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Inspection carried out on 24 July 2019

During a routine inspection

About the service

Talgarth Road is a residential care home providing personal care to people with mental health conditions. The service can support up to 10 people and there were nine people using the service at the time of the inspection. The home is a four-storey domestic property with a small rear garden.

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

People were provided with a safe and supportive environment. Staffing levels were arranged to enable people to have the support they needed from a staff member to attend appointments and other meetings.

People were supported by staff to receive their prescribed medicines. Where applicable people managed aspects of administering their medicines with guidance and monitoring from staff.

People were encouraged by staff to tidy their rooms and take part in cookery sessions. Staff motivated people to be as independent as possible in line with their training about how to effectively support people with mental health needs.

People were involved in the planning and monitoring of their care and support. Staff worked with people to ensure they understood their health care needs, attended appointments and adhered to guidance from health care professionals.

People and staff had developed positive relationships and we observed good interactions during the inspection. One person told us they particularly enjoyed their cooking sessions with a staff member. Another person was working collaboratively with a senior support and review worker to train interested parties about the value and benefits of co-production. People were treated with respect.

People were supported to engage in a wide range of meaningful activities within the service and in the wider community, for example day centre resources, exercise groups and adult education classes to promote their emotional and physical wellbeing. Staff encouraged people to maintain valuable friendships and relationships.

There were clear systems in place to provide people with information about their rights and entitlements living at the service, for example people knew how to make a complaint.

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. People were consulted about how the service should be operated through residents’ meetings and co-production to organise social events.

People received their care and support from staff who felt well supported by the provider and the registered manager. Relatives felt assured their family members lived in a service that was managed in a competent and open manner.

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 27 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 20 February 2017

During a routine inspection

This inspection was conducted on 20 and 22 February 2017. Talgarth Road is registered with the Care Quality Commission to provide care and accommodation for up to 10 people with mental health needs. There was one vacancy at the time of the inspection and one person had been admitted to hospital. People live in an ordinary domestic property with three storeys which does not have a passenger lift. The single bedrooms do not have en-suite facilities. There are communal sitting rooms, a dining room, bathrooms and shower rooms, and a back garden with a patio area.

There was a registered manager in post, who had worked at the service for several years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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 registered manager was present on both days of the inspection.

At the previous inspection in February 2016 we found breaches of regulation in relation to the provider ensuring that there was sufficient staff at night time and informing us of significant events in the service that impacted on the safety and wellbeing of people who used the service. Following the inspection the provider sent us an action plan which explained the action they would take in order to improve. At this inspection we found the provider had met the breaches of regulation.

At the previous inspection we found that people’s care and support needs were not always met by sufficient numbers of staff at night time, in order to ensure people’s safety. Following the inspection visit we received written confirmation from the provider that the night time staffing levels had been increased. During this inspection we found that the provider had carried out risk assessments to ensure that sufficient staff were deployed for night shifts, and these assessments were kept under review. Increased night time staffing had been implemented for a specific period to address issues that impacted on people’s safety, and these issues were no longer applicable to the service.

We had also found at the previous inspection that the provider had not informed the Care Quality Commission (CQC) of a serious incident within the service that impacted on the safety and wellbeing of people who used the service, as required by legislation. This had meant CQC could not monitor the safety of people who used the service. At this inspection we found that the provider had appropriately notified CQC of any significant events, in accordance with the law.

Staff understood how to identify and report any safeguarding concerns, and were aware of how to whistleblow about any issues of concern in regards to the running of the service. Individual risk assessments and environmental risk assessments were carried out to ensure people were kept as safe as possible from potential harm.

Rigorous recruitment practices were in place to make sure that people received their care and support from staff with appropriate experience and knowledge. Staff were provided with suitable training, guidance and supervision to carry out their roles and responsibilities. The staff we spoke with explained the different approaches they used in order to identify and meet people’s individual needs, wishes and goals. People were assisted to access healthcare support and a range of community facilities including cinemas, adult education classes, art galleries and restaurants.

People were supported to make meaningful choices. The registered manager and the staff team sought people’s consent before they provided care and support. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make d

Inspection carried out on 1 February 2016

During a routine inspection

This inspection took place on 1, 2 and 10 February 2016. Talgarth Road is registered with the Care Quality Commission to provide care and accommodation for up to 10 people with mental health needs, and the service was at full occupancy at the time of the inspection. The building is an ordinary domestic property with three storeys and does not have a passenger lift. The bedrooms are designed for single occupancy and do not have en-suite facilities. There are communal sitting rooms, a dining room, bathrooms and shower rooms, and a garden at the rear of the house.

There was a registered manager in post, who had worked at the service for several years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the previous inspection in December 2014 we found two breaches of regulation and made one recommendation in relation to improvements the provider needed to implement. The breaches of regulation were in regards to the provider not ensuring people were protected from the risks associated with unsafe premises, and not ensuring people were protected from the risks of inadequate nutrition. A recommendation was made for the provider to find out more about how to involve people in fulfilling activities and community events. Following the inspection the provider sent us an action plan which highlighted the action they would take in order to improve. At this inspection we found the provider had met the breaches of regulation and achieved sustained improvements in regards to the recommendations.

