Tudor Court Care Home

Tudor Court is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

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

Medicines processes and systems were in place and people received their medications as prescribed. However, medicines in a liquid or cream form had not been dated once opened. This meant that staff could not be assured that the medicine was safe and effective to use. We made a recommendation about this.

The environment was clean and staff followed infection control procedures in line with national guidance for reducing the spread of Covid-19.

People and their relatives told us they had no concerns about the quality of care at Tudor Court and felt that people living there were safe. Staff had a good understanding of safeguarding processes to keep people safe and knew how to report concerns.

Risks to people's health and well-being had been assessed and monitored to ensure they were kept safe. Regular checks of the environment, including equipment, fire and water safety, were completed to ensure it was safe for people to live in and complied with the relevant standards.

We observed the service had enough staff to meet people's needs. We saw people were attended to in a timely manner and staff were not rushed. Some staff reported to us that they were sometimes short staffed and relied heavily on agency staff, they felt they could not always give the care to people that they wanted to. However, this had improved recently and the registered manager told us they were actively trying to recruit staff.

The provider followed safe recruitment practices and ensured people were protected against the employment of unsuitable staff.

People's relatives told us the registered manager, management team and staff were supportive and approachable. The registered manager told us they engaged with people and their relatives on an ongoing basis.

The registered manager carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities.

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 January 2020).

Why we inspected

We undertook this focused inspection to check and review risks associated with information gathered from our monitoring activity. We undertook a focused inspection to review the key questions of safe, and well-led only. We found no evidence during this inspection that people were at risk of harm. Please see the safe and well led section of this focused report.

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.

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.

Tudor court is a residential care home providing personal care to 29 older people, some of whom may be living with dementia or memory loss. At the time of the inspection, there were 21 people living at the home.

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

The provider had made improvements to the home following our last inspection in November 2018.

Medicines were now managed in a safe way. Robust medicine management systems had been put in place that included regular auditing and daily checks to reduce the risk of error. These systems had been embedded into practice and enabled staff to ensure people received their medicines as prescribed.

Risks to people were now assessed and managed safely. Risks were monitored regularly, and daily checks were made to ensure people were receiving the care they needed to mitigate risk. Risks associated with premises safety had been addressed and maintained to ensure the environment was safe for people. The provider had taken steps ensure people were safe from the risks from falling from a height and hot surfaces.

The home was well-led by a management team who were passionate about improving care at Tudor Court and were driven to deliver a good service. Since the last inspection, quality assurance systems to monitor the safety of the home through audits and checks, had been strengthened. People, relatives and staff spoke positively about the registered manager and the care received.

People were supported by staff who understood how to keep them safe from the risk of abuse. Appropriate safeguarding procedures were in place and staff had been trained in how to protect people from abuse.

People and their relatives were positive about the quality of care and support people received. Staff treated people with kindness, respect and dignity and people's privacy was promoted. People were supported to maintain their independence and could make choices and decisions about their care.

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 home supported this practice.

Staff were recruited safely and provided with suitable training to ensure their skills and knowledge were up to date. Staff felt supported by the management team and received regular supervision to monitor their performance and discuss any issues.

Since the last inspection activities had been improved and an activities co-ordinator had been employed to engage people in activities they enjoyed. Staff interacted and engaged with people throughout the day to ensure people were not made to feel isolated.

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 requires improvement (published 18 January 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Tudor Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Tudor Court is registered to provide care, nursing and accommodation to a maximum of 29 older people, some of whom may be living with dementia or memory loss. At the time of the inspection, there were 21 people living at the home.

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.

Prior to the inspection we received a number of concerns about insufficient staffing levels, pressure area care and adequate welfare checks and supervision of people living in the home. As a result of these concerns we brought our comprehensive inspection forward to look into the care provided at Tudor Court.

Risks to people were assessed and risk assessments tools were used to identify common risks such as those relating to falls, skin integrity and medicines. However, daily monitoring records did not always show that care was being delivered as it should and checks on equipment used to reduce risk, were not always accurate. People were not always protected from risks associated with their environment. Some windows did not have window restrictors and one radiator did not have a cover fitted.

