Archived: Twynham

Updated 9 August 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection which took place over two days on 26 and 27 June 2016. On the first day there were two inspectors. The second day was undertaken by one inspector.

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification is where the registered manager tells us about important issues and events which have happened at the service. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help us decide what areas to focus on during our inspection.

During the inspection we spoke with the manager, the assistant area director and four support staff. We also reviewed the care records of four people, the records for two staff and other records relating to the management of the service such as audits, incidents, policies and staff rotas.

We spoke with six of the seven people using the service and spent time observing interactions between staff and people. Following the inspection we spoke with three relatives and obtained the views of two health and social care professionals about the care provided at Twynham.

The service was last inspected in November 2013 when no concerns were found in the areas inspected.

Updated 9 August 2016

The inspection took place over two days on 26 and 27 June 2016. The inspection was unannounced.

Truecare Group Limited are part of the Choice Care Group. Choice Care Group provide both residential and supported living services for people with learning disabilities and mental health disorders, with a particular specialism in working with individuals who have highly complex needs and may behave in a way that is challenging to others. Twynham provides accommodation, care and support for up to seven adults. At the time of our inspection there were seven men living within the service. The home is situated close to New Milton town centre. It has seven individual rooms arranged over two floors. The home does not have a lift and is so is not suitable for people with restricted mobility. Three of the rooms have ensuite facilities. There is a large kitchen and a lounge / dining area and a conservatory. This leads out to a garden and barbeque area, activity workshop and a vegetable garden. There was a covered smoking shelter in the garden. The home has its own vehicles to assist people to access leisure, recreational and educational activities in the community.

The service had a registered manager although they were not currently working within the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. A new manager had been appointed and was in the process of applying to the CQC to register.

People were not always given foods in line with their specific dietary requirements. Staff were not always present in the dining room whilst people were eating and drinking. This placed them at increased risk of harm. Other risks were appropriately assessed and planned for and staff demonstrated a good understanding of these.

Whilst staff supported people in a kind, sensitive and respectful manner, we felt some aspects of how people’s care was delivered in a generic manner and not always provided in a person centred way. It was not always clear that some of the risk reduction measures that were in place were based upon the needs of people using the service or balanced with people’s rights to a private life.

Registered managers and providers are required to send statutory notifications to the Care Quality Commission (CQC) when a significant event occurs. One type of significant event is when the local authority approve an application to restrict a person’s liberty to protect them from harm. Applications for a DoLS had been approved by the local authority for four of the seven people living at Twynham but the provider had not notified the Commission.

Policies and procedures were in place to ensure the safe handling and administration of medicines. However, the information available for “as required” (PRN) medicines, could be more detailed and staff had not always signed for medicines when they were administered.

Staff had received training in the Mental Capacity Act 2005 and they were able to demonstrate an understanding of the key principles of the Act. However staff had not always completed an assessment of people’s capacity to consent to aspects of their care and support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which are part of the Mental Capacity Act (MCA) 2005 and apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were either in place or had been applied for. Where authorisations had expired, we did note that staff had not always applied for a new authorisation in a timely manner.

Whilst staff were trained in the use of physical interventions, but in the case of two staff this was not up to date. This is now booked for July 2016. Other training relevant to the needs of people using the service was in place and generally up to date. New staff received a comprehensive induction which involved learning about the needs of people using the service and key policies and procedures. Staff received regular supervision and an annual appraisal.

Although some people could display behaviours which challenged, staff had taken steps to understand the potential triggers and had implemented methods to manage and de-escalate these behaviours in the least restrictive way possible. Incidents and accidents were reviewed and monitored. This helped to ensure the behaviour management strategies in place remained effective and helped to keep people safe.

Staffing was adequate to meet people’s needs and recruitment practices were safe and relevant checks had been completed before staff worked unsupervised.

Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.

People told us they received effective care and from speaking with relatives, staff and reviewing records, it appeared that the service achieved positive outcomes for people.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs. People were involved in decisions about what they ate although we did note that they could be more involved in preparing their meals.

Where necessary a range of healthcare professionals including GP’s, community learning disability nurses, speech and language therapists and dentists had been involved in planning peoples support to ensure their health care needs were met.

People told us they were supported by staff who were kind and caring and the atmosphere within the home was calm and relaxing. Staff engaged people in meaningful conversations but were also seen to share a laugh or a joke with them when this was appropriate. Staff were also gently challenging when this was required, which helped to prevent people’s anxieties from escalating.

Staff had a good knowledge and understanding of the people they were supporting. Staff were able to give us detailed examples of people’s likes and dislikes which demonstrated they knew them well.

People were supported to take part in a range of activities and make choices about how they spent their time.

Complaints policies and procedures were in place and were available in easy read formats within the communal areas of the home. People and their relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with.

Relatives and staff spoke positively about the manager. There was an open and transparent culture within the service and the engagement and involvement of people and staff was encouraged and their feedback was used to drive improvements. There were systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.

We found three 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 this report.