Archived: Tavistock Square

Updated 23 June 2017

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.

The inspection took place on 5 May 2017 and was unannounced. This meant the provider did not know we were coming.

The inspection was carried out by one adult social care inspector.

Before the inspection we reviewed other information we held about the service and the provider. This included statutory notifications we had received from the provider. Notifications are changes, event or incidents the provider is legally obliged to send to CQC within required timescales. We also contacted the local Healthwatch, the local authority commissioners for the service, the local authority safeguarding team and the clinical commissioning group (CCG). Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We spoke with four people who used the service. Some people we spoke to we were unable to communicate verbally with us. We saw how people displayed non-verbal signs by smiling and gesturing with their hands. The service coordinator provided us with contact details of relatives who agreed to speak with us by telephone. We spoke with one relative.

We spoke with the service coordinator, operations manager and four care workers who were all on duty during the inspection.

We looked around the home and viewed a range of records about people’s care and how the home was managed. These included the care records of two people, the recruitment records of one staff member, training records, and records in relation to the management of the service.

Updated 23 June 2017

This inspection took place on 5 May 2017. The inspection was unannounced. This meant that the staff and registered manager did not know we would be visiting.

Tavistock Square provides personal care and accommodation for up to six people. The service was supporting five people at the time of this inspection.

The service had a registered manager. 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.

The registered manager oversees several locations as part of their registration with the CQC. During the inspection we were supported by the service coordinator who manages the home on a day to day basis.

During this inspection we found the provider was breaching one of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found medicines were not being managed safely. People who were prescribed topical medicines did not have topical medicine administration charts in place to identify where on the body the cream or ointment should be applied. Boxed and bottled medicines did not have the date of opening recorded. Staff had not countersigned the controlled drug book when checking and administering controlled medicines.

You can see what action we have asked the provider to take at the end of this report.

Recruitment procedures were thorough and all necessary checks were made before new staff commenced employment. For example, two references and disclosure and barring service checks (DBS). These confirmed whether applicants had a criminal record or were barred from working with vulnerable people.

There were systems in place to keep people safe. We found staff were aware of safeguarding and whistleblowing processes and how to raise concerns if they felt people were at risk of abuse or poor practice. Accidents and incidents were recorded and monitored as part of the provider’s audit process.

People’s care and support needs were regularly monitored to develop staffing rotas, taking into account specific activities and people’s holidays. We found staffing levels to be appropriate to the needs of people who used the service.

Environmental risks were assessed and reviewed to ensure safe working practices for staff, for example, to prevent slips, trips and falls.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates to reflect fire inspections, gas safety checks, and electrical wiring test had been completed.

A business continuity plan was in place to ensure staff had information and guidance in case of an emergency. People had personal emergency evacuation plans in place that were available to staff.

Staff training was up to date or planned in for refresher training. Staff received regular supervision and an annual appraisal. Opportunities were available for staff to discuss performance and development.

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. DoLS authorisations were in place for people and care workers supported people to make as many of their own decisions as possible.

People’s nutritional needs were assessed and we observed people enjoying a varied diet, with choices offered and alternatives available. People were encouraged to prepare food as part of their living skills. Staff supported people with eating and drinking in a safe, dignified and respectful manner.

People were supported to maintain good health and had access to healthcare professionals when necessary and were supported with health and well-being appointments.

People were supported by kind and caring staff, in a respectful dignified manner. Staff discussed interventions with people before providing support. Staff knew people's abilities and preferences, and were knowledgeable about how to communicate with people. Pictorial information was available for people to meet their communication needs.

Care plans were individualised and person centred focussing on people's assessed needs. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date. Risk assessments were completed for people where necessary with interventions for staff guidance and support to minimise risks. People had personalised activity plans with a range of different activities and leisure opportunities.

Processes and systems were in place to manage complaints.

People who used the service, relatives and staff felt the management was open and approachable. Staff meetings were held on a regular basis.

The provider had a quality assurance process in place to monitor the quality of the care and support provided by the service. We found the quality assurance process had not identified the concerns regarding medicines.

Senior management visited the service on a regular basis. Action plans were in place to drive quality and improvement.