Archived: Tiddington Court Limited

Tiddington Court is registered to provide personal care to older people. Care and support was provided to people at pre-arranged times in a specialist ‘independent living’ service. Tiddington Court consists of 30 apartments and 12 bungalows. People living at Tiddington Court own their own home and share on-site communal facilities such as a passenger lift, lounge, dining room and the use of an on-site restaurant.

This provider is based at Tiddington Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living at Tiddington Court receives a regulated activity of personal care. At the time of this inspection visit, Tiddington Court staff supported three people, so we only looked at the care and support for those three people receiving personal care from this provider.

People's experience of using this service

At the previous inspection, provider audits needed to be improved and become embedded. At this visit we found those improvements had not been made. We asked to look at audits for incident and accidents, analysis of falls, care plan audits, risk management, staff training, complaints, medicines and survey questionnaires to see how actions had been taken to drive improvements. Some of the analysis of information was either not completed or inaccurate, so we could not be confident actions were taken when improvements were identified. This meant the registered manager and the provider had limited assurances people received a safe, effective and well led service.

We looked at infection prevention and control measures under the Safe key question. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. Infection control systems implemented during a pandemic were in place, however these were not always followed and observed. People and staff told us on some occasions, face masks were not worn when providing personal care. During our visit, the management team were based in a small office and on occasions, up to four senior staff were seen, not socially distancing and not wearing a face mask in line with government guidelines. Some of these staff could meet those people who received a regulated activity.

People’s plans of care were not detailed enough for staff to provide safe care. The registered manager was in the process of updating those plans with important information that staff needed to know. Staff’s knowledge of how to support people was inconsistent.

Risks related to people’s care were not recorded, accurate and reviewed. Some risks were scored, however there was no instructions for staff to follow to manage those identified risks. Where people were at risk of falling, records were not consistent with events and although falls analysis was completed, it failed to record all falls and incidents. In some examples, intervention by a GP or falls team was suggested. There was no evidence to show, this had been followed.

Staffing levels met people’s needs. People told us staff supported them in an unrushed manner and were able to respond to requests for support without any undue delay.

People receiving personal care, spoke positively about their experiences living at Tiddington Court and the quality of their care demonstrated by the staff team.

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 28 November 2018)

Why we inspected

The inspection was prompted in part due to information received about concerns in relation to staff supporting people with personal care, a lack of training, staff not adhering to government guidelines with PPE and a culture of staff not feeling supported. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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 Tiddington Court on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe care and treatment and good governance 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 from 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.

Further information is in the detailed findings below.

Tiddington Court is registered to provide personal care to older people. Care and support was provided to people at prearranged times in a specialist ‘extra care’ housing service. Tiddington Court consists of 30 apartments and 12 bungalows. People living at Tiddington Court share on site facilities such as a passenger lift, lounge, dining room and the use of an onsite restaurant.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. At Tiddington Court, each person exclusively owns their own home and the building is designed to enable and facilitate the delivery of care and housing related support to people now, or in the future. The provider is based at Tiddington Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living in extra care housing receives regulated personal care.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection only looked at people’s personal care service provided by Tiddington Court.

At the time of this inspection visit, Tiddington Court staff supported six people. Therefore, for this inspection, we only looked at the care and support for those six people receiving personal care from this provider. All six people continued to be independent and did not have any complex care needs.

The service 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.

At our last inspection we rated the service Good overall and found the service continued to be Good. However, in well led, we found this had changed to requires improvement because there were limited and effective quality assurance checks recorded that assured the provider, people received good care outcomes.

People were pleased and satisfied with the quality of care provided by a consistent, kind and caring staff team. People and relatives were complimentary of the service and staff and people said there were enough staff to provide them with the care and support they needed, at the times they preferred. There was flexibility in the rota to enable people to change their times if needed and any emergency calls, could be responded to.

People said the service was well managed and changes in management since our last inspection had positive results on the care provision. Staff echoed people’s comments. Staff were complimentary of the management and said the changes had meant people and staff were more settled and enjoyed living and working at Tiddington Court.

