Tynedale House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At the last inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider and registered manager had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to identify and embed good practice. Accidents and incidents were recorded and consistently reviewed to identify learning and improvements, and the registered manager reviewed incidents to make sure safeguarding concerns received a prompt response. Staff described the registered manager as approachable and said concerns were addressed. Staff feedback showed an improving culture where people increasingly felt listened to and able to contribute ideas, although staff gave mixed feedback about the regularity of staff meetings and their involvement in reviewing how well the service worked. A staff member said, “I feel in the past, I wasn’t listened to but I do feel that since the new home manager has been appointed that we are generally a team within Tynedale House now which is positive and views are listened to and considered.”

The registered manager and staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They supported continuity of care and worked effectively with other services to respond to people's changing needs. Healthcare professionals described staff as proactive, responsive and good at keeping them informed about people. Staff worked with speech and language therapy, district nurses, GPs, physiotherapy and occupational therapy services and followed specialist recommendations. Care plans and risk assessments were reviewed when people's needs changed, and hospital and dental passports supported information sharing. A visiting professional said, “Each person presents their own challenges, however the staff seem to cope well, and have encouraged them. People tell me they feel at home now.”

The registered manager and staff team worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff protected people’s right to live safely and shared concerns appropriately. People felt safe, and staff understood safeguarding procedures and took appropriate action following incidents. Staff had training and a good understanding of what to do to make sure people were protected from harm or abuse. Relatives and professionals were positive about people's safety and the care provided. A relative said, “They really look after [person’s name] well and they feel very safe at the home.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Staff understood when Deprivation of Liberty Safeguards (DoLS) authorisations would need to be sought, the impact of the recent Supreme Court judgement and what to do if there were conditions imposed.

Staff did not always work well with people to understand and manage risks in a personalised way. Staff knew people well and understood their needs and presenting risks, and staff described involving people in discussions about their care and risk management. However, risk assessments did not give staff person-specific guidance about how to support people to manage and mitigate known risks. Some assessments were generic organisational documents rather than individualised assessments. The registered manager recognised this shortfall and was taking action to improve the quality of risk assessments and make them person centred. A person said, “The staff always make sure I am okay and safe.”

The provider did not always make sure potential risks in the care environment were fully identified and managed in a way which supported people's independence. The service had undergone a range of environmental improvements and others were planned. These improvements included new lighting, flooring and decoration, with fire doors being replaced and plans to replace the perimeter fence. However, consideration needed be given around how to reduce some environmental restrictions. For example, the use of baffle locks (2 door handles opening in different directions) and whether these were necessary. Also, people were also prevented from entering unit kitchens, which restricted their opportunities to undertake ordinary activities and develop independent living skills. The registered manager immediately took action to ensure this was addressed.

The provider did not always make sure there were enough suitably skilled and experienced staff to meet people's individual needs and enable them to lead ordinary lives. Recruitment practices met requirements and staff received mandatory and condition-specific training. However, staffing arrangements restricted people's opportunities for activities, community access and development of independent living skills. Night staffing also reduced staff's ability to respond to emergencies and had contributed to people becoming accustomed to going to bed before 9pm. Staff provided mixed feedback about staffing, and some specifically identified pressure on activities and concerns about night staffing. A staff member said, “I feel we have good qualified staff although it would be nice to have more staff so that we could get residents out more.”

Although staff received a range of training, further development was needed around supporting people living with dementia and responding safely to distress or behaviour that presented risk. The registered manager had identified these issues and was reviewing staffing and training arrangements.

Staff managed the risk of infection effectively. Staff received infection prevention and control training and the service had 2 infection control champions who received updates and shared these with the wider staff team. Staff followed hand hygiene expectations, infection control practices and there were effective arrangements for communicating any changes in guidance. Staff also received food hygiene training, and systems were used to monitor food storage and temperatures. Staff supported people with personal hygiene and monitored people for signs of illness so they could seek medical advice when needed.

Staff made sure medicines and treatments were safe and met people’s needs, capacity and preferences. Staff received medicines training and competency assessments before working independently. Staff followed expected practices around the administration of medication such as Stopping over medication of people with a learning disability and autistic people (STOMP).Everyone prescribed medicines had received a regular review from a GP or another appropriate healthcare professionals. A staff member said, “We always tried to support people in ways which reduce their need for medications such as Lorazepam.”