Archived: Tudor Manor

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them, visiting healthcare professionals and from looking at records.

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

Is the service safe?

People told us they felt safe and their rights and dignity was respected. They told us they were receiving safe and appropriate care which was meeting their needs. Safeguarding procedures were in place and staff understood how to safeguard the people they supported. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. Relevant staff had been trained to understand when an application should be made and in how to submit one. We found staffing levels were adequate with an appropriate skill mix to meet the needs of people using the service. People told us staff were available when they needed them.

We looked at the recruitment of new staff. This showed that the service wasn't always following their own procedures. Gaps in employment history were not being explored at interview. We also found references had not always been received from the line manager of the persons most recent and previous employment. Interview notes had not been retained after interview as stated in the provider's recruitment procedure. This put people at risk of being supported by people who may not be safe to work with vulnerable people. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff.

Is the service effective?

People's health and care needs had been assessed with them. People said that their care plans were up to date and reflected their current needs. Visitors confirmed that they were able to see people in private and that visiting times were flexible.

We looked at a sample of care plan records. We found Waterlow scores on care records had been completed but not correctly documented. We found the (Body Mass Index) BMI had been documented incorrectly and the nutritional element of the score was wrong. This meant the actions being put in place didn't reflect the person's needs and address weight loss or weight gain.

We found the MUST scores on people's care plans were incorrect due people's weight loss not being scored correctly. These errors caused the final score to be wrong. This meant incorrect action and management plan had been taken for people identified as being malnourished, at risk of malnutrition or obese.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs.

Is the service caring?

People were generally supported by kind and attentive staff. We saw most care workers showed patience and gave encouragement when supporting people. The people we spoke with were very happy with the care being provided. One person said, 'I don't mind it here at all. I am well looked after'. Another person said, 'The staff are very helpful and responsive when I need them. I am very happy with my care and have no issues with the staff who I find very friendly'. A visiting General Practitioner told us they had no issues with the care they had seen. Care plans had been maintained recording the care and support people were receiving. Regular checks had been made on bed rails and pressure relief mattresses.

We spoke with three people sat outside the ground floor lounge. They told us they enjoyed each other's company and there was lively banter between them. One person said, 'It is a nice comfortable home. I find the staff are very caring and I have no complaints. They look after me and we have a laugh'. We asked if resident meetings took place. One person told us they did and commented, 'I have asked for garden furniture and it is coming today'.

Good care practices were generally observed and people who were able told us they were happy with the support they were receiving. A range of activities were organised by the homes activities coordinator to keep people entertained. People we spoke with said they enjoyed the activities organised. People with higher dependency needs had less interaction with staff. There were no records maintained within the home of the daily activities people were supported with. It was unclear if there was any oversight regarding how people with more complex needs were supported on a daily basis with activities that were stimulating and supported their mental well - being.

We saw one person in the downstairs lounge had slipped forward in their specialised chair and were in danger of falling out of it. The persons care plan said the chair should be in a tilted position to ensure they were safe. There was no risk assessment in place for the use of their specialised chair.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting the individual needs of people in their care.

Is the service responsive?

We found a range of activities were organised to keep people entertained. People who were able told us they enjoyed participating in these and they had fun with staff. We saw little interaction with people who had higher dependency needs and unable to the engage in activities organised. One person who had behaviour that challenged had no risk strategies in place. This meant there were no effective procedures for staff to follow to prevent the risk of harm to themselves and the person. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to acting on people's changing care needs.

Is the service well-led?

The service had a quality assurance system in place. Records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff had a good understanding of their roles and responsibilities. People we spoke with said they received a good quality service at all times. We saw visiting health and social care professionals had completed surveys commenting on the service provided by the home. The comments seen were all positive. One healthcare professional said, 'No concerns about the home. Very good staff, always helpful and very caring'.

All of the staff we spoke with had a good understanding of safeguarding procedures and the homes whistleblowing policy. All of the staff said that if they witnessed poor practice they would report their concerns.

In this report the name of a registered manager who appears was not in post and managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

During the inspection we observed meal times, looked at care records, staff training and supervision arrangements and undertook a tour of the building. We observed the quality of care and support provided by staff during the inspection. We spoke with the manager, two representatives of the provider, a number of people living at the home and staff throughout the inspection.

Good care practices were observed and people were having their nutritional needs met. We found people were being supported by staff who had been properly trained and supervised. Care records were being maintained recording personal care delivery, personal hygiene support and food and fluid intake.

The people we spoke with said they were happy and enjoyed living at the home. One person said, 'I am being looked after very well. The staff look after me and I enjoy the food. I always join in the activities they organise'. Another person said, 'I have no issues with my care. The staff are all ok. I always look forward to my meals. We get three courses and a choice is always available'.

We spoke with five people who lived in the home and observed medicines being administered. One person told us 'Staff are great' and 'I have no problems'. A relative told us 'staff are very caring, we have no complaints'. Due to people having varying degrees of dementia it was difficult to obtain their direct views but overall we found medicines were not being handled safely and improvements were needed.

When we undertook this inspection a number of safeguarding incidents raised with the local authority had been investigated and upheld. The concerns identified related to poor care practice, poor care planning and lack of communication between nursing staff and other health professionals. We also had concerns that appropriate action had not been taken when concerns about one persons care had been raised. We found additional management support had been given to the registered manager by the provider (HC-One Limited) to address the issues being raised about people's care.

During the inspection we were accompanied by a specialist advisor who helped us to assess how people's nutritional needs were being met. We observed meal times, looked at care records, the homes duty rota and undertook a tour of the building. We observed the quality of care and support provided by staff during the inspection. We spoke with the manager and a number of people living at the home and staff throughout the inspection.

We found staffing levels were adequate with an appropriate skill mix to meet the needs of people using the service. The home was clean and hygienic. with good infection control procedures in place. Good care practices were observed and people were having their nutritional needs met.

The people we spoke with said they were happy and enjoyed living at the home. One person said, 'The staff look after me really well. I am having breakfast in bed and will get up later. The food is very good'. Another person said, 'I have been unwell recently. The staff looked after me really well'.

The people we spoke with said they were receiving safe and appropriate care which was meeting their needs. One person said, 'I find all the staff very caring. I can't think of one I don't like'. Another person told us they couldn't find fault with anything. They said, 'The staff are very kind. The meals are good and we have plenty of choices provided for us. We also have plenty of snacks and drinks in between meals'.

During our inspection we contacted the Blackpool contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We also spoke with Lancashire Fire & Rescue Service. They told us they had no issues with the building when they last undertook an inspection.

The home was divided into two units. The ground floor was for people who had mainly nursing needs. Conversation with some residents on this floor was limited due to their health needs. We therefore spent much of the time in the lounge/dining area making observations of how people were being cared for. However residents we did speak with on this floor and relatives, said they were well cared for and praised the nursing and care staff for the support they received.

People told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs.

People we spoke with said the staffing levels were not sufficient. Our observations found at times not enough staff were available to meet the needs of the residents. Comments included, 'I have to wait a while sometimes when I press the buzzer for help.' Also, 'The carers provide a great service for my relative considering they are short staffed.' Staff we spoke with all felt they needed more people to ensure the residents received quality care.