Tynedale House

We found the following examples of good practice.

• Staff had completed infection prevention and control training (IPC). The service was supported by the local IPC nurse to ensure they were following local and national requirements.

• Where possible service users were supported to understand the actions they needed to take to keep them safe during the pandemic. Two metre social distancing by residents and staff was encouraged where possible.

• Additional cleaning tasks had been added to schedules to ensure touch points and surfaces were cleaned throughout the day.

• Measures were in place to enable essential visitors to access the service. Hand sanitisers were available for visitors and staff to use on arrival and before leaving the home. Posters were displayed advising visitors and staff to use the hand sanitiser.

• The home is signed up to the national testing programme for all service users and staff. Quality assurance audits were completed to ensure safe infection control practices were being followed and to identify any improvements.

Further information is in the detailed findings below.

Tynedale House is a residential care home providing accommodation and personal care to people who have a learning disability and/or autism, some of whom also had physical disabilities and dementia related conditions. At the time of our inspection 23 people permanently lived there and five people were using the respite service for a short break.

The provider was aware that the size of service does not meet current best practice. They recognise the challenge to deliver high-quality, person-centred care in a large environment which supports high numbers of people. They have adapted the environment to overcome this challenge to enable people to have their own smaller self-contained areas. There were three areas where up to eight people lived permanently. There was also a smaller area where up to six people accessed the respite service. Each area has its own lounge, kitchenette and access to the gardens. People had named these areas after local landmarks. Each area had its own front door access to maintain people’s privacy. The areas were linked by a large foyer, where people could also access communal facilities such as activity rooms and the registered manager’s office.

The provider was committed to developing the service further to ensure they continue to deliver a service for people in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

People received remarkable support from extremely compassionate staff, who knew them all exceptionally well. People experienced a sense of belonging and felt safe in the comfort and security of what relatives described as a loving family orientated environment. Staff were incredibly respectful of people and protected their privacy and dignity. Independence was strongly encouraged.

Staff provided extremely person-centred support which helped people to achieve many positive outcomes and significantly enhanced their quality of life. A wide variety of activities were arranged which helped people to pursue their own interests and hobbies, as well as encouraging socialisation amongst people, their relatives and the local community. People also benefited from opportunities to pursue education and work-related roles.

People received a service which was exceptionally well managed by a committed and passionate registered manager. Staff were extremely well supported by the senior management team to provide high quality, person-centred care to people.

The management and staff fully embraced person-centred care and made sure people were at the heart of the service and totally involved in making decisions about their care. People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service fully reinforced this practice.

People’s care needs were thoroughly explored and carefully assessed. Staff provided care which met people’s current needs and exceeded their expectations and those of relatives and external professionals. People received timely interventions from external services with whom the staff worked in very close partnership.

Extensive checks and audits were carried out to monitor the safety and quality of the service. The senior management team and provider organisation set themselves very high standards and consistently achieved them through continuous improvements and developments to the service. Best practice guidance was firmly embedded into the service staff delivered to people.

People were very safe living at Tynedale House and relatives confirmed this. The premises were safe, and the home was clean and comfortable.

There were plenty of staff deployed to meet people’s needs safely. Staff recruitment was safe and staff training was up to date. There were lots of additional training opportunities for staff to meet people’s specific and complex needs.

There were thorough risk reduction measures in place to protect people’s health, safety and well-being. People’s medicines were well managed. Any accidents or incidents were fully investigated and reported as required. Lessons learned were shared with staff.

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 June 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 Tynedale House until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tynedale House is registered to provide accommodation for up to 30 adults. The home is subdivided into four units. Six places at the home are designated for respite, short term care for adults with learning and/or physical disabilities. The remaining 24 places are used to provide longer term accommodation, support and personal care to older people with a learning disability, some of whom also are living with dementia. Tynedale House does not provide nursing care. At the time of the inspection there were three people receiving respite care and 23 people living permanently at the service.

The home had a registered manager who had been registered since November 2014. 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 and relatives told us they felt the home was a safe place to live. Staff were aware of safeguarding issues, had undertaken training in the area and told us they would report any concerns of potential abuse. The premises were effectively maintained and safety checks undertaken on a regular basis, including checks with regard to fire safety.

Appropriate staffing levels were maintained to support the changing needs of people living at the home. Proper recruitment procedures and checks were in place to ensure staff employed at the home had the correct skills and experience. Previous minor issues around the safe handling of medicines had been addressed.

Relatives told us people enjoyed access to adequate food and drink at the home and we observed this to be true. Kitchen staff had an exceptional understanding of people’s dietary needs. Staff said they were able to access the training they required and records confirmed mandatory training was up to date. Staff told us, and records confirmed there were regular supervision sessions and that they had an annual appraisal.

The registered manager had a good understanding of the Mental Capacity Act 2005 and appropriate action had been taken where Deprivation of Liberty Safeguards had been applied. Staff were aware of the need for best interests meetings to take place where decisions needed to be made and people did not have capacity.

People had access to health care professionals to help maintain their wellbeing. Decoration in communal areas of the home had been improved and bathroom and toilet areas updated.

Relatives and visiting professionals told us they felt the care was outstanding, highly personal and responsive to people’s needs. They told us the home’s dementia care was of an exceptional standard. Relatives and carer questionnaire responses rated the service highly. We observed excellent relationships between people and staff. Staff described people as being almost like family and demonstrated a genuine interest in them as individuals.

People were treated with dignity and respect. A ‘residents’ forum’ had been established to ensure people were involved in determining their care. Professionals spoke to us about the high quality end of life care provided by the service and described how the service worked cooperatively to ensure people could be cared for with compassion at this time of their lives.

People had individualised care plans that addressed their identified needs. People and relatives talked enthusiastically about activities, holidays and individual sessions they had participated in. People and relatives told us they had no reason to complain about the service. Two formal complaints, received in the previous 12 months, had been fully addressed.

The registered manager showed us records confirming regular checks and audits were carried out at the home. Staff were exceedingly positive about the leadership of the home and felt well supported by management. People and staff all talked about the family atmosphere at the home and how they enjoyed working and being there. Records were detailed and up to date.

We found that people's care needs were assessed and their care and treatment was planned. Where necessary, external healthcare professionals had been consulted about people's care needs. We talked to one person's representative who told us they were satisfied with the care delivered at the service. They said, "Staff do a sterling job. If X was not happy he would show it. We are quite happy about him here." A visiting professional told us, "The staff are receptive to advice we can give."

We found people were supported to eat and drink and provided with a choice of suitable food and drink to meet their requirements.

We saw that people had enough equipment available to enable them to maintain their independence as much as possible and this equipment was suitably maintained. Updating of equipment could be more equally distributed across the home.

We found staff were appropriately supported to deliver care through on-going training, opportunities for additional support and qualifications, supervision and appraisal.