We carried out a review of the data available to us about Tudor House Nursing Home 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 Tudor House Nursing Home, you can give feedback on this service.
Tudor House Nursing Home is a residential care home providing accommodation with nursing and personal care. The home accommodates up to 37 people in one house. At the time of our inspection 34 people were living at the home, many of whom were older people living with dementia.
People’s experience of using this service and what we found
The provider carried out a range of health and safety checks. Although window restrictors were in place, some required adjusting to ensure the risk of falls was reduced. The provider carried out water safety checks although they had not carried out an assessment to ensure all risks were identified and managed. The provider told us they would improve immediately.
Staff supported people with their medicines safely. Risks to people, including those relating to dementia and any health conditions, were suitably managed. The provider carried out recruitment checks on staff, including checks of nursing registrations, to ensure they were suitable to work with people. There were enough staff to support people safely. Staff followed suitable infection control practices and received training to understand their responsibilities and the service was clean and free from malodours.
Staff received a suitable induction with ongoing training and support to care for people with dementia and nursing needs. People were supported to maintain their health and staff assessed and monitored their needs. People received food they enjoyed and were given food choices. 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.
People liked the staff who supported them and developed good relationships with them. Staff knew people well and treated them with dignity and respect. People were involved people in their care. People’s care plans were based on their needs and preferences and people received personalised care. An activity officer engaged people in activities they were interested in and people had enough activities to occupy them. The provider had a suitable process to respond to any concerns or complaints.
The provider had sufficient oversight of the service and carried out a range of checks to ensure standards remained high, although their checks of window restrictors and water hygiene required improvement. A registered manager was in post who understood their role and responsibilities, as did the director and staff. Staff felt well supported by the management team. People, visitors and staff told us the service was well-led and the provider engaged well with them.
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 (report published August 2017).
Why we inspected
This was a planned inspection based on the rating at the last inspection.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
At the last inspection in May 2016, the service was rated Good.
At this inspection we found the service remained Good.
The service demonstrated they continued to meet the regulations and fundamental standards.
The home had 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 about how the service is run.
People using the service were positive about the care and support provided. They said staff treated them in a kind and caring manner.
Feedback about staffing levels was however mixed and the registered manager acknowledged there had been staffing shortfalls earlier in 2017 following some experienced staff leaving the employment of the service. New staff had now been recruited and the staffing ratios were now restored to previous levels. Staff spoken with and records seen confirmed this.
Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by the registered manager and acted upon.
Staff were positive about the service provided and felt confident in the quality of care given to people using the service. Staff felt able to speak to the registered manager or other senior staff to raise any issues or concerns.
People were supported effectively to have their health needs met. We saw that people’s prescribed medicines were being stored securely and managed safely.
Some people using the service said they enjoyed the food provided to them whilst others said they would welcome more variety in the menus offered.
The staff attended regular training which gave them the knowledge and skills to support people effectively. The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of gaining people’s consent before assisting people.
An experienced registered manager was in post who knew the service well. There were systems in place to help ensure the safety and quality of the service provided.
Further information is in the detailed findings below
We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tudor House Nursing Home on our website at www.cqc.org.uk.
We found improvements had been made so that the service complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). We saw that staff had received further training in the MCA and DoLS since our December 2014 inspection.
Where people no longer had the capacity to consent to aspects of their care, we found that the registered manager and staff worked in people’s best interests. Assessments were completed to document the decision making process with involved family and medical professionals consulted as appropriate.
This inspection took place on 13 October, 9 December and 11 December 2014 and was unannounced.
Tudor House Nursing Home provides accommodation and nursing care for up to 37 older people. It is a purpose built care home that offers accommodation to people on three floors.
We last inspected the home on 28 July 2014. At that inspection we found the service was meeting all the regulations that we assessed.
There was a registered manager in post at the time of our inspection. 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.
People using the service and their representatives told us they felt safe and well cared for at Tudor House Nursing Home. People were able to take part in activities and maintain relationships with family and friends who were important to them.
There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers on each shift were sufficient to help make sure people were kept safe. Medicines were stored securely and safely.
We found however that further work was required to ensure that the provider consistently acted in accordance with the requirements of the Mental Capacity Act 2005. The assessments of capacity showed a lack of understanding in applying the Act to protect people who may not be able to make decisions for themselves. You can see what action we told the provider to take at the back of the full version of this report.
Staff were caring and treated people using the service with dignity and respect. They received training and support to help them carry out their role effectively.
A positive culture was evident at Tudor House Nursing Home where people using the service, their relatives or friends and staff were included with their views listened to and acted upon.
We have made a recommendation for the provider to look at ways of making the environment more dementia friendly. Further work should take place in ensuring the premises continue to meet the needs and dependencies of the people living there in line with sector guidance such as that available from the Social Care Institute for Excellence (SCIE).
People using the service told us "I think it's excellent", "I could not ask for more" and "Marvellous, I'm very happy". One person said "I could not have fallen into a better place, one of the best things I've done". Relatives or friends commented "Very good, I think it's one of the best" and "My relative is looking much better since they came here". We asked people about the care they received. The individuals we spoke with said that the care staff treated them well and they felt safe. Their feedback included "The nurses are marvellous", "The carers are very nice", "Very caring staff" and "I like the people here, we are lucky to have them".
At the last inspection on 17th January 2014, we asked the provider to take action to make improvements to the assessment and care planning processes. We found that this action had been completed.
The manager told us that home's policy to do with staff training and staff supervision had been revised since the last inspection and new practice implemented. We were told by the manager that staff now received individual supervision bi-monthly and have attended appropriate training. Staff told us that they now received improved supervision and improved access to training. We saw evidence that demonstrated that staff had been on appropriate and relevant training since the last inspection.
During this inspection we spoke with six people who used the service, two relatives and four members of staff. Residents who we spoke with said that they were able to choose what they wanted to do with regards to their personal care and support as well as with their activities and trips out. One resident told us, 'I don't like going to bed too early so I don't'.. I like to get up later after 9.00am and staff are OK with that'. Another resident told us that they can go out when they want to and they told us 'I feel like it's my home and I have choices about what I want to do'.
The feedback received from relatives and visitors was positive, one person said, 'I have no suggestions, I hope that the high standards can be maintained'. Another person said, 'They are doing well in the quality of care for individuals, very loving towards service users'. Somebody else said, 'The care is excellent'.
People told us that they liked the food and that they felt safe and well cared for in this home.
People said they received a good standard of care. We also observed that people looked well cared for. One person said 'they [staff] keep you clean'. One relative said 'I have never come and found [my family member] unhappy'.
Staff asked people about their choices and respected these. We saw that people could choose how they spent their day and make choices about their meals and activities to take part in. There were arrangements in place to promote people's involvement in the community. Relatives confirmed that staff promoted people's privacy and dignity.
People's care records however showed that their needs were not always comprehensively assessed and reviewed to ensure these appropriately addressed all of their needs. Care plans were also not always updated and risk assessments were not reviewed at periodic intervals to ensure these appropriately reflected people's needs and the care they required. Daily records kept about the care people received were also not always completed accurately to fully describe the care people received.
People received support with their healthcare needs and were referred to the GP and other healthcare professionals according to their needs. The management of medicines was however not always effective to ensure people were protected against risks associated with medicines.
Overall, we have found that Tudor House meets the essential standards but to maintain this we have suggested that some improvements are made. Please see main report for this information.