CQC report explained · a nursing home
What the CQC found at Telford Hall
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, June 2023
The Farmstead rated Requires Improvement overall; inspectors found kind, effective care but ongoing medicines and leadership weaknesses.
Inspectors visited on 9 and 10 May 2023. The first day was unannounced and the second was announced. They spoke with people living at the home, relatives, staff and a visiting professional. They also checked care plans, medicines records, staff records and health and safety records.
People said they felt safe and praised the staff. Inspectors found enough staff, safer recruitment, improved risk management and good infection control. However, some medicines were not given at the correct times, and some skin patches were not applied according to the manufacturer's guidance.
The home was rated Good for Effective, Caring and Responsive. It was rated Requires Improvement for Safe and Well-led. Inspectors found that improvements had been made since the previous inadequate inspection, but more time was needed to show that these improvements would last.
The home had been in Special Measures since 7 February 2023. It was no longer rated Inadequate and was removed from Special Measures after this inspection. The provider was no longer in breach of regulations at this inspection.
Kind and respectful staff
People and relatives were very positive about staff. Inspectors saw staff interacting with people in a kind, respectful and unhurried way.
“Staff interacted with people in a kind, respectful and unhurried way, and they knew what was important to people.” from the report
Improved safety systems
Risk assessments, environmental checks, safeguarding arrangements and infection control had improved since the previous inspection.
“At this inspection, improvements were found. There were regular checks on the environment and any issues identified were addressed in a timely manner.” from the report
Good food and healthcare support
People received food and drink that met their needs and preferences. Staff made timely referrals to healthcare professionals and followed their advice.
“People received food and drink which met their needs and preferences.” from the report
Personalised care and activities
Care plans included people's needs, preferences, cultural and religious choices, and communication needs. People were supported to maintain relationships and take part in activities.
“The care plans we read detailed people's needs and preferences.” from the report
Some medicines were not given correctly
seriousSome long-acting pain medicines were not always given at the correct time intervals. Some medicinal skin patches were not applied according to the manufacturer's guidance, which could affect how the medicine worked.
“Those people receiving long-acting oral analgesic medicines were not always receiving these medicines at the correct time intervals.” from the report
Leadership changes still need to settle
needs fixingThe management and monitoring systems had improved, but inspectors said the changes needed more time to become consistent and lasting. There was no registered manager in post during the inspection.
“However, more time is needed to ensure improvements are embedded and can be sustained over time.” from the report
- 01How do you make sure long-acting pain medicines are given at the correct time intervals?
- 02How are medicinal skin patches checked to make sure they are applied according to the manufacturer's guidance?
- 03What quality checks are now used to identify and correct medicines problems?
- 04Who is currently responsible for managing the home while the manager's registration application is being assessed?
- 05What evidence can you show that the improvements from the previous inspection have been sustained?
This was a follow-up inspection after the previous inadequate rating, covering all five key questions and infection prevention and control, with particular follow-up on action required from the previous inspection. This explanation was written from the published report of 2 June 2023 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, February 2023
Rated Inadequate and placed in special measures; inspectors found serious risks involving medicines, safeguarding, infection control and management.
This was an unannounced inspection on 1 and 7 December 2022. Inspectors spoke with people, relatives, staff and professionals. They reviewed care plans, medicines records, staff files and management records, and observed care.
People were put at risk by unsafe medicines management, poor infection control, missed health referrals and risks such as damaged carpets and an obstructed emergency exit. Staff did not always report abuse or poor practice, and known problems continued.
Inspectors also found that consent was not always obtained lawfully, people were not always treated with dignity, complaints were not always handled properly and end of life wishes were not recorded. People did enjoy activities, had their preferences recorded and generally gave some positive feedback about staff and management.
The overall rating was Inadequate. Safe, Effective and Well-led were rated Inadequate, while Caring and Responsive Requires Improvement. The previous rating was Good, published on 21 April 2022.
Preferences recorded
People's preferences and what mattered to them were included in care plans. Staff also knew how to support some people when they became anxious.
“People's preferences were recorded in their care plans along with what was important to them.” from the report
Activities and relationships
People were supported to keep in touch with family and take part in activities. The home had a cinema room, and staff made recordings of activities for people who could not attend.
“People were supported to maintain relationships with the important people in their lives.” from the report
Food and drinks
People said they enjoyed the food and could ask for alternatives. Inspectors saw drinks available during the inspection.
“We saw people had drinks available to them throughout our inspection.” from the report
Some positive experiences
Most people told inspectors they felt safe and received support when they needed it, despite the wider concerns.
“Despite our findings, most people told us they felt safe when receiving care from staff and they got support when they needed it.” from the report
Medicines were unsafe
seriousMedicines were not always stored or given safely. Staff did not consistently follow instructions for patches, fridge temperatures, self-administration or medicines given when needed.
“People's medicines were not managed safely.” from the report
Safeguarding failures
seriousStaff did not always report poor practice or witnessed abuse. A significant weight loss was recorded but was not acted on, leading inspectors to make a safeguarding referral.
“People were not protected against the risk of abuse.” from the report
Health needs were missed
seriousStaff did not always make timely referrals or provide accurate information to health professionals. One person's malnutrition risk was not supported by a suitable plan or detailed food records.
“People were at risk of poor health outcomes because staff did not always make referrals to external health care professionals in a timely manner.” from the report
Poor infection control
seriousInspectors saw repeated poor mask use and hand hygiene. Visitors were not given consistent instructions about infection prevention.
“We were not assured the provider was using personal protective equipment (PPE) effectively and safely.” from the report
Dignity and choice
needs fixingPeople were not always involved in decisions or supported according to their preferences. Inspectors saw staff enter rooms without knocking and leave one person in an undignified situation.
“We saw both positive and negative interactions throughout our inspection between staff and people.” from the report
Weak management oversight
seriousAudits and governance systems did not identify or resolve continuing problems. At the inspection there was no registered manager in post, and the interim manager had been there for three days.
“The provider's audit and governance systems were not effective.” from the report
- 01What action has been taken to make medicines safe, including storage temperatures, patches, self-administration and medicines given when needed?
- 02How do you make sure staff report suspected abuse, poor practice and safeguarding concerns immediately?
- 03What checks now show that staff follow infection control guidance, including mask use, hand hygiene and visitor instructions?
- 04How are health concerns, weight loss, skin problems and malnutrition risks identified, escalated and followed up?
- 05What evidence can you show that the warning notices and special measures concerns have been addressed and that improvements are lasting?
This was an unannounced comprehensive inspection covering all five key questions, including infection prevention and control; the previous ratings had been Good for Safe, Effective and Caring and Requires Improvement for Well-led. This explanation was written from the published report of 9 February 2023 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 Telford Hall
4 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2023Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2021Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Requires improvement
- November 2019Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2019
Registered with the Care Quality Commission on 15 February 2019.
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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Most charge £980 to £1,210 a week. 88 can care for a couple. 10 years' experience on average.
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