Tegfield House

Updated 17 September 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service

Service and service type

Tegfield House 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before we inspected Tegfield House, we looked at the information we already held about the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We looked at notifications. Notifications are sent to us by the service to tell us about significant events.

Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We reviewed Healthwatch reports for Tegfield House to support our inspection planning. We used all of this information to plan our inspection.

During the inspection

During our inspection we spoke with nine staff members including, the registered manager, regional manager, deputy manager, activities officer, senior carer, care assistants, and a housekeeper. We also spoke with three relatives and five people living in the home to find out their experiences of the care provided. Three visiting healthcare professionals and a visiting care provider provided us with feedback about their views of the service.

We saw records concerning the safe upkeep of the premises, recruitment files for five staff members and three care records. We also reviewed policies and procedures along with newsletters and staff rotas.

After the inspection

We received all of the information we had requested from the provider both during and after our inspection.

Updated 17 September 2019

About the service

Tegfield House is a residential care home providing personal care to up to 24 in a two-storey adapted building. At the time of the inspection, there were 23 people using the service.

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

People and their relatives told us the care they received at Tegfield House was exceptionally good and we saw that people were enabled to participate in assessments and care planning and direct their care plans to ensure they could lead fulfilling lives.

People told us they felt safe. Staff had been trained and received regular updates in safeguarding and were clear about what they should do if they saw signs and symptoms of potential abuse.

People and their relatives felt that care provided was done safely and we saw that all safety monitoring was completed to a high standard to ensure this was the case.

The provider investigated all concerns thoroughly and according to relevant policies and procedures.

People were supported to remain safe through the extensive use of risk assessments.

Technology was used to minimise risks. Falls mats and movement sensors were utilised along with other equipment such as air mattresses to maintain skin integrity.

Maintenance checks and servicing of equipment was completed at set intervals. When we inspected, all checks and services were current from the daily safety ‘walkaround’ to tree surveys to ensure that trees in the grounds were in good condition.

Sufficient, safely recruited staff were deployed to meet the needs of people living at Tegfield House. Staff had recently identified a time during the day when additional staff would be beneficial. A twilight shift had been introduced which had reduced pressure on staff and improved care delivered to people.

Medicines were safely administered by staff who had been trained and checked for competency.

The registered manager and quality team reviewed all accidents and incidents and ensured that lessons learned were shared. Information was passed in a timely way to the care team through the electronic care record system.

Staff members were supported to complete an extensive induction before they worked with people. Additional support to staff through training and supervision had enabled them to progress through roles in the service and develop their careers in social care.

Assessments were thorough and completed so that people moving to the home were already known by staff who would be supporting them. The registered manager ensured the assessment process was inclusive and put people at ease and the stressful move into a care home was made as comfortable for them as possible.

Services were delivered in line with current legislation and best practice guidance. Consent was sought and documented, and outcomes were developed so that people were able to live an active life, taking positive risks in order to maximise their experiences.

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 provider had introduced an electronic care system which had improved care delivery and recording of interactions with people.

Food and drink were integral aspects of the service and the provider not only supplied appetising meals but provided them in a person centred way. Meals could be pureed, vegetarian, vegan, menus changed to accommodate likes and dislikes and if someone didn’t want what was offered then a different meal would be prepared.

The building had been adapted to meet the needs of people living with dementia. Toilet doors had been painted yellow as per the latest best practice guidance and items such as a dementia clock and reminiscence objects were placed about the home.

Personalised images on each person’s bedroom door offered people visual clues that this was their room and a talking point. A pilot remembered his work and a lady who had lived near to a canal could remember her previous home.

The provider had forged positive working relationships with local health and social care professionals. This enabled people to have good access to GP surgeries and social workers as needed.

The service was compliant with all aspects of the Mental Capacity Act 2005 and all Deprivation of Liberties Authorisations were applied for and updated as needed.

We heard many happy interactions between staff and people living in the home. Staff were affectionate when speaking about people they cared for and this affection was mirrored by people.

People were treated respectfully both in life and after death. Families had praised staff for the standard of care and respect shown to their relative when they had passed away.

People and their relatives were involved in the assessment and care planning process as fully as they were able or wanted to be.

People were constantly being offered choices about what they wanted to do, where they wished to sit and what they wanted to eat. Staff always asked for consent before providing care to people.

We were told about examples of exceptional care provided by staff, these were celebrated in the service however staff members did not see their exceptional practice as anything more than what should be provided.

Support was person-centred and delivered as the person wanted it to be. Staff went out of their way to make people’s lives better if they could and some simple actions such as taking someone to their home to collect belongings had a far-reaching impact on the person. The impersonal environment of the room they had moved to become their home when their own belongings had arrived.

Information was supplied to people in the most suitable manner for their needs, the provider offered large print and symbols / photos and could look at other methods of presentation as needed.

There was a full programme of activities that people could choose to join in. Some people preferred to make their own entertainment by, for example, doing some gardening, others enjoyed the group activities and entertainers.

The provider had supported people with end of life care. Feedback and accounts of exceptional care provided to people highlighted the importance the provider and staff gave to end of life care and the respect shown to people before and after death.

There was a registered manager in post who lead by example. We saw them helping on the floor of the service and being available to staff, people and relatives at all times.

Feedback about the management team was very positive and the registered manager and deputy manager were known to be very supportive, approachable and keen to improve people’s experiences of living at Tegfield House.

People were always at the centre of Tegfield House. If something was not positive to the people living in the home, it did not happen.

The management team were supportive and empowering to staff.

Staff turnover at the service was low and there had been no use of agency staff for more than six months. This was a proud achievement as it meant that people had received consistent care from staff they knew.

Staff, relatives and people living in the service were able to participate in monthly meetings or support groups. Feedback about meetings was positive, people could bring items for the agendas and a recent change to the relative’s group had been positively received.

Thorough auditing ensured attention to detail in recording and quality care delivery. All items identified for improvement were immediately followed up and plans made to change practice.

Engagement with stakeholders such as people, relatives, health and social care professionals and the public was good. Open days and other events were held regularly along with meetings and support groups.

The provider was constantly striving to improve. If anything went wrong, learning was taken and shared, and all improvements were embedded into 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 8 November 2016).

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 re-inspection programme. If we receive any concerning information we may inspect sooner.