Improvements were required to ensure that medicines were managed safely. Whilst medicines were stored and administering safely, random sampling of five medicines found discrepancies with the stock levels of two medicines and staff were unable to tell us how much stock they should have of another medicine. During the inspection the registered manager amended their daily medicines audit to include stock checks of boxed medicines.

The provider had systems in place to monitor the quality and safety of the home, however, these were not always robust nor effective because they had failed to identify and address the issues we found during this inspection.

People and relatives had differing opinions about the amount of staff available and if there was enough staff to meet people’s needs. One person told us, “It seems to be fine. There are always some staff around. I have no concerns.” However, another person told us, “They can be rushed off their feet." Staff also felt they were short staffed. One said, “It’s terrible we are constantly short staffed. We are not spending enough time with people. The only time you spend with residents is when you get them up in the morning.” We made a recommendation to the provider to review their staffing levels to ensure people’s needs were met.

We found that improvement was needed in relation to supporting people to maintain their social activities and interests to avoid the risk of social isolation. The provider arranged a programme of entertainers that came into the home to provide activity. There was no activity coordinator. The responsibility to generate activity fell to the staff team. However, staff told us, and we observed, that staff rarely had time to sit with people and engage them in an activity they enjoyed. One person told us, “There’s nothing you can do here, only sit in the chair.” People and staff told us that staff talked to them when providing care but did not have time to spend with them for one to one activities. We made a recommendation to the provider regarding the provision of one to one activities.

People told us that they felt safe and secure living at Tudor Court. Comments included, “Yes, I feel safe, there are always two staff” and “I feel safe and well cared for.” People were protected from the risk of abuse because staff understood how to identify possible abuse and were clear in how they would report this. Staff told us they had received safeguarding training.

People were supported by staff that had been recruited safely and had sufficient knowledge and skills to enable them to care for people. There was a comprehensive staff training programme in place and staff told us they felt supported.

Staff respected people's privacy and dignity and interacted with people in a caring, compassionate and professional manner. People were encouraged to be as independent as possible but where additional support was needed this was provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the home supported this practice. Where people lacked the capacity to make decisions about their care, the home had taken appropriate action in line with the Mental Capacity Act 2005.

People's care plans were comprehensive, person centred and detailed, providing staff with relevant and appropriate guidance in how to support each person. There was personal information in people's care plans describing how the person wanted to spend their time, their likes and dislikes and other preferences.

People's nutritional needs were being assessed and they were supported to eat and drink sufficiently. Where people required further input, referrals were made promptly to other agencies and people were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

People living at the home, relatives and staff were happy with how the home was being managed. They found the registered manager and staff approachable. The registered manager regularly sought feedback from people living at the home and their relatives about the support provided. We saw evidence that the feedback received was used to develop and improve the service.

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

Tudor Court is a residential home in Paignton, Devon providing accommodation and care for up to 29 people. People living at the home are older people, most of who were living with dementia. On the day of our inspection, 24 people were living at the home. Accommodation consists of 28 bedrooms some had en-suite facilities.

The home 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 and associated Regulations about how the service is run.

People told us that they were happy and felt well cared for. It was clear to see that people were comfortable living at Tudor Court and really felt they were at home. People’s care was personalised and it was evident that staff knew people they were supporting very well. We saw them interacting with kindness and compassion. People and their families described management and staff as caring, respectful and approachable. The families we spoke with had regular contact with the registered manager.

People told us they felt safe, and we found that the registered manager had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in relation to safeguarding adults. Staff were knowledgeable about how to recognise and report abuse. We saw risk assessments in place regarding risks associated with people's care. These explained how people's care should be delivered in a safe way and how to reduce any risks involved.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people were deprived of their liberty applications had been appropriately made. For people who were assessed as not having capacity, records showed that their advocates or families and other health professionals were involved in making decisions in their best interests.

