Tozer House

About the service

Tozer House is a residential care home providing accommodation and personal care for up to 15 people living with a learning disability, physical disabilities and autistic people. Care is provided across two houses, one of which can accommodate seven people and the other which can accommodate eight. There were two separate buildings used for activities, offices, kitchen and dining area. At the time of the inspection 10 people were living at the service. Five people were living in each house.

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

Right Support:

People were supported to have the maximum possible choice, independence and control over their lives. People were supported to stay safe in a way which promoted their independence and met their needs and preferences. People and those important to them were involved in their care and support was planned to ensure people had a good quality of life. A relative told us, “All [person’s] needs are being met and it’s a nice atmosphere there. It’s all about the place.” Staff supported people to make decisions and go to places of their choosing. People were supported to maintain relationships with those who were important to them, they could visit people outside their home and have people visit them. People were supported in a safe, clean environment which was suited to their needs. 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.

Right Care:

People received kind and compassionate care. Staff respected and promoted people's dignity, privacy and human rights. Care and support plans were person-centred, identified people's strengths and promoted independence. Staff were appropriately skilled to meet people's needs and keep them safe. One person told us, “Staff are always here to give you a bit of help when you need it.” Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so. People told us they felt safe and had good relationships with staff. People had unrestricted access to their rooms which promoted privacy and dignity. Staff ensured people's human rights were met and people were supported to understand they have the same rights and responsibilities as everyone else.

Right Culture:

The managers and staff demonstrated values, attitudes and behaviours which enabled people to lead confident, inclusive and empowered lives. Staff placed people's wishes, needs and rights at the heart of everything they did. Staff had a proactive approach to dealing with issues and concerns to enhance people’s wellbeing and reduce potential risks to their health and safety. The service promoted a homely culture and people were cared for in this way. Staff had received specific training to meet the needs of people with a learning disability and autistic people and spoke with passion about people and the care and support they provided. The service promoted an open and transparent culture which encouraged people and those important to them to share their views and ideas for developing the service. We saw staff fully involving people with tasks and activities they had chosen; and interactions between people and staff were patient, kind, sensitive and assuring.

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 08 January 2020) and there were two breaches of regulation. 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

We carried out an unannounced comprehensive inspection of this service on 05 November 2019 and 11 November 2019. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-Led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There was clear communication with visitors, arrangements for visiting were by appointment only with a room was set aside for visits. Visitors could take a walk with their relative in the local area. Visitors took a lateral flow test and had a temperature check before the visit to test for coronavirus.

People told us they were able to keep in touch with their families through the pandemic and they had been well supported by staff.

Relatives told us they were kept informed by the registered manager and staff during the outbreak of Covid-19 when they were unable to visit.

The layout of the service had allowed for isolation when needed to prevent the risk of spread of infection

Staff spent time with people in meaningful activities.

Staff were knowledgeable about their responsibilities with infection prevention and control. Staff told us they received support and information from managers that helped them during the outbreak.

Tozer House is a residential care home providing personal care and accommodation for up to 15 people. At the time of the inspection 13 people were living at the service which included people who lived at the service long term and some people who were supported for short stays and respite placements. Tozer House is a West Sussex County Council specialist in-house residential service supporting people who have learning disabilities, autism spectrum disorders and/or physical disabilities.

Tozer House was built and registered with the Care Quality Commission as a residential home before Registering the Right Support guidance was produced. The principles of this guidance reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. Tozer House is located close to Chichester town centre which provided people with opportunities to access the local community and people using the service received planned and co-ordinated support. The home is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by offering accommodation across two separate houses on the same site where people have their own bedroom and access to a shared lounge, kitchen and bathrooms in each of the houses. The building reflected the surrounding residential area and staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Risk’s to people were not always identified or appropriately managed. We observed staff did not always follow risk management plans in place which placed a person at risk of harm. Environmental risks and fire safety measures were not always managed in line with the provider's policy. People received their medicines safely, however management of people’s prescribed topical creams could be improved. There were clear safeguarding procedures in place to protect people from the risk of harm. People and their relatives told us they received safe care.

Systems to monitor the quality of the service and ensure all records were complete and accurate were not always effective. Audits did not identify the issues highlighted in this inspection report. There was a clear management structure in place, and people and relatives we spoke with told us they had good relationships with staff.

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. We received positive feedback from professionals that the service worked well with other organisations. People were supported to maintain their health and wellbeing. People enjoyed the meals provided and were offered foods to encourage a varied diet.

People were encouraged to engage in activities and some people accessed day services and clubs to promote their social networks. People’s communication needs were fully considered, and people has access to information that was accessible and meaningful to them. People’s care plans were person-centred and capture their likes, dislikes and preferences.

We observed people and staff had developed positive relationships, and staff treated people with compassion, kindness and respect. People’s independence was promoted where possible, and people and their relatives were encouraged to be involved in their care.

The service applied the principles and values of Registering the Right Support. These ensure that people who use the service can live as full a life as possible. Most outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was good (published 08 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulation on this inspection. This related to safe care and treatment, and good governance.

Please see the action we have told the provider to take at the end of this report.

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.

At the last inspection, in January and February 2016, the service was rated ‘Requires improvement’. At this inspection, we found the service had made improvements. The three breaches of regulation concerning medicines management, quality assurance and the sending of key notifications to the Commission had been met.

