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Archived: Tilehurst Lodge Good

Reports


Inspection carried out on 19 January 2017

During a routine inspection

We conducted and unannounced inspection of Tilehurst Lodge on 19 January 2017.

Tilehurst Lodge is a care home without nursing that provides accommodation for up to six people with a learning disability or autistic spectrum disorder. At the time of the inspection there were four people living at the service.

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.

People who were supported by the service felt safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicines as prescribed. There were systems in place to manage safe administration and storage of medicines.

The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

People’s nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with kindness, compassion and respect and promoted people’s independence and right to privacy. People received care that was personalised to meet their needs.

People were supported to maintain their health and were referred for specialist advice as required. There were good systems in place to allow safe transitioning between services.

Staff knew the people they cared for and what was important to them. Staff appreciated people’s life histories and understood how these could influence the way people wanted to be cared for. Staff supported and encouraged people to engage with a variety of social activities of their choice in the community.

The service looked for ways to continually improve the quality of the service. Feedback was sought from people and their relatives and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

Leadership within the service was open, transparent and promoted strong organisational values. This resulted in a caring culture that put people using the service at its centre. People, their relatives and staff were complimentary about the management team and how the service was run.

The registered manager informed us of all notifiable incidents. Staff spoke positively about the management support and leadership they received from the management team.

Inspection carried out on 25 July 2016

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

We carried out an unannounced comprehensive inspection of this service on 15 October 2015. Three breaches of legal requirements were found. The provider had not ensured the premises and equipment were suitably clean and had not ensured that fire equipment was safe to use. In addition, the provider did not have a system that enabled them to evaluate or improve their practice in respect of the processing of information. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection 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 Tilehurst Lodge on our website at www.cqc.org.uk.

This inspection did not change the overall rating of the service. We could not improve the overall rating from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This inspection took place on 25 July 2016 and was announced. We gave the registered manager one hour's notice so we could be sure they would be at the service.

Tilehurst Lodge is a care home without nursing that provides a service to up to six people with a learning disability or autistic spectrum disorder. At the time of our inspection there were four people living at the service.

The service had a registered manager who had been registered since 19 May 2016. The previous registered manager left the service after our last inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was present throughout this inspection.

Since the last inspection the service had seen a complete change of staff team, with the exception of one care worker. The new staff team included a new manager, a new team leader, four new care workers and two new bank care workers. The new manager had started the process of becoming registered with the CQC. Once the new manager has become registered, the current registered manager will de-register and continue to offer support to the service in her role as the area's operations manager. On 11 July 2016 the final three new staff members had started work at the service and the staff team was complete. This meant the service was able to stop using agency staff and provide more consistency for the people living at the service.

We found the provider had addressed the concerns identified at the last inspection. The premises, fixtures, fittings and equipment were clean, a number of improvements had been made to the premises and systems had been introduced to ensure the cleanliness was maintained. Systems to monitor and check fire safety equipment had been introduced and management were monitoring to make sure the system was being followed. New systems had been introduced for ongoing internal and external monitoring of the staff practice at the home. This was to enable them to amend and improve their service where applicable.

The changes to the staff team and the work on improving the premises had been managed successfully to ensure that disruptions to the daily life and routines of the people living at Tilehurst Lodge had been kept to a minimum. People were confident and comfortable with the staff on duty. We saw on a number of occasions that staff and people were laughing and joking together as they went about their day. There was a positive and cheerful atmosphere apparent.

Inspection carried out on 15 October 2015

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

The inspection took place on 15 October 2015. This was an unannounced inspection. A comprehensive review was carried out of the service in line with the Care Quality Commission’s five key areas of enquiry.

Tilehurst Lodge is a residential service for up to six people with learning disabilities or autistic spectrum disorder. Currently the home has four people using the service. People lead an independent life, with some holding employment. People accessed the community independently as they needed in agreement with the home. Risk assessments were completed to ensure measures were put in place to reduce risk before people went out independently.

The registered manager was new in post commencing employment as the registered manager in July 2015, although he had been employed for 12 months prior to registration. 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.

People were kept safe by appropriate recruitment arrangements. Systems were in place to recruit staff who were suitable to work in the service and to protect people against the risk of abuse. Sufficient staff were employed, with relevant experience and training to ensure the needs of people were met. Medicines were appropriately managed and securely kept. Staff competence was checked prior to being able to administer medicines independently. Guidelines for as required medicines were in place, reducing the possibility of over medicating.

The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). This provides a legal framework of protection for vulnerable people who may become or are deprived of their liberty. Appropriate authorisation applications had been made where necessary.

A number of risks related to the environment were present within the service. Fire doors were being propped open with items of furniture preventing automatic closure in the event of a fire. Fire equipment was not checked frequently to ensure it was functioning appropriately. Where issues were highlighted in checks, action was not taken to rectify the problem. This was a particular concern where water temperatures were exceeding the maximum safe temperature.

