Background to this inspection
Updated
3 April 2020
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 team consisted of two inspectors and one 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
Tower Bridge Homes Care Limited – Sycamore is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider did not complete the required Provider Information Return. This is information providers are required to send us with key information about the service, what it does well and improvements they plan to make. We took this into account in making our judgements in this report. We used all of this information to plan our inspection.
During the inspection-
We spoke with five people who used the service, 11 relatives and two visiting health care professionals about their experience of the care provided. We spoke with seven members of staff including the registered manager, senior care workers, care workers and the activities coordinator.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection –
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
3 April 2020
About the service
Tower Bridge Homes Care Limited - Sycamore is a residential care home, providing care and support for up to 39 older people, including people living with dementia. At the time of our inspection, 25 older people were using the service.
People’s experience of using this service and what we found
There is a history of the provider not meeting regulatory requirements and people being at risk of avoidable harm. At this inspection, we identified a continued lack of governance and oversight by the provider. People remained at risk of unnecessary harm. The systems and processes in place to effectively monitor and improve the quality of the service were not robust. The provider had not taken appropriate steps to ensure they had clear scrutiny and oversight of the service, ensuring people received safe care and treatment. The lack of managerial oversight had impacted on the quality of care provided. The provider had failed to learn lessons from previous inspections and to identify and address breaches of regulatory requirements.
A registered manager had started work at the service in September 2019. 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 service had not always taken appropriate action about safeguarding concerns. Although staff had received safeguarding training and knew how to report abuse, not all staff were aware of external whistle blowing procedures. Care records were not always accurately maintained to ensure staff were provided with clear up to date information which reflected people’s care and support needs. Risks to people had not always been identified. Where risks had been identified people’s care records had not always been reviewed and, where appropriate, updated. People received their medicines from staff who had received training however, further improvements were required to ensure people received their medicines safely in line with best practice guidance.
Staff completed the provider’s mandatory training but had not received specialist training, which the provider informed us they would be delivering to staff following our last inspection. This meant staff were not equipped with the skills, support and knowledge they needed to provide effective good quality care to people. Although staff felt supported by the registered manager, staff supervision had not been undertaken in line with the provider’s policy following our last inspection up to the date the registered manager commenced employment at the service.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.
We made three recommendations to the provider; to review end of life care planning processes in line with best practice guidance when reviewing people’s care; to consider national guidance on the environment for people living with dementia and to review the support they provide for people in relation to people’s capacity.
People, and relatives, were positive about the meals provided, however further improvements were required to improve the mealtime experience for people living with dementia. Documentation used to monitor people’s daily food and fluid intake was not always monitored effectively, placing them at risk of dehydration and/or poor nutritional intake. A range of activities were provided but improvements were required to provide people living with dementia to participate in meaningful activities. One relative told us, “There’s not enough stimulation [on first floor] at all. The activities coordinator stays downstairs and you cannot take [people] downstairs due to risk of absconding. I feel they get forgotten about.”
Staff were kind and caring towards the people they supported, treated them with dignity and respect and empowered them to remain as independent as they were able to. We observed positive, caring interactions between staff and people. People were supported to maintain relationships with people who were important to them and visitors were welcome at the service at any time.
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 4 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do to improve. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified nine breaches in relation to safeguarding people from the risk of harm and abuse, person centred care, recording of consent and the provider’ continued lack of governance and oversight to ensure people received safe care and treatment.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.