Tigh Fruin

Tigh Fruin is a residential care home providing personal care to people with learning disabilities and autism. The service is a three-story building in the small village of Hayton. Each person has their own bedroom and ensuite facilities. There are communal spaces for dining, living and creative space for activities. The service can support up to six people, and there were six people using the service at the time of the inspection.

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

There were not always enough staff to keep people safe or to provide them with the individual support they were assessed as needing. People were not always protected from the risk of abuse.

The service was not always well-led. Prior to April 2021, the provider had not ensured that their systems and processes were robust enough to identify a number of issues that potentially put people at risk. Relatives were disappointed with communication during the pandemic and felt that getting information about visiting and updates on their family members was difficult. Not all staff were up to date with training the provider expected them to do.

People were not always involved in reviews of their care, particularly where they were less able to communicate their needs. Relatives said they felt staff, particularly newer or agency staff, did not always consistently support people’s communication effectively.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. For example, people’s support was not always planned with them, and they did not always have a choice about who they lived with.

People’s needs were assessed, and any risks associated with their health conditions documented. Risks associated with the service environment were assessed and mitigated. People received their prescribed medicines safely. Accidents and incidents were monitored to identify trends and to prevent reoccurrences. The service was clean.

People were supported to eat and drink well, and to have a balanced diet. People were encouraged to make choices about decorating their personal space, and their bedrooms were clean and personalised. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People had access to GP, dentist services and other healthcare professionals.

People’s care was provided in ways which promoted their dignity and respected their independence. Staff respected people's right to confidentiality. The provider had a system in place to respond to complaints and concerns. The coronavirus lockdowns had an impact on people’s ability to go out and enjoy places and activities that had previously been part of their normal routines. Staff had worked hard to try and ensure there was still a variety of Covid-safe activities for people to take part in if they wanted. 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.

The manager had a good understanding of their role and responsibilities to manage and lead the service consistently well. Following local authority safeguarding investigations for several people living at Tigh Fruin, the provider worked with local authority staff to ensure lessons were learnt and improvements were made in the way people were supported.

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 15 April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about another service run by the provider and concerns raised by the Local Authority, which included poor governance and oversight. A decision was made for us to inspect and examine those risks.

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.

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 have identified a breach in relation to Regulation 18 (Staffing) as the levels of staff support were not consistently safe. You can see what action we have asked the provider to take at the end of this full report.

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.

About the service

Tigh Fruin is a residential care home providing personal care to people with learning disabilities and autism. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service is a three-story building in the small village of Hayton, offering ensuite accommodation with communal spaces including, dining, living and creative spaces for activities. There were six people using the service at the time of the inspection which is the number registered to this location.

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

The home was well run by committed and dedicated staff, managed by the registered manager and provider who continued to drive an open and responsive culture. New and creative approaches had been developed to provide a person-centred approach to a friendly and homely living environment .

Respect and dignity was at the forefront of the care which was provided and through this positive relationships had been developed and enhanced. Decision making was an important aspect and to support people to make their own decisions a range of bespoke communication methods were used. Family relationship had been fostered and there was a strong emphasis placed around the importance of these bonds. People’s equality and human rights were recognised and maintained.

Staff had worked with healthcare and professionals to achieve positive outcome for people in relation to supporting personal goals. We saw these relationships had had a huge impact on the person’s activity opportunities and for other people it had enhanced the time spent with family to enjoy a variety of meals. Individual health care had been promoted and there was consideration at all times to ensure the person’s wellbeing was at the centre of any medical support they may require.

People were supported by dedicated and skills staff who has received comprehensive training to support their roles. The cornerstone was the bespoke training produced by the provider which linked dignity, attitude and culture. Agreed philosophies linked to these areas were embedded which paced people at the forefront of the care. Staff were encouraged to progress within the company and were trained as their role progressed. When staff commenced their employment there was a detailed induction which equipped them for the role.

The provider used technology to support the storage of information for the care plans and a range of communication aids. All information was kept up to date and shared with staff and relatives in an organised planned way. People’s wishes were recognised, which may be required if they are approaching the end of their lives.

There was an individualised approach to support and engage people in a range of activities which promoted their interest, learning and well- being. Staff understood people well and plans reflected a variety of techniques to promote positive support when some people became anxious.

There was a complaints policy which was accessible and responded to as required in line with the policy. Complaints and other information were available in a range of formats including easy read and pictorial versions.

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 understood the importance of ensuring people were able to make their own decisions.

When people transitioned to the service there was a bespoke planned approach to support the person at their own pace with guidance from other professionals and family. The environment was decorated to support individual choices and interests.

People were protected from the risk of harm and staff understood the importance of continued hygiene for the home and individuals to reduce the risk of infection. Medicine was managed well by staff who had received the required training.

Peoples relationships were considered when staff were allocated on shift. The provider ensured there was enough staff to support people in the home, with their required one to one hours or when accessing activities. Risks had been assessed and managed to mitigate any ongoing concerns.

