30 April 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by an inspector, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Tuscany House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure the manager would be available to support the inspection.
What we did before inspection
We reviewed information we had received about the service since its registration, including notifications of significant incidents. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with the manager, a senior service manager and five members of care staff. People who lived at the service were not able to tell us directly about the care and support they received. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We checked two people’s care records, including their risk assessments, support plans and mental capacity assessments, recruitment records for three staff and the arrangements for managing medicines.
We spoke with three people’s relatives to hear their views about the care provided to their family members.
After the inspection
The manager and senior service manager sent us supporting documentation including training records, quality assurance checks and audits, the business continuity plan and the development plan for the service.
30 April 2022
About the service
Tuscany House is a care home providing accommodation and personal care for up to seven people with learning disabilities and/or autism spectrum condition. There were six people living at the home at the time of our inspection.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of using this service and what we found
The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
People’s medicines were not always managed safely. Some medicines had been administered after they had expired and there was insufficient guidance for staff about the use of medicines prescribed ‘when required’.
Some people did not have opportunities to take part in meaningful activities or to access their community. This meant people were not supported to have the maximum possible choice and control over their own lives.
Staff had not had the guidance they needed to provide support in a way which achieved good outcomes for people. Care plans did not always reflect people’s current needs or include guidance for staff about how to support them effectively.
Risk assessments were in place to help keep people safe. Accidents and incidents were reviewed and action taken to help prevent similar events happening again. The home was clean and hygienic, and staff understood how to minimise the risk of infection.
People were supported to maintain good health. Staff ensured people had access to appropriate professional input to meet their healthcare needs.
People’s dietary needs were met. People were supported to make choices about what they ate and to maintain a balanced diet.
Staff did not have all the skills they needed to meet people’s communication needs. We have made a recommendation about this.
There were enough staff available to keep people safe. When agency staff were needed, the provider used the same staff regularly, which minimised the impact of this on people’s care. The provider’s recruitment procedures helped ensure only suitable staff were employed.
Staff knew how to recognise and report abuse or poor practice. When safeguarding concerns had been raised in the past, these had been reported and investigated.
Staff were kind and caring. They treated people with respect and engaged with them in a friendly yet professional manner. Staff had worked with people to help them overcome anxieties, which had achieved positive outcomes for them. People were encouraged to be independent where possible.
Inconsistent leadership had affected the quality of care people received and the support provided to staff.
The culture within the service did not always achieve good outcomes for people. People were not involved in developing their support plans to ensure they reflected their needs and wishes.
Quality monitoring systems had not been effective and did not include seeking the views of people who lived at the home, their relatives and staff.
Staff kept relatives up to date about their family members’ health and well-being. Relatives told us that any concerns they raised had been resolved to their satisfaction.
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 the service under the previous provider was outstanding, published on 16 August 2019.
Why we inspected
The service was registered under the current provider on 1 December 2020. This was a planned inspection based on the date of the service’s registration under the current provider.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
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.