Tynwald Residential Home

The risk of infection from visitors was minimised. People could choose a named relative who could visit them in a dedicated room if the relative tested negative for COVID -19 infection. These visits were by appointment so staff had sufficient time to thoroughly clean and disinfect the room between appointments.

Arrangements could be made for a person’s relative to be an essential care-giver if this was necessary for the person’s wellbeing.

There was a video portal enabling people to see and speak with their relatives. Relatives also received email updates from the registered manager about developments in the service particularly relating to keeping people safe from COVID -19.

New people were able to safely move into the service. A negative test for COVID -19 and a 14-day isolation period were in place. Health monitoring was completed both during the isolation period and afterwards to make sure people remained free from symptoms of infection.

The service was part of the government’s whole-of-service testing programme with people and staff regularly being screened to check they were free from COVID -19 infection.

There was enough personal protective equipment (PPE) including disposable gloves and aprons for staff and visitors. This equipment was being used in the right way.

The registered manager knew about government guidance for managing risks associated with COVID -19. There were up-to-date infection control policies including those specific to COVID -19 and infection outbreaks.

There were cleaning schedules in place. The service was neat and clean. Regular infection control audits were done by the infection control lead with actions followed up when necessary.

People had consultations with their doctor when necessary. The service received advice from specialist infection control nurses.

Further information is in the detailed findings below.

Tynwald Residential Home is providing personal care to 23 older people at the time of the inspection. The service can support up to 26 people.

People’s experience of using this service and what we found

People felt safe and secure living at the service. They were supported by staff who understood how to protect people and keep them safe. People and staff knew how to report any concerns and felt confident the right action would be taken. Risks to people’s health safety and welfare were assessed, managed and regularly reviewed. Measures were taken to reduce risks whilst keeping restriction to a minimum.

People were supported by a consistent team of staff, many of whom had worked at the service for a long time. Staff worked flexibly to cover any unexpected staff absence. The registered manager followed safe recruitment practices and carried out the necessary checks to ensure new staff were safe to work with people. Staff were skilled, trained and knowledgeable. They had regular meetings to discuss their performance, learning and development.

People told us the staff supported them to have their medicines when they needed them. Medicines were stored, managed and disposed of safely. There were robust systems to check the administration of medicines.

People lived in a service which was kept clean by a team of housekeeping staff. Additional measures were in place, in line with current Government guidelines, to reduce any risks of infection.

People’s physical, mental health, emotional and social care needs were assessed and regularly reviewed. Care plans were kept up to date. This enabled staff to follow up to date information to provide the right care and support. Staff worked closely with health care professionals to provide effective, consistent joined-up care.

People told us the meals were very good and there was always plenty of choice. People were supported to eat healthily and to drink plenty. There were snack and drinks stations in the service where people and their family and friends could help themselves. Most people ate together in the dining room and meals were very social occasions. People and staff ate together, chatting and laughing with each other.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us the staff were all kind and caring. Staff knew people and their families well. Staff spent quality time with people and were not task orientated or rushed. People’s privacy and dignity were respected, and their independence encouraged.

People kept busy throughout the day with plenty of pre-arranged and ad-hoc activity sessions. People told us they enjoyed these. Photos were taken of people having fun and these were sent to families who were unable to regularly visit.

People did not have any complaints about the care and support they received. The registered manager welcomed feedback from people, relatives, health care professionals and staff to help drive improvements.

The registered manager promoted and open and inclusive culture and lead by example. People and staff felt the service was well-led. There were robust and effective quality and safety monitoring processes. The management team and staff understood their roles and responsibilities and worked as a cohesive team to provide people with the care they need.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

• The provider could not be assured that people had received all their medicines due to an error in their electronic system. We have made a recommendation about managing this.

• Not all equipment had been maintained as wheelchairs were not serviced.

• The provider had failed to identify any learning from falls by analysing these for any trends.

• Enough suitably recruited and trained staff were deployed to meet people’s needs. However, there had been feedback from people there wasn’t enough staff. We made a recommendation that the provider uses a dependency tool in the main report.

• The provider had not ensured that feedback and auditing was used to make improvements.

• Monitoring records for people’s food intake and weight monitoring where they were at risk of malnutrition needed improvement as they were not always completed or completed accurately. The failure to ensure complete records and effective quality assurance systems was a breach of regulation.

• Systems were in place to protect people from abuse.

• The provider promoted a good quality of life for people. People were happy living at the home and were supported to access the healthcare they needed.

• Care was person centred, achieved good outcomes and people were offered choice and involved wherever possible.

• Feedback from people, relatives and staff was positive.

• The provider was responsive to feedback at our inspection and has put a new management structure in place to support the necessary improvements.

• On the day of our inspection we spoke to the new manager who was in the process of registering as the current registered manager was not available.

More information is in the full report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published on 16 May 2018). This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This was a comprehensive planned inspection based on the previous rating.

Follow up: We will continue to monitor this home and plan to inspect in line with our reinspection schedule for those services rated Requires Improvement.

Tynwald Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Tynwald Residential Home accommodates up to 26 older people in one adapted building.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in August 2016 when it was rated as ‘Requires Improvement’ overall. Four breaches of Regulation were identified during that inspection. These related to person-centred care planning, management of risks; including those associated with medicines, lack of efficient oversight and auditing and staff training which was not sufficiently specific to the needs of service users. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Responsive and Well-led to at least good.

At this inspection improvements had been made in some areas, but there was more work to do to ensure that shortfalls were appropriately addressed.

Not all risks had been properly assessed and minimised; including those relating to medicines, external doors being left open and the proper use of air mattresses.

