CQC report explained · a residential care home
What the CQC found at Torkington House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found safe medicines management, suitable staffing, detailed risk assessments and appropriate infection control. They noted that support given before some medicines to manage behaviour was not always recorded.
- Effective?
- Good
- This area was not assessed during this focused inspection.
- Caring?
- Good
- This area was not assessed during this focused inspection, although inspectors observed kind and personalised care.
- Responsive?
- Good
- This area was not assessed during this focused inspection.
- Well-led?
- Good
- Inspectors found stronger systems for monitoring quality, learning from incidents and checking medicines. Managers understood people's needs and staff said they felt supported.
What inspectors found, October 2020
Rated Good; inspectors found safe, kind and well-managed care, with a small recording issue about support before some medicines were given.
This was an unannounced focused inspection on 6 October 2020. Inspectors looked at Safe and Well-led. They visited the home, observed care, spoke with people and staff, and checked care, medicines, recruitment and management records. A medicines inspector also reviewed records remotely and spoke with staff.
Inspectors found that people received personalised, kind care. Medicines were administered and stored safely, risks were assessed, staffing levels were suitable, and infection control arrangements had been updated during the COVID-19 pandemic. The home had systems for safeguarding, complaints, accidents and learning from problems.
The overall rating was Good. Safe and Well-led were both rated Good. The other three areas were not assessed at this visit, so their earlier ratings were carried forward. The overall rating improved from Requires Improvement after the previous inspection.
Personalised care
Staff knew people well, respected their wishes and adapted care to their individual, cultural and religious needs.
“People received personalised care and support. Staff knew them and their needs well and provided kind and considerate care.” from the report
Safe medicines
Medicines were stored and given safely, records were accurate and staff had the training needed. The home had introduced more checks after the previous inspection.
“Medicines were administered and stored safely. The staff had training so they knew how to administer medicines. Records of administration were accurate.” from the report
Risk and staffing arrangements
Risks such as falls, poor nutrition and skin problems were assessed and reviewed. Inspectors found enough staff and appropriate recruitment checks.
“There were enough staff deployed to meet people's needs and keep them safe.” from the report
Learning and oversight
The management team used audits, action plans and incident reviews to monitor improvements and address concerns.
“The provider had made improvements to the way medicines were managed and the audits of these.” from the report
Contact with families
During the COVID-19 lockdown, staff helped people stay in touch with relatives through visits, video calls, telephone calls and regular updates.
“The staff also supported people to make video calls and telephone calls to their relatives.” from the report
Some support was not recorded
minorSupport such as de-escalation before medicines used to manage behaviour was not always recorded. The deputy manager agreed this should be recorded in future.
“However, support (such as de-escalation techniques) provided to people prior to the administration of medicines to manage their behaviour, was not always recorded.” from the report
- 01How do you now record support given before medicines used to manage someone's behaviour?
- 02What daily and monthly checks are carried out to make sure medicines are given safely and on time?
- 03How have staffing levels changed since the previous inspection, particularly for senior staff and medicines rounds?
- 04How are families kept informed about changes to visiting arrangements and people's care?
- 05How do you check that action plans and quality audits lead to lasting improvements?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 24 October 2020 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 2020
Rated Requires Improvement; inspectors found kind, personalised care, but unsafe medicines management and weak quality checks put people at risk.
Inspectors made an unannounced visit on 21 January 2020. They spoke with people living at the home, relatives, staff and a visiting professional. They observed care and checked care records, staff records, medicines records, audits and other documents.
The main problem was medicines. Staff signed records before giving medicines, did not always record the actual time, and did not always check that people had swallowed tablets. Some medicines were given at the wrong time, and records about medicines and thickener were not always accurate. Inspectors found no evidence of harm, but people were at risk of not receiving medicines safely.
The home provided kind and respectful care. People had enough food and drink, personalised care plans, healthcare support and a good range of activities. The building and equipment were safely maintained, and there were enough staff.
The overall rating was Requires Improvement. Safe and Well-led were rated Requires Improvement, while Effective, Caring and Responsive were rated Good. The rating had fallen from Good at the previous inspection, published on 15 August 2017.
Kind and respectful care
Inspectors saw staff offering comfort, speaking gently and respecting people's dignity. People and relatives were positive about the care.
“People were treated with respect and kindness. Everyone we spoke with confirmed this” from the report
Personalised support
Care plans reflected people's needs and choices and were updated when circumstances changed. Families were involved in planning care.
“People received personalised care which reflected their needs and choices.” from the report
Food and drink
People could choose what to eat and drink. Staff monitored nutritional needs and offered snacks and high-calorie drinks when needed.
“People had enough to eat and drink and were able to make choices about this.” from the report
Activities and community links
The home offered varied activities, trips and visits from local groups. Activities were adapted to people's interests and wishes.
“On the day of our inspection, we observed lots of different activities around the home.” from the report
Staffing and risk planning
Inspectors found enough suitably qualified staff. Individual risks were assessed, planned for and regularly reviewed.
“There were enough suitably qualified staff deployed to keep people safe and meet their needs.” from the report
Medicines were not always safe
seriousStaff sometimes recorded medicines as given before they had been administered and did not always check that tablets had been swallowed. Medicines were sometimes given earlier than prescribed, and inspectors identified three occasions where people may not have received medicines as prescribed.
“Medicines were not always managed in a safe way. This meant people were at risk of not receiving their medicines as prescribed.” from the report
Medicine records were inaccurate
seriousRecords did not always show the actual administration time, the correct controlled-drug dose or returned medicines. Instructions about thickener were also conflicting, creating a risk of the wrong product or dose.
“The administration records did not show the accurate time of administration and therefore, people may have received medicines at the wrong time.” from the report
Quality checks missed known problems
seriousThe home's medicine audits did not identify the unsafe practice. Similar concerns had been raised by the local authority in 2019, but improvements had not been sustained.
“Despite the provider's action plan to address these, we found similar and additional concerns during our visit.” from the report
PRN medicines were not fully recorded
needs fixingStaff did not record why some as-needed medicines were given or whether they worked, despite advice from a pharmacist.
“The staff had not recorded the reasons for administration or the effectiveness of the dose.” from the report
- 01What changes have you made to ensure medicines are given at the prescribed time and recorded only after they have been administered?
- 02How do staff check that people have swallowed their tablets, especially when there is a risk they may spit them out?
- 03How do you make sure thickener instructions and doses are correct for each person?
- 04How do managers check that medicines audits identify problems and that improvements are sustained?
- 05What evidence can you show that staff now record why as-needed medicines were given and whether they worked?
This was an unannounced planned inspection covering all five CQC questions, including care, the premises, staff records, medicines and management systems. This explanation was written from the published report of 20 February 2020 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 Torkington House
4 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- October 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- August 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 7 December 2010.
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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