Tyspane

Tyspane is a residential care home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. The service can support up to 69 people. Tyspane is a modern, spacious building with bedrooms over two floors accessed via a passenger lift. There are communal lounges and dining rooms on both floors. All bedrooms are en-suite. There were country views overlooking the well maintained grounds.

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

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 felt safe living at Tyspane. People received safe care and were protected from the risk of abuse. Staff were aware of their responsibilities for keeping people safe and received safeguarding training. Peoples’ comments included, “Relatives were happy and felt safe leaving their loved ones at Tyspane. They said, “

People were supported by enough suitably experienced and trained staff who were safely recruited. Staff worked with health and social care professionals to help people maintain their health and wellbeing.

Medicines were safely managed by trained staff.

Risks associated with people's care had been regularly reviewed and were well managed.

Visitors were welcomed into the service and their views were sought, considered and respected. There was a welcoming, staffed reception area with information and beverages.

There were robust systems and processes in place to monitor the quality of the service. When required actions were taken, and the necessary improvement made. The registered manager was supported by the provider to identify concerns and learn lessons when things went wrong.

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 25 January 2022). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements in relation to premises and equipment and good governance. 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.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tyspane 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.

Tyspane is a residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 69 people.

Tyspane is a purpose built service with bedrooms over two floors accessed via a passenger lift. There are communal lounges and dining rooms on both floors. All bedrooms are en-suite.

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

People said they felt safe and well cared for. Some people told us that there had been times when the service appeared short staffed but no one said this had impacted on them significantly. Comments included, “I think there are enough staff to look after me day and night. There is always someone to talk to if you need them.” And, “As far as I am aware we are well looked after.” One person told us, “I think they could do with more staff. I have to wait a long time and also wait when I use the call bell. I particularly would like more time when they bath me.”

During our inspection visits we found there was sufficient staff and people were getting their needs met in a calm and caring way. The staffing rotas showed there had been some shortages due to staff ringing in sick at short notice, but the levels had not reached a stage where people’s needs or safety had been compromised.

Relatives said communication with them was good and people’s healthcare needs were being met. One said, “The staff do a remarkable job, she feels safe and is happy and thinks all the staff are friendly.” Two commented, that in their view, the service being short staffed. One said, “My relative is not happy with the staff numbers she does not think there are enough, she thinks the home is understaffed as she reports waiting for a while to have her pads changed as she needs two members of staff as she uses a hoist.

There was a strong odour in the upstairs corridor and this was also mentioned by a relative. We have asked that this be addressed as a priority as it was impacting on people’s enjoyment of their environment.

Risk assessment were being completed but where people were on pressure mattresses, it was not clear when and how staff checked this and we have made a recommendation in respect of ensuring good systems were established. This was to ensure pressure mattresses were on the right settings for the person’s weight and that these were checked daily.

Recruitment processes had not been followed in line with guidance and their own policy. Employment histories and any gaps had not been documented as fully explored. When we fed this back, we were sent documentation to show this had been followed up. We have made a recommendation in respect of ensuring future recruitment practice follows guidance and national requirements.

We had received a number of whistle blowing concerns which suggested the culture and teamwork within the service was impacting on staff and their work. Staff said there had been elements of some staff having favoured tasks. We had sent this information to the provider prior to this inspection. They had taken a number of actions to address both being short staffed and the culture and ethos with the team. This was work in progress. We found no major impact for people using the service despite being told by whistle blowers that people were at risk.

Medicines were managed safely. However, we have made a recommendation in respect of reviewing their systems for recording the application of patches and monitoring that they remain in place.

Infection control processes were embedded and staff had access to and wore appropriate personal protective equipment (PPE). People and relatives confirmed staff wore PPE at all times. However, we received information from emergency services which said not all staff on their visit were wearing PPE. We have asked the provider to respond to this.

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 training and support was done in a range of ways to ensure they had the right skills to meet people’s needs safely and effectively.

Staff showed empathy, caring and patience during our observations of interactions. Some staff were particularly skilled and assisting people with their lunch and ensuring this was a pleasant and unrushed experience.

