Tunstall Hall Care Centre

Updated 10 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Tunstall Hall Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. Tunstall Hall Care Centre is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection we spoke with two people who used the service and ten relatives about their experience of the care provided. We spoke with 11 members of staff, this included senior staff, care support staff, cook, domestic staff and activity coordinators. In addition, we with spoke with the registered manager and the deputy manager. We reviewed a range of records. This included five people's care records and multiple medication records.

We looked at three staff files in relation to recruitment and staff supervision. In addition, we reviewed a variety of records relating to the management of the service, including policies and procedures.

Updated 10 September 2022

About the service

Tunstall Hall Care Centre is a care home without nursing care. The home accommodates a maximum of 31 people in one large building and two separate bungalows. At the time of our inspection 29 people lived in the home, some of whom were living with dementia. Care was provided over three floors. On the ground floor there were large communal rooms, including a lounge, dining room and a library for people to enjoy. Bedrooms were located on the first and second floor, a lift was accessible to each floor. There were large gardens surrounding the home.

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

We found risks to people were not always assessed, managed or monitored safely. People's medicines were not always stored or administered in a safe way. Medicine stocks were not closely monitored. Risk assessments were not always completed for people’s specific risks and people's weights were not always adequately monitored in line their care and support plan. Some items, which could cause significant harm if ingested, were stored in rooms where the key was located on the wall next to the locked door.

Infection prevention control policies were not always followed regarding safe hand care practices and COVID-19 safe visiting practice.

The registered managers carried out quality assurance processes, including internal audits. However, these were not always effective in identifying the concerns we identified. This meant errors were missed which could potentially cause harm.

Notifications involving safeguarding were not always reported to us, in line with regulatory responsibility.

Concerns identified on the first day of inspection which could have been actioned were found again on the second day.

During the inspection there was a COVID-19 outbreak. Most people had chosen to self-isolate in their rooms. Staff told us how they felt rushed and under pressure to support people individually in their bedrooms.

The registered manager addressed all concerns identified and put in additional measures and systems to keep people safe from harm. We will review these in the next inspection.

People felt safe living at the home and with the staff who supported them.

Staff were recruited safely, they received a detailed induction and ongoing training.

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. Staff gained consent from people before assisting them and respected their privacy.

Staff used personal protective equipment (PPE) effectively and had attended infection prevention control training.

People’s communication needs were assessed, and people were supported to maintain relationships with others.

People told us they received care from kind and compassionate staff members.

People and relatives told us the food was well prepared and there were numerous activities for people to enjoy.

Relatives told us they felt their family members received person-centred care. They said staff respected people’s dignity and encouraged people to be independent.

Accident and incident forms were investigated by the management team. Lessons learnt were shared with the staff team.

End of life care plans were detailed and included people's preferences and wishes.

Staff told us they received regular supervisions and took part in regular team meetings.

The provider worked with other health and social care organisations to improve care and support for people using the service.

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 20 December 2018).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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 Good to Requires Improvement. This is based on the findings at this inspection. The provider took effective action to mitigate some of the risks during the inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

Enforcement

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 the way people's risks were assessed and monitored, medicines management, and governance systems at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.