The Tides

• The Tides is a care home for people with a learning and/or physical disability. The home is registered to provide accommodation and personal care for up to eight people. At the time of our inspection there were eight people living at the home.

People’s experience of using this service:

• People received outstandingly effective care and support from a consistent, committed well trained, staff team. Staff spoke passionately about their role and felt extremely well supported by an approachable, open management team.

• Staff knew people exceptionally well and expressed care and affection for them and worked hard to enable people to share their views and live active lives as independently as possible. People received care and support in an individualised way, which was planned and delivered to fully meet their needs. People were supported and cared for as individuals with a thorough person-centred approach.

• The home had undergone recent redecoration and adaptions which had positively impacted the lives of people living at The Tides. This had led to people having an improved sense of well being, and reduced instances of anxiety and agitation.

• The service worked collaboratively and closely with health care professionals to ensure people received the best care and support at all times.

• People had detailed, individual risk assessments completed which ensured they were supported to live their lives as independently as possible while minimising any identified risks.

• People were supported to have maximum choice and control of their lives and supported in the least restrictive way possible, whilst maintaining a level of independence.

• People were supported to access the community and trips to places of interest each day. People’s privacy was protected and they were treated with dignity and respect by a caring staff team who showed people kindness and compassion.

• The Tides was staffed with sufficient levels of trained staff who were themselves supported with a robust system of regular supervision and annual appraisals. Staff felt very well supported and commented very positively on the training they received.

• People’s medicines were being managed safely, stored securely and administered by trained staff.

• People and their relatives were fully involved in assessing and planning the care and support they received.

• People and relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns.

• Relatives and health professionals expressed confidence in the management team and felt the service was very well led.

More information in Detailed Findings below.

Rating at last inspection: Good (The date the last report was published was 21 October 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains rated as Good overall.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good.

There was a registered manager. 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 Tides is a care home for up to eight people with learning and or physical disabilities in Poole. At the time of the inspection there were six people living there.

Two people living at The Tides were able to talk with us. Some people communicated differently and were not able to tell us their experiences, we saw that those people and the people we spoke with were smiling, gave staff eye contact, and were happy and relaxed in the home. They interacted with staff and some of them interacted with the other people they lived with.

Relatives told us they felt their family members were safe at the home. Staff knew how to recognise and respond to any signs of abuse.

Risks to people’s safety were assessed and managed to minimise risks. Staff followed any risk management plans in place for people. Medicines were managed safely and stored securely. People received their medicines as prescribed by their GP. Staff knew when they should administer PRN ‘as needed’ medicines.

People received care and support in a personalised way. Staff knew people well and understood their needs and the way they communicated. People received the health, personal and social care support they needed. People’s health conditions were monitored to make sure they kept well.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. People were supported to take part in activities and try new experiences in the house and in the community. These were reviewed to see whether they had been successful.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. Staff were recruited safely.

The culture within the service was personalised. There was a clear management structure and people, relatives and staff felt comfortable raising any issues. There were systems in place to monitor and drive improvements in the safety and quality of the service provided.

We met and spoke with six of the people, five staff and the regional manager. We observed five staff supporting six people.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Overall, people had been cared for in an environment that was safe, clean and hygienic. There were infection control procedures and policies in place and staff had received training.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No new applications have needed to be submitted for one individual following the lapse of a previously approved application. Staff have received training in the Mental Capacity Act and managers understood when an application should be made.

Is the service effective?

We observed that people were relaxed with staff and gave them eye contact and smiles. Staff knew people well and understood their non-verbal communication and gestures. They were able to explain how they knew when people were happy, sad, uncomfortable, frustrated or in pain.

People had their needs assessed and care plans were in place. Staff understood people's complex health, learning disability and mobility needs.

People were encouraged to participate in the day to day living in the home and they were an active part of the local community.

Staff had received training to meet the needs of the people living at the home.

Is the service caring?

We observed that staff were kind and treated people as individuals. There were positive relationships between people and staff. People who were independently mobile actively sought the company of staff.

Staff encouraged people to be independent with eating and drinking. They were discrete and sensitive when people needed support with their personal care.

Is the service responsive?

People's needs had been reassessed since the last inspection and care plans included people's care needs and preferences. We saw in records that people had taken part in activities they enjoyed in the home and the community. People were supported to maintain relationships that were important to them.

People were referred appropriately to health or social care professionals and the guidance from these professionals was readily available to staff.

There were 'mental capacity act assessments' and 'best interest decisions' in place for people where needed. These decisions had been made by representatives, health and social care professionals involved with the individuals.

Is the service well-led?

There were quality assurance systems in place that ensured that the quality and safety of the home was kept under review. Action plans were put in place for any shortfalls identified.

Staff received mandatory and specialist training to be able to meet the complex needs of people living at The Tides. There was an ongoing training programme in place. There were staff meetings and staff received appraisals and one to one supervision.

We spoke with the manager, reviewed staff training records and looked at the medicines management systems in place at The Tides.

We found people were protected from risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with all of the people, two staff, the team leader, the manager, the regional manager and the provider's compliance assessor. We observed four staff supporting all seven people. The inspection took place over two days as the manager was not present in the first day of the inspection.

Overall, people's needs were assessed but care and treatment was not consistently planned and delivered in line with their individual care plan.

People were not protected from risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

There were enough staff to meet people's needs. There were plans in place to ensure that new staff were qualified, skilled and experienced.

There were systems in place to monitor and assess the quality and safety of the service.

We spoke with one person, two staff and the manager. We observed four staff supporting six people.

We observed that staff and people were relaxed with each other; they smiled and enjoyed each others company. Some people actively sought the company of staff. Staff supported one person in a calm way when they presented some challenges to staff and other people.

We saw that care workers knew each person's likes and dislikes and had good relationships with the people they cared for. They understood how people communicated and responded to people's non verbal cues and gestures.

People's relatives were involved in decision making and care planning. People were involved and contributed where possible.

People experienced care, treatment and support that met their needs.

We spoke with staff who understood what safeguarding was and what they would do if they suspected someone was being abused.

Staff were recruited safely and there were systems in place to monitor and assess the quality of the service.