Archived: Touchwood

Touchwood is a care home registered to provide accommodation and personal care for up to five people diagnosed with autistic spectrum disorders and learning disabilities. At the time of this inspection there were four people living at the home.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people .

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

People’s experience of using the service:

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 focussed on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us they felt safe and enjoyed living at Touchwood. People were relaxed and happy with staff, who knew them very well. Staff treated people with patience, kindness, dignity and respect. Relatives told us the service had greatly improved since the current registered manager had been employed.

Staff spoke knowledgably on how to identify and report abuse and were well supported in their roles. Staff received regular supervision and annual appraisals to enable them to carry out their roles competently. People were supported by staff who had received appropriate training to carry out their roles.

Risks to people’s health, safety and well being were regularly assessed, reviewed and updated. People and their families were fully included and involved in their care and support. People's views and opinions were listened to and acted upon wherever possible.

People’s health care needs were met and staff supported them to see healthcare professionals when appropriate. Medicines were managed, stored and administered safely. People were supported to take their medicines safely by staff who had received the appropriate levels of training.

People were supported by safely recruited staff and there were enough appropriately trained and experienced staff to support people in ways that suited them. Communication styles and methods were tailored to individual people and staff supported people to understand the choices available to them.

People received healthy, nutritious meals which they enjoyed planning and preparing. Meal times were a social occasion where people could choose to spend time with others or in their bedrooms if they preferred.

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.

People were supported to lead active lives and were encouraged and enabled to pursue hobbies and get involved in activities in the wider community. A variety of in- house activities were provided based on people’s interests and choices.

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

There was a complaints policy in both a text and pictorial format which gave clear guidance for all people. People and relatives told us they knew how to make a complaint if the needed to and felt any concerns would be taken seriously and action taken straight away.

There was a clear management structure and people, relatives and staff spoke highly of the registered manager who ensured there was an open, supportive, friendly, professional culture at the home.

There was a system of ongoing quality assurance systems in place to drive improvement and ensure the home offered a safe, effective, caring and responsive service.

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

Rating at last inspection and update

This last rating for this service was requires improvement (published 14 August 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up: 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.

Touchwood 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.

Touchwood is registered to provide accommodation and care for up to five people with learning disabilities or autistic spectrum disorder. At the time of our inspection three people were living at the home. 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.

The service had not had a registered manager in place since 14 October 2016. This is a requirement of the provider’s registration. 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. We served a fixed penalty notice due to this failure to comply with this condition of registration.

Robust governance and quality monitoring systems were not established or embedded within the service. This meant that some areas for improvement were not always identified, lessons were not always learnt and actions had not been put in place to address them.

Risks were not monitored adequately, including behaviours that challenge by the provider. Incidents were not fully assessed to assess and mitigate risks. Records of incidents were also not recorded and stored adequately to allow effective monitoring.

We had not received any notifications since July 2017 and we identified concerns during the inspection that we should have been notified about. A notification is the means by which providers tell us important information that affects the running of the service and the care people receive. This was a breach of the services registration requirements.

Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding. Professionals, staff and relatives told us they had no concerns relating to safeguarding.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines. However, improvements were required to implement checks on the temperature of the medicine storage room, maintenance of the medicine fridge and how audits were undertaken.

There were systems in place to carry out checks on the building to ensure it was safe. Staff understood their responsibilities for infection control.

Relatives raised concerns with us there were not enough staff at times in the evening to meet people’s needs. Concerns were shared with us that when only one member of staff worked in the evening staff could not support people individually to go into the community or spend one to one time with them. We made a recommendation that the provider reviews staffing levels in the evening.

Improvements were required to how all staff were supported to carry out their roles and attend specialist training. Improvements were required to how temporary staff were supported to understand the needs of people and to carry out their roles.

Staff told us they had not received regular supervisions. However, staff told us they felt supported by the manager and other colleagues to carry out their role. We made a recommendation about the supervision and appraisal of staff.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Assessments of capacity and best interest decisions were not all recorded. We made a recommendation about the assessment of people's capacity to make specific decisions and arrangements for best interests.

Applications had been made where required to authorise people’s Deprivation of Liberty and conditions set out in one person’s Deprivation of Liberty Safeguards were met.

People and staff told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals of their choice.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with on-going care needs. For example, one person was supported to see their GP following advice from a chiropodist. Records we reviewed showed that people had recently seen the GP, district nurses and a chiropodist.

People and relatives told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified and respectful way. Regular staff had a good understanding of people’s interests and their preferred routines.

Staff responded to the changes in people’s needs but not all care plans reflected people’s current needs.

People were encouraged to feedback. House meetings took place weekly which gave people an opportunity to give their feedback about what they enjoyed doing.

There was not a system in place for recording complaints within the service. People’s relatives told us they had raised some concerns but they had not always been responded to.

