About the service:

Tower House is a care home for older people, including those living with mental health needs and dementia. 21 people were living in the home at the time of the inspection.

What life is like for people using this service:

People and their relatives were complimentary about the care they received and about the quality of staff.

People were supported make choices and have as much control and independence as possible.

People had been supported to develop care plans that were specific to them. These plans were regularly reviewed with people to keep them up to date.

People received caring and compassionate support from kind and committed staff.

Staff respected people’s privacy and dignity.

People felt safe and received support to take their medicines safely.

Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively.

People’s rights to make their own decisions were respected. People were supported to maintain good diet and access the health services they needed.

The registered manager provided good support for staff to be able to do their job effectively.

The provider’s quality assurance processes were effective and resulted in improvements to the service.

More information is in Detailed Findings below.

Rating at last inspection:

Good. Report published 27 August 2016.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

Tower House Residential Home is a care home which provides accommodation and personal care for up to 24 older people with mental health or dementia care needs. At the time of our inspection 22 people were living at the home.

This inspection took place on 22 June 2016 and was unannounced.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

People who use the service were positive about the care they received and praised the quality of the staff and management. People told us they felt safe when receiving care and were involved in developing and reviewing their support plans. Comments from people included, “The staff are very good to me” and “Everything is very good. I have no problems at all”. We observed people interacting with staff in a relaxed and confident manner.

Staff understood the needs of the people they were supporting. People told us staff provided support with kindness and compassion. Comments included, “They look after us very well and are very good to us” and “The staff are very good to me. They are caring and look after me well”. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for support. A mental health professional we received feedback from told us staff provided good support for people with complex mental health needs and said they had confidence in the service provided.

Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service. The staff had completed training to ensure the care and support provided to people met their needs.

The service was responsive to people’s needs and wishes. People had regular group and individual meetings to provide feedback and there were effective complaints procedures. One person told us, “I don’t have any complaints but would speak to (the registered manager) if I did – she would sort any problems out”.

The registered manager assessed and monitored the quality of care. The service encouraged feedback from people and their relatives, which they used to make improvements.

Following our previous inspection we had formally warned the registered person of this service that they needed to make improvements in relation to the care and welfare of people. This specifically related to people not receiving appropriate support regarding their care or treatment in a timely manner. People were also not protected from safe moving and handling techniques and they were receiving care which was inappropriate or unsafe. Staff told us at the time, there was a lack of direction on how to meet people's care. We had formally warned registered person of this service that they needed to make improvements in relation to record keeping. The registered person sent us an action plan when requested following our inspection. This stated they would be complaint by 16 November 2013.

We carried out this visit to review improvements to service provision. We found the care and treatment people received was appropriate and had been provided in a timely and safe way. Record keeping had improved and staff told us there was information and guidance available which enabled them to carry out their jobs effectively.

During our last inspection we found people's privacy, dignity and independence was not being respected. People were cared for by staff who were not supported to deliver care and treatment safely and to an appropriate standard. The registered person also did not have an effective system to regularly assess and monitor the quality of service that people received. The registered person sent us an action plan when requested following our inspection. This stated they would be complaint by 16 November 2013.

We carried out this visit to review improvements to service provision. We found improvements had been made to the environment to promote people's privacy, systems were in place to ensure staff received formal supervision regularly and the quality of the service was being monitored.

We observed people being given their lunchtime medicines in a safe and respectful way.

A member of staff administering the medicines asked a resident if they would like a medicine that had been prescribed ‘when required.’

One person using the service told us that their medicines were safely looked after.

Staff explained to us how they gave medicines and confirmed that they signed the record after they had seen the person take their medicines.

We saw that records were signed after medicines had been administered.

Everyone we spoke was complimentary of the staff and were very satisfied with the care and support provided. Comments included; “The staff are caring and experienced and know me very well.” Another resident told us they were able to talk to any of the staff if they have any problems.

Staff told us they received training on a regular basis that enabled them to carry out their job and they had opportunities to express views and opinions about how the service was run.

Actions had been completed since our previous inspections in 2012 to remedy the shortfalls we had identified. The provider had improved their own systems to ensure routine checks for monitoring of the quality and safety of the service was effective.

People told us they were satisfied with how clean their home was. One person said "my room is always kept clean and tidy".

We found that people were not fully protected from the risks associated with the handling of medicines.

People who use and visit the service told us that they had completed surveys recently, and the registered manager and provider were available should they have any problems. Everyone we spoke with was confident any issued they raised would be taken seriously and dealt with.

The system in place to assess and monitor the quality of service that people receive, was not effective in identifying shortfalls.

People’s care records were not always accurate and maintained appropriately.

We talked with ten of the 22 people living in the home. They said they liked living there and were pleased with the care they received. One person told us “I feel safe and I like living here” and another “I’m so happy here, it’s wonderful”. Another person told us “I like the nice warm room” and another how they appreciated being able to sit outside in the sun when they wanted a cigarette.

We spoke with four members of the staff, the manager and the provider. We carried out this inspection to check that the provider had made improvements following our last inspection in October 2011. The service provider had addressed areas where compliance actions were made in our previous inspection, however we found the provider had not identified other areas of concern. We found appropriate guidance on hygiene was not being fully adhered to and certain areas needed attention to cleanliness. Risks associated with medicines were not avoided in all cases. We found systems to assess and monitor the quality of service needed development. Some records about people had not been put in place when needed and were not accurate.

People said they liked living in the Tower House. One person said “I like it here, I’m not going anywhere else” and another “the girls are all lovely”. We observed staff were always available to support people in the sitting rooms and regularly popped in and out to see if people needed any help when they were on their own in their room.

We observed people were not always protected by consistent assessments of need or by the development and monitoring of care plans. Systems for recruitment of staff did not ensure that people were sufficiently protected.

Staff told us that at the time of our visit several staff on duty had been deployed from one of the other homes owned by the provider. The provider explained this was to cover higher than usual levels of sickness at Tower House. The staff we spoke with had little knowledge of the people to whom they were providing care and support.

There were no assessments or care plans to direct staff on how people's privacy and dignity were to be maintained. Sensory mats were not being used in a way to protect people’s privacy and dignity. Their use was not regularly reviewed to ensure they were not placing unnecessary controls on people’s freedom and independence.

People were not given appropriate support regarding their care or treatment in a timely manner. People were not protected from safe moving and handling techniques, they were receiving care which was inappropriate or unsafe. Staff told us there was a lack of direction on how to meet people's care.

Repositioning charts for two people were not available for review when requested during our inspections. People were at risk of their weights not being monitored correctly to show changes. Record keeping was inconsistent and not accurate.

We were concerned some of the security measures put in place may limit the effectiveness of people evacuating the building if needed. We informed Wiltshire Fire & Rescue Service.