Tynefield Care Limited

Tynefield Care Limited is a residential care home providing personal and nursing care to up to 49 people. The service provides support to older people, younger adults and people with a physical disability. At the time of our inspection there were 45 people using the service. The care home accommodates people in a purpose-built ground floor building.

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

People received their medicines as prescribed. People received the support they required with their medicines from staff who were regularly assessed as being competent. Systems and processes were in place to protect people from harm. Areas of risk in people’s lives had been identified and were regularly reviewed. There were enough staff safely recruited to meet people’s needs. Infection prevention and control measures were in place to help keep people safe.

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 supported by staff who knew them well and what was important to them. People and relatives were involved in decisions about their care. Care was personalised and took into account people's personal preferences.

There was a positive culture within the home and the staff were led by a registered manager passionate about providing high quality care. People and staff had opportunities to give feed back and felt listened to. There was a governance system in place that monitored the quality of the service and the provider had plans in place to drive forward improvements.

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 requires improvement (published 15 January 2021). An outstanding breach of regulation 9 was not inspected. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The service had clear visiting protocols in place with robust infection, control and prevention procedures that all visitors were required to follow. This included guidance upon arrival relating to personal, protective equipment (PPE), COVID-19 testing and a health screening questionnaire.

¿ The service had an infection control policy in place which staff followed. The service had the required Personal Protective Equipment (PPE) in stock.

¿ The service was regularly cleaned throughout the day. There was cleaning schedules in place which staff followed, this included regular cleaning of high touch areas.

¿ Risks had been assessed and measures were taken to mitigate risk to ensure the safety of people, staff, and visitors. For example the way in which visitors gained entry to the service had been changed to reduce foot fall in communal areas.

¿ Staff received training in relation to infection prevention and control. Staff told us how they managed risks in relation to COVID-19 such as how they took part in regular testing, we observed staff to be wearing the correct Personal Protective Equipment (PPE) throughout our inspection.

Tynefield Care Limited is a nursing home providing personal and nursing care for up to 45 people. There were 31 people living at the home at the time of our inspection. The service provides support to younger and older people with a range of support needs including complex health conditions, acquired brain injury, learning disability and dementia.

The service is a purpose-built home with all accommodation on the ground floor, split across three wings. It is situated on the edge of Etwall village with limited access to public transport and facilities.

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

Infection control practices needed to be reviewed to ensure staff wore personal protective equipment correctly and suitable cleaning products were used. Quality monitoring systems were carried out in the home although further review was needed to ensure these were fully embedded and identify where all improvements were needed.

Staff were being supported to undertake additional training to enable them to have a specialism and have responsibility for carrying out audit in their specialist area.

People felt safe living at the service and risks to people’s safety and well-being were assessed and mitigated as much as possible. There was sufficient staff working in the service, who had been safely recruited to work with people.

People’s medicines were managed safely. The provider undertook assessments of staff practice to ensure that staff were competent to safely administer medicines.

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 requires improvement (published 20 December 2019).

Why we inspected

We carried out an unannounced focused inspection of this service on 30 November. We reviewed the information we held about the service. 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 coronavirus and other infection outbreaks effectively.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

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

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.

Tynefield Care Limited is a nursing home providing personal and nursing care for up to 45 people. There were 25 people living at the home and three people staying on a short-term basis at the time of our inspection. The service provides support to younger and older people with a range of support needs including complex health conditions, acquired brain injury, learning disability and dementia.

The service is purpose built, it is all on ground floor level and accommodation is split across three wings. One of the wings was closed for refurbishment at the time of our inspection.

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

People did not always receive personalised support in a timely manner and their communication needs were not always met. People did not consistently have enough to do with their time and some people were socially isolated. People received caring and compassionate support at the end of their lives. People’s complaints and concerns were handled appropriately.

Staff were kind and caring, however, they did not always have enough time to ensure people received a truly person-centred service. People were not always provided with care that promoted their dignity. In contrast, people told us staff respected their right to privacy. Further work was needed to maintain and enhance people’s independence.

The management team had a clear vision to provide high quality care, however further work was needed to implement and sustain this. Overall systems to ensure the safety and quality of the service were effective. The management team were proactive and told us that action would be taken to rectify the issues found during our inspection. Work was underway to better involve people, families and staff in the running of the home. The management team were meeting their legal duties to notify us about significant events and to display their rating.

Since our last comprehensive inspection, significant improvements had been made to the safety of the home. People told us they felt safe. The management team had a good understanding of safeguarding adults procedures to protect people from harm. Overall, risks associated with people’s care and support were managed safely and action was now taken to learn from accidents and incidents. Staff were recruited safely and there were enough staff to meet people’s needs and ensure their safety.

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. Staff were knowledgeable and had training in key area. People had enough to eat and drink. People had access to healthcare when they needed it, and advice was sought from specialist health professionals.