Improvements were required to how the service was managed to ensure that staff were clear of their responsibilities when the manager was not based within the service or on leave.

The service worked in partnership with other agencies.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach under Health and Social Care Act 2008 (Registration) Regulations 2009.

Touchwood provides care and accommodation for up to 5 people. On the day of the inspection 4 people lived within the home. Touchwood provides care for people who have a learning disability. Each person received one to one support from staff and needed to be supervised whenever they went out.

The service had a registered manager 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.

On the day of our inspection there was a very calm, friendly and homely atmosphere. People were relaxed and happy. People’s relatives and health and social care professionals all spoke highly about the care and support staff provided at Touchwood. Comments included, “I hold them in very high regard”, “I think it’s a super place” and “The staff are amazing, they go beyond the call of duty”.

Care records were comprehensive and written to a high standard. They contained detailed personalised information about how individuals wished to be supported. People’s individual method of communication was taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep people safe.

People were encouraged by staff to be as independent as possible. People had choice and control over their lives and were supported to take part in a varied range of activities both inside the home and outside in the community. Activities were meaningful and reflected people’s interests and hobbies.

People had their medicines managed safely. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, community psychiatric nurses and speech and language therapists.

People were supported by staff who had a strong understanding of how to keep them safe. Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. The manager had sought and acted on advice where they thought people’s freedom was being restricted.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff were highly motivated, creative in finding innovative ways to overcome obstacles that restricted people’s independence, and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.

The service had an open door policy, relatives and friends were always welcomed and people were supported to maintain relationships with those who matter to them. Staff were well supported through induction and on-going training. Staff were encouraged to enhance their skills and individual development was promoted. A staff member said, “I’ve started my level five, I need the challenge of having something to work towards. It’s given me more responsibility and I’ve been really well supported”

Staff had confidence in how the service was managed, and were happy in their work. The management of the home were consistent in their approach and led by example. Staff were inspired to provide and maintain a high standard of care. Comments included, “I love my job, absolutely love it. When I take leave I miss the guys. I think I was destined to do this job”, “I’m really positive about my job, I love it. It’s a really nice atmosphere and a great place to work”, “The managers are really good at praising you, they encourage you to do better” and “I absolutely love this job, it is so rewarding. The guys we support are just wonderful, wonderful people”.

The service had a very open and transparent culture. The registered manager had set values that were respected and adhered to by all staff. Staff were encouraged to come up with innovative ways to improve the quality of care people received. Staff felt listened to and empowered to challenge practice when they felt more appropriate methods could be used to drive quality.

People’s relatives and health and social care professional’s opinions were sought to raise standards of care and monitor people’s satisfaction with the service. Effective quality assurance systems were in place. Timely audits were carried out, investigations following incidents and accidents were analysed. Changes in practice were made to help ensure positive progress was made in the delivery of care and support provided by the service.

We also examined records, spoke with the manager and two support workers, and observed staff assisting people in communal areas. We saw that staff treated people respectfully and supported them to do things for themselves, such as preparing drinks. We noted that people appeared comfortable with staff, readily approaching them and starting conversations.

We found that the provider had addressed the compliance action from our inspection in September 2013. This related to planning and delivering care and welfare in a way that was intended to ensure people's safety and welfare. Risk assessments and care plans were reviewed and, where necessary, updated after each incident, such as a fall or display of agitation. Staff recorded their contact with people's families and professionals.

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care. Staff knew exactly how each person communicated which meant people's wishes were understood and respected. One person told us "I am very happy here - I like the staff as they are nice."

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas cooking with staff, completing jigsaw puzzles and interacting with each other. During our inspection we observed people spending time in their bedrooms watching television and learning to play the guitar. We also saw people being involved with activities in the living room with staff members.

The care plans showed that risk assessments were not updated following falls. The lack of updates meant that people using the service were not protected from harm and the risks were not reduced. Incident forms were detailed although there was not any evidence of care plans or risk assessments being updated following an incident.

The relative we spoke with told us 'the service provided to my son is excellent, he is very settled here and the staff do everything they can to promote his independence, he is very happy living here'.

One person we spoke with told us 'I love it here, everyone listens to me and you get to meet new friends'.

We found that care plans were detailed, person centred, accurately reflected people's needs and had been drawn up with their involvement.

People were supported by staff that had been recruited in a safe manner. People told us there was always enough staff available to make sure their needs were met.

We observed that care workers and people living in the home were relaxed with each other, laughing and chatting and enjoying each others company. We saw care workers knew the people who lived in the home well and could anticipate their needs as required.

One care worker we spoke with told us 'all the staff are friendly, it cheers you up when you come to work here'.

Records we saw showed the home had a detailed system to regularly assess and monitor the quality of service that people receive.