The provider promoted independent living and people were supported to remain as independent as possible so they could live their lives as they wanted. People made day to day choices about what they wanted to do for themselves and how they lived their lives. People were encouraged to maintain important relationships with family and people built friendships with others living at Tiddington Court.

Care plans needed more specific information for staff to provide consistent and individualised care. For people assessed as being at risk, care records did not include sufficient information for staff to help minimise those risks, although we saw, this did not have a negative impact on people who received care.

Staff knew how to keep people safe from the risk of abuse. Staff and the management team understood what actions they needed to take if they had any concerns for people's wellbeing or safety. People told us they felt safe, comfortable and at ease when staff provided their support.

Training records showed staff training was up to date and staff were equipped with the skills and knowledge to look after those in their care.

Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). All six-people had capacity to make their own decisions and staff sought people’s consent before any care and support was provided. Staff recognised this was an important part of their role in promoting choice and continuing to promote people’s independence.

People or their families made their own healthcare appointments. Some people received regular support from district nurses and people continued to be registered with their own GP practice. If people required healthcare support in an emergency, staff were available 24 hours a day to seek that help.

Most people took responsibility for their own medicines management while staff supported others by administering their medicines and recording what was given.

There were limited examples of completed audits and checks that gave the registered manager and the provider confidence people received a safe, responsive and effective service. We asked to look at audits for incident and accidents, analysis of falls, care plan audits, complaints, medicines and survey questionnaires to see how actions had been taken to drive improvements. Records were available in some cases, however analysis or records of what was checked were not always completed, so we could not be confident actions were taken when improvements were identified.

Further information is in the detailed findings below.

Tiddington Court provides a home care agency service which can include personal care delivery, depending on individual needs. The provider manages Tiddington Court which provides home ownership for up to 42 people in their own apartment or bungalow. The amount of care and support varies from a few hours domestic support each week, to people receiving support up to 24 hours a day. At the time of our visit four people purchased care and support from Tiddington Court staff and others purchased their care and support from other external home care agencies.

Tiddington Court had a manager who was not yet registered. 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.

People told us they felt safe. There were systems to ensure peoples’ safety was managed effectively. Staff were aware of the actions to take to report their concerns. There were sufficient staff to ensure peoples’ needs were met and people were supported to manage their medicines safely.

People received care and support from staff who were trained and well supported. Staff knew people well and understood, and met, their needs. Peoples’ rights to make decisions about their care were respected. The manager and staff had a good understanding of the Mental Capacity Act 2005.

People told us the staff were kind, caring and respectful. People were involved in decisions about their care on a day to day basis.

There were opportunities for people to pursue their interests and access the local community. Peoples’ care records were detailed and provided staff with sufficient guidance to ensure their needs were met consistently. People had access to information on how to make a complaint and were confident their concerns would be acted on.

People were encouraged to provide feedback on the service in various ways. The provider had an effective system for assuring quality. There were however inconsistencies in recording in staff files.

People who lived at Tiddington Court told us, 'Wonderful community.'

We saw staff were kind and attentive when speaking with people. We saw people were supported and encouraged to maintain their independence.

We looked at two people's care records and saw their care plans reflected their personal needs.

We found the court worked well with other providers, for example outside care agencies. This ensured safe care was delivered to people.

Care staff had received training to enable them to look after people safely. We saw some of the staff had a formal meeting with the manager.

We found the service had systems in place to monitor the quality of service provided at Tiddington Court.

We last inspected the service on 13 August 2012 and we found the provider had not provided care staff with relevant training in the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLs).

A system to safeguard people's money was not in place and whilst we were inspecting the service a safeguarding referral was made. We also found that the provider did not have a system in place to monitor the quality of service provision. For example, regular medication audits and a system to monitor complaints.

We were told by the provider that training would be delivered and systems would be in place by 19 December 2012.

We saw training had been delivered in MCA and DoLs. The provider had undertaken an investigation into the safeguarding allegation with the local authority and the provider had taken appropriate action.

We saw systems were in place to record and monitor complaints and regular audits had taken place to ensure medication had been correctly administered to people who used the service.

The provider had undertaken regular meetings with care staff to enable them to raise any concerns and to support them with their training needs.