Turret Villa Retirement Home

Turret Villa Retirement Home is a care home which provides personal care and accommodation for up to 35 older people. At the time of the inspection, 27 people were living at the service and 26 people received the regulated activity.

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

Medicines were not always managed safely. Medicines were not always stored appropriately or disposed of safely. Medicines stock balances were not correct and care plans for specialist medicines were not always in place. Medicines audits were not robust.

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. The practices around documenting decisions were not in line with guidance.

The provider’s quality assurance and monitoring systems were not always effective. Some staff training was significantly out of date. We could not be assured that lessons had been learnt and shared with staff following incidents or accidents. The quality monitoring systems had not identified the issues we found during the inspection.

Risks to people had been assessed but actions to reduce risks were not always followed. Some risk assessments were generic, others were in place for people who did not need them such as a denture assessment for someone who didn’t wear them.

Staff understood how to protect people from poor care and abuse. The service had enough staff to meet people's needs and keep them safe.

The building was well maintained, and health and safety risks were assessed. People enjoyed the food and special dietary needs were catered for.

There was a positive culture in the service. Staff said the management team were supportive. People enjoyed living at the service and felt listened to. People generally felt the care was good.

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 22 August 2020).

Why we inspected

We received concerns in relation to medicines management and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Turret Villa Retirement Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management, staff training, consent to care and quality assurance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Turret Villa Retirement Home is a care home providing personal care to 35 older people. At the time of this inspection there were 29 people living there.

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

People and relatives spoke positively about the home and staff. Comments included, “I feel very comfortable here because of people being around. There is always somebody I can ask or stop if I need something. It's not easy being old and staff are keeping us safe and active” and “This place came as blessing; we don't have any worry since she is there.”

Medicines were managed safely. Risks to people’s health and safety were assessed and minimised. Many areas of the home had been redecorated and refurbished since our last inspection. Checks and tests were carried out on the premises and equipment to make sure they were safe. Systems were in place to help prevent the catching and spreading of infections. There had been no known cases of Covid-19 at the home.

Whilst there were enough staff on duty to meet people’s needs, some staff told us that more staff would be appreciated. Following our inspection, the registered manager reviewed staff duties and the times of shifts to ensure additional staff were available at busy times of the day.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.

People received care and support which met their needs. Care plans were now more detailed and guided staff on how to provide person-centred care. A health professional told us, “They are super at looking after people.”

People and relatives told us the home was well managed. One relative told us, "We had a good manager before and now the new manager is also good but in different way. I think her expertise in dementia is a wonderful asset for this place.” Audits and checks were carried out to monitor the quality and safety of the home.

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 26 June 2019). We identified two breaches of the regulations relating to safe care and treatment and good governance. 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 taken and the provider was no longer in breach of regulation.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, responsive and well led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Turret Villa Retirement Home on our website at www.cqc.org.uk.

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.

People’s experience of using this service: At our previous inspection we identified shortfalls with the management of medicines. In addition, risks relating to equipment and the premises had not been fully assessed. We also found omissions in the maintenance of records relating to the Mental Capacity Act 2005 (MCA) and records relating to people's care. These issues had not been highlighted by the provider’s quality monitoring system.

At this inspection, action had been taken with regards to medicines management and the MCA. However, improvements were needed with regards to the premises, care plans and the provider’s quality monitoring system. Actions identified on the legionella risk assessment had not been fully completed and the bath chair had not been serviced. We had identified these issues at our previous inspection.

Care plans were not always detailed, however, many of the staff had worked at the home for a considerable number of years and knew people well.

We did not identify any major impact of these omissions and shortfalls upon people's health, safety and wellbeing. People told us they felt safe and happy living at Turret Villa Retirement Home. One person told us, “I love living here.” A relative said, “It’s like one happy family - very homely.”

There were enough care staff on duty to meet people’s needs. Safe recruitment procedures were followed and there was a staff training programme in place.

People were supported to have maximum 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 were supported with their nutritional and hydration needs. People told us that the meals had improved since our last inspection. This was confirmed by our own observations.

