Tigh Calman

Tigh Calman is a care home providing accommodation and personal care for up to six people in an adapted two storey building. It provides a service to younger adults and people living with autism and a learning disability. At the time of our inspection there were six people using the service.

Peoples experience of using this service:

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 kept at the centre of their support and all the decisions made about their care. Staff and managers had a passion for promoting people’s independence. There was a focus on supporting people to live their lives free from restrictive practices. People were supported to celebrate their achievements and achieve good outcomes.

People were supported to be independent in a safe way. Trained and competent staff managed and administered people’s prescribed medicines. We observed staff wore their personal protective equipment (PPE) correctly and systems were in place that promoted good infection prevention and control. Lessons' were learned when things went wrong, and learning was shared across the staff team.

Staff knew how to keep people safe and communication strategies were in place for people to be able to raise any safeguarding concerns. Staff were safely recruited and there was a robust process to ensure there was always enough staff. The manager told us how unplanned staff absences were covered.

The service did not have a registered manager in place. However, the manager had applied to be a registered manager. They were supported by the provider's health and safety, compliance and management teams. They knew their responsibilities and had developed a positive, open and honest staff team culture. Quality assurance processes and governance systems were effective in driving improvements.

The manager worked well with others to provide people with joined up care and support. The staff team promoted the provider’s equality and diversity policies and treated people equally well. The manager and staff team supported people to have a say in how the service was run.

Why we inspected:

The inspection was prompted in part due to concerns received about risks to people’s safety and the management of the service. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

This focussed inspection looked at the Safe and Well-led domains. The overall rating for the service has remained Good. This is based on the findings at this inspection.

Rating at last inspection

The last rating for this service was Good (published 11 September 2018). At our focused inspection in December 2020 we looked at infection prevention and control procedures only, but we did not provide a rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

We found the following examples of good practice.

Visits to the service had been enabled under strict processes including a health questionnaire, wearing personal protective equipment (PPE) and, a rapid test for COVID-19 where visitors were not involved in a regular testing programme. Staff had enough supplies of PPE; they knew when and how to use this correctly including space to put it on and take it off.

The home was tidy and clean, and a cleaning schedule was in place for frequently touched areas such as light switches. Staff ensured people's rooms and en suite facilities were deep cleaned with sufficient ventilation. Contaminated waste was stored and disposed of safely.

People were kept informed about the pandemic in a way which met their communication skills. People did not always socially distance, but staff helped promote this as much as practicable including undertaking pastimes in different places at different times.

The provider had contingency plans in place to manage any potential future outbreak of COVID-19. These plans included for staff to work in a set group. Only these groups of staff would support a person if there were any infection outbreaks.

Visits to people were being pre-booked and, as of 8 March 2021 would be limited to one indoor visitor. Where people needed regular visits, these were facilitated such as with a relative wearing PPE in a purpose-built building. Other means of staying in touch with relatives and friends included daily phone calls and video recordings of people's achievements.

There was an effective process to ensure staff had regular COVID-19 tests. This included risk assessments to manage any person who was not able to have a test. Staff used their knowledge of people's behaviours and actions to help identify any changes in health condition.

Tigh Calman is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were six people using the service. Tigh Calman accommodates six people in individual en-suite bedrooms in one adapted building. It provides a service to people with a learning disability and autism. 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.

A registered manager was 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 was safe. People were safeguarded by staff who knew how to recognise and report any concerns. Risks to people were identified and managed well. Sufficient staff were in post and the recruitment process for new staff had helped ensure that only suitable staff were employed. Lessons were learned when things had not always gone well and prompt actions were taken to keep people safe. Medicines were administered and managed safely. Staff adhered to the provider’s policies in maintaining and clean environment.

The service was effective. People’s needs were met by staff who had the right training and skills to do this effectively. People ate healthily and had sufficient quantities of food and drink. People were enabled to access health care services. 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. The registered manager worked with external stakeholders to help ensure that when people moved into the service they received consistent care.

The service was caring. People were cared for by staff and supported in a compassionate way. People’s privacy and dignity was promoted and respected. Access to advocacy was enabled should people ever need this support. People were involved in their care as much as practicable. People were treated with fairness whatever their needs were.

The service was responsive. People received person centred care that was based upon their strengths and levels of independence. Technology was used to enhance the quality of people’s lives. People were supported to raise concerns when required. Concerns were responded to effectively and this helped drive improvement. Systems were in place to support people, staff and family members if any person needed support with end of life care.

The service was well-led. The registered manager led by example and ensured the staff they supported had the right skills and values. Staff worked as a team to help people and each other. Quality assurance and governance systems were effective in identifying and acting upon improvements when these were needed. People had a say in how the service was run. Feedback to staff was provided in a positive way. An open and honest staff team culture was in place. The registered manager and staff worked in partnership with others who contributed to the quality of people’s care.

Further information is in the detailed findings below.