Tonbridge House Care Home

Updated 15 April 2021

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.

As part of CQC's response to the coronavirus pandemic we are looking at the preparedness of care homes in relation to infection prevention and control. This was a targeted inspection looking at the infection control and prevention measures the provider has in place.

This inspection took place on 15 March 2021 and was announced.

Updated 15 April 2021

We held an unannounced comprehensive inspection at Tonbridge House Care Home on 17 October 2018. Tonbridge House is a ‘Nursing home’ for people with dementia and accommodates up to 63 people in one purpose built new building. The care is provided over two floors. The upper floor catered for people with more advanced dementia and the lower floor for people with more nursing needs. All bedrooms had en-suite bathrooms and people had access to a luxury bathroom on each floor. There was a nursing station positioned in the middle of each floor. Each floor had their own dining room and lounge. There was also a private dining room which could be booked by people and their relatives, a hairdressing salon and an activities room. On the day of our inspection 24 people were living at the home, seven of which were upstairs.

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.

This is the first time the home has been inspected since it registered on 29 May 2018. There was 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 and relatives told us they had no concerns with their safety and could speak to the registered manager if they did. Safeguarding and whistleblowing policies were in place and the provider had notified us of any concerns. Risks to people were assessed on an individual basis and there was comprehensive guidance for staff. There were enough suitably trained and safely recruited staff to meet people’s needs. The registered manager had ensured the environment was safe and staff understood how to prevent and control infection. The property was well maintained and cleaned to a high standard. The registered manager had an overview of accidents and incidents, had analysed these through their electronic system and learnt from these.

Medicines, including those ‘as required’ were ordered and given safely through an electronic system. Medication was stored safely, stock levels were managed and discarded medication was disposed of appropriately. There was one incident of a liquid medication where an incorrect expiry date had been recorded and it had been given after it should have been discarded. We spoke to the registered manager about this who took immediate corrective action and the pharmacy advised there would be no adverse effect to the person.

People had assessments which were person centred, included all their needs and their rights to equality. The provider ensured managers, nurses and care staff had the right induction, training and on-going support to do their job. People were supported to eat and drink enough to maintain a balanced diet. People had the involvement of a dietician and there was information in the kitchen regarding people’s dietary needs. Feedback on the food was very positive and we observed people were enjoying the mealtime experience. People were offered choice and were encouraged to have as much as they wanted to eat and drink.

People accessed the healthcare they needed and the provider worked closely with other health professionals to ensure people were supported with various health conditions. People’s needs were met by accessible facilities and the environment had been tailored to maintain the independence and dignity of people with dementia. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff knew people well and interacted with people in a caring and respectful manner. Medication was administered kindly and nurses offered people any explanations they required. People were involved in their day to day care and developing their care plans as much as possible where they wished to. People’s rights to a family life were respected. Relatives told us they could visit whenever they wanted and were made to feel welcome. Some relatives visited every day. Peoples’ privacy and dignity was respected by staff and people’s independence was promoted.

People’s care plans were person centred, had been reviewed regularly and updated when people’s needs changed or more information was learnt about the person. Some care plans were work in progress as the home was new and people had only been there for a few months, a few weeks or days. People were receiving care which met their individual needs and effective outcomes were achieved from assessments. People’s care plans included a section on communication to detail their individual needs. People were supported to take part in activities they liked within and outside of the home.

People and relatives could raise any concerns or complaints they had and told us who they would talk to. The complaints procedure was available and the provider actively sought feedback from people and their relatives. Complaints were recorded, monitored and managed appropriately. There was an advanced care plan in place for one person described as end of life.

Relatives told us they thought the home was well managed. The management team consisted of the registered manager, the residential care manager, the deputy manager, the client services manager, nurses and team leaders. The registered manager and provider promoted a positive, person centred and professional culture, had good oversight of the quality and safety of the home, and risks were clearly understood and managed. The provider supported good governance through using a system which alerted the registered manager to any incidents. Internal audits were completed, used to check compliance and produce action plans. Record keeping was good and was made easily accessible for staff. The registered manager demonstrated continuous learning by reviewing audit action plans, complaints, promoting feedback and analysing accidents and incidents. Action was taken where needed as a result of the analysis.

Staff told us they were supported by the management team and were encouraged to complete further training. Good communication and staff engagement was promoted. Surveys had been done with staff and were being developed for people and relatives. Meetings were held and the management team were receptive to feedback. The management team worked in partnership with other agencies and engaged with their local community.