Staff had been recruited appropriately to ensure they were suitable to work at the home. People who lived at the home, families and staff told us there were sufficient numbers of staff on duty during the day but some concerns were raised about staffing levels at night. This was discussed with the registered manager who told us that staffing levels were determined by dependency and there were always two staff on duty at night. Rotas confirmed this. The registered manager felt that two staff would be able to meet the needs of people living at Tudor Court but would revise staffing and dependency levels within the home.

Staff knew how to meet people’s needs. Records showed they had a thorough induction and on-going training to help ensure they had the skills and knowledge they needed to provide effective care. We saw staff received regular supervision as part of their on-going development. This provided an opportunity to discuss their work, any concerns and any training opportunities they may have. We saw appropriate records were maintained to show these had taken place.

We looked at the way in which the home managed people’s medicines. Medicines were secured safely and accurate records were maintained. Staff received regular competency assessment checks to ensure the on-going safe management of medicines. Safe systems were in place to manage medicines so people received their medicines at the right times.

People and their relatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences. The care plans contained information about each person, who they were and how they should be supported to ensure their needs were met. However, we found that care plans would benefit from additional guidance for staff on individual preferences of how people wished to receive their care to ensure they are individual and fully person centred. We saw that care plans were reviewed regularly.

People told us they were satisfied with the meals. We saw that people were offered a nutritious and balanced diet which met their needs. People had a good choice of food and were served drinks and snacks in-between meals. We observed lunch being served and some people required assistance from staff to eat their meals. This was provided in a caring and unrushed manner.

Risks to people from malnutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. For example, where people had been assessed as being at risk with regards to their nutrition, we saw appropriate referrals were made. Staff ensured people obtained advice and support from other health professionals when their health needs changed. We saw care plans showed when professionals had been involved in people's care and referrals were made to other professionals when required.

People's preferences and personalities were reflected in the décor and personal items present in their rooms. People were living in a home that was comfortable and homely and suitable for their needs. The home had made some adaptations to meet the needs of people living with dementia. However, communal areas, corridors and people’s bedrooms were not well signed.

We have made a recommendation about dementia friendly signage.

People and relatives were asked for their views about the care provided and informed how to make a complaint or raise any concerns. These were acted on and used to make improvements for people's care when required.

The registered manager’s quality monitoring system included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's needs were assessed and care and treatment planned and delivered in line with their individual care plan. This was recorded in the five care plans we reviewed. People's daily care was recorded by the staff providing their care on each shift. This showed that care was provided as had been detailed in the plan. The people we spoke with told us that they could make choices about their care and felt well looked after.

One relative told us "I'm much happier with my relative being here, it was such a worry them being at home. We're happy knowing they are safe and well cared for. They added "The staff are lovely and we've seen an improvement in their well being."

People who use the service told us they felt safe and were well treated by the staff. When asked if they had ever been treated badly or witnessed anyone being treated badly, one person said "All the staff are lovely. There isn't one problem at all. If there was I can approach the Manager or any of the care staff."

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people's human rights. The Registered Manager said they had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the Manager was aware when an application should be made and knew where to go if an application was required.

Is the service effective?

Two relatives told us that they had visited the service before their family member had come to stay. They were shown around and were able to ask questions and given information about the care and choices that were available for their family member.

One person told us "We were lucky enough to be shown a choice of rooms. We chose the one that we thought suited them best." They added "We've seen an improvement in our family member since coming to live here, they are no longer lonely and if they are happy we are too."

People told us that they felt respected and involved in the planning of their care right from the start. One person told us "I'm very happy here, it's home from home. I was able to bring my own personal belongings for my room." They added "I had been for respite and I decided to stay. I can do as I please, my family visit, I go away with them and I couldn't be happier."

We were told care plans were reviewed monthly by care staff and reviewed annually by service users and their relatives. Examinations of people's files confirmed this was the case. This demonstrated people and their relatives had been involved in the planning and delivery of their care and had been asked to express their views. In addition we saw records were updated when people's needs changed. For example we saw people's medication was adjusted to improve their health and well being.

Is the service caring?

