Archived: Talgarth Road

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.

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 decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff had received applicable training and demonstrated they understood the legal requirements of the MCA.

Staff encouraged people to actively engage with the daily running of their home, including weekly meetings to plan menus, activities and entertainments. People told us they enjoyed their meals and snacks, and felt their skills and confidence with cooking and baking had improved. People described staff as being “lovely” and “respectful” and felt comfortable about raising any concerns or complaints.

People’s needs were regularly assessed and reviewed. The care planning model used by the provider enabled people to monitor their own progress and contribute to the planning of new goals. Key working sessions took place so that people knew they had a scheduled time to talk about their needs with their allocated member of staff. We observed that people approached staff during the inspection if they needed support or wanted to chat.

People and relatives described the registered manager as being approachable, supportive and committed to improving the quality of the service. There were systems in place to monitor and audit practices within the service and people told us how much they enjoyed participating in regional quality assurance events organised by the provider.

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. The care planning model used by the provider enabled people to monitor their own progress and contribute to the planning of new goals. People told us they had developed good relationships with staff and felt able to raise any concerns or complaints.

We noted that the provider had made significant improvements since the previous inspection visit in order to ensure that the service was properly managed. This included increased support for the registered manager and the staff team from the area manager and systems to regularly audit the quality of the service. This included questionnaires to seek and act on the views of people who used the service and their representatives.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009, in relation to the provider ensuring that there was sufficient staff and informing us of significant events in the service that impacted on the safety and wellbeing of people who used the service.

You can see what actions we asked the provider to take at the back of the main report.

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.