Townsend Manor

We undertook this assessment to follow up on the previous 3 breaches of regulation in relation to safe care and treatment, staffing, and good governance. At this assessment we continued to find significant concerns. Whilst the provider, registered manager and management team were keen to improve the service and took our feedback seriously; we could not be assured there had been reflective and positive learning from the previous CQC assessment. As such, there are 3 continued breaches of regulation in relation to safe care and treatment, staffing, and good governance. We also found a new breach of regulation in relation to premises and equipment and dignity and respect.

Whilst we found no evidence that people had come to harm, we identified a continued increased risk of harm to people’s well-being. This was in relation to the safe management of people’s known risks, including emerging new risks. People at a high risk of poor skin integrity were not being repositioned by staff in line with their risk assessments, thus increasing the risk of further skin deterioration. Specialist mattresses used to help promote good skin integrity, were set at the wrong settings. Governance systems in place to monitor the accuracy of records held and whether staff were following the guidance as set out in these records continued to be not effective nor robust. The improvements required found during this assessment had either not been identified by the service or had been identified but actions taken not fully embedded and sustained.

The senior management team were unable to quickly evidence that all staff had up to date training in fire-safety. Nor could they evidence that all staff had attended a recent fire drill practice. Fire drill practices help ensure knowledge and confidence in the event of an emergency such as a fire. As such, we made the fire service aware of our concerns.

Whilst we observed staff working hard, some people, relatives and staff told us there were shortages of staff. We observed occasions when there were not enough staff to meet people’s needs.

Staff treated people with kindness. However, we also observed some conversations held between staff in the presence of people that were not always dignified. We also saw some missed opportunities by staff to engage fully with people. People’s dignity and privacy was not always promoted and maintained by staff or the environment. Group activities took place and there was a bistro area that people could sit should they choose to do so and engage with other service users or visitors.

There was some misunderstanding within the management team about what constituted a safeguarding allegation and reportable incident. This improved during this assessment and notifications detailing some incidents, that the registered person was legally obliged to notify the CQC of, were received retrospectively.

Environmental improvements were required to promote people’s safety and maintain their dignity. During our site visits we found some doors and cupboards open that should be closed. This was so people did not have easy access to items such as chemicals and or gauzes. Certain areas of the building, including shared corridors, had a very strong smell of urine that did not dissipate or promote the people who lived there’s dignity. For a service where some people were living with dementia and or were sensory impaired, there was a lack of information, including daily menus and signage in line with the Accessible Information Standard.

People’s medicines were stored and administered safely. However, audits on safe medicines management had not identified that records did not always include enough information to guide staff.

There was a continuity of care when people moved between different services and staff worked with health professionals to promote people’s wellbeing. Whilst some external health and social care professionals expressed some mixed opinions about the service, we also received some positive feedback. This included how staff at the service had worked well with a health professional to help improve a person’s quality of life.

Systems and checks were in place to help recruit staff safely. People’s needs were assessed prior to admission. Consent and least restrictive practices were in place as required by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff had mixed opinions on whether they enjoyed their roles. In the main staff told us they had supervisions. There were opportunities for staff to develop their skills and knowledge, should they choose to do so. Leaders were visible within the service and led by example.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward. In addition, we have asked the provider for an action plan in response to the concerns found at this assessment.