Tynedale House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At the last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always assess and review people’s health, care, wellbeing and communication needs in a sufficiently personalised way. Assessments were completed with people and their relatives and contained a lot of information. However, they did not always clearly explain how staff should use this information to meet each person’s individual needs. This was important in the context of 'Right Support, right care, right culture’ because care records did not always highlight people’s individual strengths, needs, preferences and how to maximise their choice, control and independence. The registered manager recognised this and was taking action to improve the records

There were challenges within the respite service, where staff used the same care planning templates and recording expectations as the rest of the service. This resulted in staff producing large volumes of documentation rather than records being designed around the specific purpose and needs of short-term respite support. The registered manager had identified this and was reviewing the templates and working with staff to develop a more appropriate approach.

The provider did not always ensure people received care and treatment that reflected current evidence-based practice and standards. Staff generally followed current best practice when supporting people and visiting health and social care professionals were positive about their knowledge and ability to support people. However, some aspects of practice needed further development to consistently reflect the principles of 'Right Support, Right Care, Right Culture’. For example, while staff delivered compassionate care, some established practices and routines did not consistently maximise people’s independence, choice and control.

Staff had training to support people with specific healthcare needs, including epilepsy and seizures, percutaneous endoscopic gastrostomy feeding, oxygen and cough-assist equipment. However, we identified gaps in staff knowledge in other areas. For example, de-escalation, breakaway techniques and supporting people living with dementia. Staff feedback reflected these concerns. One staff member said it would be helpful to have more knowledge and guidance where people could become violent. Another described staff as not being equipped for the level of dementia experienced on their unit. The registered manager had identified these needs and was taking action to resolve this.

Staff worked effectively across teams and services to support people’s health and wellbeing. Staff worked closely with health and social care professionals and shared information when people’s needs changed. Visiting professionals consistently described staff as responsive, approachable and proactive, and said staff kept them informed about changes affecting the people they supported. Staff worked well with other professionals and services to support people. They worked with speech and language therapy, district nurses, GPs, physiotherapy and occupational therapy services. Staff followed professional recommendations and reviewed care plans and risk assessments when people’s needs changed. Hospital and dental passports were used to support the transfer of important information about people

Professionals were particularly positive about partnership work. A visiting professional described the team as “very approachable and empathetic” and proactive in raising concerns. Another professional said staff kept them up to date with issues affecting the people they supported and described how people with challenging circumstances had made significant progress after moving to the service. Staff also described working with other healthcare professionals as part of meeting people’s needs. The provider's partnership arrangements helped staff identify changes in people's health and seek appropriate specialist intervention.

Staff supported people to manage their health and wellbeing and access appropriate healthcare services. Staff were attentive to changes in people’s health and sought professional advice when needed. Visiting healthcare professionals reported staff responded to changes in people’s conditions promptly and in ways that met their individual needs. A professional described a person who had been unable to communicate verbally or walk unaided when they arrived at Tynedale House. Following their admission, the person began speaking, regained the ability to walk unaided and became more independent and involved in making everyday choices.

Staff routinely monitored people’s care and treatment to improve it. Staff responded to changes in people’s needs and there was evidence that people experienced positive physical, emotional and social outcomes. The registered manager had good oversight of the service and used quality assurance systems to identify where improvements were required. Care plans and risk assessments were reviewed when people’s needs changed, and staff sought input from relevant healthcare professionals. Professionals described staff as knowledgeable about people and responsive to changes. A staff member said, “We involve every person in the planning of their individual care plan asking how they would like to be cared for. Identify any risks that are important to them and how we can manage them so we can give the best possible care we can.”

Staff did not always ensure people’s rights around consent were consistently recorded and demonstrated when delivering care and treatment. Staff had received training in the Mental Capacity Act 2005 and its associated Code of Practice and understood the need to support people to make their own decisions. Staff had positive relationships with people and there was evidence that they encouraged people to express preferences and make decisions about their lives. However, records did not always clearly demonstrate the rationale and best interests decision-making process was being used when restrictions were placed on people. This was particularly relevant because some established arrangements restricted people's everyday choices. For example, people could not routinely enter unit kitchens, which reduced opportunities to develop ordinary daily living skills such as making their own drinks. The registered manager had identified these issues and was taking action to resolve this.