Archived: Tancred Hall Care Home

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in place, we found these were not always up to date or effective in their purpose and information was sometimes out of date.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.

Below is a summary of what we found.

The summary describes what people using the service told us or their relatives, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risks to people's health and wellbeing were known by the staff. These risks were kept under review to help to maintain people's health.

The service had policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were assessed upon admission and on an on-going basis, this helped to ensure their rights were protected.

Systems were in place to make sure that the manager and staff learnt from accidents and incidents. Audits were being undertaken and people's views were sought. There were policies and procedures in place to deal with any complaints that may arise. This helped to ensure that the service continually improved.

Staffing levels were monitored by the manager who also worked shifts where this was required. People we spoke with said 'The staff are here when I need them, they are kind.' and 'This is a good service, the staff are decent.' More care staff had been recruited and were about to start work at the home. When agency staff where required it was requested that staff were sent where possible who had worked at the home before. This helped to maintain the continuity of care for people.

Is the service effective?

People's health and care needs were regularly assessed. People were encouraged to live their life and be as independent as possible, even if there were risks attached to this. A person we spoke with said 'I am looked after well. I can go out when I want.'

Help and advice was gained from relevant health care professionals to ensure that people received the support they needed to maintain their wellbeing.

People were provided with a choice of nutritious food. Snacks and drinks were available at any time. People's dietary likes and dislikes were known by the staff. Health care professionals were involved in monitoring people's dietary needs where this was required which ensured people nutritional needs were being met. People we spoke with told us that the food was good and that there was plenty of it.

Is the service caring?

We observed people that were supported by staff who appeared to be patient and kind. A person we spoke with said 'I like it here it is home from home.' Another person said 'I like living here. Staff help me, they are kind.'

We saw that when staff had a moment to spare they sat and spoke with people. Staff were seen to act upon what people said which ensured they felt listened too. People were asked for their views about the service. The manager had an open door policy so that anyone could speak with her at anytime. The ethos of the home was continued improvement in all aspects of the service provided.

Is the service responsive?

There were robust systems in place to deal with complaints. People told us they knew how to make a complaint. No complaints had been received at the home since our last inspection. People told us they had no complaints to make, they said this was because small issues were acted upon in a timely way.

Is the service well led?

The manager and staff told us they would act on any changes in people's condition, informing relatives or health care professionals as necessary. Staff told us that they worked as a team to make sure people received the care they needed

The staff worked with other health care professionals to ensure that people received the care they required.Quality assurance systems were in place. The quality of the service provided was constantly being monitored by the manager and senior manager. Improvements were made where necessary, to make sure that people living at the home received the help and support they required.

Staff we spoke with understood their roles and responsibilities. They told us they were happy working at the home. The manager told us that staffing levels were monitored and further recruitment was taking place to enhance the current staff team. Staff we spoke with told us that the manager listened and acted upon what they said. This helped them to feel valued and supported. Although the manager had only been in place for a short period of time they had assessed the service and had identified a list of priorities to undertake to improve the service people received.

People looked well cared for, they were supported by the staff in a kind and dignified way. We saw records that showed some people were involved in developing their care plans and that some people's representatives had been involved, if the person was unable to contribute. This meant people were able to say what their likes and dislikes were.

The menus were varied, offering choice and a variety of nutritious foods. The staff we spoke with told us that everyone was weighed monthly and those who had a lower Body Mass Index (BMI) were weighed weekly. This helped to identify the people who were at risk of not having sufficient food to meet their individual needs.

We observed the care staff being kind and respectful to people. They told us they had received training in safeguarding vulnerable adults and they were able to tell us how they would or could protect people who used the service from abuse.

The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.