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 (report published 31 August 2019). We imposed a condition on their registration which required provider to make improvements in relation to safety, risk management and governance. The provider complied with this condition. At this inspection improvements been made in many areas, sufficient improvements had been made to comply with many of the regulations, but there remains one breach.

This service has been in Special Measures since 4 July 2019. 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 was a planned inspection based on the previous rating. It was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified one breach in relation to person centred care at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tynefield Care Limited is a nursing home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 45 people. The service provides support to younger and older people who may have a specific neurological disorder, nursing needs or living with dementia.

The accommodation at Tynefield Care Limited is on the ground floor and over three separate wings. There is one shared lounge and dining room for people to use. The home is located outside of the village of Etwall and accessed from a private road. There are no public facilities or public transport services within easy reach of the home.

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

Following a fire within the service, necessary work to repair and renovate the affected area of the building had been completed. The provider had obtained necessary building and fire certificates to ensure any work carried out met current regulations and the building was safe to use.

People were happy to move back to their home and staff had ensured they had all their personal clothes and belongings. People felt staff had continued to provide support in their temporary accommodation and had been kept informed about the how the building work was being completed.

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 Inadequate (Published 31 August 2019)

This service has been in Special Measures since August 2019 and we imposed positive conditions for the provider to send us an action plan each month to record how improvements were being made within the service.

Why we inspected

We carried out this inspection to ensure the home and people were safe following a fire in the laundry room. As a result, we undertook a focused inspection to review the Key Questions of Safe.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions for this inspection. We therefore did not inspect them. The rating was not reviewed on this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern.

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

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.

The overall rating for this service remains ‘Inadequate’ and the service remains 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.

About the service: Tynefield Care Limited is registered for 45 beds and provides personal and nursing care and accommodation for older people and younger adults who may have neurological conditions, nursing needs or are living with dementia. On the day of our visit 24 people were using the service.

People’s experience of using this service:

Risks associated with people’s care and support were not always managed safely. There was not enough staff to ensure people’s holistic needs, such as their social and leisure preferences were met. Improvements in the deployment of housekeeping staff were required to ensure all areas of the home were maintained to a good standard on a daily basis. There were systems and processes in place to minimise the risk of abuse, but these had not always been followed and we had not always been notified about incidents that had occurred. Accidents and incidents had not been reviewed and analysed to try to reduce future incidents occurring. Recruitment practices required review to ensure robust checks were undertaken. Staff required more training to enable them to provide safe and effective care.

People’s dignity was not always promoted and opportunities for people to access the community and follow their preferred interests were limited. The governance and oversight of the home had not identified or made improvements that were needed; to ensure people received good quality care. Overall, the home was adapted to meet people’s needs, but some areas required repair.

People’s rights under the Mental Capacity Act 2015 were protected. People enjoyed the meals and their dietary preferences were met. People had access to a range of health care professionals, and care plans included information about people’s health to ensure consistent support was provided.

People told us the staff were kind and caring and they were supported to maintain relationships with their family and friends. There were systems in place to respond to complaints but some people felt their complaints had not been addressed. We have made a recommendation about the management of complaints.

Where people needed support at the end of their life this was provided in their preferred way. Staff had and were receiving training, to enhance their skills and knowledge in this area.

Rating at last inspection: Requires Improvement (report published13 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. This service has been rated as Requires Improvement at the last three inspections. Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive.

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.

Enforcement: We identified five breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safeguarding, safe care and treatment, staffing, dignity and respect and governance. We identified one breach of the Care Quality Commission (Registration) Regulations 2009 around notification of other incidents. Details of action we have asked the provider to take can be found at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: Following our inspection we requested an action plan. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Tynefield Care Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 30 people using the service.

At the time of the inspection the service had a manager who had submitted their application to register with us. However since concluding our inspection we have been made aware that the situation has changed and the new manager is no longer in place. 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. This report reflects our findings from 3 January 2018 and the service remains under review.

Tynefield Care Limited was last inspected on 30 March 2017 and the service was rated as Requires improvement. We identified concerns that they were not meeting standards to support people to manage individual risks; consent was sought where people did not have capacity, although it was not always evident how capacity had been assessed to support how specific decisions were being made. People were not always happy with the choice of food available to meet their cultural preferences and there was a limited range of activities available for people to suit their interests and develop living skills. At this inspection, we saw that improvements had been made although further improvements were still required. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective. Medicines were not managed safely as the provider had not considered how all medicines could be safely administered to people. The provider had systems in place to assess risk although how risks were managed was not always understood, as information was not always clear. This meant actions were not always put in place to reduce identified risk and information in people’s care records did not always match the care they needed. There were limited opportunities for people to engage in activities that interested them. People had mixed views about how they were supported to do the things they enjoyed in the home and to have opportunities to go out. The staff recognised where people may be at risk of harm although following our inspection, it had been identified that suitable action had not been taken to ensure people remained safe. People used different ways to communicate and accessible information about the service provision was not always available. We have made a recommendation about ensuring people are able to understand information provided.

