We carried out a review of the data available to us about Tudor Bank Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tudor Bank Nursing Home, you can give feedback on this service.
Tudor Bank is a residential care home providing personal care to 39 people at the time of our inspection. The service can support 46 people across two floors. The service consisted of two halves, one which specialised in the care for those living with dementia, and one for those living with enduring mental health conditions. The service is located within a residential area of Southport with access to shops, public transport links and parks.
People's experience of using this service and what we found
At our last inspection we rated the service overall as Good and Outstanding in the caring domain. There has now been a change of rating to Outstanding for the responsive and well-led domains.
The culture and ethos of the service was to ‘make it happen’ for people. The registered manager told us, "People come to Tudor Bank to live, we make every day count.’’ The service focused on pro-active approaches, and staff worked hard to ensure that people lived a life which was meaningful to them. People’s diverse needs were not seen as barriers to people living life to the full.
Distinctive leadership at the service meant that every member of staff genuinely valued the uniqueness of each person, and promoted the provision of care and support as individual as the person receiving it. Staff were passionate about empowering people to have a say in the care and support they wanted, and ensuring people received person-centred and dignified support of an exceptionally high standard.
The service took the time to get to know about what was most important to people. This information was used to determine people’s aspirations for the future, and to empower people to live a more independent and enriched life.
Tudor Bank had a relaxed and informal environment. People told us they thought of Tudor Bank as their own home. People’s relatives told us they were often astonished by how much progress their loved one had made since arriving at Tudor Bank, and how they were now enjoying ''a quality of life they wouldn’t otherwise have had.’’
People received care and support from staff who were kind, caring and compassionate and familiar to them. It was evident staff had formed genuine relationships and bonds with the people they supported. Staff told us they, ‘’looked forward to coming to work and making people smile.’’
The service demonstrated great innovation in its commitment to continuously seek ways to drive forward improvements. This drive and innovation helped to achieve extremely positive outcomes for people.
People were supported in such a way that allowed them 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
At our last inspection, the service was rated "Good." (Report published August 2017).
Why we inspected
This was a planned inspection based on the rating of the last inspection.
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.
Situated in Birkdale and located close to public transport links, leisure and shopping facilities, Tudor Bank Nursing Home is registered to provide accommodation for up to 46 younger and older adults who have mental health needs and require nursing or personal care. The location has a specialist unit for people living with dementia. It is a large three storey property which is fitted with a passenger lift. All the bedrooms are currently in use for single occupancy and have hand-basins.
At the time of inspection 18 people were using the services for younger people with mental health conditions and 24 people were using the dementia services.
A registered manager was 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.
At the last inspection, the service was rated Good.
At this inspection we found the service remained Good.
Why the service is rated Good.
People and their relatives told us that the service at Tudor Bank was safe. Staff were deployed in sufficient numbers to monitor people’s safety. We asked people living in the home and their relatives about staffing levels. Everyone said they thought there were enough staff on duty to meet people’s needs and keep them safe. We saw that staff were not rushed and were available to monitor and provide care as required. Staff were recruited in accordance with a robust procedure.
We saw that people were protected from the risk of abuse or harm because staff knew people well and were vigilant in monitoring risk. Risk assessments had been regularly reviewed and changes applied where necessary.
Medicines were safely managed within the service by nursing staff and in accordance with best-practice guidance for care homes. We checked the storage, administration and record-keeping for medicines and found that stock levels were correct and records were completed correctly. We noted one stock error which had been caused by a labelling mistake at the pharmacy. This was addressed immediately by staff.
Safety checks had been completed as required. Safety certificates were up to date although there had been a slight delay in the gas safety check caused by a late cancellation by the contractor. This was addressed during the inspection and no issues were identified.
Staff were trained in subjects relevant to the needs of people living at Tudor Bank. This training was refreshed on a regular basis.
People’s capacity was assessed and consent sought in accordance with the Mental Capacity Act 2005 (MCA). This process included the use of best interest decisions for example, in relation to end of life care.
People were supported to maintain a varied and healthy diet in accordance with their preferences and healthcare needs. The service operated a menu which offered good choice.
We saw from care records that staff supported people to access a range of community based healthcare services on a regular basis. Some people were also supported to access specialist healthcare services where there was an identified need.
Part of Tudor Bank was specifically adapted to meet the needs of people living with dementia. Adaptations and décor had been developed with the support of information from Stirling University which specialises in understanding dementia and the care of people living with the condition.
Throughout the inspection we saw that staff were exceptionally caring in their approach to the provision of care. People living at Tudor Bank, their relatives and professionals were extremely complimentary about the quality of care provided and the positive impact that the service had on people’s lives. The relatives that we spoke with were equally clear that they valued the staff and the quality and positive impact of the service.
