Tudor Grange

Updated 31 December 2019

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 was carried out by one inspector.

Service and service type

Tudor Grange 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection visit on 24 October 2019 was unannounced. We returned, announced, on 25 October 2019 to complete the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service and five relatives/friends about their experience of the care provided. We spoke with ten members of staff including the registered manager, deputy manager, care staff, catering staff, admin worker, regional manager and resident experience support manager. We observed care staff interactions with people throughout the inspection.

We reviewed a range of records. This included three 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 also looked at training data provided by the registered manager.

Based on our observations, we notified the local borough council food safety service about the cleanliness issues we found in the care home kitchen.

Updated 31 December 2019

About the service

Tudor Grange is a residential care home providing personal care to 21 people at the time of the inspection. The service operates within an adapted building and can support up to 33 people.

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

People lived in an environment that was not always safe, and the provider’s safety monitoring checks were not always effective. Repairs were not always carried out in a timely manner and the cleanliness of the kitchen equipment and utensils was not satisfactory. Other communal areas and people’s bedrooms were clean, and staff understood how to prevent the spread of potential infections by following their infection control training.

People did not always receive their medicine in the way it had been prescribed, and the recording of controlled medicines was not always done correctly.

People were supported by staff who understood how to protect them from abuse. There were enough care staff available to meet people’s personal care needs. However, people were not always supported to access healthcare services in a timely way, and some relatives told us that they had needed to point out to care staff when a person required a visit to a GP. Care staff had not received training on how to support people’s oral healthcare needs.

Some people were not able to give their consent to live at the care home, but the records relating to the decision, taken on their behalf, were not always clear.

Notices, and written information, were not always easy for people to see and understand; or could be confusing for some people. Some relatives told us they wanted to be more involved in the planning of their relative’s care. The care home had electronic devices available that people could use to give feedback to the provider about the service; but some relatives told us they were not aware of the devices and did not know how to use them.

People enjoyed the food and drink provided; and were pleased with the variety offered to them. Care staff knew how to support people and had access to updated care plans to refer to if needed.

Care staff supported people with respect and kindness, and in ways which protected their dignity and independence. Relatives could visit people at any time and the care team encouraged people to maintain links with their families.

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.

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 requires improvement (published 20 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

Following the inspection, the provider has taken effective action to reduce the potential risks to people caused by some of the environmental issues we found. This included improvements to kitchen cleaning and a repair to a faulty shower.

Enforcement

We have identified breaches in relation to the hygiene and maintenance of the property, the administration of prescribed medicines, and the provider’s processes for ensuring the quality of the service. 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 work alongside the provider and 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.