Care plans and risk assessments were written with people. These were reviewed regularly, with changes made to reflect the needs of the person. People were encouraged to maintain independence. They were involved in choosing the home's décor and encouraged to become involved in running the home. However, the home was found to be dirty. Toilet rolls and hand washing handtowels could not be found in the communal cloak rooms and bathrooms. A significant pungent odour was present in these rooms, specifically on the first floor.

Annual quality assurance audits were completed by the parent organisation. However the registered manager did not complete audits of any documents within his service. This therefore meant that he was not aware of some of the shortcomings in the paperwork and concerns that may have been picked up, had he reviewed these.

People felt that communication with the service was good. Staff were appropriately supervised, received handover, and attended team meetings. This allowed information to be shared as required. People felt that staff worked in a caring manner, always preserving their dignity and respecting their individual choice.

We found that the service was in breach of Regulations 17, 15 and 12 of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. The provider did not maintain accurate records in order to meet the requirements of the fundamental standards. The provider did not ensure the premises were clean. The provider failed to mitigate any such risks that may practically be possible and had not ensured equipment was safe for use. You can see what actions we told the provider to take at the end of the full version of the report.

Inspection carried out on 25 & 29 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an unannounced inspection.

Tilehurst Lodge provides accommodation and care for up to six people with a learning disability or autistic spectrum disorder. There were six people living in the home at the time of our visit.

The home requires a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. There was a manager who started working in this role in April 2014. This person was not yet registered with the Care Quality Commission and had not submitted an application to do so.

There were times when people were not safe. People who could become anxious or upset were not always protected from harm. When these issues were discussed with the manager they took immediate and appropriate action.

There were areas of poor maintenance in the home and garden. Décor was worn and damaged and the overgrown garden was unsafe. Action to address these issues had been discussed by the provider, but there were no plans in place for when this would take place.

Although there were enough staff to keep people safe, feedback about staff skills and competency was mixed. The provider was using agency staff to cover current vacancies which had caused a lack of continuity for people. The use of agency staff also meant there were sometimes care workers on duty who did not know the people who use the service well. The provider was currently addressing this issue and a recruitment day was due to take place in the next week. Recruitment practices were safe and staff received appropriate training and all staff training was up to date.

The provider had not always recorded and investigated incidents properly. On occasions when people had become anxious or upset, appropriate action was not taken to reduce the risk of these incidents being repeated. Risk assessments and management plans were in place which allowed people to remain as independent as possible as well as safe.

Apart from the incidents above, staff knew how to protect people from harm and what action they should take if they thought a person was at risk of harm. However, staff did not have easy access to contact details for the relevant authorities should they need them.

People had access to health care professionals such as the GP or dentist when they needed them and each person had an up to date health action plan.

People had enough to eat and drink, and maintained a healthy diet. They were supported to be as independent as possible with food preparation and were supported to make healthy choices about the food they ate.

People were well supported to take part in activities such as going to work and taking the bus to town. They were also encouraged to maintain relationships with their families, and relatives were able to visit whenever they wanted to. Relatives said they were able to give feedback about the service and this was mostly acted on.  One relative told us they had asked for more regular updates about their family member and this had been done. Other relatives said they had asked to meet the new manager but this had yet to be organised.

There was a complaints procedure in place and complaints received had been investigated and resolved appropriately. The provider had quality monitoring processes in place, at home and organisational level.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 4 April 2013

During a routine inspection

People living in the home had individual communication and behavioural needs. We spoke with five people who used the service and they told us they liked living in the home. They said staff were great and they could talk to staff about anything that was troubling them. One person told us that the manager �was lovely�. Another told us "I love living here. I�ve lived here for years �. We saw that people were involved with their care and the running of the home as far as they were able.

We were told that independence and individuality were promoted within the home. People living there were supported and enabled to do things for themselves as far as they were able. They were encouraged to express their views and to participate in making decisions relating to their care and treatment. One person told us �I have done really well here. I do lots of different things and I like living here�.

We looked at a range of records, spoke with the manager and two members of staff in private. We saw the communal areas of the home, some people�s bedrooms and spent some time observing interactions between staff and people living in the home. We saw two funding authority reports which had been produced following quality audits of the home. Both were complimentary about the care provided and both described a homely, warm and welcoming atmosphere in the home.

Inspection carried out on 24 April 2012

During a routine inspection

Some people told us that they liked living in the home. Staff were kind and friendly and they could talk to them if they had concerns. One person said that they �liked living in Tilehurst Lodge because it�s like a family here� and, �staff are great�. Another person said �I like it�. People were involved with their care and the running of the home.

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