We carried out a review of the data available to us about Topaz House 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 Topaz House, you can give feedback on this service.
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.
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; people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
Maintenance issues were not always reported to ensure these were addressed promptly. This was rectified during inspection.
Systems of governance and oversight were not sufficiently robust to have identified the issues we found in relation to maintenance. We made a recommendation about governance and oversight in the report.
Appropriate checks to ensure the service and equipment was safe for people were completed.
The environment was warm, welcoming, clean and free from malodours. People had personalised rooms.
Staff had appropriate skills and knowledge to deliver care and support people in a person-centred way. Staff recruitment was safe and staff understood how to keep people safe. Staff could recognise and report any safeguarding concerns if they suspected abuse.
Risks to people were well managed. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.
There was a wide range of opportunities for people to engage in activities and follow hobbies and interests.
People were positive about the staff and told us that their privacy and dignity was promoted.
Care records contained information about people's needs and risks. Preferences and choices were considered and reflected within records.
People were involved in meal preparation and had access to a varied balanced diet. Staff monitored people’s weights and worked with healthcare professionals to make sure people received medical attention when needed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice.
People and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed. Staff told us they were well supported by the registered manager and management team.
People using the service and staff had the opportunity to feedback about the service. There was a system in place to respond to any concerns.
Rating at the last inspection: Good (published June 2017).
Why we inspected: This was a scheduled inspection based on the previous rating.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
The registered provider was required to have a registered manager in post and on the day of the inspection this requirement was being met. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People were protected from the risk of harm because the registered provider had systems in place to manage safeguarding concerns and staff were trained in safeguarding adults from abuse and understood their responsibilities in managing safeguarding concerns. Risks were also managed and reduced so that people avoided injury or harm.
The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people’s need and we saw that rosters cross referenced with the staff that were on duty. Recruitment systems were followed to ensure staff were suitable to support people. The management of medicines was safe.
Qualified and competent staff were employed and supervised. Their personal performance was checked at an annual appraisal. Communication was effective.
People’s mental capacity was appropriately assessed and their rights were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitably designed and furnished for providing care and support to people with mild learning disability and mental health needs.
People received compassionate care from kind staff that knew about people’s needs and preferences. People were supplied with the information they needed, were involved in their care and asked for their consent before staff undertook any support tasks.
People’s wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.
People were supported according to their person-centred care plans, which reflected their needs and were reviewed. People engaged in some pastimes and activities if they wished to and developed their living skills. People had very good family connections and support networks.
An effective complaint system was used and complaints were investigated without bias. People and their friends and relatives were encouraged to maintain relationships of their choosing.
The service was well-led and people had the benefit of a culture and management style that were positive. An effective system was in place for checking the quality of the service using audits, satisfaction surveys and meetings.
People made their views known through direct discussion with the registered provider or the staff and via the complaint and quality monitoring systems. People’s privacy and confidentiality were maintained as records were held securely in the premises.
Further information is in the detailed findings below.
We undertook this unannounced inspection on the 26 November 2014. We previously visited the service on 2 and 3 June 2014. We found that the registered provider did not meet the regulations that we assessed in respect of consent, care and support, keeping people safe, medicines, staff recruitment, staffing levels, staff support, supervision , monitoring the quality of the service and the reporting of notifiable incidents and we asked them to take action. Following the inspection the registered provider sent us an action plan telling us about the improvements they were going to make. At this inspection we found that appropriate action had been taken to make the identified improvements.
The service is registered to provide accommodation for persons who require nursing and personal care and treatment of disease, disorder or injury. Topaz House can accommodate up to four people with a learning disability and mental health diagnosis.
The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 8 June 2011. 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.
When we had previously visited the service on 2 and 3 June 2014 we found that the registered manager was working on a part time basis at the service, a manager had been appointed from within the organisation but after a high staff turnover, was finding it difficult to manage the responsibilities of the role.
During this inspection we found the management arrangements at the home were more consistent than we had seen at the last inspection. An experienced manager had been appointed in July to deal with the day to day management of the home along with a further two deputy managers and this meant there was a manager on duty over a seven day period.
The new manager has applied to become the registered manager of the service and when the registration process has been completed the current registered manager intends to de register from this role.
People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005. We saw where a person may not have the ability to make a certain decision, an assessment was completed to establish if they understood the choice they had been asked to make. When people were assessed as lacking capacity to make their own decisions, meetings were held with relatives and health and social care professionals to plan care that was in the person’s best interests.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider had followed the correct process to submit applications for a DoLS where it was identified a person needed to have their liberty restricted in order to care for them safely, and that this was in their best interests. At the time of the inspection one person who used the service had their freedom restricted and the registered provider had acted in accordance with the Mental Capacity Act, 2005.
People spoken with told us the staff listened to them and supported them in a caring manner. They were very happy with the care they received. People told us they had many different opportunities to engage in a variety of structured activities and had access to the local community.
People lived in a safe environment. Staff knew how to protect people from abuse and equipment used in the service was checked and maintained. Risk assessments were carried out and staff took steps to minimise risks without taking away people’s rights to make decisions.
People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health based professionals in the community.
People’s nutritional needs had been assessed and people told us they were satisfied with the meals provided by the home.
Medicines were stored, administered and disposed of safety. Training records showed the staff had received training in the safe handling and administration of medicines. Staff administering medicines had also had competency checks before being approved to administer medicines.
Staff had been recruited following the home’s policies and procedures to ensure that only people considered suitable to work with vulnerable people had been employed.
