We carried out a review of the data available to us about Tennyson Wharf 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 Tennyson Wharf, you can give feedback on this service.
Tennyson Wharf is a residential care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service can support up to 60 people in five separate wings, each of which has separated adapted facilities. One of the wings specialises in providing care to people living with dementia. The provider had submitted an application to cancel their registration for nursing and was not providing nursing care at the time of the inspection.
People’s experience of using this service and what we found
The service had experienced a high turnover of managers since our last inspection. Staff told us this had an impact on consistency and had affected the morale of the team. Most staff we spoke with told us they did not feel supported by the registered manager. Staff told us they did not always feel listened to and valued.
Most relatives told us that communication from the registered manager was insufficient and had caused them anxiety during the recent outbreak of COVID-19 in the service. We raised these issues with the provider who took immediate steps to address these concerns.
The provider used a staffing calculator to calculate staffing levels according to people's needs and this had been recently reviewed. Staff and relatives, we spoke with consistently told us they were concerned low staff levels were having an impact on the quality of care people received. We discussed this with senior managers who assured us staffing levels would be kept under constant review.
Systems and processes were in place to manage risks associated with people's care. Risk assessments were in place to reduce risks associated with choking, falls and skin breakdown.
People were protected from abuse. Staff received training in safeguarding and were able to tell us how to recognise abuse and how to report it.
Records relating to the administration of ‘as needed’ medicines were not always consistent. We raised this with the registered manager who made immediate changes following the inspection to rectify this. Staff were observed following good practice when administering people's medicines. An effective medicines error reporting form had been implemented to enhance monitoring of errors and ensure lessons were learned to improve practice.
The service was visibly clean, and staff were observed following cleaning schedules. Regular enhanced cleaning of high touch points was recorded. Staff were observed using personal protective equipment (PPE) in line with government guidance. Staff had received training about infection prevention and control. We were assured the provider was preventing visitors from catching and spreading infections. The providers policies and procedures reflected the latest national guidance in relation to COVID-19.
A system was in place to record accidents and incidents and staff described how they used this. Some recording discrepancies were identified where falls were not always recorded on people's falls logs. We raised this with the registered manager who provided us with assurance this had been addressed immediately following the inspection.
The provider had a system to ensure the quality and safety of the service were reviewed on a regular basis. Senior managers had access to the audit reports throughout the pandemic and had clear oversight of the actions and progress of 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 28 January 2020).
Why we inspected
As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place.
In addition, the CQC received a notification of a specific incident. Following which a person using the service sustained a serious injury. As a result, this inspection did not examine the circumstances of the incident.
The information CQC received about the incident indicated concerns about the management of falls from moving and handling equipment. This inspection examined those risks.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern.
Please see the safe and well-led sections of this report.
Tennyson Wharf is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 60 people in five separate wings, . Each of which has separated adapted facilities. One of the wings specialises in providing care to people living with dementia.
People’s experience of using this service and what we found
People were protected from abuse. Staff were knowledgeable about how to recognise and report abuse. Records showed staff were provided with safeguarding training. Systems were in place to ensure people's safety. Risks were assessed and managed. For example, risks associated with choking and falls were managed and plans were clear for staff to follow. Accidents and incidents were recorded and measures were taken to improve and learn. Medicines were managed appropriately. Issues identified at the previous inspection were resolved. A more robust approach to medicines management had been developed.
Staffing levels met the needs of people living in the home. The home was not at full occupancy at the time of inspection. Staffing levels were to be reviewed and occupancy was expected to increase. The registered manager and regional director described how they would increase occupancy and assured us this would be managed carefully. Staff were recruited safely and in line with regulation.
People’s needs were assessed, and outcomes were met. People and relatives told us their needs were met well. People told us food was of good quality, the cook had systems in place to ensure people could eat and drink what they wanted and liked. Fresh fruit and snacks were available. Staff told us that they received training they needed to do their job well and were supported in their roles. People’s consent to care was sought. 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 observed throughout the inspection to be caring, thoughtful and attentive. Staff were motivated and enthusiastic in their roles. People and relatives consistently told us staff were kind and caring and they were treated well. People were given the opportunity to express their views regularly and were involved in their care. Staff were knowledgeable about how to maintain privacy and dignity.
People received care that was responsive to their needs. Care planning captured people’s wishes and care was delivered by staff who understood the needs of the people they were supporting. Care plans were being developed to include more person-centred information. Some care plans contained enough information to meet people's needs, others contained better detail which enabled staff to know more about the person and therefore meet their needs in a more person-centred way.
