Tupwood Gate 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.

Tupwood Gate is a nursing home that provides support to up to 35 people. They provide nursing care to older people, people with long term medical conditions and people living with dementia. Care is provided across multiple floors in one adapted building. At the time of our inspection, there were 27 people living at the home.

The inspection took place on 12 April 2018 and was unannounced.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

Why the service is rated Good

People’s care was delivered safely with personal risks assessed and managed. Staff responded appropriately to incidents or concerns and were knowledgeable about safeguarding processes. People’s medicines were managed and administered safely and people lived in a clean and safe home environment. There were sufficient numbers of staff at the home to meet people’s needs safely and checks had been undertaken on all staff to ensure they were suitable for their roles.

People liked the food they were served but information on choices was not always clear to them. We made a recommendation about information on meal options. Staff had the appropriate training for their roles and staff provided support that met people’s healthcare needs. 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. The building was adapted to make the home accessible to people.

Staff were caring and people’s feedback on them was positive. People received care that was dignified and people’s privacy was respected by staff. Staff found ways to encourage people’s independence and to involve them in their care.

Care was delivered in a person-centred way. People had access to a range of activities and further improvements were underway in this area. People’s care plans reflected what was important to them and had been regularly reviewed. End of life care was provided in a sensitive and person-centred way and the provider had received a number of compliments in this area. There was a clear complaints policy and complaints were documented and responded to appropriately.

People knew the registered manager and had regular meetings to involve them in the running of the home. Regular checks on care were carried out through a variety of audits and the provider took action where improvements had been identified. There were strong links with the local community that people benefitted from. Staff felt supported by management and there were robust communications systems in place for staff.

Further information is in the detailed findings below

Tupwood Gate is a residential home which provides nursing care, and accommodation for up to 35 older people with physical health needs some of who require palliative care and some people who are living with mild dementia. Respite care is also provided (Respite care is short term care which gives carers a break by providing care away from home for a person with care needs).

On the day of our inspection there were 26 people living in the home. The registered manager stated that some rooms were for two people and they would be applying to deregister these shared rooms as well as one that was not fit for purpose.

This inspection took place on 24 June 2015 and was unannounced.

The home had a registered manager. They liked to be referred to as ‘Matron’. 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 told us care staff treated them properly and they felt safe. One person said; “Yes, I have felt safe and I’ve never lost anything.” We saw staff had written information about risks to people and how to manage these in order to keep people safe. One person had been assessed as being at risk of skin breakdown, we saw a skin risk action plan detailing actions for staff to undertake to minimise the risk to the person which detailed the appropriate pressure mattress settings, repositioning schedules, and reference to nutrition care plans to promote skin healing.

Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted. One person said; “I do think there are enough staff about.” Another person said “You never have to wait.”

Processes were in place in relation to the correct storage and auditing of people’s medicines.

Medicines were administered to people with dignity and disposed of in a safe way.

The premises were safe and fit for purpose accept for one room that was being decommissioned.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or needed to be restricted to keep them safe. They had undertaken the appropriate assessments on people who lacked capacity to make certain decisions and the appropriate DoLS had been submitted to the local authority.

People were provided with a choice of freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed some positive interactions and it was evident people enjoyed talking to staff. However not all staff interacted with people in a social way and addressed people only to provide a task e.g. “Its lunch time, Have a drink. Etc. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit. One relative said; “There are all sorts of nice things happening.”

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. The home had been commended in the Gold Standards Framework. Staff ensured people had access to healthcare professionals when needed. For example, details of doctors, opticians, tissue viability nurses visits had been recorded in people’s care plans.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to.

Staff recruitment processes were robust to help ensure the provider only employed suitable people.

The provider had quality assurance systems in place, including regular audits on health and safety, infection control and medication. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

People told us the staff were nice, they liked the food, they got enough to eat and were asked before staff provided support.

People also told us that their room was cool enough in summer and warm enough at night. They said that their taps worked and the water was not too hot. They liked their rooms, the home and the gardens.

One person said ‘‘What more could anyone want with the lovely home, lovely garden, nice staff and the food is wonderful’’.

We saw that people who use the service could be confident that their human rights would be respected and taken into account because the provider had systems in place to gain and review consent from people who use services, and act in accordance with this.

We found where people did not have the capacity to consent, the provider acted within legal requirements.

Our visit was unannounced and early in the morning and we found that the home was hygienic, clean and fresh.

We found that although the building was generally well maintained, in reasonable decorative condition and the garden was well maintained, the provider had not always taken steps to provide care in a home that was suitably designed and adequately maintained in all areas.

Although people were genarly cared for they were not always cared for by staff who were properly supported to deliver care and treatment safely and to an appropriate standard.

People we spoke with told us they liked living in the home and that the staff were friendly and caring. The relatives we spoke with also told us they were happy with the standards of care in the home.

People told us that that they were treated with respect, kindness and dignity. Individual preferences concerning food were met, reviewed and changed if necessary.

People had the freedom of choice over how and where to spend their day in the home and were actively involved in the planning of the care they received.

We saw that staff interacted well with the people who used the service. Staff interactions often resulted in positive outcomes for service users.

People told us that the staff "were excellent" and that they "would not want to live anywhere else". One service user told us that "the matron is simply excellent...she gets the job done in an efficient and professional manner and really does keep this place ticking over".

A number of people using the service were not able to tell us their views directly, but we saw they were at ease in the company of staff.

Two people using the service told us they felt safe and well cared for and knew who to speak to if they were dissatisfied or had any concerns. A representative of a person using the service made similar comments. We were also told that staff were kind and helpful.

Two people using the service told us that a choice of meal is not offered and they have to ask staff to find out what meal is being served.