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 31 January 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, people’s needs not being met and records not being completed. We also heard from whistle blowers that the culture within the service was bullying and had led to staff leaving and low staff morale. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make some improvements in other areas not identified by the information we received. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Following feedback, the provider had taken actions to address staff morale, monitoring of pressure relieving mattresses and deep cleaning of carpets where there was an odour issue.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to premises and equipment and good governance 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.

At the last inspection in January 2015, the service was rated Good.

At this inspection we found the service remained Good.

People said they felt safe and cared for in the home. There were sufficient, suitably qualified staff to

meet people’s needs. The provider was needing to use agency staff where additional staffing was required. There were robust recruitment checks in place.

People were protected from the risks of abuse as staff understood and carried out what they needed

to do when they identified a concern.

There was a safe system to ensure the safe management of medicines at the service. Medicines were administered by registered nurses and care practitioners who had been trained regarding medicine management and had their competency regularly checked.

People’s needs and risks were assessed before they were first admitted to the home and these were

reviewed on a regular basis and when a change in their needs was identified. There were environmental risk assessments which ensured the premises were safe.

Staff had the skills and knowledge to support people appropriately. They received regular supervision and appraisals to support them with their performance and future development. New staff undertook a thorough induction when they started working at the service

People were supported to have a balanced and variable diet. Where people had specific dietary requirements these were catered for.

People had access to health professionals. A Physiotherapy worked at the home each Friday and a physiotherapist assistant was provided at the service to provide on going support to people with their physical mobility needs.

Staff were very caring and kind. They treated people with respect and dignity at all times. There was a friendly atmosphere at the home and a strong ethos from the registered manager and all staff regarding it being the people’s home and a privilege to be able to spend time with them.

The registered manager and deputy manager had been undertaking the six steps end of life programme to further improve end of life care at the service.

There were four designated activity staff to support people to engage in activities that they were interested in, on an individual and group basis.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with any member of staff without any worries about repercussion. There had been two complaints since our last inspection which had been responded to in line with the provider’s policy.

There was a registered manager in post who was very active within the service. They led by example and had a high level of expectation of the staff to deliver good quality care.

The provider had several assurance systems in place to assure themselves the service was running safely. These included monitoring visits from the quality team, health and safety and monthly visits from the regional operations director. There were systems in place where the registered manager input data onto the provider’s computer system which could be analysed at the head office.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report:

Is the service safe?

We found the service was not always safe. However people who lived at the service told us they felt safe. One person said "The staff are excellent and can't be faulted". Another person said "The staff are lovely". People and relatives told us they felt they could speak with the staff and manager and that they were 'very approachable.'

We found that the home was not meeting current practice standards for DoLS (Deprivation of Liberty Safeguards), and did not act in accordance with legal requirements where people lacked the capacity to consent to care and treatment.

People who used the service were not always protected from the risk of abuse because the recording of safeguarding incidents did not allow for a robust cycle of the process to be recorded. This meant it was not clear if the provider responded appropriately to any allegation of abuse. It may also have made it difficult to prevent abuse from happening again in the future.

On the day of our inspection we met seven people who were supported by the service and they looked happy and relaxed. They told us that the support they received made them feel reassured. A relative we spoke with said the support their relative received gave them 'peace of mind', and that staff always seemed very attentive and approachable.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw comprehensive assessments of need were done before a person received support. We saw the manager did regular audits on medication, infection control, health and safety, and professional practice to make sure care and support were being delivered safely by the staff.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The manager and training co ' ordinator told us that DoLS training forms part of the safeguarding course and that the relevant staff have been trained to understand when an application should be made, and how to submit one.

However, it was noted during the inspection that potentially restrictive practices were used regularly by the home. For example the use of alarmed and monitored internal and external doors, floor and bed pressure pads, and bed sides. The use of these methods had not been formally assessed or documented in relation to whether they may result in a deprivation of liberty for people living there. This meant it was unclear if people who used the service were protected against the risk of unlawful or excessive control or restraint because the provider had not made suitable arrangements.