People were given the opportunity to take part in regular activities of their choosing. The activities coordinators were enthusiastic and keen for people to try new things. Plans to ensure activities were more 'dementia friendly' were underway. People knew how to complain and raise concerns and felt listened to. Complaints were responded to appropriately and in line with policy. Several compliments from people using the service had been received since the last inspection.
There was a new registered manager in post who had made a significant impact in a short space of time. The registered manager quickly identified areas for improvement and had a clear plan to develop and improve the service. Staff were complimentary about the support they received from their managers. Leadership in the home were visible. Staff appreciated the hands-on approach the management team took. Processes were in place to ensure the delivery of care was monitored and checked regularly. Governance systems identified areas for improvement and plans were developed and actioned. The registered manager and the team had built good working partnerships with other health and social care professionals and were developing and building strong links in the community.
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 28 May 2019) and there were multiple 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 re-inspection programme. If we receive any concerning information we may inspect sooner.
Tennyson Wharf 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.
Tennyson Wharf can accommodate 60 people in one adapted building across three floors. At the time of the inspection 51 people were resident, some of whom were living with a dementia.
The service 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 2008 and associated Regulations about how the service is run.
At the last comprehensive inspection in January 2017 we rated the service as ‘Requires Improvement’ overall. We found the service did not consistently act in accordance with the Mental Capacity Act 2005 (MCA) and as required medicines (PRN) protocols were not consistently in place.
At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to safe care, need for consent and treatment and good governance. You can see what action we have asked the home to take at the end of this report.
Medicines were not always administered in a safe manner and in accordance with NICE (National Institute for Health and Care Excellence) guidance and the provider’s own policy. People did not always have their care needs met. Some people required repositioning to prevent skin deterioration and other people needed their fluids monitoring due to the risk of dehydration. People did not always receive safety checks and observations when they needed them. The service did not ensure people received the planned support which placed people at risk of harm.
The service was still not acting in accordance with the Mental Capacity Act 2005 (MCA). The service had a range of audits in place but these failed to identify the issues we found during this inspection. Where issues had been identified, actions plans were produced however these were not always completed as required.
People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice.
Risks were not always identified and mitigated against.
The provider used a dependency tool to calculate staffing levels. People and relatives gave mixed views when we asked if there were enough staff to support people. We observed a number of times, staff were supporting people in their rooms leaving other people unattended. Personal emergency evacuation plans (PEEP) did not accurately reflect the staffing support people needed during an evacuation.
The service supported people to gain access to healthcare professionals.
People were complimentary about the meals provided. People were encouraged to be healthy and a balanced diet was promoted.
Staff treated people with respect and dignity. Staff were knowledgeable about people, their preferences, interests and people important to them. Staff supported people to be involved in all aspects of decision making about their care and treatment. People were encouraged to be as independent as possible.
Staff spoke positively about the management team and said both the registered manager and the deputy manager were supportive and approachable.
The premises were well maintained. Regular health and safety checks were conducted for equipment and the building. The home was clean and tidy throughout, with infection control procedures followed as required.
The provider ensured systems were in place to protect people from abuse. The service conducted a robust recruitment process. Staff had completed training to ensure they were able to recognise the types of abuse and take appropriate action. Safeguarding concerns and accidents and incidents were investigated and analysed to identify any trends.
People were encouraged to take part in a range of activities and had opportunities to access the wider community.
Following the inspection the provider took immediate action to address the concerns identified. However additional concerns were raised about the safety and welfare of people. We carried out an additional day of inspection to look at these concerns. A meeting was held with the provider to gain assurances that people were safe and the issues would be addressed. The provider gave assurances and produced action plans outlined it's intended actions.
The overall rating for this service is 'Requires Improvement'.
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.
On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe from abuse including financial abuse.
Medicine records and guidance were not consistent. Protocols were not consistently in place for as required (PRN) medicines. Medicine administration sheets did not clearly identify when medicines were PRN.
We saw that staff obtained people’s consent before providing care to them. The provider did not consistently act in accordance with the Mental Capacity Act 2005 (MCA). Best interests assessments were not clearly documented. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the Deprivation of liberty Safeguards (DoLS) and to report on what we find. We found that the provider acted in accordance with DoLS.
We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.
People in the downstairs unit said response times were sometimes slow. We found there were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support.
Staff had the knowledge and skills they needed to care for people in the right way and they had received most of the training and guidance they needed. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.
Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had sent us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.