Archived: Tudor Lodge

Updated 10 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14 and 15 June 2016 and was unannounced. The inspection team comprised of two inspectors on the first day and one inspector on the second day.

Prior to the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information provided in the PIR and used this to help inform our inspection. We reviewed the records we held about the service, including the details of any safeguarding events and statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about.

At inspection we met and spoke with 13 people who lived in the service. We observed how people interacted with each other and with staff over a lunch period using the strategic Short Observational Framework for Inspection (SOFI); SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff carrying out their duties and how they communicated and interacted with each other and the people they supported.

We spoke with 5 visiting relatives and two health professionals. We also spoke with the registered provider, registered manager, deputy manager, three team leaders and six other staff. After the inspection we spoke with 6 relatives a further three health and social care professionals.

We looked at six people’s care and health plans and risk assessments, medicine records, and operational records that included three staff recruitment training and supervision records, staff rotas, menus, accident and incident reports, servicing and maintenance records, complaints information, policies and procedures and survey and quality audit information.

Updated 10 August 2016

The inspection was unannounced and took place on 14 & 15 June 2016. Tudor Lodge is a care home which provides care and support for up to 44 older people with mental health needs. There were 38 people living at the service at the time of our inspection. People have their own bedrooms; some have ensuites; bedrooms are located over the basement, ground, first and second floors. A shaft lift provides access to all floors and a number of stair lifts are installed to help people access mezzanine areas of the premises. The service is in a central location in the town of Folkestone and has limited off street parking.

This service was last inspected on 3 December 2014 under previous methodology and at that time the provider was found to have addressed previous noncompliance and no breaches of regulations were identified.

There was a registered manager in post. A registered manager is a person who is 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.

People told us they were happy living at the service. People’s relatives spoke positively about the quality and delivery of care provided by staff to their family members, but expressed concerns that staffing levels meant staff could not always give people the time they needed; staff said they felt rushed all the time. We observed that for the needs and dependency of the people being supported there were not enough staff available at some busier times of the day and also during the night, when a number of people were up. Recruitment procedures and checks of new staff were made but this needed improvement to ensure these were carried out thoroughly and in line with regulatory requirements.

The risk assessment framework used needed expanding to ensure all potential risks people may be subject to were assessed and measures implemented to reduce risk of harm occurring.

Care plans were individualised but did not always reflect in depth strategies used to manage behaviour or support in respect of specific health conditions. Quality audits were in place but not always carried out robustly or evidenced clearly actions taken to provide assurance that the service was meeting standards. The Care Quality Commission was not routinely informed as required of deaths of people at the service.

Professionals we spoke with during and after the inspection spoke positively about the improved communication with them from staff and good working relationships that the registered manager was developing with them.

Visual checks that fire extinguishers and emergency lighting was in working order were not routinely undertaken each month. Staff were not attending the minimum number of fire drills annually and had not trained in the use of some evacuation methods contained in people’s personal evacuation plans.

People enjoyed the activities provided for them and although they were consulted through meetings and questionnaires about what else they might want to do, the type of activities available were not suitable for everyone and we have recommended the registered manager sources appropriate training for the activities organiser to make activity sessions more appropriate to the needs of people.

Staff received supervision and appraisal of their work performance. They had opportunities to meet and felt able to raise issues individually or within staff meetings, staff said communication was good and they felt part of a team and enjoyed their work but did not always feel their views were valued or listened to by some of their line managers.

There was a high level of accidents occurring. Staff took appropriate action to support people when accidents occurred and sought medical advice if necessary, the manager analysed these for trends but we have suggested additional analysis to help understand more about why they were occurring.

Staff treated people respectfully, showed kindness and patience and we saw many examples of positive interactions from staff towards people. Staff placed people at the centre of the support they provided and delivered this in a personalised way to meet individual needs.

People and their relatives told us they felt informed by the staff and that communication was good. They were asked for their views and people felt able to voice their comments openly in user meetings. People ate a varied diet that took account of their preferences. Peoples health needs were monitored and they were supported to access healthcare appointments.

Staff knew how to protect people from abuse. The premises were clean and well maintained and servicing checks were in place. New staff received appropriate induction and all staff completed a regular programme of training. Staff understood and worked to the principles of the Mental Capacity Act 2005, although improvements in recording of some decisions was needed.

People’s privacy was respected. Staff supported people to maintain links with their relatives and representatives, and relatives said they were kept informed and consulted about their relatives care needs. People and relatives understood the complaints procedure and felt confident any issues if they had any would be addressed immediately.

We have made one recommendation:

We recommend that the Registered Manager enables the activities organiser to access an activities training course from a competent and recognised source that promotes activities for people with dementia type conditions using the latest best practice.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.