The provider used a range of quality audits supported by a dedicated team to ensure the home continued to provide good quality care. People and family were encouraged to be part of any changes and to provide feedback on the level of care.

Staff felt supported, listened to and an integral part of the development within the home. They worked with a range of partners to encourage learning and use the latest best practice to support people’s needs.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 (5 September 2017)

At this inspection the service had improved to Outstanding.

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service had a registered manager in place at the time of our inspection. They had been appointed since our last inspection and had been at the service since March 2017. 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.

At the last inspection on 30 January 2017 we asked the provider to take action to make improvements to how people were protected against the risk of abuse, how staff were deployed, how the registered provider monitored and assessed the service to identify and act on any improvements needed and how the Care Quality Commission was informed of incidents the provider was required to report.

We told the provider they must send us a written plan setting out how they would make the improvements and by when. Following our inspection the provider immediately sent us an action plan and subsequent action plans of the action they would take to make the required improvements.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found in January 2017. We found that the provider had taken action and all the breaches had been met. In addition there is an ongoing police safeguarding investigation, the provider continues to work with the police and the local authority safeguarding team. We will continue to monitor this work.

Staff had received further safeguarding training and new systems had been introduced to help protect people from the risk abuse. Risks to people’s needs had been assessed and planned for but relatives and professionals had some concerns about information sharing relating to incidents in how these were communicated.

Improvements had been made to the deployment of staff and safe staff recruitment practice was in place and followed. Some minor improvements were identified with the management of medicines and immediate action was taken to address this. People received their prescribed medicines when required and safely. The storage, ordering and disposal of medicines were found to follow best practice guidance.

Improvements had been made to staff induction, ongoing training and support provided to staff. The implementation of the Mental Capacity Act 2005 was found to have ongoing issues. However, the registered manager took immediate action to address this.

Improvements had been made to how people’s anxiety and behaviours were assessed and planned for. However, further work should be undertaken to ensure new recording systems and processes are effective to understand better people’s unique and complex behavioural needs.

Improvements had been made with menu planning and the involvement of people in choosing their meals. People’s dietary and nutritional needs had been assessed and planned for and staff provided support with people’s healthcare needs appropriately.

Staff had a caring approach and understood people’s needs, preferences and what was important to them. Staff were more effective in how they responded to people’s communication preferences and needs. People were involved as fully as possible in choice making and independence was promoted. Independent advocacy information was available should this support have been required. Staff supported people with dignity and respect.

Improvements had been made to the activities and opportunities available to people, these were meaningful and represented people’s interests and hobbies. Relatives felt on the whole more involved in discussions and decisions about their family members care and support.

Where concerns had been made, the management team had responded in a timely manner and action had been taken to improve people’s experience of the service.

Relatives and staff were positive that improvements had been made at the service. Some relatives had concerns about these being sustained but were confident the management team would achieve this. External professionals on the whole were positive that improvements were being made.

The provider had made improvements in the systems and processes used to monitor the quality and safety of the service. This included better accountability and scrutiny of the service by senior managers. Staff were more motivated and positive about working at the service.

Tigh Fruin provides accommodation and personal care for up to six people living with learning disabilities and an autistic spectrum disorder. At the time of our inspection there were five people living at the service.

Prior to our inspection visit we were informed that the registered manager was no longer 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. At the time of the inspection the registered manager had very recently left the service. The regional manager with the support of the assistant director for the organisation were managing the service. A new manager had been appointed and was due to commence employment in March 2017. We will monitor this.

Appropriate action was not taken in response to safeguarding issues. Staff had correctly reported safeguarding incidents to the registered manager, who failed to report these to the local authority safeguarding team or CQC. No analysis of incidents were completed to consider patterns, themes or lessons learnt.

Sufficient numbers of staff were on duty to meet people’s needs during our inspection, however, systems were not robust to ensure that sufficient staff were on duty at all times. Consideration to the mix of staff with respect to skill, training and experience had not always been considered. Staff were recruited through safe recruitment processes.

There were systems in place to monitor and improve the quality of the service provided, however, they were not effective. People and their relatives were not involved or had limited opportunities to be involved in the development of the service. The provider was not meeting their regulatory requirements.

Risks associated to people’s needs and the environment had been assessed and planned for. The provider had a policy and procedure for the use of physical restraint. Not all staff had received training in the restraint method used. Behavioural strategies to support staff to meet people’s needs were more reactive than proactive.

People received their medicines safely.

Staff received an induction but training was not always provided in a timely manner. The staff training plan showed gaps in training and refresher training. Staff received opportunities to review their work.

The Mental Capacity Act 2005 was not fully adhered to. Menu planning was not routinely being used to ensure people received an informed choice including healthy meal options. People were supported to maintain their health.

Staff were kind and respectful and knew people’s needs. People and their relatives were not always fully involved in decisions about their care. Advocacy information was available to people.

People did not always receive personalised care that was responsive to their needs. Individual activities and opportunities were limited. Staff’s knowledge and understanding of people’s preferred communication methods was limited. A complaints process was in place.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.