42 Twyford Gardens

Updated 4 November 2022

The inspection

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 Health and Social Care Act 2008.

Inspection team

This inspection was carried out by one inspector and one assistant inspector.

Service and service type

42 Twyford Gardens is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. 42 Twyford Gardens is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

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

This inspection was unannounced.

Inspection activity started on 8 September 2022 and ended on 22 September 2022. We visited the location’s service on 8 September 2022.

What we did before the inspection

Before the inspection, we reviewed information we held about the service. We considered the information which had been shared with us since the last inspection by the provider, the local authority and other agencies and health and social care professionals. This information helps support our inspections. We received email feedback from two social care professionals about their recent knowledge about the care being provided at the service.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 4 August 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with one person who used the service and observed two people's experience of the care provided. We spoke with four members of staff, including the interim service manager (‘the manager’) and the regional manager. We reviewed a range of records. This included two people’s care and medication records and a variety of records relating to the management of the service, including policies and procedures. We looked at training data and quality assurance records. We received further feedback from health and social care professionals. We spoke with three relatives of people using the service.

Updated 4 November 2022

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.

About the service

42 Twyford Gardens is a residential care home providing personal care to three people, one of whom was in hospital at the time of the inspection. The service can support up to four people. The service was a detached bungalow with a garden, near to the town. People had their own bedrooms and bathrooms. There were shared eating and living areas.

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

Right Support:

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. People’s medicine support was not being managed safely. People were not always supported to assess their needs effectively and did not always achieve good outcomes from their support. Staff had not always received effective training or supervision. The service was clean and hygienic.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

Staff did not always communicate or support people in dignified or respectful ways. Improvements were needed to make sure people were involved and included in a personalised way when being supported by staff. People told us staff were not always caring and did not always encourage them to be as independent as possible. Professionals who worked with staff and relatives of people at the service gave us mixed feedback about the quality and safety of the support people received.

Right Culture:

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Internal quality assurance systems and processes to audit or review service performance and the safety and quality of care were not operating effectively to identify or resolve issues.

People and their relatives said they did not always feel involved and engaged in planning their support or developing the service. Staff did not always feel supported to fulfil their roles and responsibilities. Staff and people told us the culture of the service was negative and was not helping people to achieve good outcomes.

The provider was aware of quality and safety issues at the service. They had offered assurances about actions they would take and were committed to providing resources to make any necessary improvements as quickly as possible.

The provider had an Equality and Diversity Policy and the interim manager told us how it was important to them that they always promoted and respected staff equality and diversity as a leader within the provider’s organisation.

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 9 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 42 Twyford Gardens on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified multiple breaches of regulations at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.