This inspection took place on 23, 24 January and 11 February 2019 and was unannounced.

Tennyson Wharf is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Tennyson Wharf can accommodate 60 people in one adapted building across three floors. At the time of the inspection 51 people were resident, some of whom were living with a dementia.

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.

At the last comprehensive inspection in January 2017 we rated the service as ‘Requires Improvement’ overall. We found the service did not consistently act in accordance with the Mental Capacity Act 2005 (MCA) and as required medicines (PRN) protocols were not consistently in place.

At this inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to safe care, need for consent and treatment and good governance. You can see what action we have asked the home to take at the end of this report.

Medicines were not always administered in a safe manner and in accordance with NICE (National Institute for Health and Care Excellence) guidance and the provider’s own policy. People did not always have their care needs met. Some people required repositioning to prevent skin deterioration and other people needed their fluids monitoring due to the risk of dehydration. People did not always receive safety checks and observations when they needed them. The service did not ensure people received the planned support which placed people at risk of harm.

The service was still not acting in accordance with the Mental Capacity Act 2005 (MCA). The service had a range of audits in place but these failed to identify the issues we found during this inspection. Where issues had been identified, actions plans were produced however these were not always completed as required.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice.

Risks were not always identified and mitigated against.

The provider used a dependency tool to calculate staffing levels. People and relatives gave mixed views when we asked if there were enough staff to support people. We observed a number of times, staff were supporting people in their rooms leaving other people unattended. Personal emergency evacuation plans (PEEP) did not accurately reflect the staffing support people needed during an evacuation.

The service supported people to gain access to healthcare professionals.

People were complimentary about the meals provided. People were encouraged to be healthy and a balanced diet was promoted.

Staff treated people with respect and dignity. Staff were knowledgeable about people, their preferences, interests and people important to them. Staff supported people to be involved in all aspects of decision making about their care and treatment. People were encouraged to be as independent as possible.

Staff spoke positively about the management team and said both the registered manager and the deputy manager were supportive and approachable.

The premises were well maintained. Regular health and safety checks were conducted for equipment and the building. The home was clean and tidy throughout, with infection control procedures followed as required.

The provider ensured systems were in place to protect people from abuse. The service con

This inspection took place on 18 January 2017 and was unannounced. Tennyson Wharf provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 60 people who require personal and nursing care. At the time of our inspection there were 46 people living at the home. The service is provided across three floors and divided into five units providing specific care to people, for example one of the units provided care to people living with dementia.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe from abuse including financial abuse.

Medicine records and guidance were not consistent. Protocols were not consistently in place for as required (PRN) medicines. Medicine administration sheets did not clearly identify when medicines were PRN.

We saw that staff obtained people’s consent before providing care to them. The provider did not consistently act in accordance with the Mental Capacity Act 2005 (MCA). Best interests assessments were not clearly documented. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the Deprivation of liberty Safeguards (DoLS) and to report on what we find. We found that the provider acted in accordance with DoLS.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

People in the downstairs unit said response times were sometimes slow. We found there were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support.

Staff had the knowledge and skills they needed to care for people in the right way and they had received most of the training and guidance they needed. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Accidents and incidents were recorded and investigated. The provider had sent us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.