Archived: The Tudors

About the service

The Tudors is a residential care home providing personal care and accommodation to up to 21 people. At the time of the inspection, 13 people were living there. The service supports older people with a range of needs in one converted building.

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

This was a targeted inspection that considered fire safety at The Tudors. Based on our inspection of fire safety, we found people were not always protected from the risks of their environment and equipment. Action had not been taken by the provider to make sufficient changes to the environment to improve the safety of the service. In addition, specific safety concerns which had been identified by experts and external professionals had not been addressed in a timely manner.

The staff team at the service had made changes where possible to improve staff knowledge and skills and keep people safe. For example carrying out fire drills, sharing information and carrying out additional checks of the environment.

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 12 August 2022).

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 the provider remained in breach of regulations.

Why we inspected

We had planned to check whether the Warning Notices we previously served in relation to Regulations 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We learned that the provider had entered administration and the closure of The Tudors was planned within a few weeks.

We therefore undertook this targeted inspection to check on a specific concern we had about fire safety. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check 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.

Follow up

We will meet with the provider following this report being published to discuss 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 further actions.

About the service

The Tudors is a residential care home providing accommodation and personal care to up to 21 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 16 people using the service.

The Tudors is in an adapted residential building with individual bedrooms on two floors, ground floor communal spaces and a rear garden.

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

People could be at risk of harm in the event of an emergency situation because health and safety standards were not always assessed and maintained in accordance with legislation and guidance. Risks included fire doors which did not comply with regulations, an ineffective evacuation strategy and lack of practical staff training and knowledge.

Risks to people were not always managed safely. Risk assessments relating to the health, safety and welfare of people using services were not complete or reviewed regularly. This meant staff did not have current guidance to support them in caring for people.

Medicines were not always managed safely. This included the ordering, safe storage and management of medicines. Audits had been carried out but had not always identified the shortfalls we found during our inspection.

Staff had received training, but some information was not well understood or embedded in their everyday practice. We have made a recommendation about staff training and comprehension. Staff were beginning to receive supervision and consistent support.

Governance processes were not always effective because they had not been consistently and robustly embedded. Improvements were not introduced because standards had not been regularly monitored.

There had been several changes within the management team which had led to a lack of consistency and oversight. Concerns had not always been identified relating to the safety, quality and standard of the service. Monitoring systems and processes had been introduced, but these were not yet carried out consistently or embedded. The new management team appeared open to feedback and were keen to make improvements.

There were enough staff to support people safely, and staff knew people well. Safe recruitment practices were in place, and work was underway to standardise staff personnel files.

People were kept safe from COVID-19 and other infection outbreaks effectively. Improved cleaning regimes and recording was needed in some bedrooms and bathrooms.

People were kept safe from avoidable harm and staff told us they would take action if they had concerns about abuse or risk to people.

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.

The management team were keen to develop an open and positive culture within the service. They aimed to keep people and their families at the heart of what they did and worked with staff to ensure they provided high quality care.

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 14 July 2021).

Why we inspected

We received concerns in relation to the safety of the building, fire safety, staffing and management oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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 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 The Tudors 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 the safe care and treatment of people who lived at the service, the premises and equipment, management systems and monitoring. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The Tudors is a residential care home providing personal care and accommodation to people aged 65. The service can support up to 21 people. At the time of the inspection 16 were living at the home.

The home is arranged over two floors. There is communal lounges and a dining room on the ground floor. The service has a large garden area.

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

People were safe. People and relatives spoke positively about the care and support received. The service was clean. Staff were clear on infection prevention and control measures.

Medicines were administered and managed safely. Assessments were in place to identify and reduce risks to people. Staff knew how to identify and report safeguarding concerns.

The service was well-led. We received positive feedback about how the service was managed. There was a calm and positive atmosphere. Systems were in place to monitor and review the quality of 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 21 January 2018).

Why we inspected

We received a range of concerns about people’s care and support. As a result, we undertook a 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 not changed and remains Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern.

You can read our previous reports, by selecting the ‘all reports’ link for The Tudors 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.

The Tudors is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Tudors is registered to provide personal care and accommodation to up to 21 people. The home is an older style building with accommodation for people arranged over two floors. The second floor can be accessed by stair lifts. The home specialises in the care of older people. At the time of the inspection there were 13 people living at the home.

