CQC report explained · a nursing home
What the CQC found at Talbot House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments, safeguarding, infection control and environmental safety had improved. However, some people and staff said they could benefit from more staff, and some medicine records were inaccurate.
- Effective?
- Requires improvement
- People received care that reflected their assessed needs and staff training had improved. However, the home did not always complete individual capacity assessments or best-interest decisions, and some DoLS conditions were not followed.
- Caring?
- Good
- No rating was given for this question in this report.
- Responsive?
- Requires improvement
- No rating was given for this question in this report.
- Well-led?
- Requires improvement
- Audits, environmental checks and incident analysis had improved. Inspectors said the governance systems were still not robust enough to identify every area needing improvement.
What inspectors found, June 2022
Rated Requires Improvement; inspectors found clear progress, but consent law was still not followed and further work was needed to keep people safe.
This was an unannounced follow-up inspection after the previous Inadequate rating. One inspector and an Expert by Experience spoke with nine people, reviewed six care records and checked the home’s management records, care and infection control arrangements.
The home had improved from Inadequate to Requires Improvement overall. Safe, Effective and Well-led were all rated Requires Improvement. Inspectors found better staff training, risk assessments, safeguarding processes, infection control and monitoring of accidents and incidents. People said they felt safe and enjoyed the food.
Important problems remained. Mental capacity assessments and best-interest decisions were not always completed for restrictions, and some Deprivation of Liberty Safeguards conditions were not followed. Some medicine records were inaccurate, staffing could be tight, and parts of the building needed repair. The home was no longer in Special Measures, but it remained in breach of Regulation 11.
People felt safe
People raised no safety concerns and said they felt safe being supported by staff.
“People raised no concerns around safety and felt safe being supported by the staff.” from the report
Improved staff training
Staff had received more training, and a training matrix had been introduced to track their needs.
“Staff had received training and there was further training booked in the coming weeks, for example, for diabetes.” from the report
Food and support
People enjoyed the food, were offered choices and received support with eating and drinking when needed.
“People enjoyed the food and the atmosphere was relaxed.” from the report
Health support
The home worked with health professionals and followed advice about people's individual needs.
“Records showed people were frequently supported by the GP, podiatrist and other professionals.” from the report
Better monitoring
The home had introduced more audits and analysed accidents and incidents to identify possible improvements.
“There was now an analysis in place for the incidents and accidents that had occurred within the month, this was reviewed and analysed” from the report
Mental capacity decisions
seriousIndividual capacity assessments and best-interest decisions were missing for some restrictions, including bed rails, door sensors and covert medicines.
“People did not always have individual capacity assessments or best interest decisions in place to consider these restrictions.” from the report
DoLS conditions
seriousSome staff did not know about conditions attached to DoLS authorisations, and some conditions had not been followed. This could leave people unnecessarily restricted.
“Staff were not always aware of these conditions and some of these conditions had not been complied with.” from the report
Medicine records
minorRecords for as-required medicines were not always completed correctly, which led to inaccurate stock totals. Inspectors found the stock was accurate and medicines had been given as prescribed.
“When people had received 'as required' medicines, staff had not always completed the paperwork correctly and this showed inaccurate totals.” from the report
Staffing pressure
needs fixingThere were enough staff during the inspection, but people and staff said that people sometimes waited for support and that one more staff member could help.
“People and staff felt they would benefit from more staff as on occasion they needed to wait for support.” from the report
Building repairs
minorSome parts of the home were tired and dated. Inspectors saw damaged or peeling finishes and areas needing repair.
“Some areas of the home were in need of repair.” from the report
- 01How have you completed individual mental capacity assessments and best-interest decisions for people who have bed rails, door sensors or covert medicines?
- 02How do you check that every condition attached to a person's DoLS authorisation is known by staff and followed?
- 03What has changed to prevent inaccurate records for as-required medicines?
- 04How do you decide whether there are enough staff when one person needs extra support or staff are distracted?
