Tigh Bruadair

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

Incident analysis was not sufficiently detailed to fully support staff to identify any themes or patterns of people’s behaviour. The management team had identified improvements were required and were taking action to address this.

Risk assessments associated with people’s individual care and support needs to mitigate known risks had been completed. However, guidance for staff was inconsistent in places. The management team agreed to amend this immediately where required.

Staff turnover was high, the provider was taking action to review staff retention difficulties, and staff recruitment was ongoing. Agency staff were used to cover staff shortfalls. Staff recruitment checks were completed before staff commenced their role. Staff received opportunities to discuss their work, training and development needs.

The provider had safeguarding procedures to protect people against abuse and avoidable harm. Where safeguarding allegations had been made, action had been taken to report these to external agencies and they were investigated.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were involved in their care and treatment as fully as possible and care and support maximised their choice, control, and independence.

Whilst there had been staff retention difficulties and new staff were being recruited, the staff team overall were an established and experienced team. Staff knew people well and understood what was important to them. Staff were respectful and treated people with dignity and respect. People were empowered to live active and fulfilling lives. Opportunities to engage in stimulating and meaningful activities, interest and hobbies including social inclusion were provided.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received their prescribed medicines when required. Some people had experienced positive outcomes in the reduction of their medicines.

Infection prevention and control best practice guidance was followed, the service was clean and hygienic. The environment and layout of the service met people's individual needs.

People’s dietary needs and preferences were assessed and planned for. Healthy eating was encouraged, and people were involved in menu planning. People were supported to access health services.

Effective communication methods were used to support people's different communication needs and preferences.

The provider had systems and processes to assess, review and monitor quality and safety. An action plan was in place to develop the service. Relatives were positive their family member received person centred care. Feedback from people who lived at the service was positive.

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 Outstanding (published 10 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about another service ran by the provider and the concerns raised by the Local Authority, which included poor governance and oversight and inappropriate use of restraint. A decision was made for us to inspect and examine those risks. As a result, we undertook a comprehensive 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Outstanding to Good. This is based on the findings at this inspection.

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

Follow-up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection there was a registered manager in post. 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.

The service had previously been rated as overall ‘good’. At this inspection the service remained as overall ‘good’. At the previous inspection the caring domain was rated as 'outstanding' and remained so at this inspection.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. The environment was clean. There were arrangements to prevent and control infections.

Guidance was in place to ensure people received their medicines when required. Medicines were administered safely.

Where people were unable to make decisions arrangements were in place to ensure decisions were made in people's best interests. Best interest decisions were specific to the decisions which were needed to be made.

A robust system was in place to carry out suitable quality checks and effective checks had been regularly carried out. Everyone involved in the service were encouraged to contribute to the continuous improvement. The provider had ensured that there was enough staff on duty. Sufficient background checks had been completed before new staff had been appointed according to the provider’s policy.

Staff had been supported to deliver care in line with current best practice guidance. Arrangements were in place to ensure staff received training to provide care appropriately and effectively. In addition, people received person-centred care. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a range of activities. People were supported to access local community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care.

The registered manager promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been regularly consulted about making improvements in the service. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

Tigh Bruadar specialises in the care of people who have a learning disability. It provides accommodation for up to 13 people who require personal and nursing care. The home is divided into two separate units. On the day of our inspection there were 13 people living at the home.

At the time of our inspection there was a registered manager in post. 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.

On the day of our inspection staff interacted well with people and people were cared for safely. The provider had systems and processes in place to safeguard people and staff knew how to keep people safe. Risk assessments were in place and accidents and incidents were monitored and recorded. Medicines were administered and stored safely.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).If the location is a care home Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals such as a dietician and GP. Staff were kind and sensitive to people when they were providing support. Staff had a good understanding of people’s needs and used innovative ways to involve people in their care and understand their choices. People had access to leisure activities and excursions to local facilities.

People had their privacy and dignity considered. Staff were aware of people’s need for privacy and dignity.

People were supported to eat enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff available to care for people appropriately. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

Staff felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. The provider recorded and monitored complaints.

Audits were carried out on a regular basis and action put in place to address any concerns and issues.

We found where people were able to they gave consent to their care and support. Staff were provided with the leadership they required to protect the rights of people who did not have the capacity to consent. People received care and support that met their needs and this was regularly reviewed to ensure it was up to date. A person who used the service told us, 'I have my review.'

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. There were sufficient staff to meet people's needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, 'There is always staff around. I was a bit upset last night and someone came and helped me.'

During our visit we observed how staff interacted with, and supported people with their care and activity needs. We looked at records. These included care records and information about how the service operated.

We spent some time in communal areas of the home. We also spoke with two people who lived at the home, two staff members and the registered manager.

We saw that people were cared for and treated with dignity and respect. We observed that staff were able to communicate with people by speaking with them direct, and through the use of non verbal actions. This helped to ensure people were able to express their views and be involved with any decisions that needed to be made.

Wherever possible people were able to make choices about the activities they undertook both inside and outside the home.

One person told us, 'I am having Carbonara for my tea. I cook it myself with any help I might need. I like it that way' and 'I go to college to do hair and beauty. We like to go on Holiday. We went to Whitby last year and it was great.'

Where appropriate we found evidence that relatives of people who used the service were involved in reviews about peoples care and treatment.

We also found that the provider monitored the service and gained views on the service from relatives and from people who used the service.