Following the last inspection in October 2016 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective and Well led, to at least good.

At the last inspection we found that improvements were needed in the recording of medicines administration, staff training and ensuring people’s legal rights were respected. At this inspection we found that improvements had been made in all these areas.

At the last inspection we also found that improvements were needed to make sure the service was well led and there were systems in place to effectively monitor the quality of care provided to people. At this inspection we found that improvements had been made but further improvements were needed in this area.

Records maintained, including risk assessments and internal audits, were not robust. They did not give full information about who would be responsible for actions or how control measures identified in risk assessments would be reviewed to promote people’s independence. The poor quality of the records could potentially place people at risk because staff may not have all the information required to safely and effectively support people.

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.

People said that the registered manager and the provider were very approachable and listened to their views and concerns.

People felt involved in decisions about their care and told us they made choices about their day to day lives. However records seen did not always show how people had been involved in planning or reviewing their care needs.

Staff said they felt well supported and it was a ‘Happy’ place to work. This helped to create a warm and homely environment for people. One visitor described the home as being like a family.

People were cared for by staff who were kind and caring. Throughout the day we saw staff showed kindness and patience when supporting people. People were supported with personal care in a way that respected their privacy and dignity.

The provider had systems in place to help to minimise the risks of abuse to people and people felt safe at the home. One person said, “I do feel safe here. Everyone is nice and they make sure it’s all locked up at night. It gives you peace of mind.”

People told us they would be comfortable to make a complaint if they had any concerns about their care. One person said, “I would just talk to [staff member’s name] they’d sort out anything.”

Further information is in the detailed findings below

The Tudors is registered to provide accommodation with personal care for up to 21 older people. The service does not provide nursing care. At the time of this inspection there were 20 people living there (including two people who were in hospital). There was a registered manager in place. 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, and we saw evidence of many improvements to the building, services and care since the provider took over the home. Further improvements to the environment were planned. However we identified some further areas where actions were needed in their management of medicines, staff training, assessment of people’s capacity to make decisions, and notification of incidents, accidents and deaths. The providers and registered manager carried out a range of quality monitoring checks on a weekly and monthly basis. However, further improvements were needed to the quality monitoring processes to ensure all legal requirements were met.

While medicines were generally stored and administered safely there were some areas where improvements were needed. Tablets were stored, administered and recorded safely. However, there were gaps in the records of creams and lotions and this meant there was a risk some creams had not been administered regularly in accordance with the prescriber’s instructions. Medicines that required refrigeration were not stored securely.

There was a warm and friendly atmosphere in the home. People praised the care and services they received. One person said “Everyone is very kind to you. Very thoughtful.” A relative told us “I am quite happy with the care they give to (person’s name). I think we can say (person’s name) is very happy.” The staff were patient, kind and friendly.

There were sufficient staff to meet people’s needs. We asked a person if they thought there were enough staff and they replied “I think so. If you want any help someone will come and help you.” A member of staff told us “There are enough staff. Everyone knows what they have to do. Nobody rushes.” However, staff training needs had not been closely monitored to ensure staff had received essential training and updates to enable them to meet people’s needs effectively. Risks of abuse were minimised because the provider checked all new staff and made sure they knew how to recognise and report abuse.

People were confident their health needs were met effectively. Regular checks were carried out to enable staff to pick up and act on any signs of potential illness quickly. Where concerns were noted the staff contacted the person’s GP or health professionals promptly for advice or treatment.

People were offered meals and drinks in accordance with their dietary needs and preferences. People told us they enjoyed the meals. For example, one person “The food is good wholesome food.”

People received care that met their assessed needs from staff who had sufficient information about how they wished to be supported. Before a person moved into the home an assessment of their needs was carried out. This information was used to draw up a plan of their care. People told us they were satisfied with the care they received.

People had opportunities to take part in a range of activities that met their individual needs. Group activities included games, arts and crafts, parties, visiting entertainers. People had been consulted in resident’s meetings about the activities they wanted staff to arrange. They had been on various outings and shopping trips including Clarkes Shopping Village and a local school. Staff described how some people ‘came to life’ when activities were provided.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014).You can see what action we told the provider to take at the back of the full version of the report.