Decisions about care and treatment were made by the appropriate staff at the appropriate level. We saw that people's care records contained details about who had been involved in their care. We saw that healthcare professionals and clinicians had been involved in supporting people's healthcare needs when required. It was evident that the home regularly sought the support and advice of relevant professionals, such as, GP, hospitals and district nurses. This showed that staff were given information to enable them to provide care that met with people's specific needs.

People were able to choose to spend time in their rooms or in the communal areas of the home, or go out if they were able to. We observed people moving freely around the home and using the outside areas as they wished. These measures helped promote the rights and choices of the people who use the service.

Staff and the Registered Manager were knowledgeable about all the people in their care, and spoke warmly and sincerely about people using the service. We observed that all staff interactions with people were patient and respectful. There was a relaxed and friendly atmosphere in the home and we saw that people responded favourably to this. Staff were polite, respectful and friendly without exception.

Is the service responsive?

Care records also contained information on areas such as communication, behaviour, daily living, personal care, emotional needs, professional involvement and support and risk assessments. This showed that staff were given information to enable them to provide care that met the person's specific needs. Observations were made and recorded by staff if they felt people's needs were changing. This was then discussed with the individual or their representative and care plans updated to reflect a change when required.

Relatives told us that they were kept updated with their family member's progress by staff. One person said "Communication from the home is really good. They tell me if there are any changes." Another person said "Staff are constantly supportive with advice and are experienced in even difficult situations. The Manager has been a tower of strength during a difficult transition for me and my family member." This showed that people were being given information on the care and treatment being provided.

During the inspection, we looked at the quality and monitoring systems the provider had in place. People who used the service and their representatives were annually asked for their views about their care and treatment. We saw that people had completed the survey and positive comments had been made. This meant that people who used the service had an opportunity to have their say.

Following the survey the manager wrote to all service users and their next-of-kin identifying what comments had been made and what the provider intended to do to improve the service. For example some people had asked for a change to the menu and this had been done. This showed not only was the provider committed to a philosophy of continual quality improvement but was open and transparent in communications with people who used the service and their families.

Is the service well led?

All staff received one to one supervision four times a year and on-the-job supervision as and when required through supervision and observations by the manager. Any additional training needs for staff were identified and training completed if required. Supervision notes were completed and held on file. This demonstrated more structured supervision with the Manager was provided. Staff confirmed that they had the opportunity to raise any area of concern in supervision and told us that they felt well supported by the Manager and senior staff.

The Manager demonstrated a good awareness of the needs of the people that lived in the home and looked at good practice guidance in order to improve care provided. We saw that they sought professional advice when needed and this was in the best interests of the people that lived at the home.

This visit also started at 6am and we looked to see if people were still being got up early and if the provider had addressed the areas of non-compliance.On this visit we found the provider had made improvements.

We found that four people were up and in the lounge when we visited. One person had declined to go to bed, one person had come downstairs because it was too warm, one person sleeping and the fourth person's care notes stated they liked to get up around 6am.

At this visit we found there had been improvements in relation to the recording of people's preferences and weight records. We saw that where there had been concerns over people's weight, records showing their food and fluid intake were kept and reviewed.

We found that staff respected people's dignity and their choices in relation to what time they got up in the morning. We did not hear people being referred to by their room number or as 'singles' or 'doubles' ' a reference to how many staff were needed to care for them.

We saw that improvements had been made in the way care records were completed and reviewed.

We spoke to five people, four relatives, the manager, deputy manager and seven members of staff. We looked at 10 sets of care records.

Not all the people in the home were able to speak with us so we spent two periods of time observing interactions between staff and people.

We found that people were given choice and options about their care although they were not always treated in a respectful way. Staff were knowledgeable about peoples care needs and people accessed NHS services and community healthcare. However, sometimes did not have their care needs met appropriately at the home.

Relatives were pleased with the care their family members received and people spoke highly about the staff.

There were good recruitment processes in place and effective training and induction programmes in place which were monitored well. Staff knew what to do if they suspected abuse and were aware of how to raise any concerns.

Records were securely stored and generally kept up to date however, they did not always reflect staff knowledge of care needs or the care that had been delivered.