Staff received training and support to enable them to fulfil their role and they were encouraged to develop their skills. People felt that there were enough staff to meet their needs promptly and that they felt safe. They were supported to maintain good health and had regular access to healthcare professionals.

We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about their care and staff knew how to respond if people no longer had capacity to make some specific decisions.

Staff developed caring relationships with the people they supported which were respectful and staff were kind and patient. They knew people well and their privacy and dignity were maintained at all times. Mealtimes were not rushed and people were given a choice of what to eat.

Visitors were welcomed at any time. People knew who the new manager was and knew about the meeting that had been planned to share information. People felt confident that any concerns they raised with the new manager would be resolved. The new manager was approachable and provided support to the staff team. People were encouraged and supported to provide feedback on the service and quality assurance systems were in place to identify where improvements could be made. People were encouraged to contribute their views and felt listened to.

We found breaches 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 the report.

Tynefield Care Limited provides residential care for up to 45 older people and younger adults with a physical disability. At the time of our inspection 34 people were receiving a service. This report reflects our findings from 30 March 2017. However since concluding our inspection we have been made aware that the situation has changed and the new manager is no longer in place. The service remains under review.

There was a registered manager although they were not working in the service 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 now understood what constituted abuse and how to report concerns. New support plans had been developed for some people and contained relevant information for staff to help them provide the care people required. Other people’s care still needed to be reviewed. The new plans included procedures to manage identified risks with people’s care and for managing people’s medicines safely.

Staff sought people’s consent before they provided care and support. However, where people lacked capacity, information about how capacity had been assessed for specific decisions was not recorded. There were limited opportunities for people to engage in activities that interested them or to be involved with developing living skills. People enjoyed the food provided although felt more choice was needed to meet specific cultural preferences.

Under the new management arrangements, people felt staff were caring and kind and treated them with respect and dignity. Staff understood the importance of treating people with kindness and compassion. Where changes in people’s health were identified, they were referred to other healthcare professionals. Information about making a complaint was available for people and people knew how to complain if they needed to. Staff said they could raise any concerns or issues they had with the new manager, knowing they would be listened to and information would be acted on.

People and staff thought the new manager was open and approachable. The manager supported staff well to provide good quality care to people. People were provided with opportunities to comment on the quality of the service provision and felt the new manager listened to what they had to say. The new manager was working with commissioners of the service to develop systems to ensure people received safe and effective care.

Tynefield Care Limited provides residential care for up to 45 older people and younger adults with a physical disability. At the time of our inspection 41 people were receiving a 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.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. Standards to improve infection control were being addressed following concerns raised by commissioners of the service, however, one person’s chair was in a poor state of repair and dirty and some rooms needed cleaning. This meant that where improvements were needed this was not always identified by the registered manager and provider.

Staff sought people’s consent before they provided care and support although some decisions were made by others when people had capacity to make decisions themselves. Some people were subject to restrictions and the provider had not identified where their support needed to be reviewed.

Social and leisure based activities were not consistently promoted and provided, and people were not always supported to maintain and develop independent living skills.

Staffing had been organised to meet people’s needs and staff spoke kindly with people although interactions with people often occurred when people were supported with personal care needs. On occasions, the call bells were not always responded to in a timely way although staff were available. Risks to people were identified although some identified risks were not always minimised as the assessments were not followed to reduce the risk of preventable harm.

Staff received training and support that provided them with the knowledge and skills required to work at the service. There was a homely and relaxed atmosphere and people were treated with care and compassion. However, some interactions were not dignified as staff did not speak to people when they supported them to eat at lunch time.

Health care professionals visited the service regularly to provide additional healthcare services to people. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People knew how to complain about their care and complaints were managed in accordance with the provider’s complaints policy. People were confident they could raise any concerns with the registered manager or staff and were complimentary about the registered manager and staff. They told us the registered manager was always available and was approachable.

We found breaches 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 the report.

To help us understand the experiences people have we can use our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We used the SOFI tool for a forty minute period in the dining area. Our SOFI observation involved five people during the lunch time period. Our overall observation was that people were supported appropriately throughout the lunch time meal, staff were polite and helped people in an unhurried way, this enabled people to have a relaxed and positive experience.

Evidence was in place to demonstrate that all of the compliance actions left at our last visit in December 2012 had been met.

One visitor said that there were not enough activities to stimulate their family member. Another visitor confirmed that they had not seen any activities taking place when they visited. We observed that no activities were taking place on the day of our visit, although people told us about the external entertainment that had taken place the previous weekend and said that they had enjoyed this.

Staff were observed supporting people appropriately and staff told us they enjoyed their job and felt well supported.

Essential training was provided to staff but not all staff had received training that was specific to the needs of people using the service, which meant that not all staff had been given training that enhanced the care provided to people.