We carried out a review of the data available to us about Tigh Lenach on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tigh Lenach, you can give feedback on this service.
Tigh Lenach is a residential care home providing personal care to six younger adults living with learning disabilities and/or autism at the time of the inspection. The service can support up to six people.
People’s experience of using this service and what we found
People were protected from the risk of abuse and discrimination. Staff had received training in safeguarding vulnerable adults and were knowledgeable of the policies and procedures in place regarding identifying and reporting possible abuse. There were sufficient numbers of staff to meet people’s needs.
People’s risks were assessed and plans to mitigate them were detailed in care records. People had individualised behavioural support plans and people were supported proactively to prevent the risk of behavioural incidents occurring. When required, safe restraint techniques were used to protect people from harm. The use of these were under continuous review to ensure it remained safe, appropriate and the least restrictive option.
Safe medicines management processes were in place. Staff had supported people to have their medicines reviewed and reduced in line with the STOMP (Stop overmedicating people with learning disabilities) campaign.
Overall safe infection protection and control processes were in place and the risk to people of catching and spreading the COVID-19 virus had been reduced. However, we found some of the provider’s procedures were not in line with current guidance which impacted on visiting arrangements. We continue to work with the provider to seek assurances that their practices are in line with current government guidance.
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.
This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were involved in the design and delivery of the service. A personalised service was provided which gave people as much choice and control as possible over their care. The staff worked with other healthcare professionals to ensure their practice was in line with people’s best interests and staff were supported people to be as independent as possible.
The registered manager and staff were clear about their roles and responsibilities. Staff reported any concerns appropriately and the registered manager took accountability for the service. The registered manager was aware of their responsibility under the duty of candour. They told us they had an open and transparent approach to their management of the service and would communicate with people and their relatives if mistakes had been made.
There was a comprehensive programme in place to review the quality and safety of the service. Where improvements were identified as being required, these were addressed promptly. There was a drive and dedication within the team to continuously develop and improve the service. The staff were in the process of trialling a number of projects on behalf of the provider to further improve practices and provide a more responsive service focused on improving outcomes for the people using the service.
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 30 June 2018).
Why we inspected
The inspection was prompted in part due to concerns received from Ofsted about one of the provider’s other services regarding unexplained injuries on people using the service and poor joint working with other agencies. We also identified a pattern in the types of notifications CQC received from the provider. 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.
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.
Tigh Lenach does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports up to six young adults with learning disabilities and/ or autism, all of whom had complex needs. There were five people using the service at the time of our inspection. All people were unable to communicate verbally.
This was our first inspection of the service since they registered with us in September 2016.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
There was a registered manager in post at the time of our inspection. 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 provider had good systems in place to support people in relation to behaviours which challenged the service. The provider encouraged people to take positive risks to help them live meaningful lives. Staff received specialist training in relation to positive behaviour support and understood people’s needs well in relation to this. There was a plan was in place to further improve training in relation to this area. People had ‘positive behaviour support guidance’ in place for staff to follow in helping them manage behaviours which challenged which were personalised for each person. People and staff were involved in recruitment. After passing the interview stage candidates spent half a day at the service working with people and staff while the management team assessed how well suited they were to supporting the individuals at the service.
People were protected from the risk of abuse as the provider had suitable systems in place to safeguard people. The premises were well maintained and spacious and met people’s needs in relation to their disabilities well. People’s medicines were safely managed. The service was clean and suitable infection control processes were in place.
Staff were suitable to work with people as the provider carried out recruitment checks. There were sufficient staff deployed to work with people and staff had sufficient time to develop good relationships with them.
Staff received training to help them understand their roles and responsibilities and were also supported with supervision and appraisal. Staff told us the management team were supportive, accessible and approachable.
People received food of their choice and were supported in relation to eating and drinking where necessary. People also received support with their day to day healthcare needs. People received coordinated care when moving between services such as hospital admissions and when newly admitted to the care home. People were encouraged to exercise and some people had personal trainers to help maintain good health.
The provider had followed the Mental Capacity Act 2005 in assessing people’s capacity to consent to their care. The provider applied for authorisations to deprive people of their liberty (DoLS) as part of keeping them safe and people all required constant supervision and staff support when leaving the service.
Staff were caring and understood people’s needs well. Staff also knew the best ways to communicate with people. People were treated with dignity and respect. People were encouraged to develop their independent living skills.
People were supported to do activities they were interested in. Most relatives felt people had access to sufficient suitable activities although one relative felt the service could do more for their family member in relation to this. People were supported to maintain relationships with people who were important to them and relatives were encouraged to visit at any time.
People’s care was planned and delivered according to their needs. People and their relatives were involved in their care plans. Care plans reflected people’s physical, mental, emotional and social needs, their personal history, individual preferences, interests and aspirations. Processes were in place to develop end of life care plans as part of a programme run by the local hospice.
The registered manager, deputy, seniors and support workers had a good understanding of their role and responsibilities. Leadership was visible and capable and there was a clear management structure in the service. The staff team worked together in a supportive way.
The provider had good governance systems in place to audit and improve the service with frequent checks of the service in line with CQC standards. Systems were in place for the provider to communicate and gather feedback from people, relatives and staff. Relatives told us staff communicated well with them. Complaints and concerns were investigated and responded to appropriately by the provider.