Archived: Care Management Group - Tuscany House

Tuscany House is a residential home which provides care and support to up to six people living with autism and complex communication needs. At the time of inspection there were 5 people living at Tuscany House.

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. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

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. Staff at Tuscany House were exceptionally skilled and motivated in ensuring these principles were fully embedded at the heart of the service.

There was a distinct will amongst the staff team for people to be living the life they wanted. When speaking about people staff were animated and repeatedly spoke about people’s achievements and goals. Staff demonstrated a clear and in-depth understanding of each individual’s communication needs, routines and personalities. People appeared relaxed in the company of staff and relatives described staff as caring, committed and approachable.

Staff supported people in a proactive and positive manner to find ways of managing their anxieties in order to maximise their opportunities. Through detailed planning and organisation, staff supported people to take risks and achieve things which had previously been seen as unattainable. Relatives felt that people’s lives had improved and been enriched by living at Tuscany House.

The provider ensured staff had the training and resources to support people effectively. The service worked with colleagues from the training and positive behaviour support teams to develop and enhance their skills for the direct benefit of the people they supported. Staff felt incredibly supported in their roles and understood the need for cohesive team work. This was extended to include families, professionals and others central to people’s lives.

People had access to a wide range of activities which were personalised to their own interests and skills. This included a wide range of social activities, college and work experience. Staff worked closely with a range of healthcare professionals to ensure people received their health care in a way which caused them minimum distress and anxiety.

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.

There was extremely strong leadership which focussed on ensuring people received highly personalised care which maximised opportunities. Staff told us they felt listened to and cared for which enabled them to work well as a team and maintain their positive approach.

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 (31 October 2016) insert date last report published in brackets.

Why we inspected

This was a planned inspection based on the previous rating.

There was a manager in post who was waiting to be registered by CQC. 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 inspection took place on 30 June 2016 and was unannounced.

The service had sufficient staff on duty to meet the needs of the people who used the service. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. These were reviewed regularly to ensure they were up to date and current. In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency

People received their medicines when they needed them. Staff managed medicines in a safe way and were trained in the safe administration of them. Medicines were stored securely and disposed of appropriately.

We talked to staff who demonstrated that they understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team, police and CQC.

Staff told us that they received a comprehensive induction program and ongoing training, tailored to the needs of the people they supported. Staff appeared knowledgeable and knew how to support people appropriately.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people's ability to make decisions for themselves had been completed. Staff asked people for their permission before they provided care for them. Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected.

People had a good choice of food and drink available to them. People received support from staff where a need had been identified. People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them.

There was positive feedback about the home and caring nature of staff from people and relatives. The staff were kind and caring and treated people with dignity and respect.

Good interactions were seen throughout the day of our inspection, such as staff sitting and encouraging people in activities of their choice. There was positive feedback about the home and caring nature of staff from people and relatives.

People looked relaxed and happy with the staff, people could have visitors from family and friends whenever they wanted . There was a strong emphasis on key principles of care such as compassion, respect and dignity. We observed that the people who used the service were treated with kindness and that their privacy and dignity was always respected.

Care plans were based around the individual preferences of people as well as their medical needs. People were not always involved in their care plans due to their complex conditions. The manager used other ways to gain information about people and their preferences by using a keyworker system of staff who knew them well or by consulting with relatives and health and social care professionals.

Care plans gave a good level of detail for staff to reference if they needed to know what support was required. Feedback from a healthcare professional was positive about the actual care given to people.

People had access to a range of activities that met their needs. The staff assisted people to fully participate in activities that had meaning to them. Some activities were based in the local community giving people access to experience things in a safe and supportive way.

A complaints policy was available to help people and relatives know how to make a complaint if they wished. We looked at the complaints log and saw none had been made in the last 12 months. The manager told us that if a complaint was raised they would take action to minimise or rectify the situation as soon as possible.

Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. Records for checks on health and safety, infection control, and internal medicines audits were all up to date. Accident and incident records were kept, and would be analysed and used to improve the care provided to people should they happen.

People had the opportunity to be involved in how the home was managed and were supported to have some input in house meetings to give people a chance to have their say.

A person who used the service wanted to go out but was not happy with using the train as was suggested by staff. They said this and were supported to use their choice of transport.

People told us their room was not too hot or cold, their taps worked and the water was not too hot and they liked their rooms and the home.

A person who used the service told us that if someone upset them they would tell the manager or staff.

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We saw examples of good practice with regard to creative strategies used to manage and avoid conflict

We found good practice and high standards in regards to the environment which was thoughtfully and suitably designed and adequately maintained.

There had been input from a psychologist in relation to the lighting and colour of the d'cor, with the intent to have the best effect on people with Autism.

We saw bedrooms had a keypad but people also had the option of a fob or key.

We also saw that all bedrooms had en-suite wet rooms with a shower. All but one of these had fixtures and fittings ready so the option of a bath could easily be fitted and offered, and we saw that this was offered in practice.

We found both the bath/ shower option, and the keypad/fob/traditional key option provided better access, independence, privacy, dignity and security for people.

We saw that people were given support to make a comment or complaint when they needed assistance, and people had their comments or complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.