Is the service effective?

This service was found to be effective because people told us the service supported them to live their lives in a way that suited their personal needs and maintained their quality of life. Some relatives told us there were times when they felt more staff were needed, such as weekends and bank holidays, but on the whole were very happy with the care and support provided. People told us they felt the support they received was good, and one said 'There are plenty of staff and you don't have to wait for help if you ring the bell.'

The training co ' ordinator, manager, and staff told us the provider arranged a range of relevant training and support to help staff meet the needs of the people they supported. Training records confirmed this and showed specialist training such as catheter care, epilepsy, nutrition, and CPR had been delivered. This meant staff were enabled to provide safe and effective care to people.

A relative we spoke to told us that told us 'My relative is well looked after.' Another told us 'It's wonderful here, I have no complaints.' People and their relatives told us that if they were unhappy with something, they felt confident they could talk to staff or the manager and it would be sorted out quickly. This showed people's views were listened to and the service was effective at dealing with any concerns or issues.

Is the service caring?

We found the service was caring. For example, we observed staff treated each person as an individual with dignity and respect. People told us that all of the support staff were very kind and 'It's a lovely place to live'. A relative told us that the longer standing members of staff were very skilled at caring for their relative with limited communication, and this familiarity made them feel their relative was well cared for.

During the inspection we heard and saw staff speaking respectfully with people who lived at the service. We also saw staff using different forms of communication, such as showing people the lunchtime meal options, so people could make their own decisions. This showed that people were communicated to in a way that enabled them to make their own decisions.

Is the service responsive?

We found the service was responsive because people's needs were thoroughly assessed by the service before they received support. The deputy manager told us most people would trial the service for up to three months and during this time a fuller assessment and care planning would take place. This meant people had the opportunity to see if they were satisfied with the service and their needs and preferences were fully understood.

We saw people's care was planned and delivered in line with their individual preferences. Each person's care plan was formally reviewed every six months, and changes made if necessary. We saw people's support needs were also re-assessed every month to ensure they were happy with the support they were receiving and it remained appropriate. This showed the service was responsive to people's changing needs.

People told us they were able to make choices regarding what time they received their support. The staff we spoke with demonstrated a good understanding of each person's support needs and preferences and how they should be met. This meant people were able to retain control over their daily activities and were supported by skilled staff who were responsive to people's needs.

Is the service well led?

We found the service had the potential to be well led following a period of several management changes. The new manager had been in post for three weeks at the time of the inspection and was in the process of registering with CQC. She had previously been registered manager in another service. During the inspection she displayed a clear and extensive knowledge of managing a similar size home previously for fourteen years. She was aware of the weaker areas of practice highlighted by the inspection and expressed a determination to prioritise and address these as soon as possible.

There was a clear staffing structure in place with clear lines of reporting and accountability. Staff said they felt well supported by colleagues and the new manager appeared to taking early action to improve the home. They said they now felt they could report any issues or concerns to the manager in the first instance, which they hadn't previously. The manager said they were able to contact their regional operations manager for advice or support whenever needed. This showed that appropriate support was available for all staff.

The quality of the service was monitored through regular contact and meetings with people and their representatives, audits, staff supervision, and monthly monitoring visits by a senior manager from the provider.

During this inspection we spoke with 11 staff and the registered manager. We also spoke with one visiting relative and with nine people about their experiences of living at the home. We spent time observing how care and support was delivered. We looked at some key records. These included care plans, daily records, risk assessments, staff rotas, menus and staff training and recruitment files.

People we spoke with were positive about the staff and the care and support they received. Comments included, ''couldn't ask for better, the staff are all very good.'' ''I I can't find any problems, staff are all lovely. I have never had a problem.''

We observed care and support being delivered in a respectful way, with dignity and independence promoted. We saw that care was well planned and risks were assessed and measures put in place to minimise any identified risks.

Recruitment processes were robust and we found that there were sufficient staff to meet the needs of people currently living at the home.

Systems were in place to review and monitor the quality of care and support provided.