We carried out a review of the data available to us about The Tidings on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Tidings, you can give feedback on this service.
People’s experience of using this service and what we found
We received positive feedback from people’s relatives who told us they wouldn’t hesitate to recommend the service to others. One described the happy and homely environment where staff, “Do what they’re supposed to do… Do what they promise… It’s a kind place.”
Relatives felt their family members were provided with safe care, in a homely, clean environment. Staff had received training in safeguarding and understood their responsibilities in reporting any concerns. People received their medicines safely as prescribed by trained staff. Safe recruitment processes were being followed and there were enough staff available to support people’s individual needs.
People living in the service, staff, and relatives felt the positive management of the service ensured good communication and they felt comfortable to voice an opinion and raise any issues, knowing they would be acted upon.
Staff had been sensitive to people’s anxiety about the pandemic, providing individual support to explain why staff were wearing face masks and carrying out routine testing. Staff explained to people why they were unable to temporarily attend some of the external activities they enjoyed, whilst creating new indoor activities to support their well-being.
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.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The outcomes for people using the service promoted choice and control, independence and inclusion. One person told us, “I tell staff what to do,” not the other way round, and they felt included in decisions. Staff and leadership focused on ensuring people reached their personal goals through person centred approaches.
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 requires improvement (published 4 March 2020).
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 17 February 2020. 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 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.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Tidings on our website at www.cqc.org.uk.
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.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The provider did not have effective measures in place to ensure the environment people lived in was safe. We found risks to people where they had access to unguarded hot surfaces such as scalding hot radiators. Risks to people with epilepsy who had access to unguarded hot surfaces had not been identified with action taken to reduce the risk of harm.
Not all areas of the service were clean and well maintained. Sufficient measures were not in place to prevent and control infections. We have made a recommendation regarding infection control practices.
Staff were trained, and competency assessed to administer people's medicines safely. We were unable to audit stocks of as and when required medicines (PRN) against records. This shortfall had not been identified in any of the management audits in place. We have made a recommendation regarding the need to improve the current system in place for management auditing of medicines to ensure timely monitoring of medicines errors.
Management systems in place to monitor the safety of people who used the service were not robust and did not identify the shortfalls we found at this inspection.
Staff understood how to recognise and report any concerns they had about people's safety and well-being. There was enough staff to meet people’s needs at the time of our inspection.
Staff were provided with a variety of training relevant to their roles. Staff told us they were supported by the management team with their training and development needs.
Personalised care plans had been developed, which provided the staff team with guidance about the needs of people and how these needs were to be met.
Staff monitored people's weight for signs of changes and where necessary referred people for specialist advice and support.
People's records provided information reflective of their personal histories and backgrounds. This included information about people's diverse, religious and cultural needs.
People's capacity in relation to day to day decisions had been assessed. People were supported to have 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 support this practice.
The service worked with other organisations and people were supported to access a range of healthcare services. People had access to specialist advice and support to meet their health care needs.
Staff knew people well. People's communication needs were understood by staff. People were able to be involved in decisions about their day to day care. Activities were specific to people's interests.
We recommended further work be carried out to ascertain people’s needs and wishes in the event of sudden death or the need for palliative care support.
The registered manager had a system for recording and managing complaints but had not received any since the last inspection.
The service consistently applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The 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 30 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to how people's safety was managed and how the quality of the service was assessed. There were shortfalls in how the registered manager and the provider assessed and monitored the service. Risks to people’s safety had not been identified and action taken to reduce the risk of harm.
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 our last inspection in June 2015 this service was rated Good. At this unannounced inspection we found the overall rating for this service remained Good.
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 2008 and associated Regulations about how the service is run. The manager registered for this service is also registered for two other services local, nearby care services.
Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risks to people’s health, welfare and safety had been assessed and guidance provided for staff with recorded action they should take to mitigate these risks.
People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff.
There were systems in place to ensure that staff were trained, regularly competency assessed to ensure that people received their medicines as prescribed. Medicines were stored safely and appropriate records of administration maintained.