There was a new manager in post. The previous registered manager had retired in October 2018. The new manager had worked at the home for many years. She knew the home, people and staff very well; although she was still learning about the legal requirements and regulations relating to managing a care home.

Following the inspection, the bath chair was serviced and deemed safe to use. The deputy manager wrote to us and stated that all actions identified on the legionella risk assessment had been completed, more detailed risk assessments had been introduced and audits and action plans had been implemented to help ensure all areas of the service were monitored and any shortfalls addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires improvement (published April 2018). This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected: This inspection was carried out to follow up action we told the provider to take at the last inspection.

Enforcement: We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published 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 any concerning information is received, we may inspect sooner.

Turret Villa Retirement Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 35 people. There were 24 people living at the home at the time of the inspection.

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.

We found continuing shortfalls in the management of medicines. Risks relating to the premises and equipment had not always been assessed.

Safeguarding procedures were in place. No one raised any safeguarding concerns. Systems to monitor people’s monies however, were not always documented.

There were sufficient staff deployed. Staff carried out their duties in a calm unhurried manner. Recruitment checks were carried out prior to staff working at the home to ensure they were suitable to work with vulnerable people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found omissions in the maintenance of records relating to the MCA. People told us consent was sought before care was carried out. However, records were not always maintained to evidence this or to demonstrate that staff had followed the principles of the MCA.

There were omissions and shortfalls in the maintenance of records relating to people’s care. We did not identify any major impact of these omissions and shortfalls upon people’s health, safety and wellbeing. People told us they received good care. However, we considered that an effective system was not fully in place to ensure people’s care plans were accurate and reflected their needs.

People told us they were generally satisfied with the meals at the home. Some of the gentlemen told us that larger portions would be appreciated. We observed the lunchtime experience and saw that staff were attentive to people’s needs.

Staff worked with various agencies and accessed other services when people's needs had changed, for example, consultants, GPs, speech and language therapist, dietitians, the chiropodist and dentist.

We found that not all aspects of the environment met best practice guidance relating to supportive environments for people living with dementia. We have made a recommendation about this.

People, relatives and health and social care professionals told us that staff were caring. Many of the staff had worked at the home for a considerable number of years. This meant that people were supported by staff who knew them well and could respond in a person centred way.

People living at the home had formed friendships with each other. Staff supported these friendships.

People told us they were encouraged to be as independent as possible and were able to move around the home freely. Several people self- administered some of their medicines. One person enjoyed getting a taxi to visit their relative in Berwick.

People and relatives told us that staff promoted people's privacy and dignity. We observed that staff knocked on people's doors before they entered and spoke with people respectfully.

We found shortfalls in certain aspects of the service. This included omissions in the monitoring of health and safety, medicines, people’s monies, the MCA, training and care plans. These issues had not been highlighted by the provider’s quality assurance system. Despite these issues, we did not identify any major impact upon people’s health, safety and wellbeing. People and relatives were very positive about the care home.

Staff told us they enjoyed working at the home. We observed that this positivity was reflected in the care and support which staff provided throughout the inspection.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance.

People told us the food was well cooked and they enjoyed their meals. One person said, 'The food is very good and I can have something different if I don't like what is on the menu.' We saw people were supported to be able to eat and drink sufficient amounts to meet their needs.

We found the home was comfortably furnished and well maintained. People told us they liked the accommodation and were warm enough. One person said, 'I am really pleased to have my own toilet and that is one of the reasons I chose this home.'

At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance.

People's personal records were updated to reflect people's changing needs. Other records were fit for purpose and all records were held securely. Staff records were kept in an appropriate format.

We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us staff asked them for their consent before they provided their care.

People's needs were assessed and care and treatment delivered in line with their individual care plan.

There were effective systems in place to reduce the risk and spread of infection.

Appropriate checks were carried out before staff started work.

People who use the service, their representatives and staff were asked about their views about the care and support provided and these were acted upon.

People were made aware of the complaints system. Their comments and complaints were listened to and acted upon.