Tower House

Tower House is a residential care home providing accommodation and personal care to up to 12 older people in one adapted building. At the time of our inspection there were 12 people using the service.

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

Systems and processes to ensure effective oversight of the service required embedding into practice. The provider had a range of audits and had identified some of the concerns found on inspection. We made a recommendation regarding effective systems and processes being put into place.

Not all risks had been assessed and mitigating strategies recorded. However, people told us staff knew them well and understood their known risks.

People were supported by staff who knew them well and who had been safely recruited. We observed sufficient staff to meet people’s needs.

Staff received adequate training to ensure they understood and could respond to people’s individual needs and understand environmental risks.

People, relatives and staff were all positive regarding the management of the service. People and relatives described staff as kind, caring. The service had a positive culture, and the registered manager was visible and accessible to people, relatives and 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.

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 2 November 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

We carried out an unannounced comprehensive inspection of this service on 9 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 requires improvement to good based on the findings of this inspection.

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tower House is a residential care home providing personal and nursing care to 11 people aged 65 and over at the time of the inspection.

Tower House can accommodate up to 12 people in one adapted building.

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

Medicines were not always managed safely, and people did not always get their medicines as prescribed. Systems for ensuring peoples’ safety were not always managed effectively. There were sufficient staff to meet people’s needs. Infection control measures were in place.

Systems to monitor and improve the quality of the service were not always effective. The management team promoted a person-centred service that valued people as individuals. People described the service as ‘a family’ and were involved in decisions about the service.

Staff felt supported and completed training to give them the skills and knowledge to meet peoples’ needs. People were positive about the food and received food and drink to meet their dietary needs. The service had a good working relationship with health professionals and people were supported to access health services when needed.

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 were kind and caring. People and relatives described staff as ‘exceptional.’ People were treated with dignity and their choices respected. Staff encouraged and promoted people’s independence.

People’s care needs were assessed and there were care plans in place to guide staff in how to support people. People were able to spend their day as they chose and had access to some activities. Any issues raised were resolved and people were comfortable to raise concerns.

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 13 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines and the safety of people in the event of an emergency. The systems to monitor and improve the service are not effective.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

There were sufficient staff to meet people's needs. Staff were not rushed in their duties and had time to chat with people. Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. People received their medicines as prescribed.

People continued to receive effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

The service continued to provide support in a caring way. Staff were kind and respectful and treated people with dignity and respect. People benefited from caring relationships with staff. People were involved in decisions about their care needs and the support they required to meet those needs.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. Staff understood people's needs and preferences. People's needs were assessed to ensure they received personalised care. There was a range of activities for people to engage with.

The service was led by a registered manager and deputy manager who promoted a service that put people at the forefront of all the service did. There was a positive culture that valued people, relatives and staff.

During our inspection we observed a clean environment throughout the home. People who use the service and relatives we spoke with told us the home was kept clean and tidy. People were protected from the risk of infection because guidelines published by the Department of Health about infection prevention and control had been followed.

The provider had put measures in place to ensure staff received appropriate training and professional development. This was to enable them to deliver care and treatment to people safely and to an appropriate standard. A system of staff supervision and appraisal was in place to support workers.

People who use the service told us they felt safe and trusted staff. However the provider had not ensured that users of the service were safeguarded against the risk of abuse by identifying and responding appropriately to incidents involving allegations of abuse.

During our inspection we observed a clean environment throughout the home. There were audit schedules in place to ensure standards of cleanliness were maintained. People living in the home and relatives we spoke with told us the home was always kept clean and tidy. However, people were not always protected from the risk of infection because some protocols based on current Department of Health guidelines had not been followed.

Appropriate checks were not always undertaken by the provider before staff began work. For example; enhanced Criminal Records Bureau checks (now called Disclosure and Barring Service checks) and full employment histories. This meant the provider did not have an effective recruitment process to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable.

A system of staff supervision and appraisal was in place to support workers. Staff did receive appropriate training and professional development to enable them to deliver care and treatment to service users safely and to an appropriate standard.

Systems were in place to identify any possible concerns in the delivery and quality of care. These included collecting feedback from people, staff and health care professionals and a complaints procedure. Where improvements to services were required, these were made.

One person said, 'I like to stay in my room, staff come in to see me often, and sit and talk to me'. Another person said, 'They will always cook something else for me if I don't like what is on the menu'. We found from our observations that people were not always treated with dignity and respect.

We spoke with staff and looked at people's care plans and supporting documents. We found that peoples care plans detailed people's needs and associated risks and had detailed how to meet those needs whilst minimising identified risk.

The provider had not always ensured staff received appropriate professional development or support to deliver care and support to the people who live in the home.

We found people and their relatives did not have opportunities to contribute their views about the quality of the service. We found the provider did not have any system for monitoring services provided to be confident people were being well cared for and safe.