CQC report explained · a residential care home
What the CQC found at Tower House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm, with enough staff and safe recruitment. However, some risk, injury, accident and as-required medicine records were incomplete.
- Effective?
- Good
- This key question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This key question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This key question was not inspected during this visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Good
- People, relatives and staff were positive about the management. The manager was visible and approachable, but systems for checking records were not yet fully embedded.
What inspectors found, July 2023
Rated Good; inspectors found kind, safe care, but some risk and medicines records were not complete.
This was an unannounced focused inspection on 26 June 2023. One inspector and an Expert by Experience spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment and management records.
The home was rated Good for Safe and Well-led. Inspectors found enough staff, safe recruitment, suitable infection control, and staff who knew people well. People and relatives described staff as kind and caring, and felt able to raise concerns.
Some records were still being improved. Not all risks, injuries, accidents and as-required medicines had been fully recorded. The provider was no longer in breach of regulations, but inspectors recommended making management checks more robust and fully embedding them in practice.
Kind and familiar staff
People and relatives said staff were kind and caring. Inspectors found that staff knew people well and understood their known risks.
“People and relatives described staff as kind, caring.” from the report
Enough staff
Inspectors observed enough staff to meet people's needs, and staff were recruited with appropriate checks.
“We found sufficient staff were deployed to maintain people's safety and meet individual needs.” from the report
Open management
People and relatives knew the manager and felt confident raising concerns. The manager was visible and accessible.
“People and relatives all knew who the registered manager was and told us they felt confident in raising any concerns with them.” from the report
Improved safety
The home had improved since the previous inspection. Fire safety, medicines handling, infection control and staff training were checked positively.
“Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12.” from the report
Risk records
needs fixingNot every risk had been assessed and the steps to reduce it had not always been recorded. New care plans and risk assessments were being introduced.
“Not all risks had been assessed and mitigating strategies recorded.” from the report
Injury and accident records
needs fixingSome records did not fully describe injuries or accidents. A new recording system was being introduced.
“When a person sustained an injury, the records were not always clear regarding the size, shape, position on the body or colour of the injury.” from the report
As-required medicines
needs fixingThe reason and outcome for some as-required medicines were not recorded together with the medicines record. The manager agreed to improve this and added it to the audit.
“Information was not always recorded with the medicine record regarding why a person had been given a 'as required' medicine.” from the report
Management checks
needs fixingThe provider had audits, but they did not always identify incomplete records. Inspectors recommended more robust checks and analysis.
“Systems and processes were in place but not fully embedded into practice.” from the report
- 01How do you now make sure every person's health risks and the steps to reduce them are recorded?
- 02How are injuries and accidents recorded, including their size, shape, position and colour?
- 03How do you record both the reason for and the outcome of an as-required medicine?
- 04How often are care, risk and medicines records audited, and who checks that actions have been completed?
- 05How do you monitor staffing on shifts where staff may feel there are not enough people?
This was a focused inspection of Safe and Well-led only; the other ratings carried over from the previous inspection. This explanation was written from the published report of 12 July 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, November 2019
Tower House was rated Requires Improvement overall; inspectors found kind, person-centred care but unsafe medicines and weaknesses in safety checks and management.
The inspection was unannounced and took place on 09 October 2019. One inspector spoke with four people, one relative, four staff members and one visiting professional. They also reviewed care records, medicines records, staff files and management records.
The home was rated Good for Effective, Caring and Responsive. People were supported by kind staff, involved in decisions, helped to stay independent and given food and healthcare that met their needs. Care plans generally reflected people's needs, and people could raise concerns.
The home was rated Requires Improvement for Safe and Well-led. Some medicines were missed or lacked clear instructions. Fire safety arrangements, risk assessments and quality checks were not reliable enough. The overall rating fell from Good at the previous inspection, published on 13 April 2017.
Kind and respectful staff
People and relatives were very positive about staff. Inspectors saw kindness, compassion, respect for privacy and support for people's independence.
“The staff genuinely care about you. They make you feel loved and that makes a big difference.” from the report
Enough staff available
There were enough staff to meet people's needs. Staff responded promptly when people asked for help and checked on people who stayed in their rooms.
“I press the button and they come and help. They are very good at coming.” from the report
Good healthcare support
People were helped to access health professionals promptly. A visiting professional said staff referred people appropriately and followed instructions.
“They (staff) refer appropriately and in a timely fashion and carry out any instructions to the letter.” from the report
Personalised care
Care plans reflected people's needs, choices and communication requirements. People were supported to personalise their rooms and spend their days as they wished.
“Care plans promoted independence and showed people had been involved in decisions about their care.” from the report
Medicines were not always safe
seriousOne person missed three doses of a high-risk medicine over three days. Some as-needed and cream medicines did not have clear instructions for staff.
“One person had not received three doses of a high-risk medicine over a three-day period.” from the report
Fire and emergency arrangements
seriousFire instructions did not match the home's policy, fire drills had not been carried out and emergency information included seven people who no longer lived there.
“Fire drills were not carried out to ensure staff knew what to do in the event of a fire.” from the report
Some risks were not assessed
seriousA person who needed a pureed diet because of a choking risk did not have a risk assessment or care plan for this need.
“However, there was no risk assessment and no care plan relating to the person requiring a pureed diet.” from the report
Quality checks missed problems
needs fixingThe home had audits, but they did not identify the issues found during the inspection. This meant the management systems did not give enough assurance about safety.
“However, these had not identified the issues we found during the inspection.” from the report
Limited activities
minorActivities were organised one day a week. Some people said they would like more activities, although others were happy with their own company.
“However, some people felt they would like access to more activities.” from the report
- 01What action has been taken to make sure every medicine, especially high-risk medicine, is given as prescribed?
- 02How do you now check instructions for as-needed and cream medicines are clear and up to date?
- 03When was the last fire drill, and how do you make sure staff know what to do in an emergency?
- 04What risk assessments and care plans are now in place for people at risk of choking?
- 05How do your current audits identify and correct safety problems before they affect people?
This was an unannounced inspection covering all five CQC questions, with the home rated Good for Effective, Caring and Responsive and Requires Improvement for Safe and Well-led. This explanation was written from the published report of 2 November 2019 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 Tower House
5 rated inspections over 8 years: the service has improved, from Inadequate to Good.
- July 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- April 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2015Goodup from InadequateSafe: GoodEffective: GoodResponsive: GoodWell-led: Good
- March 2015InadequateSafe: InadequateEffective: InadequateCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 29 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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