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Inspection carried out on 21 August 2018

During a routine inspection

The Tynings is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Tynings can accommodate up to six people with a learning disability. People have their own rooms with en suite facilities. They share a lounge, dining room and conservatory. Grounds around the property are accessible.

The Tynings has been developed and designed in line with the values that underpin the Registering the Right Support, Building 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People’s care was individualised reflecting their backgrounds, likes and dislikes and aspirations. They were involved in the planning of their care and had the opportunity to talk with staff about their care and support. Their diversity was recognised and their human rights were respected. They were provided with accessible information which used pictures and photographs to illustrate the text. Staff promoted communication through a range of strategies and resources to enable people to express their views and feelings. People occasionally became unsettled or anxious. Staff supported them to cope with these emotions effectively following their care records. Staff knew people well and recognised the importance of good communication to ensure continuity of care and support.

People were kept safe from harm. Risks were minimised whilst encouraging people to be as independent as possible. People were supported to learn the skills to live more independently and helped out around their home. They had access to a wide range of activities both at home and in the community. They had individual support when needed to participate in activities such as the cinema or concerts. People were supported to stay healthy and well. They had access to health care professionals and were supported to attend appointments. The registered manager was working closely with health care professionals to ensure all people had access to the support they needed. People’s medicines were safely administered and people were helped to manage their own medicines if they wished. People’s dietary needs were considered and special diets provided.

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 whose liberty was restricted had the necessary safeguards in place. People made choices about their day to day lives. Best interest meetings were held when people were unable to make decisions about aspects of their care.

People were supported by staff who had access to training to equip them with the skills to meet their needs. A satisfactory recruitment process was in place to make sure staff had the right character and skills. Staff were confident raising concerns and found the registered manager to be open and accessible. Staff levels reflected the needs of people and were reviewed as people’s needs changed.

People’s views and those of their relatives and staff were sought as part of the quality assurance process. A range of audits and checks were completed to monitor the quality of service provided and make sure a safe environment was ma

Inspection carried out on 17 May 2017

During an inspection to make sure that the improvements required had been made

This unannounced focused inspection took place on 17 May 2017.

We carried out an unannounced comprehensive inspection of this service on 24 June 2015. A breach of a legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to Regulation 9 Person centred care.

We undertook this unannounced focused inspection on 17 May 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Tynings on our website at www.cqc.org.uk.

The Tynings is a care home for up to six people with a mild to moderate learning disability, autism or sensory impairment. Six people were accommodated when we completed this inspection.

People were now supported by relevant healthcare professionals to maintain their health and wellbeing. We have made a recommendation about healthcare professionals completing mental capacity assessments for specific medical conditions and their treatment and monitoring.

At the time of our inspection visit The Tynings had a registered manager in post who was on special leave and the assistant manager was in charge supported by the provider’s representative. 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.

Inspection carried out on 24 & 25 June 2015

During a routine inspection

This unannounced inspection took place on 24 and 25 June 2015.

The Tynings is a care home for up to six people with a mild to moderate learning disability, autism or sensory impairment. Five people were accommodated when we completed this inspection.

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.

Most people with health problems were supported to improve their health. However, staff had not taken appropriate action when a person refused professional support and their health was at risk.

Staff were aware of the Mental Capacity Act 2005 to protect people when they needed support for certain decisions in their best interest. There was one example where this could be improved. Support care plans included people’s mental capacity assessments which showed how choice for each person was displayed by them. People made everyday decisions as staff knew how to effectively communicate with them.

People were safeguarded from harm or abuse because staff were aware of their responsibilities to report any concerns. Risk assessments were completed which reduced risk for people helping to keep them safe and independent. All accidents and incidents were recorded and had sufficient information to ensure preventative measures were identified.

Medicines were administered safely and each care plan identified how people liked to take their medicines. When creams were applied for people staff had clear protocols to follow. Monthly and annual audits of medicine had been completed

People were supported by sufficient staff and were able to access the community with them. Five people were accommodated and there were two staff all day in addition to the two staff that exclusively supported two people.

The staff were well trained, knew people’s individual care needs well and supported them effectively. Staff told us the training was good and they had supervision every three months with the registered manager. People were protected by thorough recruitment practices and staff induction to the service.