It was clear from observations and conversations with staff that they knew people well and understood their care needs in detail. We saw and were told about other methods of reducing anxiety and distress. Staff were able to explain that their approaches and interventions varied depending on the person and the particular situation.
We saw in records and were told of numerous examples where the quality of care had a significant positive impact on people living at Tudor Bank. A professional shared information on a number of people who they had referred to the service and spoke extremely positively about the provision of care.
Throughout the inspection we saw that staff spoke to people in a gentle tone and supported their communication by smiling and using other facial expressions at appropriate moments. There was gentle physical contact between staff and the people living in the home, for example, hand-holding which offered re-assurance and aided communication. We observed that people responded with warmth towards staff and that staff spoke with great compassion and care for the people living in the home.
Visitors were welcome to visit at any time. Mealtimes were protected for the benefit of some people living in the home and families were encouraged to let the service know if they intended to visit during these periods. One relative told us how staff had supported them to stay and feed a family member to help them settle-in. Staff told us that relatives were often invited to stay and have a meal with their family member. For example, on Christmas Day.
Tudor Bank provided exceptional end of life care and had achieved commended status within the Gold Standard Framework for end of life care. The Gold Standard Framework provides training and accreditation for care services which specialise in providing end of life care.
The majority of people living in the service were involved in the planning and review of their care. For some people this was not practical because their health condition limited their understanding of the process. Where this was the case information from relatives and staff was used to update care plans. Care records provided evidence of regular review and personalised approaches.
Care records showed clear evidence of family involvement in the pre-admission assessment. We saw evidence that relatives were invited to reviews of care with the local authority. However, some family members said that they would welcome more opportunities to discuss care needs with staff.
People living in the home were invited to attend weekly meetings where they could discuss matters of concern or interest. Minutes of these meetings were made available to the inspection team.
The service had a complaints procedure in place which was clearly displayed. We saw that only one formal complaint had been received in 2017. This had been responded to in accordance with best-practice and the relevant policy.
People living in the home, relatives and staff spoke extremely positively about the registered manager and their management of the home. Throughout the inspection the registered manager demonstrated knowledge of the people living in the home and the staff team.
We saw copies of questionnaires that had been issued to people living in the home and their relatives. The questionnaires had all been issued recently and contained ratings and comments which were extremely positive and complimentary.
We saw that the staff on duty during the inspection were motivated to provide a high-quality, responsive service to the people living in the home. Our observations of their practice and their responses to our questions were positive throughout the inspection.
This unannounced inspection was conducted on 11 August 2015.
Situated in Birkdale and located close to public transport links, leisure and shopping facilities, Tudor Bank Nursing Home is registered to provide accommodation for up to 46 younger and older adults who have mental health needs and require nursing or personal care. The location has a specialist unit for people living with dementia. It is a large three storey property which is fitted with a passenger lift. All the bedrooms are currently in use for single occupancy and have hand-basins. Two of the bedrooms where suitable for shared occupancy.
The location offers two services:
At the time of inspection 36 people were using the service.
A registered manager was 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. All staff spoke positively about the influence of the registered manager.
There were sufficient numbers of staff available to meet the needs of each person living at the home. There was a programme of staff training available, which included general health, social care and specialist topics relevant to the needs of the people using the service. Staff were recruited subject to satisfactory references and appropriate checks being completed.
At the time of the inspection two magnetic door closure devices were not operating. Wedges had been used to keep these doors open. The registered manager took immediate action when alerted to the matter.
Systems were in place for people living in the home, their relatives and staff to raise concerns. Evidence of appropriate and timely responses to issues raised was provided. The provider had received one formal complaint in 2015. The provider shared documents which demonstrated that they had listened to and acted on concerns and complaints. There were systems in place to engage with people using accessible communication.
The service had a system for the ordering, storage, administration and disposal of medication and conducted regular audits and checks. Medication was administered safely in accordance with this system.
Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority. Some people had a deprivation of liberty safeguard (DoLS) plan in place. Staff sought people’s consent before providing routine support or care.
Individual dietary requirements were met through the production of personalised menus. This was documented in care files.
People had access to a range of primary health care and specialist services, such as GPs, dentists and mental health teams.
People were supported with dignity and respect throughout the inspection. Staff spoke to them before providing care and checked that people understood what this meant. Staff demonstrated awareness of the needs of the people and interacted with them in a professional, caring and courteous manner. Each person had a nominated key-worker.
