Tushmore Lane

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 is a detached property with single occupancy bedrooms located over two floors. People have access to a kitchen, lounge, dining room, quiet room, a conservatory and a garden. The building and accommodation is wheelchair accessible. The service has a well-maintained garden.

At the last inspection of 4 August 2015, the service was rated Good.

At this inspection, the service remained Good.

There was 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.

People were safe at the service. Staff knew how to identify abuse and understood the safeguarding procedures to follow to protect people from abuse.

Risks to people’s health and well-being were assessed and managed. Appropriate risk management systems were in place which ensured staff delivered safe care.

People’s needs were met in a safe and timely manner by a sufficient number of staff. The provider followed appropriate recruitment procedures to ensure they employed staff who were suitable to provide care.

People received their medicines when needed. Medicines were administered and managed safely by staff who were trained to perform that role. Health and social care professionals were involved in the planning and reviewing of people’s care to ensure support provided met best practice guidance and legislation.

Staff provided care that was responsive to people’s needs. Lessons were learnt from incidents and accidents to minimise a recurrence. Staff were supported and trained to undertake their roles.

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. People gave consent to care and support.

People were happy that staff delivered their care in a kind and caring manner. People had developed positive working relationships with the staff who supported them.

Staff involved people in planning their care and knew their likes, dislikes and preferences. People were treated with respect and their confidentiality maintained. Staff promoted people’s privacy and dignity.

People were provided with a healthy and balanced diet. Staff ensured people had sufficient amounts to eat and drink. People’s health needs were met.

People took part in a wide range of activities. Staff supported people to develop and maintain their daily living skills. People were actively involved in the community and engaged in voluntary service and gainful employment.

People using the service and their relatives’ views were sought about the service. The provider welcomed their feedback and made changes when necessary. People knew how to make a complaint and were confident their concerns would be resolved.

People and staff commented positively about the registered manager and how the service was managed. There was an open and transparent culture at the service. People received care that was focussed on meeting their individual needs.

Regular audits and checks were carried out on the quality of care people received. Shortfalls identified were addressed in a timely manner to develop the service.

People’s health and well-being was improved because of the close working partnership between the registered manager and other agencies.

Following our meeting with them, the provider sent us a more robust action plan which outlined what they would do to keep people safe and comply with the law. This inspection was a focussed visit to assess if this action plan had been followed.

There were two people living at Tushmore Lane at the time of this inspection. At the previous inspection we identified one person whose needs were not being met and who was incompatible with the other people who lived at the home. This person has since left the service. The registered manager had also returned from maternity leave and a new staff structure had been put in place.

We met with one of the people who lived at the home and gained the views of the other person by speaking with staff and looking at the minutes of their keyworker and residents' meetings. From this information, we were able to evidence that the needs of both these people were now being met. The person we spoke with confirmed that they "Liked living at the home" and went on to say "It is much better here now." We observed that this person was now spending time in the communal areas, compared to previous inspections where they were alone in their bedroom. Staff confirmed that both people now freely accessed all areas of the home, spent time together and cooked for each other. This meant that people were benefitting from living with other people whose needs were compatible with their own.

Due to the two vacancies in the home, staffing levels had been reduced. We saw that a new staff rota had been introduced in which most shifts were covered by one or two members of staff working long days. Staff and the person we spoke with told us that this new system was working well because people received more continuity in their support. It also meant that people could be supported outside the home without needing to return home early afternoon in order to accommodate staff shift patterns.

We found that care plans had been reviewed and staff training had been either undertaken or planned to meet the needs of the people they supported. The person we spoke with told us that they got on well with the staff. Staff confirmed that they felt confident with the people they worked with.

We saw evidence that the home was now recording the feedback it received and that any concerns or complaints were logged, investigated and responded to appropriately. This meant that people felt more confident to raise issues because they knew they would be listened to.

We interviewed four members of staff and met with the operations manager. Since our last inspection, one person had moved out of the service on a permanent basis. Some staff members had also left employment at the home and some new staff had been recruited. We saw evidence that staff had recently reviewed some of the care plans. New guidelines had been introduced for one person which had led to some improvements in the way they were supported.

We saw that agency staff now received an induction to the home and that the person with complex behavioural needs was supported by a core of regular staff. This meant that care was being provided in a more consistent and safe way.

Whilst some improvements had been made, we were still concerned about the compatibility of people who lived at the home. Staff told us that they still did not feel fully supported in their roles.

People told us that they liked the staff and had opportunities to participate in activities that they enjoyed. Each person raised issues about their compatibility with the other people they lived with. One person said that they would like to "Leave Tushmore Lane and live with people my own age and who share my interests." Another person said that they "Don't like living with X." One of the other people said "I get on with the staff, but I don't like the noises of some of the other people." The parents of one person told us that they had taken their relative home as they "Feared for his safety when X was in the house."

We spoke with the four staff on duty and had feedback from two other staff prior to our visit. Each staff member expressed serious concerns about the compatibility of the user group and the number of challenging incidents. Staff reported that they felt "Unsupported" and "Fearful" in their working with one person. Staff said that guidelines were not followed and that their training was insufficient.

We reviewed care records and found that guidelines for known triggers were insufficient. The management team had failed to implement systems to adequately support staff and protect the people who lived at the home.