Archived: Tancred Hall Care Home

Updated 7 October 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 was carried out over two days on the 17 and 18 of August 2016 and was unannounced. The inspection team consisted of one adult social care inspector.

Before the inspection, the provider completed a provider information return (PIR). The PIR 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 reviewed the information we held about the service, such as notifications about any incidents or accidents that we had received from the registered provider and information we had received from the local authorities that commission a service from the home.

On the day of the inspection, we spoke with three people who lived in the home, three visiting relatives, two visiting health care professionals, the cook, four members of staff, the registered manager and a fire officer.

As part of the inspection, we reviewed the care records for five people including their medicine records and risk assessments. We also looked at five staff files and other records used in running a care home that included quality assurance systems, policies and procedures and health and safety records. We observed the care and support being provided to people and observed two medication rounds and the lunchtime meal in the dining room.

Updated 7 October 2016

This inspection was carried out over two days on 17 and 18 August 2016 and the inspection was unannounced.

Tancred Hall Care Home provides personal and nursing care and accommodation for up to 49 people who have nursing and/or dementia care needs. The home is located in a rural setting on the outskirts of Whixley village between Harrogate and York. There is a large car park to the side of the home. Care is provided in two separate units. There is disabled access and two lifts to the rooms on the first floor. At the time of our inspection there were 33 people receiving a service.

The provider registered the service as Tancred Hall Care Home on 10 August 2012 and this was their first comprehensive inspection. There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 registered provider had a medication policy in place however; we found this information required updating. The nurse in charge had received training in the management and administration of medicines in their previous employment but they told us this required updating and we were unable to see how their competencies were assessed by the registered provider. We found management and administration of medications was not always safe.

The registered provider completed pre-employment checks on care workers to help ensure they were of suitable character to work with vulnerable people. However, the induction process for new care workers failed to demonstrate how they were supported, skilled and assessed as competent before independently carrying out their roles.

We found the registered provider had established systems and processes in place to assess monitor and drive improvement in the quality and safety of the service provided. These measures included the review of policies and procedures and audits on documentation that included care plans. Despite the measures in place, we found these were not always up to date or effective in their purpose and information was sometimes out of date. They did not always reflect people’s individual needs and care workers did not always have access to up to date records.

The registered manager discussed how they obtained feedback from people who received support and care at the home. They told us they had a schedule to send out questionnaires quarterly and that the results were evaluated to help improve any areas of concern. However, we did not see any evidence that suggested feedback was collated and evaluated to drive improvement to the quality or safety of the service.

There was a cleaner in the home and systems were in place to ensure the environment was clean which helped people remain free from infections. However, the environment was not always free from odours despite a cleaning process in place.

A record was on people’s file with regard to their interests and preferred activities. Activities were provided but at times, these were limited due to pressures on staff resources. Staffing was monitored by the registered provider. Due to concerns raised by other care workers we asked the registered provider to review their staffing dependency to ensure sufficient staff were available at all times to meet people’s individual needs.

Risk assessments and associated support plans were in place to identify and manage risks to people and the environment, which helped people to live safely and maintain their independence and personal choices.

Staff had completed up to date training in safeguarding adults from abuse and understood how to keep people safe from harm and abuse and how to raise their concerns.

People received an assessment of need as part of their admission process to the home. This meant the provider could ensure they were able to meet the person’s needs and the information formed the basis of their individual care plan. People were involved in development and review of their care plans and where they lacked capacity the registered provider followed the Mental Capacity Act 2005. Care workers we spoke with understood how to apply the principles of the Mental Capacity Act 2005 and they were clear any decisions made for a person had to be made in the person's best interests.

People had access to a range of health professionals to ensure there holistic needs were met. Care plans were reflective of their care needs but despite reviews, some information required updating. People were supported to maintain a healthy life, food was prepared freshly on site to meet people’s individual dietary requirements, and wherever possible the cook catered to individual choices.

People were consulted on their end of life preferences and where they agreed this information was recorded in their care plans. When they did not have capacity to make those decisions families and other health professionals had been consulted and the outcomes recorded.

People received care from care workers who were kind and caring and who treated them with dignity and respect. Care workers knew and understood their likes, preferences, needs, hopes and goals and promoted people’s independence wherever possible.

We found four breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.