Staffing levels had been reviewed and increased to meet people’s needs and to support people to access activities. Staff received training and support to enable them to carry out their tasks in a skilled and confident way.
The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns.
We considered the findings of our inspection to answer 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:
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
Safeguarding procedures were in place and some staff understood how to safeguard the people they supported. Other staff told us that they had not had training or did not feel they had had enough training to enable them to confidently safeguard people. Staff also told us that they were unsure of what their responsibilities were in relation to safeguarding people who used the service.
The practices in the home did not protect the people who used the service or staff from the risk of harm. Some incidents had resulted in verbal and physical abuse between people who used the service. There had been a sexual assault on a member of staff by a person who used the service.
There was no system in place to make sure that the acting manager and staff learnt from events such as accidents and incidents, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learnt from mistakes that had occurred.
Staff were not aware of risk management plans and we were unable to see examples of these, or how they were followed. People were put at unnecessary risk and were not always included in decisions about their support, leaving them unable to remain in control of their care and lives.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
We found that people's medicines were not always managed safely; we found shortfalls in the recording, administration and effective ordering of medicines. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.
Is the service effective?
There was little direction and support for staff and the support given to people who used the service was inconsistent and contradictory. The service was for people with complex needs around their learning disability and or their mental health and often people presented with behaviours that challenged the service. Yet systems had not been put in place for all persons to safely manage these behaviours or have a consistent approach.
Some people told us they were involved in the development of their plans of support and were consulted about their assessment of their health and care needs. Whilst others told us decisions were made without their involvement.
There were gaps in the staff training and development programmes as some staff had not received training to meet the specialist needs of the people who used the service.
Staff had not completed training in The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This legislation protects people's rights to be involved in making decisions about their lives and where they do not have the capacity to do so, then safeguards must be put in place and followed to ensure decisions are made that are in the person's best interests. We found that one person who used the service was subject to a DoLS authorisation; however the specific restrictions that were in place to help to protect them had not been properly implemented.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
Is the service caring?
During the inspection we found that staff were supportive and attentive to the people who used the service. We observed people were given choices about their care. We observed staff speaking to people in a friendly and professional way.
We saw a lack of evidence to show that all people's preferences, interests, aspirations and individual needs were recorded or that care and support was provided in accordance with their wishes and feelings.
Is the service responsive?
People had access to a range of health and social care professionals for support and treatment but changes in their health needs were not always followed up.
Staff we spoke with told us they did not have access to key information about people's care needs. They told us they were at times supporting people based on verbal information received from head office, other staff or previous knowledge of their needs. This meant people may not always receive effective care.
Sufficient numbers of care workers were not always provided to respond to people's health and welfare needs.
Safe recruitment practices in line with the provider's policies and procedures had not always been followed to ensure new staff were safe to work with people who used the service.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
Is the service well-led?
There was no clear leadership in the service. Staff were given conflicting guidance from the management team and this guidance was not always written down, which led to confusion and inconsistency with the care provided.
The acting manager had been appointed from within the organisation, but following a high turnover of senior staff, they told us their workload had increased considerably and they needed additional support in order to fulfil their role.
We found the service did not have an effective quality assurance system in place and some records relating to the management of the service and people's care and welfare had either not been completed or were not on the premises.
There was some documentary evidence to show the views and opinions of people who used the service and staff were sought as part of the quality assurance process. But there was little evidence that the provider was taking action to address the shortfalls identified. This lack of documentary evidence made it difficult to establish if the service was being managed in people's best interest.
Turnover of staff was high and staff absence due to sickness was also significant. Although this was monitored by the provider there was little evidence of any action taken to improve staff sickness rates and staff retention.
Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is completed.
What people who used the service and those that matter to them said about the care and support they received:
People told us they generally liked the staff but the staffing shortages happened quite a lot. One person told us they thought most staff treated them as individuals.
People told us they went out into the community on their own and with support. One person explained how they could not stay at the service on their own and whenever staff accompanied another person who used the service into the community, they were asked to leave their home. They described how on occasions they had waited up to an hour on the door step after a pre- arranged time, before they could re-enter the home. They told us they had not been given an explanation for this.
We have raised our concerns about the care of people at the service with the local authority safeguarding team and with commissioners. We are working with all relevant authorities to protect and improve people's care.
We found that staffing provision had improved and that people who used the service received a consistent group of staff. The people who used the service told us they were satisfied with the staff and care provided.
The provider had failed to ensure that staff had adequate training to meet peoples complex needs safely.
The provider had failed to ensure that all incidents of alleged abuse had been reported or investigated and there may be a risk of further abuse occurring if appropriate action has not been taken.
The provider had failed to notify the Commission of incidents reported to the police and incidents of possible abuse and allegations of abuse.
People we spoke with told us they liked living at the home and were satisfied with the care and support they received.
We found that the service worked well with other agencies and people who used the service were supported to access health care appointments.
We found there may not be enough qualified, skilled and experienced staff to meet people's needs. People who used the service told us that they liked the staff .
We found that arrangements were in place to ensure staff would receive appropriate professional development.
We found that there was a comprehensive system in place to monitor the quality of the service. There was evidence that learning from incidents took place.
People's clinical care was provided through a multi disciplinary approach which included clinical psychology and psychiatric input as well as peoples' own opinions taken into account. We were told "I see [nurse] regularly and he sorts things out for me. [Care support worker] is alright, they all are really."