Tanglewood Mews

Tanglewood Mews is a care home providing accommodation and personal care for up to seven people with physical and/or learning disabilities. Care is provided in a purpose-built house over two floors. At the time of inspection there were five people living at the home. The service also provides personal care to people living in supported living. There were 14 people receiving personal care at the time of our inspection.

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

There were some omissions and inconsistencies that the provider’s auditing system had not identified. We found that some records required a review to ensure they reflected people’s current needs and guidance.

We have made a recommendation about the provider improving auditing processes.

When we visited the service, the registered manager was no longer in post and the home was being managed by an interim manager. During the inspection a permanent manager was appointed and applied to be registered with the Care Quality Commission.

People who used the service, relatives, staff and professionals told us they felt management were approachable and knowledgeable about the service. Most staff told us there had been recent improvements in the service. Some staff told us, however, that they did not always feel involved in the running of the service and were not asked for their views on how it could develop.

We observed staff following infection prevention and control guidance including wearing appropriate personal protective equipment. The environment was clean, and the management made checks of safety and cleanliness. The service was maintained to a good standard and people’s rooms/apartments were personalised. Where people had complex needs the service was working to make the environment as safe and suitable as possible.

There were arrangements in place to ensure people received their medicines safely and when required. Staff undertook training in the safe management of medicines and regularly had their competencies assessed to ensure they were following the correct practices.

There were enough staff to meet people’s care needs. The service followed safe recruitment practices.

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.

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

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 (published 27 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about management support, infection prevention and control and staffing levels. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained at Good at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Well-Led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tanglewood Mews.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tanglewood Mews provides accommodation and personal care. The home accommodates up to five people in one house. The service also provides personal care to people living in supported living apartments. There were 17 people receiving personal care at the time of our inspection.

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.

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

People said they were happy living at Tanglewood Mews and supported living They told us they enjoyed being with the staff and getting out and about.

Some communal areas of people’s apartments were being used by staff for training and paper work, the registered manager agreed to address this immediately. Avery large ‘Autism Care’ sign was at the entrance of the home which identified people’s homes as a care facility to the public. This was removed before the inspection was completed. The environment was very clean and homely. The décor was personalised in people’s bedrooms and also in communal areas where people chose the colours.

People received person centred support and staff knew people very well. People were supported to build and maintain important personal relationships that mattered to them, with their, peers and relatives.

The provider had systems in place for communicating with staff, people and their relatives to ensure they were fully informed via team meetings, phone calls and emails. People had good links to the local community through regular access to local services.

People were supported to be independent, their rights were respected and access to advocacy was regularly available. Support was provided in a way that put the people and their preferences first. Information was readily available for people in the correct format for them, including easy read.

Audits and monitoring systems were used effectively to manage the service and to make improvements as and when required.

Medicines were managed well, safely administered and recorded accurately.

There were enough staff to support people and staff were always visible. Staff received support and a variety of appropriate training to meet people’s needs.

Individualised risk assessments were in place. Staff were confident to raise concerns appropriately to safeguard people. Robust recruitment and selection procedures reduced the risk of unsuitable staff being employed.

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.

Appropriate healthcare professionals were included in people’s care and support as and when this was needed. People were supported to have enough to eat and drink people who need specialist diets were assisted with these.

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

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 (published 22 February 2017).

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.

At this inspection we found that the registered manager, who had been in post for 6 months, had ensured improvements were made regarding the understanding and application of consent as well as staff support. We found the service was no longer in breach of the Regulations.

Tanglewood Mews is a residential home in Stanley, County Durham, providing accommodation and personal care for up to seven people with learning disabilities. There were four people using the service at the time of our inspection. The service also provides personal care to people living in their own apartments. There were 16 people receiving personal care at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

There were sufficient numbers of staff on duty in order to safely meet the needs of people using the service and to maintain the premises, whilst the rota system for the on-call rota system had been improved.

All areas of the building including people’s rooms, bathrooms and communal areas were clean.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). Specific plans were in place for people with ‘when required’ medicines and controlled drugs were safely stored.

Pre-employment checks such as Disclosure and Barring Service (DBS) checks, ID checks and references were in place to reduce the risk of employing unsuitable people.

People who used the service acted in a trusting, calm manner with staff and relatives we spoke with expressed confidence in the ability of staff to protect people who from harm.

Staff we spoke with demonstrated a good understanding of safeguarding procedures and what was expected of them, whilst risk assessments in place were suitably person-centred and detailed. Person-centred means a focus on the individual's needs, wants, desires and goals so that these become central to their support.

There was regular involvement by GPs, nurses and specialists such as physiotherapists to ensure people received the treatment they needed. External professionals we spoke with confirmed staff knowledge of people’s needs was good.

Staff were trained in areas specific to meeting people’s needs, for example Autism awareness and Non-Abusive Psychological and Physical Intervention NAPPI) training, and were also trained in areas the registered provider considered mandatory, such as safeguarding, fire safety, food safety, manual handling, medication administration and infection control.

The manager had ensured staff were supported by regular supervision meetings and staff confirmed they received a range of formal and ad hoc support to perform their roles.

Staff were aware of people’s dietary needs and preferences and we observed people being supported to choose a range of meal options.

Group activities included outings to a local social club, themed nights and walks, as well as day-to-day activities such as shopping and swimming. The registered manager had made improvements to activities provision planning and was committed to ensuring these improvements continued. The registered manager had also ensured people were able to access the local community through attendance at local clubs.

A complaints process was in place and we saw this had been followed were a complaint had been raised.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager displayed a good understanding and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the Deprivation of Liberty Safeguards (DoLS). DoLS are decisions to restrict a person's specific liberty or liberties when it may be in their best interests to do so, for instance if they are at a particular risk of harm. Where a decision was taken regarding a person’s care we saw the people who knew them best had been involved to ensure the decision was in their best interests.

The atmosphere at the home was vibrant and welcoming. People who used the service, relatives and external stakeholders told us staff were caring and we saw numerous friendly interactions.

Person-centred care plans were in place and regular reviews took place.

Staff, people who used the service, relatives and external professionals we spoke with expressed confidence in the registered manager and the improvements they had made in the past six months. They were able to explain how they intended to sustain improvements already made and make other improvements and we found there was a strong emphasis on the accountability of all staff. We found the culture to be a positive, open one, with people’s needs and preferences prioritised by a staff team who were given clear direction by the registered manager.