There were enough trained and competent staff on duty to meet people’s needs. Staff received regular supervision sessions. Safe recruitment processes were operated to make sure only suitable applicants were employed to work with people.

Staff knew how to recognise and report abuse or discrimination and provider policies underpinned staff training. Accidents and incidents had been properly recorded and actions taken to prevent reoccurrences were documented.

The service was clean and hygienic and equipment and utilities were routinely safety checked.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were treated as individuals and staff encouraged people to be themselves. The provider had an equality and diversity policy in place.

People’s health and well-being was monitored and a range of professionals supported staff to keep people well. Meals were varied and plentiful and people said they enjoyed them. People were encouraged to drink plenty and had access to jugs and carafes of drinks, aside from tea and coffee rounds.

Staff were kind, caring and considerate and took account of people’s privacy and dignity when supporting them.

A range of innovative and interesting activities were available and people said their needs for social stimulation were met. People and relatives knew how to complain and had confidence that the staff and registered manager would listen and act on any concerns.

Staff knew people very well and care planning prioritised people’s wishes and preferences.

Auditing had improved since our last inspection, but was more effective in some areas than others.

Feedback was routinely sought from people and there was evidence that it had been acted upon.

The registered manager was visible and approachable and understood their responsibilities to inform CQC of particular events and the provider had displayed the rating awarded at our last inspection; which is a legal requirement.

This is the second consecutive time the service has been rated Requires Improvement.

We have recommended that the provider and registered manager implement regular, more detailed checks on medicines; including creams, the environment and pressure prevention equipment.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Tynwald Residential Home is registered to provide personal care and accommodation for up to 26 people. There were 23 people using the service during our inspection; who were living with a range of health and support needs. These included; diabetes, dementia and some people who needed support with their mobility.

The service is a large detached house situated in an elevated residential area overlooking Hythe, with large communal lounge and dining area, a solarium, quiet lounge and an enclosed sun terrace. A large well-kept garden with a veranda, patio and seating areas is located to the rear of the property. Accommodation is provided over two floors, a passenger lift and stair lifts provide step free access to each floor.

Tynwald Residential Home is run by The Alice Butterworth Charity, established to provide a residence or home for people who either live or have ties to Hythe town or surrounding district. The operation of the service is overseen by a committee of voluntary trustees

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Tynwald Residential Home was last inspected in May 2014, where no concerns were identified. At this inspection we found improvement was required in some areas where some regulations were not being met.

Medicines were not stored below the maximum temperature; some medicines were not accounted for properly which had not been identified.

Hot water temperature checks to safeguard against scalding were not sufficiently detailed.

Planning and delivery of training had not ensured a continuous learning process to ensure staff had the skills and knowledge to support the people they cared for.

Elements of care planning did not fully establish some people’s needs or reflect their wishes about how they wanted to be supported.

Auditing, for the purpose of identifying shortfalls in the quality and safety of the service provided were not wholly effective or fully developed; some records were incomplete.

Deprivation of Liberty Safeguarding authorisations had been applied for where people were unable to consent to restrictions in place.

People’s health needs were well managed and referrals to outside healthcare professionals were made in a timely way.

There were enough staff to meet people’s needs. People were supported by enthusiastic staff and volunteers.

Staff were caring, compassionate and responsive to people’s needs and interactions between staff and people were warm, friendly and respectful.

People enjoyed their meals, they were supported to eat when needed and risks of choking, malnutrition and dehydration had been adequately assessed and addressed.

People commented positively about the openness of the management structure and were complimentary of the staff and registered manager.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection; speaking with people using the service; speaking with the staff supporting people, and to a visiting healthcare professional. We also looked at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed that people were treated with respect and dignity by the staff. People we spoke with during our inspection told us they felt safe in the home.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. An application that we reviewed had been appropriately submitted. This meant that people were being safeguarded as required.

The service was clean and hygienic. Domestic staff cleaned the home following a regular and deep cleaning schedule. We saw that staff wore aprons and washed their hands before providing care.

Training and supervision of staff was in place and staff were qualified to carry out their roles.

Is the service effective?

People's individual health and care needs were assessed and care was given that met their needs.

Care records were detailed and contained care plans and risk assessments that were regularly reviewed, along with records of daily care given. People told us that staff made sure their needs were met. Records we looked at included notes from visits by professional clinicians.

We found people were involved in making choices about their care. People told us that they felt well looked after in the home. They were able to choose from a range of activities and could choose to spend time in their own rooms or in the communal areas of the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One person told us, 'I am quite happy'. People told us that the staff were friendly and caring. One said, 'The staff are very good'.

People's preferences, interests, and needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People could participate in a range of activities. Regular residents' meetings were held at which people could share their views with the staff and management of the home.

People and staff told us that they felt comfortable to speak out if they were unhappy.

Is the service well-led?

The service worked well with other agencies and services to make sure people received care that met their needs. A visiting healthcare professional told us that they had a good rapport with the management and staff at the home.

People we spoke with told us that they felt well cared for in the home.

We found that staff employed in the home were well supported and had training available to them. This ensured that staff were appropriately qualified to undertake their roles.

Care records were detailed and contained care plans and risk assessments that were regularly reviewed. People told us that staff made sure their healthcare needs were met and care records included notes from professional clinicians. A relative told us " there couldn't be a better place; has given us peace of mind".

All the people we spoke to who used the service told us that they felt safe and would know what to do if they had any worries or concerns. One person stated that they "feel able to talk to people; they are ready to listen".

The home undertook regular audits of the premises and there was a formal complaints procedure that people could use if they needed to.

We found that there were enough staff employed in the home who had a good understanding of their roles and responsibilities. They were able to provide appropriate care and support to the people who used the service according to their individual needs, including a range of planned social activities and events.