At this inspection we found that people’s care and support needs were not always met by sufficient numbers of staff at night time, in order to ensure people’s safety. Following the inspection visit we received written confirmation from the provider that the night time staffing levels had been increased.

We noted that the provider had not informed the Care Quality Commission (CQC) of a serious incident within the service that impacted on the safety and wellbeing of people who used the service, as required by legislation. This meant CQC could not monitor the safety of people who used the service.

Staff understood how to identify and report any safeguarding concerns, and were aware of how to whistleblow about any issues of concern related to the running of the service. Risk assessments were conducted to ensure people were kept as safe as possible from potential harm.

People were supported by safely recruited staff, who had received appropriate training, guidance and supervision to carry out their roles and responsibilities. Staff understood people’s individual needs and how to support people to meet their individual wishes and objectives. This included support to access health care, and community resources for leisure, sports and education.

People’s dignity and privacy was promoted, and staff supported people to make meaningful choices. The registered manager and the staff team sought people’s consent before they provided care and support. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff demonstrated that they understood the legal requirements of MCA.

Systems were in place to enable people to actively involve themselves with the daily running of their home, including weekly meetings to plan activities and menus. People told us they liked the food and enjoyed participating in the preparation of meals.

People’s needs were regularly assessed and kept under review. Th

Inspection carried out on 11 and 15 December 2014

During a routine inspection

The inspection took place on the 11 and 15 December 2015. At our previous inspection on 11 April 2014 we found the provider was meeting regulations in relation to the outcomes we inspected. Talgarth Road is registered with the Care Quality Commission to provide care and accommodation for up to 10 people with mental health problems. The service was at full occupancy at the time of our inspection and the age group of people using the service ranged from adults in their 30’s through to their 70’s.

There are 10 single occupancy bedrooms, which do not have en-suite facilities. There are communal sitting rooms, a dining room, bathrooms and shower rooms. There is a garden at the rear of the premises. The building is three storeys and does not have a passenger lift.

There was a registered manager in post, who had worked at the service for several years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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 not able to safely access support from the night time support worker because they could not reach the office. People told us they had to go into the rear garden and bang on a window or use their mobile telephone and ring for assistance.

We found that people had limited access to food during the night time and had to ask staff for access to some food items during the day if they wanted to make a nutritious snack.

Staff had received training about how to protect people from abuse and described how they would report any concerns. We observed areas of the premises that needed to be improved and saw that the provider had established a schedule of required improvements for the environment, which was taking place at the time of this inspection. The four care plans we looked at contained risk assessments, which showed that any risks to their safety and welfare had been assessed and planned for. There were sufficient staff to support people, however we observed that preparation for meal times was a busy time for staff and did not consistently involve people using the service. Medicines were stored, administered and disposed of safely. Staff undertook appropriate medicines training and could describe their duties in regard to the safe management of medicines.

Staff had regular supervision and training, including training about how to meet the needs of people with mental health difficulties. This meant that people were supported by staff with suitable knowledge and skills to meet their needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. We found that staff understood the provider’s policy and could explain how they protected people’s rights.

We saw that people had positive relationships with staff, who spoke with them in a kind and respectful manner. Relatives and health care professionals told us that staff were caring. People’s privacy was maintained, for example we saw staff knock on bedroom doors and await permission to enter and people were given their mail directly.

People using the service told us they were happy with their care and we received positive remarks from their families. Care plans reflected people’s needs as identified at their Care Planning Approach meetings and were up to date, although some people said they would like more support for working towards a more independent lifestyle. People were encouraged to get involved with the planning and reviewing of their goals, and relatives told us they were consulted about their family member’s care and support. People accessed community medical and healthcare facilities and staff attended appointments with them, if required.

People’s relatives told us they liked how the service was managed and they described the registered manager as being “a wonderful man” and “very caring”. We observed the registered manager interacting well with people who used the service and staff, and staff told us they felt properly supported by him. There were systems in place for the ongoing monitoring of the quality and effectiveness of the service. However, this monitoring was not consistently effective.

We found two breaches of regulations relating to the safety and suitability of the premises and nutrition. You can see what actions we told the provider to take at the back of the full version of this report.

Inspection carried out on 11 April 2013

During a routine inspection

People we spoke with told us that they could choose how they wanted to spend their day and what activities they wanted to get involved in. In care planning meetings, goals were set with a person on how to better manage their mental and physical health. One person we spoke with told us that that staff supported them to be independent.

During the inspection we observed positive interactions between staff and people, for instance when a person was being supported to carry out their chores or if they wanted to talk with a staff member.

The service had arrangements in place to give people their medicines. There were also arrangements in place if a person took their own medicines and staff would support them in this task.

People using the service came to the service on a long term basis which allowed management sufficient time to plan and arrange staffing levels in advance of each shift. Staffing levels were adjusted if for example a person needed escorting to a hospital appointment. One staff member worked the night shift. Management told us that staffing levels at night would be increased if people were assessed as requiring more support during this shift.

Inspection carried out on 30 May 2012

During a routine inspection

People told us they were encouraged to spend their time engaged in therapeutic activities. For example people liked gardening, painting and cooking. They were involved in the running of the service and liked choosing their menus and daily activities.

People we spoke with knew their key worker and felt they were listened to by staff. They said the staff were nice and helpful. We saw staff supporting people in their daily activities and encouraging them to be independent.

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