This comprehensive inspection took place on 13 and 14 November 2018; the first day of the inspection was unannounced.Towneley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Towneley House is registered to provide accommodation and personal care for up to 22 older people; there were 21 people living in the home at the time of the inspection. The home is situated in a residential area in Burnley near to Towneley Park. Accommodation is provided over three flours in 12 single bedrooms and four shared bedrooms; 13 of the bedrooms have an en-suite facility and all upper floors are accessible via stair lifts. Communal space is provided in two lounges, a dining room and a conservatory.
The service was managed by 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. The registered manager was not present on either day of the inspection. We therefore had to contact them after the inspection to request additional information from them; this was received within the requested timescale.
At our last inspection in February 2017 the service was rated as requires improvement. This was because we found there was a continuing breach of the regulation in relation to record keeping. There was also a continuing breach of the regulation which requires providers to notify the commission of important events which occur in the home. We therefore issued a fixed penalty notice in relation to this breach of regulation. In addition, we found further shortfalls in the maintenance of one person's bedroom, the implementation of the Mental Capacity Act (MCA) 2005 and the recruitment of new staff. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations.
During this inspection, we found improvements had been made in relation the submission of required notifications, the implementation of the MCA and the recruitment of staff. However, we identified five breaches in regulations. These related to the way medicines were managed in the home, the lack of risk assessments and care plans for one person and the measures in place to ensure people’s dignity and privacy were protected. There was also a lack of robust governance systems to monitor the quality and safety of the service. This has led to the service again being rated as required improvement. This is the fourth consecutive time the service has been rated as required improvement since May 2015. You can see what action we told the provider to take at the back of the full version of the report.
The provider had a quality assurance system in place which included the completion of audits relating to care plans, medicines, the environment and infection control. However, these had not been effective enough to identify the shortfalls we found during this inspection.
Although systems were in place for the safe handling of medicines, we found arrangements for the administration of prescribed topical creams needed to be improved. In addition, improvements were needed to ensure all medicines were stored safely to prevent misuse. Staff had not followed the correct procedure to authorise the covert administration of medicines for one person in their best interests (i.e. in food or drink when the person was unaware), although at the time of the inspection medicines were not being administered in this way.
We looked at the care records for four people and found one person did not have any care plans or risk assessments in place. This meant there was a lack of a complete and accurate record for the person concerned and a risk staff might not provide safe care to this individual. Although the care plan audit undertaken in October 2018 had identified this person's care records were incomplete, no action had been taken to address this matter at the time of the inspection. Following the inspection, the registered manager assured us all required documentation was in place. The remaining care records we looked at included detailed care plans and associated risk assessments which had been reviewed on a monthly basis.
Proper arrangements had not been made to protect the privacy and dignity of people who shared a bedroom. A privacy curtain had previously been in place in this bedroom but had not been replaced after it had fallen down. Staff were unable to give us consistent information about satisfactory alternative arrangements in place to protect people’s dignity and privacy. In addition, staff failed to take into account issues of dignity and privacy when approaching a person to administer a topical cream in a communal area.
People told us they felt safe in Towneley House. They told us staff were kind, caring and responsive to their needs. Although we received mixed feedback about staffing levels, our observations during the inspection showed there were enough staff on duty to meet people’s needs in a timely way.
There were policies and procedures in place regarding safeguarding adults. Staff were able to tell us the correct action to take should they witness or suspect abuse. Improvements had been made to the recruitment process which meant all staff had been safely recruited.
During the inspection, we noted some areas of malodour and noted improvements also needed to be made to the measures in place to prevent the risk of cross infection. We have therefore made a recommendation that the service ensures it acts in accordance with best practice guidance regarding infection prevention in care homes. We have also recommended the provider considers guidance regarding the lighting in care homes for people living with dementia.
The registered manager and staff understood the principles associated with the Mental Capacity Act 2005 (MCA) and acted according to this legislation. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to various aspects of their care was considered and was clearly documented in their care records.
Staff had completed an induction when they started work and completed regular training to keep their knowledge and skills updated.
People received support with eating and drinking and their healthcare needs were met. People clearly enjoyed the meals which were provided for them. Appropriate referrals were made to community health and social care professionals, to ensure that people received the necessary support.
People told us they received care that reflected their needs and preferences. A range of activities were provided to meet people’s social needs, although some people told us they missed trips out in the minibus which was being repaired at the time of the inspection.
There were systems in place for people to provide feedback on the care they received. People were aware of how they could raise a complaint or concern if they needed to and had access to a complaints procedure.
People spoke positively about the registered manager and the way the home was run. People spoken with during the inspection, including two visiting health professionals told us they would recommend the home to others as they considered people received good quality care.