People had a choice of food and special diets were provided to maintain and improve their health and wellbeing. People and staff had meals together and people chose where they liked to eat their meals. People were supported by professionals when required to ensure food was taken safely.

We observed staff responding to people in a calm and compassionate manner consistently demonstrating respect. Staff knew peoples individual communication skills, abilities and preferences. There was a range of ways used to make sure people were able to say how they felt. Staff knew by people’s body language and expressions how they felt and when they wanted to be on their own. Staff supported people to choose activities they liked. People had taken part in activities in the community and holidays with staff. A relative told us the staff were great and the person was always happy to return to the home after a few days with them.

People had personalised care plans and staff supported them to be involved in making decisions about their care. Staff used a picture board to describe to one person what was happening each day. Peoples care plans and risk assessments were reviewed regularly and people knew they could talk to staff at any time and make changes. There was a complaints procedure and an easy read version for people. Complaints and concerns were taken seriously and used as an opportunity to improve the service.

Quality checks were completed and examples told us that action plans identified where changes were made to address any shortfalls. People were given the opportunity to answer questions about the service in an appropriate way to make sure they were satisfied. Relatives, supporters and health and social care professionals were asked for their opinion about the service. Regular staff meetings were held for staff to be involved in the running of the home and improvements had been made or were planned as a result. The registered manager was accessible and supported staff, people and their relatives through effective communication.

We found a breach 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.

Inspection carried out on 30 September 2013

During an inspection to make sure that the improvements required had been made

During our inspection in June 2013, we found the provider was not compliant with a number of different outcomes. We asked the provider to produce an action plan detailing what action they needed to take to achieve compliance. We also found the provider was still not compliant in outcome 12 (requirements relating to workers). This had previously been found non-compliant during an inspection in January 2013. Enforcement action was taken and the provider was told to put measures in place to be compliant by the end of August 2013. This visit was an unannounced inspection and we did not speak to people who used the service on this inspection because we were checking compliance on these essential outcomes.

We found the provider had reviewed the care plans for all the people who used the service. Where necessary, staff had completed body charts correctly and investigations had taken place and documented. We checked people's medicines charts for July, August and September and found them to have been completed correctly. We could not check full compliance for the new recruitment practices because there had been no new member of staff employed since our last inspection.

The provider had completed the actions plans produced in response to our last inspection. We found the provider to be compliant with outcomes previously found to be non-compliant.

Inspection carried out on 20, 24 June 2013

During a routine inspection

We spoke with two people who use the service and both were informed about their care and treatment choices. Care records showed that people were involved with planning their care as far as they were able to be. We looked at the care records for six people who used the service. For four of those people we found that care plans and risk assessments were in place. These reflected people�s needs at the time they were produced. However, there had been no review of these care plans since July and December 2012. For two people we found no care plans were in place.

In one person�s care file we found body charts had been completed. These charts showed that the person had sustained several injuries that could not be explained. The staff had not made any notes about these injuries in the daily notes. There was no evidence that any investigation had taken place to establish how the injuries happened.

Whilst staff had been trained to safely administer people's medicines, we found gaps in recording on the medication charts and issues regarding administration and disposal of medicines, that gave us cause for concern.

We saw evidence that recruitment procedures had not been effective and that people were not always cared for, or supported by, suitably skilled and experienced or appropriate staff.

The provider's quality monitoring process was not effective and had not picked up all the areas of concern we identified during our inspection visit.

Inspection carried out on 9, 10 January 2013

During a routine inspection

One person said that that staff listened to them and helped them to understand the treatment recommended for them by health professionals. Another said about staff who assisted them, �They do ask if it�s alright to do things�. Detailed step by step guidance /protocols were in place for staff to refer to when managing specific aspects of people�s care, to make sure that a consistent and safe approach was followed.

We found that the home was nicely decorated and the layout suited the needs of the people who live there. However we found that some required home maintenance checks had not been completed in recent years. People were happy with the care and support they received from staff but we were concerned that not all appropriate checks had been completed before staff started working with people.

A �service user council� ran monthly and this was valued by those that attended. One person said �It�s brilliant, you feel like you can say anything you want and can let off steam�. They felt that the council �made a difference� as when they had raised issues these had been acted upon.

Reports under our old system of regulation (including those from before CQC was created)