Each person was supported to be as independent as possible through a process of positive risk taking. Appropriately detailed risk-assessments supported this process. The service had supported people to move-on to alternative provision.
People had private space within the service and staff were respectful of this when engaging with them.
Relatives and friends were free to visit the service without any obvious restriction other than at mealtimes which were protected for the benefit of some people living in the home.
Systems were in place to encourage people to discuss any concerns with staff. Changes to care plans demonstrated that the provider had responded to people’s preferences and changing needs. The service had systems in place to monitor and support quality assurance.
The accommodation was decorated and furnished to a high standard. People had chosen to decorate some areas according to their personal preference. Shared areas were bright, clean and uncluttered.
The provider had appointed an activities coordinator who had successfully developed a range of individual and group activities for people to access.
' 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 is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
We found there was sufficient staff on duty to meet the needs of the people who were living at the home. Systems were in place to check the environment was safe. Arrangements were in place to monitor accidents and incidents on a monthly basis.
The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection one of the people who lived at the home was on a Deprivation of Liberty Safeguards (DoLS) plan. The manager and staff had a good understanding of the Mental Capacity Act (2005). Some people were receiving their medication without their knowledge and these best interest decisions had been agreed with each person's doctor.
Is the service effective?
People were satisfied with the care they received and said their needs were being met. Everybody we spoke with was pleased with the care and support they received. They said staff supported them if they needed to see a health professional, such as a doctor or dentist. Comprehensive and personalised care plans were in place for each person. Care plans were reviewed each week to ensure they were current.
People told us they were satisfied with the food and menus. Any suggestions about changes to the menu were listened to and acted upon.
Is the service caring?
People told us the staff were approachable and responsive if they needed support with a task or activity. One of the people living there said, 'The staff are nice. They help with anything you need.' Throughout the day of the inspection we observed care staff engaging with people in a positive, respectful and individualised way. Staff had a good knowledge of each person's needs.
Is the service responsive?
People were involved in decisions about their care and they received a copy of their care plan. They told us they had access to recreational and social activities, including activities within the home and trips out to the local community.
Is the service well-led?
The home had systems in place to regularly monitor the quality and safety of the service provided. People who lived at the home and their relatives had the opportunity to provide feedback about the home by completing an annual questionnaire. Meetings were held each week at the home so people could mention any concerns they had and suggest how the service could be improved.
Staff we spoke with said they felt well supported by management. They told us they received good quality training and had an annual appraisal.
One visiting relative told us, 'I can't fault it here. The staff are helpful and very nice' and 'I feel that (name) is safe here.'
The care records we observed were well organised and included detailed assessments of individual's needs, risk assessments and strategies to manage those risks.
During our visit to Tudor Bank a pharmacist inspector carried out a medicines inspection. It was found that the home had systems in place for the safe administration of medication. The pharmacist inspector looked at the personal care and treatment records of eight people who use the service, spoke with Registered Nurses, care workers and people living in the home.
We saw that staff had been provided with up to date and relevant training, which helped to ensure that members of staff were suitably trained and skilled to meet people's needs.
On checking medication management we found that people received their medicines as prescribed. Records regarding medication were completed correctly.
We observed staff interacting with people who lived in the service during our visit. We observed some examples of where staff supported people well, such as acknowledging anxieties and attempting to reassure them. We spoke with two relatives of people living in the home during our visit who told us, 'You only have to ask staff for something for your relative and it gets done' and 'My relative receives good care here.'
Throughout our visit we saw residents moving freely around the home and coming and going. One resident told us he was on his way out to meet a friend, he said that this was something he liked to do regularly.
We found the atmosphere of the home was very relaxed and homely and residents appeared to be content and comfortable. We spoke to a number of residents during our visit and received some extremely positive feedback about the service provided at Tudor Bank. People expressed satisfaction with all aspects of life at the home and were happy with the standard of care they received. Comments included;
'They (the staff) are always good to me.'
'We are lucky here ' everyone is really nice.'
'The carers are ever so good. They bring me a nice cup of tea to cheer me up.'
'I like the food we have some nice things.'
'We have a lot of activities ' they are all on the board so we know what's happening.'
'The cleaners keep it nice, it's always nice and tidy.'
We were also fortunate enough to speak to some visiting relatives during our inspection. Again, we received some very positive feedback and relatives expressed satisfaction with all aspects of their loved ones' care. One relative commented 'They cannot do enough for you here ' and there is always someone to speak with if you have any concerns.'
Another relative told us he was delighted with his loved one's care. He told us that his relative was very settled and content at the home. He went on to explain that the home had supported her to reduce her medication and that she had benefited from this greatly. 'She seems so much brighter now, but really calm as well,' he said.