- 05What repairs and refurbishment have been completed since the inspection, and what remains outstanding?
This was an unannounced follow-up inspection after the previous Inadequate rating; it examined Safe, Effective and Well-led, while no new ratings were given for Caring or Responsive. This explanation was written from the published report of 30 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2021
Rated Inadequate and remains in special measures; inspectors found risks with safety, consent and management had not been dealt with.
This was an unannounced focused inspection on 10 and 11 November 2021. Inspectors reviewed information, spoke with people, a relative, staff and visiting professionals, observed care and checked care, medicines, staff and management records.
The home had enough staff to meet people's needs, and infection prevention had improved. However, people were still at risk because environmental hazards, medicines, care records and some staff training were not managed safely. The mealtime experience and the environment for people living with dementia also needed improvement.
The home was rated Inadequate overall. Safe, Effective and Well-led were rated Inadequate. Caring and Responsive were not inspected during this visit, so earlier ratings for those areas were used in calculating the overall rating.
Staffing levels
Inspectors found enough staff to meet people's needs, and people did not have to wait for support during the visit.
“There were enough staff to meet people's needs.” from the report
Infection prevention
Infection prevention and control had improved since the previous inspection. Inspectors were assured about several areas, including PPE, testing, hygiene and managing outbreaks.
“Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12 in relation to infection prevention and control practices, though some improvement was still required.” from the report
Safeguarding responses
The home was no longer in breach of the safeguarding regulation. Records showed that concerns had been investigated and referrals or advice had been sought when needed.
“Records showed that investigations had taken place when concerns about potential abuse or avoidable harm were raised.” from the report
Staff support
Staff said they could raise concerns and felt the registered manager was approachable and supportive.
“Staff told us the registered manager was approachable and supportive.” from the report
Environmental safety
seriousThe boiler room was unlocked with very hot pipes exposed. Water safety checks and some fire safety actions were incomplete, leaving people at risk of harm.
“The provider had failed to ensure people were protected from environmental risks.” from the report
Medicines management
seriousCovert medicines were not supported by clear pharmacist and prescriber advice. Some creams were unlocked, and guidance for as-required medicines was not always clear.
“The provider failed to ensure that medicines were safely managed.” from the report
Consent and restrictions
seriousMental capacity assessments did not always follow the correct process. Restrictions such as lap belts and bed rails were not always supported by recorded consent or best-interest decisions.
“This meant there was a risk that people were being unnecessarily restricted, and their rights may not be upheld.” from the report
Weak management checks
seriousAudits did not identify important problems with water temperatures, care plans, fluid monitoring, DoLS records or medicines. This meant known risks were not reliably corrected.
“Governance systems were chaotic and disorganised.” from the report
Staff training and induction
needs fixingThere was no training matrix, some training was overdue, and a new activities staff member had no induction or training despite supervising people in communal areas.
“A new member of activities staff had not received any induction or training.” from the report
Mealtimes and dementia-friendly design
needs fixingSome people were disturbed or uncomfortable while eating, and fluid targets were not always recorded. The dining room and bedroom signage were not always suitable for people living with dementia.
“These issues meant the mealtime experience was not a positive experience.” from the report
- 01What has been done to secure the boiler room, protect people from hot water and complete the outstanding fire safety actions?
- 02How are covert and as-required medicines now authorised, stored and checked?
- 03How do you record mental capacity assessments, best-interest decisions and all restrictions such as lap belts and bed rails?
- 04What training and induction has each member of staff completed, and how is overdue training tracked?
- 05What changes have been made to mealtimes, fluid monitoring and the environment for people living with dementia?
This was a focused inspection of Safe and Well-led, with Effective also inspected after concerns were identified; Caring and Responsive were not inspected and earlier ratings were carried forward. This explanation was written from the published report of 22 December 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Talbot House Care Home
6 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- June 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2021Inadequatestayed InadequateSafe: InadequateEffective: InadequateWell-led: Inadequate
- April 2021Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- March 2018Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- September 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 7 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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