Twyford House

About the service

Twyford House is a residential care home providing accommodation and personal care to 11 people at the time of the inspection. The service is registered to support up to 14 people.

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

Right Support

The service did not always support people to have the maximum possible choice, control and independence as possible. Peoples views about the service they received, and the support provide by staff was not sought. People did not always have a voice in their own care.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

The size of the service was larger than current best practice guidance. However, was set back from the street and there were no signs to identify it as a service for people with learning disabilities and autism.

Right Care

There were times where there were not enough staff to provide the support people were assessed as needing and people did not receive this support.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

Staff turnover had been high, which did not support people to receive consistent care from staff who knew them well. Staff recruitment processes had been followed to ensure staff were safe to provide support to people.

Governance processes had not always been effective in ensuring there was up to date information for staff.

There were areas where staff practice could be improved to ensure people were treated with kindness, dignity and respect. For example, how some staff spoke to people.

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 19 February 2019)

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care right culture. We received concerns in relation to staffing levels, the management of the service and the support provided to people in relation to risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 improvement. Please see the Safe and Well-led sections of this full report.

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.

Follow up

We will request an action plan from 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.

Twyford House is a residential care home that was providing care and accommodation to 11 younger adults with learning disabilities, autism and/ or emotional support needs at the time of the inspection. The service is registered to support 14 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building being discreetly set back away from the road. There were no signs that indicated that the building was a care home and staff did not wear a uniform which would identify them as care workers.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; staff recognised that people had the capacity to make day to day choices and supported them to do so. People were encouraged to be independent. People were engaging in the community, for example through attending clubs, accessing shops and visiting the pub.

There was a positive atmosphere at the service. People were happy, and staff engaged with people in a kind and caring way. People were busy when we visited, engaging in activities, undertaking daily living tasks such as helping in the office or going out. One relative told us, “The service is excellent in keeping my [family member] active and occupied.”

The service continued to provide effective and safe support to people living with a learning disability and or autism. People were provided with good support to communicate, staff knew people well and understood their communication. People were supported to manage their emotions and had positive behaviour support strategies in place. Relatives told us that they had seen a positive change in their loved ones. People were supported to feedback on their experiences and contribute to planning their own support in ways which were suitable for their communication needs. For example, through using pictures, stories and electronic communication.

Staff were kind and caring and had the skills, learning and training they needed to support people. People were encouraged to increase their independence. The service supported people to maintain family relationships. When relatives could no longer visit people were supported to visit them.

The service was well led. The registered manager knew people well and people were comfortable coming in to the office to communicate with them. The registered manager carried out the appropriate checks to ensure that the quality of the service was maintained.

The service met the characteristics of Good in all areas; more information is in the full report.

Rating at last inspection:

At the last inspection on 14 July 2016 the service was rated Good.

Why we inspected:

This inspection was a scheduled inspection based on previous rating.

Follow up:

We will visit the service again in the future to check if they are changes to the quality of the service.

Twyford House is registered to provide accommodation and personal care for up to 14 people. One person lived in an annexe to the main house, on the same site. People living at the service had a range of learning disabilities. Some people had physical disabilities and required support with behaviours which challenged.

Downstairs there was a kitchen, dining room, lounge and two conservatories. There was also a toilet and washroom. There were 12 bedrooms split over two floors, many of which had an ensuite bathroom. The annexe had it’s own bedroom, bathroom, kitchen and lounge. At the time of the inspection there were 11 people living at the service and one additional person living in the annexe.

The service had a registered manager in post. A registered manager is a person who is 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 were checked to make sure they were of good character and suitable to work with people. Further details of how decisions were made to employ staff who may need to be monitored were not in place. This was an area for improvement. Staffing levels were flexible depending on the needs of people and what was happening that day. People were able to access the activities they wanted and any appointments as necessary.

Staff completed incident forms when any accident or incident occurred. If there were any incidents of behaviour that challenged these were reviewed by the provider’s behavioural therapist to look for any trends or potential triggers.

Risks relating to people’s health, their behaviour and other aspects of their lives had been assessed and minimised where possible. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were undertaken.

Staff knew how to recognise and respond to abuse. The registered manager had reported any safeguarding concerns to the local authority and these had been properly investigated.

Medicines were stored appropriately. People received their medicines when they needed it and were encouraged to be as independent as possible when taking their medicines.

Staff had received induction, training, support and supervision to support people effectively. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are a set of checks that are designed to ensure that a person who is deprived of their liberty is protected, and that this course of action is both appropriate and in the person’s best interests. Some people had DoLS in place and the conditions on these DoLS, such as accessing external activities was being met. Staff had up to date knowledge on the Mental Capacity Act 2005 (MCA) and DoLS. They supported people to make their own choices where possible and best interest meetings had been held when people could not consent to the support required to manage their behaviours safely.

People were supported to eat healthily. They were involved in planning and preparing meals. People were seen and assessed by a speech and language therapist (SALT) when they needed support to eat and drink safely. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible.

People and their relatives said that staff were kind and caring. Some people were unable to communicate verbally but staff anticipated their needs and understood their non verbal methods of communication. People were treated with dignity and respect and staff knocked on people’s doors before entering.

Staff were responsive to people’s needs. Before people moved into the service a detailed assessment was carried out and staff added to this as they got to know people better. There were behavioural support plans in place outlining potential triggers for behaviour that challenged and different strategies to deal with them. We saw these being followed. People had helped to write personalised communication passports that told staff how to communicate with them effectively.

People accessed a variety of activities both inside and outside of the service. Some people volunteered at the East Kent Railway Trust and others attended social groups and sensory sessions.

There was a complaints policy in place and people’s relatives said they knew how to complain if they needed. The registered manager recorded any concern or area for improvement as a complaint to ensure it was investigated fully. The actions taken were documented and shared with staff.

Staff and relatives told us they thought the service was well led. The registered manager was experienced in working with people with learning disabilities and providing person centred care. The Care Quality Commission (CQC) had been informed of any important events that occurred at the service, in line with current legislation.

The registered manager told us the ethos of the service was, “Flexibility with the underlying structure. We can plan and make sure people know what they’re doing, but for the people we support things can change, their needs can change and we need to be able to adapt to that too.” There was a culture of openness and honesty and staff responded to the needs of people as they changed.

The registered manager and the area manager regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care. People, their relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. The results of these surveys were collated and any areas of improvement were identified and actioned.