SENSE Tanglewood

About the service

SENSE Tanglewood is a residential care home providing personal care to up to 7 people. The service provides support to people with sensory impairment, learning disabilities and autistic people. At the time of our inspection there were 6 people using the service. The service is provided in a large, detached home in a residential area.

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

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People did not always have support that matched their assessed needs, and where people were assessed as needing additional support to manage risks, this was not always provided.

Right Care:

Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. People were not always engaged in meaningful activities and where people had hobbies and interests this was not reflected in what they did through the day.

Right Culture:

Whilst there had been an improvement in the culture, ethos and values in the service; attitudes and behaviours from staff did not always ensure people using services lead confident, inclusive and empowered lives. The provider’s governance systems were not effective. Governance systems did not ensure people were always kept safe and received a high quality of care and support in line with their personal needs.

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 inadequate (published 7 September 2023).

At this inspection we found improvements had been made and the provider was no longer in breach of some regulations, however the provider remained in breach of other regulations.

This service has been in Special Measures since 7 September 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Enforcement

We have identified breaches in relation to person-centred care, people’s safe care and the governance of the service at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

SENSE Tanglewood is a residential care home providing personal care to up to 7 people. The service provides support to people with sensory impairment. At the time of our inspection there were 6 people using the service. The service is provided in a large, detached home in a residential area.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were carrying out restrictive actions with people that was not in line with the assessed needs.

Right Care:

Care was not always person-centred and did not promote people’s dignity, privacy and human rights. Safeguarding procedures were not followed and appropriate action had not been taken to protect people from abuse and poor care. Care was not always delivered in line with standards, guidance and the law.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives.

The systems for reporting were not always open and transparent.

The provider’s governance systems were not effective. Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

Rating at last inspection

The last rating for this service was good (published 14 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about restrictive practices. A decision was made for us to inspect and examine those risks.

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 see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

Immediately following the inspection the provider has brought in internal senior managers from their wider organisation to undertake a full review of incidents including where necessary taking retrospective actions to safeguard people.

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, person centred care, management of risks, safe premises and management and governance of the service.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was 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 care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and participation within the local community was encouraged.

At our last inspection on 25 January 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good.

People continued to receive a safe service. People were supported to stay safe. Staff knew how to recognise abuse and how to report it. Risks were assessed so that staff knew what action to take to keep people safe. They did this while also promoting people’s independence as much as possible.

There were sufficient numbers of staff, with the required knowledge, skills and experience to support people with their needs. Many people required a one- to- one ratio of staff and this was provided. Recruitment processes were safe and this meant that so far as possible only people of suitable character and experience were employed.

Medicines were managed in a safe way. Staff had received training about this and supported people to take their medicines at the right time and in a safe way.

People continued to receive an effective service. Staff were knowledgeable about the needs of the people they supported. People were supported to make choices around their care and daily lives. Staff had attended training to ensure they were able to provide care based on current practice when assisting people.

People were supported to have the 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 supported to eat and drink enough and had a balanced diet. Staff understood and met people’s nutritional needs. They supported people in a sensitive way. People had access to the healthcare professionals they required.

People continued to receive a service which was caring. People were treated with kindness and compassion by the staff. Staff knew people well and often went that extra mile to make sure people were as comfortable as possible. People’s social needs as well as their physical and emotional needs were incorporated into the plan of care and used to promote and maintain people’s abilities and independence.

People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon. Staff treated people with dignity and respect. People knew how to raise concerns and had confidence that they would be listened to and action would be taken. Feedback provided was used to make improvements to the service.

The service continued to provide responsive care and support. Staff knew how to effectively communicate with people. They had developed innovative ways to meet people’s information and communication needs. This had resulted in improved outcomes for people because they had gained more independence and were able to take part in a range of activities they had previously been unable to.

People continued to receive a well led service. People were complimentary about the registered manager and staff. It was clear that relationships between people and staff were positive and people had confidence in the service. There were effective quality monitoring systems. A variety of audits were carried out and this meant that any shortfalls were quickly identified and used to drive improvements.

We had the opportunity to talk with two people who lived at the home on the day of the inspection. We have therefore not used quotes within this report and the examples we have given are brief because we respect people’s right to confidentiality.

A registered manager was in post at the time of our inspection. 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 obtained advice from health professionals and took action so people’s health needs were met. Staff arranged for people to see their GPs and other health professionals when they needed to. Staff supported people to take their medicines so they remained well.

People benefited from living in a home where staff understood their individual needs and preferences. Staff recognised when people’s needs changed and took action so people continued to receive care in the best way for them. Staff knew about the things which were important to people and what things they liked to. People were encouraged to try new things which they might enjoy.

People’s right to make decisions and their freedom was protected. Staff worked with other organisations to make this happen. Staff knew what actions to take, if they had any concerns for people’s safety or well-being and were able to obtain advice from the manager, provider or external organisations if required. Staff were supported through regular supervision, training and meetings.

People had enough to eat and drink. People were encouraged to prepare their own meals where possible. Other people were supported to enjoy a range of food, drinks and snacks by staff so people would remain well.

People enjoyed being with the staff who cared for them. We saw people got on well with the registered manager and caring relationships had been built with the staff. Staff supported people to keep in touch with their families and to do the things they enjoyed doing. Staff knew how to support people so they were able to make choices about how their care was given and people’s levels of independence was taken into account by staff. People were given encouragement and reassurance by staff when people when they wanted this.

People were involved in deciding what care they received and staff encouraged people and their relatives to be involved in their care reviews so they received the care which was right for them. Relatives knew how to raise any complaints they had and were confident staff would take action if this happened.

The registered manager and senior staff team supported care staff to provide safe and compassionate care. There was clear and open communication between the registered manager and staff, so staff knew what was expected of them. Checks were undertaken on the quality of the care provided by the registered manager and provider and actions were taken where developments had been highlighted. The registered manager and provider made sure there was a focus on continuous development of the home.

We spoke with relatives of two people, who told us they were very happy with care that was being provided. We also spoke with the registered manager, the deputy manager and three other staff members.

We watched staff as they cared for people. They provided care and support that met people's needs. We found that staff knew about the needs of the people they cared for. We looked at four people's care records and found that these contained guidance for staff on how to meet people's needs. We saw that people's needs had been reviewed regularly. Relatives told us that they had been involved in planning their son's or daughter's care.

Relatives told us that their relations were happy with the food that they had been given and that they had been offered choices. People had been protected from the risk of harm and abuse because staff had received training in how to safeguard vulnerable people. Staff showed us they had a clear understanding of their roles and responsibilities with regard to safeguarding. We looked at records which showed that the provider was regularly monitoring the quality of its service.