Archived: Theoc House

Theoc House is a residential care home providing accommodation and personal care to up to 10 people. The service supports people living with acquired brain injury, some of whom may have mental health needs and/or physical disability. At the time of our inspection there were 7 people using the service.

Theoc House offers purpose-built accommodation with 7 bedrooms and 2 self-contained flats within the main building. One flat has 2 bedrooms, the other has 1 bedroom. All bedrooms have en-suite facilities and the option for ceiling hoists. The main house has an adapted bathroom, communal kitchen, lounge, and gym area. The main house, ground floor flat and enclosed garden are wheelchair accessible.

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

People were positive about life at Theoc House and told us they were supported by staff who were kind and respectful. We saw people were able to raise complaints and their views were listened to. People benefitted from a calm and inclusive approach where their individual needs were understood.

People’s risks had been assessed and their support plans described the actions staff should take to keep them safe and to promote their independence. Risk assessments and support plans were reviewed regularly, and timely action was taken when people’s needs changed. Staff followed advice from professionals when managing risks in relation to choking, pressure care, seizures and medicines.

One person declined to follow the specialist advice in their support plan to manage their risk of choking and we found a lack of clarity around how this risk was being managed by the service. We recommended the provider review their risk management processes to ensure these are sufficiently robust in such circumstances.

People’s medicines were reviewed regularly to ensure they remained suitable. The registered manager ensured the equipment people needed was requested and appropriately maintained. Provider policies were followed to manage environmental risks including fire and control of infection.

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. When people were unable to consent to any restrictions needed to keep them safe, capacity assessments had been completed and applications to deprive them of their liberty had been submitted.

Increased investment, improved oversight and leadership, recruitment changes, staff training and support were all having a positive impact on the service's culture. Each person had a named staff member [keyworker] who supported them with planning and decision-making. Senior staff had recently completed workshops in key-working and supervision [of staff] to strengthen performance in these areas. Progress on the service’s improvement plan was closely monitored by the provider.

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 20 September 2018).

Why we inspected

We received concerns in relation to meeting people’s care needs, safeguarding people and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good, based on the findings of this inspection.

Recommendations

We recommend the provider review their processes to ensure these are sufficiently robust when people decline to follow recommended care and treatment plans.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Theoc House on our website at www.cqc.org.uk.

Follow up

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

At the time of our inspection, 10 people were receiving accommodation and support with their personal care and rehabilitation support. Theoc House is in Tewkesbury, Gloucestershire. The care home contains seven bedrooms, and two apartments (with one apartment housing two people). On the ground floor there is a dining room, kitchen, lounge and therapy room. People had access to a secure garden. Theoc House is located to a range of amenities and services. This was an unannounced inspection.

We previously inspected the home in August 2017 and rated the service as ‘Requires Improvement’. During our August 2017 inspection we found the provider was not always meeting all the required regulations. People did not always receive care and support which was personalised to their individual needs. The provider did not always ensure people’s care and rehabilitation records were current and accurate. There were not always systems in place to assess, monitor and improve the quality of care people received. At this inspection we found the provider and registered manager had ensured improvements had been made and the service was meeting all the required regulations.

We rated the service as ‘Good’ overall.

There was a registered manager in place at Theoc House. 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.

People were safe living at Theoc House. There were enough staff deployed to ensure people’s needs were being met. People received the support they required to meet their health and wellbeing needs. People were supported with their rehabilitation needs and plans were in place to support people to achieve their own personal goals and where appropriate move to more independent accommodation.

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

People received their medicines as prescribed. The risks associated with people’s care were managed well and people were supported to take positive risks and maintain their independence.

Support workers treated people with dignity and ensured their nutritional needs were met. Staff spoke positively about the support and communication they received. Support workers felt they had all the training and support they required to meet people’s needs.

People were supported to live their life to the fullest and enjoyed a wide range of activities and events. People benefitted from engagement and activities which were tailored to their individual needs and preferences. People were happy living at Theoc House.

Support workers were caring and were aware of people’s health needs. People and their relatives concerns and views were listened to and acted upon.

The registered manager and provider had systems to monitor and improve the quality of service people received at Theoc House. The registered manager, the deputy manager, the provider and support workers had a clear vision of how they wanted the service to develop and improve, with a focus on meeting people’s rehabilitation potential.

The service was rated ‘Good’ at our last inspection in December 2015. We found the provider was meeting all of the requirements of the regulations at that time; however we found that good practices had not always been established and maintained in relation to maintaining people’s care records and the monitoring of the quality of care being delivered.

People’s care records were not always current or reflective of their needs. The service did not always take opportunities to support people with promoting and developing their well-being needs, such as relationships with others.

There had been a recent change in management of Theoc House. Prior to these changes there was not always a clear and consistent record of audits being carried out. The provider had provided additional management support to Theoc House. There were detailed action plans in place to develop the service.

People told us they felt safe and comfortable living at Theoc House and they were in control of their care. People felt their needs were met by skilled and dedicated support workers. People were happy with the care and support they received. People received support which met their individual needs, such as personal hygiene, personal care, medicines and nutrition needs. People were supported to work towards individual goals.

Support workers spoke confidently about the support they received. They openly discussed the transition the service was going through. Support workers had the skills and training they needed to meet people’s needs. Support workers received support from the manager and their professional development was promoted.

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

The service had a registered manager. 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 and associated Regulations about how the service is run.

People told us they enjoyed living at the home. People were supported by kind, caring and compassionate care staff, who clearly knew people’s needs. Staff supported people to spend their days as they wished.

People were supported with activities, and enjoyed time spent with care staff and other people. People told us there were things for them to do in the home.

People told us they felt safe in the home, staff had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.

People were protected from the risks associated with their care. Staff had clear guidance to protect people from risks such as smoking. Care workers took action to help maintain people’s independence.

There was a positive caring culture, promoted by the registered manager. Care workers were passionate about providing high quality personalised care and support. They spoke confidently and positively about people and their preferences. Care workers felt supported by the registered manager describing them as approachable and supportive both personally and professionally.

Care workers were knowledgeable about the people and carers they supported. They had access to development opportunities to improve their skills and the service people received. Care workers received the training they required to support people with individual needs and had access to effective supervision (one to one meetings with their manager).

People's needs were assessed. Where any risks were identified, management plans were in place. People were supported in a way that recognised their rights to take risks. The care and support people received was personalised to their needs. Care workers did not always record the support they provided people; however the registered manager had identified these concerns and was making appropriate changes.

Where people’s needs changed, care workers had taken action and made referrals to healthcare professionals where necessary. Care workers ensured people had care and support which met their needs and rehabilitation goals. Care workers went beyond their duties to support people with the things that were important to them.

People and their relatives view on the service were continuously sought. Care managers and the registered manager made every effort to ensure people’s views mattered. People and their carers felt the management was approachable and felt confident in their ability to complain.

Quality assurance systems were in place to enable the service to identify areas for improvement and ensure people received a good quality service. The registered manager was supported by a provider who carried out their own good governance audits. A recent audit showed the service was performing well. The service ensured people had the information they needed to make decisions and be involved in the day to day running of the home.