They said they attended regular residents’ meetings held at the service. People spoke positively about the provider and management team and said they were visible and approachable at the service.

The service worked in partnership with other agencies to support people’s physical and mental health needs.

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 22 July 2019) and there were breaches of regulation. 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 that although some improvements had been made the provider remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

At the last inspection a recommendation was put in place for the provider to review best practice guidance in relation to the principles of ‘Registering the Right Support.’ At this inspection we found the provider had done this however; all the people they continued to support had mental health needs and no new admissions had occurred since the last inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tunnicliffe House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) at this inspection. The provider had not ensured all risks relating to people were considered and had not always taken prompt action following incidents that had occurred at the service. Systems were not always effective at identifying risks to people and taking prompt action to address them. Lessons learned were not consistently recorded.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tunnicliffe House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection. Tunnicliffe House is small domestic style building in a quiet cul-de-sac that offers two-storeys and can accommodates up to 16 people. At the time of the inspection 13 people were receiving support.

In June 2017, CQC published Registering the Right Support. The service had not been developed and designed in line with the principles and values that underpin this publication and other best practice guidance. This guidance reflects the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service was registered for people with mental health needs and four people with learning disabilities. However, there was no one living at the service with a learning disability. The provider advised they would review the principles in practice to see how they could update the service to reflect best practice.

We have made a recommendation for the registered provider to review best practice guidance in updating their service and on reflecting the principles of ‘Registering the Right Support.’

People’s experience of using this service and what we found

Quality assurance measures were informal and had no recorded checks in place. They lacked any process to show oversight and general management of the quality of the service. The registered provider was proactive during the inspection and took actions to improve all aspects of records to demonstrate appropriate audits and checks within the service.

The registered provider was knowledgeable about the actions they took to keep people safe. However, aspects of health and safety needed improving. There was a lack of records to show how risks were managed for the environment, for evacuating people in the event of a fire and the health and safety policy was out of date.

The management of medications needed review as staff had not routinely signed in the delivery of medications each month. This meant it was difficult to accurately audit medications.

Aspects of the environment were well maintained but needed updates to reflect a homelier environment. For example, bedroom doors had some frosted glass windows which did not reflect good practice in promoting privacy. The provider took immediate actions to cover windows to promote each person’s privacy. The use of CCTV within the building had not been appropriately registered and managed. The registered provider made the decision to remove the use of CCTV during the inspection.

Support plans and risk assessments generally contained the correct level of information in relation to the support people needed. However, the records needed improving as they did not always record updates or reviews.

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. However, records were not always updated to reflect people’s choices and in identifying people’s consent.

The registered provider had a complaints procedure in place. Complaints records were brief and in need of improvements to reflect a full audit trail of investigating people’s concerns. No one raised any complaints during the inspection. People and their relatives told us they would speak with the staff at any time to raise any issues.

People told us that they were happy with the support they received. There was a friendly atmosphere at the service. People were relaxed and comfortable with staff. People and relatives told us they liked Tunnicliffe House and got on well with all the staff. Although most people lived independently, some people suggested they would like regular meals out with staff and a holiday each year.

Staff were familiar with people’s likes and preferences and positive relationships had developed between them. Staff were long standing members of staff offering great stability and most people had lived at the service for many years.

Rating at last inspection and update The last rating for this service was 'good' (published 12 May 2016.)

Why we inspected This was a planned inspection based on the previous rating.

Enforcement We have identified breaches in relation to 'health and safety' and 'good governance' at this inspection. The provider has taken action during the inspection to mitigate the risks identified.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will work with the 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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Tunnicliffe House is a large detached property in a quiet cul-de-sac close to Macclesfield town centre. The people who live there are accommodated on the ground and first floors of the building. There are six single and five double bedrooms. The home has a passenger stair lift to access between the ground and first floor. Staff members are on duty 24 hours a day to provide support for the people who live in the home. At the time of our visit there were 13 people living there. Twelve people had lived there for a long time and one person had recently moved in.

Tunnicliffe House had a registered manager. 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.

Prior to this inspection we contacted the local authority quality monitoring team. They told us that they had visited in March and June last year and had identified some minor issues with the staff supervision system in place. This was addressed and during this inspection we were able to confirm the improvements had been maintained. Full details regarding this are in the main body of the report.

We asked people if they felt safe living at Tunnicliffe House. All the people who commented said that they did and that they were happy living there. Comments included, “Of course I am, [we] have all that we need”, “Staff are good”, “Very safe” and “I am safe here and get on with the staff”. We did observe a relaxed and welcoming atmosphere in the home between the people living there and the staff and owners.

The service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

We looked at the files for the two most recently appointed staff members to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We asked the staff member on duty about training and they confirmed that they received regular training throughout the year and that it was up to date.

The service had a range of policies and procedures which included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. .

There was a flexible menu in place which provided a good variety of food to the people using the service.

The four care plans we looked at contained personalised information and they were written in a style that would enable any staff member reading it to have a good idea of what help and assistance someone needed at a particular time. Three of the plans that we looked at were well-maintained and were being reviewed monthly so staff would know what changes, if any, had been made. We did identify one plan that was in need of up-dating. We queried this with the registered manager who explained that a new deputy manager had recently been appointed. She was in the process of reviewing them all and they were being re-written if necessary. We have since received written confirmation that the review process had now been completed and all of the care plans have been up-dated so no further action is needed.

The staff member on duty during our inspection was positive about how the home was being managed and throughout the inspection we observed them, the member of the domestic team on duty and the two owners who were also present interacting with each other in a professional manner.

We found that the providers used a variety of methods in order to assess the quality of the service they were providing to people. These included regular contact with the people living at Tunnicliffe House.

The care being delivered at the home was person centre because people living there were involved in their care decisions were appropriate whilst respecting the person and their dignity. Reasonable processes were in place to ensure people were protected from harm or risk.

We spoke with people who lived at the home; we asked them to share with us their views and experience of care support they received. One person told us 'I have lived here a long time; the care is brilliant; they (the staff) give me my medication on time when I need it.'

We spoke with four people who lived at the home and they told us that staff looked after them well and showed them dignity and respect at all times.

We reviewed four care files and found them to be well organised; the care documents provided staff with detailed information on how to support people's needs.

We spoke with staff who had an understanding of how to protect vulnerable adults and how to report any concerns.

Systems were in place to review the people's care needs and dependencies to contribute towards the preparation of the staffing rotas. We were told by staff that they felt the staffing levels were sufficient and managed effectively.

We spoke with staff who told us they felt well supported by the management and colleagues. They (the staff) said they worked well as a team and enjoyed their job.

We spoke to one person who said there had been changes made to the home which included a new assisted shower area and this had made their life alot easier. We spoke to another person who had moved rooms because they needed to be on the ground floor now and they were happy with this.

People also said that the staff were "very good"; one person told us that they were "very lucky to be here". Some people who live at the home have done so for a number of years and said that they "have been very happy here". We also spoke to one person who had moved recently to the home and commented that they were settling in very well and "like it here a lot".