Staff were provided with training in Safeguarding Adults from abuse. The registered manager had been proactive in reporting safeguarding concerns to the local safeguarding authority. Staff were aware of the provider's whistleblowing policy. This is a policy which guides staff in how to report concerns about poor practice within their organisation and to local safeguarding authorities.
Staff were provided with training in understanding their roles and responsibilities with regards to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People’s capacity to make decisions about their everyday lives had been assessed and their consent was considered in the planning and provision of their care and support.
The staff team were very caring and had built strong relationships with people who used the service. Staff were able to demonstrate that they knew people well and people told us they were treated with dignity and respect. 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 had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. People were supported to maintain good health and had access to external health care professionals when required. This included health screening and access to learning disability nurses, GPs, chiropodists and dentists.
People were provided with the opportunity to participate in personalised, meaningful activities which interested them, according to their assessed needs, wishes and preferences. People were encouraged to develop and maintain as much independence as possible. People had access to annual holidays and opportunities to be integrated into the local community.
The provider had a system in place to respond to suggestions, concerns and complaints. The service had a number of ways of gathering people’s views including; regular meetings and satisfaction surveys.
Staff understood their roles and responsibilities and were well supported by the management of the service. There was an open culture where people felt comfortable to air their views and, provide honest feedback.
The registered manager was a visible presence in the service and carried out a number of quality and safety monitoring audits to help ensure the service was running effectively and to plan for improvement of the service.
For a more comprehensive report regarding this service you can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk
The inspection took place on 4 June 2015 and was unannounced.
The service provides care and support to two people with learning disabilities.
There was a registered manager in post. 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.
Staff were trained in safeguarding people from abuse and systems were in place to protect people from all forms of abuse including financial. Staff understood their responsibilities to report any safeguarding concerns they may have.
Risks to people and staff were assessed and action taken to minimise these risks. People were encouraged to remain as independent as possible and any risks related to this were assessed.
Staffing levels meant that people’s needs were met. Recruitment procedures were designed to ensure that staff were suitable for this type of work and checks were carried out before people started work to make sure they were safe to work in this setting. New staff were recruited before posts were vacant.
Medicines were administered safely and records related to medicines were accurately completed.
Training was provided for staff to help them carry out their roles and increase their knowledge of the healthcare conditions of the people they were supporting and caring for.
People gave their consent before care and treatment was provided. Staff had received training in the Mental Capacity Act (MCA) 2015 and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with legal requirements.
People were supported with their eating and drinking needs and staff helped people to maintain good health by supporting them with their day to day healthcare needs.
Staff were very caring and treated people respectfully making sure their dignity was maintained. Staff were positive about the job they did and enjoyed the relationships they had built with the people they were supporting and caring for.
People were involved in planning and reviewing their care and were encouraged to provide feedback on the service.
No formal complaints had been made but informal issues were dealt with appropriately and to people’s satisfaction.
Staff understood their roles and were well supported by the management of the service. The service had an open culture and people felt comfortable giving feedback and helping to direct the way the service was run. People were well integrated into their local community.
Quality assurance systems were in place and audits were carried out regularly to monitor the delivery of the service. These audits did not monitor the hours staff worked and some staff were working excessive hours which could place people who used the service and staff at risk.
We found that care plans were centred on people's needs and preferences and that they assessed and minimised any associated risks. We found that the service provided a variety of fresh food and supported people to eat a balanced diet and manage their health conditions. The service had systems in place to support people to manage their money and keep them safe from financial abuse.
We found that the premises was maintained to a reasonable standard and provided a safe and suitable environment for the people who lived there.
We saw that staff were trained to administer medicines safely and that records related to medicines were organised and well maintained. We spoke with the member of staff on duty and the registered manager and looked at staff records and rotas. We found that staff were appropriately skilled and experienced and we observed them providing care and support in a sensitive and respectful manner.
We observed one person in the service's kitchen area completing a puzzle. The one person we spoke to told us they were happy with the service, they liked their room and were able to take part in activities when they wished.
We found the premises did not provide a safe and secure environment for those who lived at the service. This was because the back gate was broken and had been for sometime. This meant that people who lived at the service were at risk of leaving the premises without the knowledge of staff.