Tozer House is a residential care home that provides support to a maximum of 15 people who have a range of learning disabilities and some who were living with dementia. The home comprises two houses, Rosemead and Bramley, where people live and a third building with the communal dining area and offices. The buildings are situated around a garden area. The home is located within walking distance of Chichester town centre. At the time of this inspection there were 12 people living there, some on a temporary basis.

The service had a new registered manager. They started in post in October 2016 and were registered with the Commission in December 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

The provider and registered manager had overseen improvement at the service. There were systems in place to monitor the quality of the service delivery and to drive improvement. Action plans were in place and monitored to ensure that necessary changes were implemented. Records relating to staff training and supervision were in place and up-to-date.

Medicines were managed safely. New systems were in place to ensure that people received their medicines as prescribed. Staff who administered medicines had received training and their competency was assessed. Systems were in place to monitor the administration of medicines and to pick up any omissions or concerns.

The registered manager had notified the Commission of important events as required by law. We discussed the various notifications that services are required to send to the Commission. The registered manager demonstrated a clear understanding of her responsibilities in this area.

Feedback from people, relatives and staff about the service was very positive. People told us they felt safe, that they enjoyed support and friendship from a regular staff team and that they were regularly asked for their views and opinions. Staff felt supported and told us their ideas and opinions were valued by the management team.

People told us staff treated them respectfully and said there were enough staff on duty to assist them. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed and reviewed.

People had developed good relationships with staff and had confidence in their skills and abilities. There was an established team of staff at the home, which offered continuity of care for people. Staff had received training and were supported by the management through supervision. Staff were able to pursue additional training which helped them to improve the care they provided to people.

People enjoyed a variety of home-cooked food. Staff were aware of people’s dietary needs and preferences and adapted the menu accordingly.

People were involved in planning their care and staff understood what was important to them. Each person had a keyworker who took the lead in supporting them and coordinating their care.

Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff supported people to be as independent as they were able and to pursue their hobbies and interests. People received one to one time to develop their independent living skills, including managing finances, cooking, laundry and accessing the community.

Staff responded to changes in people’s needs and adapted care and support to suit them. Where appropriate, referrals were made to healthcare professionals such as the GP or chiropodist and their advice followed.

Tozer House is a residential care home that provides support to a maximum of 15 people who have a range of learning disabilities and some who were living with dementia. The home comprises two houses, Rosemead and Bramley, where people live and a third building with the communal dining area and offices. The buildings are situated around a garden area. The home is located within walking distance of Chichester town centre. At the time of this inspection there were 12 people living there.

The service had a registered manager who was registered with the Commission in October 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

In the year leading up to our inspection, there had been significant vacancies in the senior team, including at assistant manager and senior support worker level. People had continued to receive good care and support but there had been a lack of oversight in other areas. This had led to gaps in staff training and supervision and checks on the quality of the service had not always been carried out or used effectively to improve the care that people received. We found that people had not received their medicines safely as there were gaps in administration and records. This had not been identified by the registered manager or provider as there was no audit or check in place to ensure that medicines were administered safely.

The registered manager took prompt action in response to the concerns that we identified. Before our inspection, new senior support workers had been recruited and the registered manager had started to make improvements in how records of staff training and supervision, as well as documents relating to the management of the service, were made and filed. A new staff training matrix had been prepared which made clear which staff required refresher training and could be used as a tool to monitor progress. Supervisions and appraisals were underway, with each senior support worker responsible for supervising a small number of staff.

Staff felt supported in their roles. The registered manager placed high value on a good induction and staff spoke positively of their experiences and the level of support they received. There were enough staff on duty to meet people’s needs and to support them to participate in social activities and to access the community. The staffing level was adapted to reflect changes in people’s needs or to facilitate particular activities. The evening meal was a sociable time, with people and staff eating together. There was a choice of food available and people were supported to make choices and to eat a balanced diet.

There was a happy and open atmosphere at the home. People enjoyed positive relationships with staff and were treated respectfully. People were involved in planning their care and were supported to be as independent as they were able. Staff monitored people’s health and were kept up-to-date via handovers and regular staff meetings. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This often included the involvement of healthcare professionals, such as the GP, occupational therapist or specialist clinics such as for diabetes.

People felt safe at the home and were able to speak up if they had concerns. Risks to people’s safety had been assessed and were managed in order to maximise their independence. Staff knew people well and helped them to make decisions relating to their care and support. We observed that staff took time to discuss options with people and respected their wishes. Staff understood how people’s capacity should be considered and had taken steps to ensure that their rights were protected in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People and their relatives were asked for feedback. People were enthusiastic about their keyworkers. They told us that they helped them with shopping and that they could talk freely to them. A new pictorial survey had been developed for people and the registered manager was planning to reintroduce meetings for people who used the service so that they had a formal opportunity to share their views and ideas on the service and their support.

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

We spoke with a health professional who told us the home works well with them to meet people's needs. We were told "People are well looked after"

We also spoke with a social care professional who had placed a person in the home and no concerns were expressed. The feeling about the home, we were told "Was very positive". We were told that the home offered care and support as assessed.

We saw from care records that people's care and support needs were assessed and met. We also saw that before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

People who use the service were safeguarded against the risk of abuse because training was taking place.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.