Timaru

Timaru is a residential care home providing personal care to 6 people with a learning disability and/or autism. It is part of the Sequence Care Group. At the time of the inspection 6 people were using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right support: Whilst improvements had been made the model of care and environment failed to consistently maximise people’s choice, control, and independence.

Right care: Whilst improvements had been made, care was not consistently person-centred and at times, and on occasions, failed to promote people’s dignity, privacy, and human rights.

Right culture: The ethos, values, attitudes, and behaviours of leaders had improved since the last inspection.

Staff received appropriate training, supervision, and competency assessment. The provider had safe recruitment and selection processes in place. Infection control procedures were effective, and the environment was clean and well maintained. The provider had suitable arrangements in place to assess and mitigate risk to people and staff.

Governance systems were more effective at driving improvement and staff were aware of their roles and responsibilities. The provider worked effectively with external organisations and referrals to professionals were made when required.

The provider was open and honest about the improvements required and were aware of their responsibilities under duty of candour. The culture of the service had improved, and people were engaged in more meaningful activities.

Rating at last inspection

The last rating for this service was inadequate (published on 6 April 2023)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At the last inspection we identified 4 breaches of regulation. At this inspection, we found improvement had been made and the provider was no longer in breach of Regulation 12 (safe care and treatment) and 17 (governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

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 undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Timaru is a residential care home providing personal care to six people with a learning disability and/or autism. It is part of the Sequence Care Group.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. This service was unable to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and environment failed to maximise people’s choice, control and independence.

Right care:

• Care was not always person-centred and often failed to promote people’s dignity, privacy and human rights.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff failed to ensure people using services lead confident, inclusive and empowered lives.

People did not consistently receive care and support from staff who were properly inducted, qualified, skilled and experienced. The provider failed to appropriately deploy staff to ensure people were able to access the local community and to engage in their chosen activities. At the time of our inspection, all but one support worker were employed from agencies. None of the agency staff had received supervision or appraisal and their training needs had not been documented. Following the inspection the provider submitted additional information, stating that all agency staff had since received supervision.

People were placed at risk of harm because staff had not completed training in how to support people when behaviours challenged others. We could not be assured people were safeguarded from possible abuse because the service did not have effective oversight for identifying and investigating accidents and incidents. The provider did not have effective systems in place to protect people from avoidable harm.

People were not always protected against the risk associated with poor infection control and maintenance. Staff raised concerns about the state of the building and told us areas of the service required repair. We observed improvements were needed to promote safety.

Governance arrangements were not effective in responding to concerns about staff training, staff deployment, staff supervision, staff induction, infection control, activities, person centred care, learning lessons, risk management and leadership.

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 and the report was published on 8 September 2017.

At this inspection we identified breaches in relation to four regulations. The service has now been rated inadequate.

Why we inspected

The inspection was prompted in part due to concerns received identified during our Direct Monitoring Assessment and from concerns raised by the Home Office.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We identified breaches 4 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see what action we took at the bottom of the report.

Follow up

We will meet with the provider following this inspection to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection was announced and was carried out on 29 June 2017 by one inspector.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Staff were skilled in communicating with people in a way that met their needs, such as reading body language, pictures and signing, which ensured people felt valued, listened to and in control.

Staff respected people's diversity and human rights, empowering them to make choices and take control of their lives. There was an excellent focus on person centred support and staff were exceptionally committed and determined in finding ways to help people develop trust, confidence, self-esteem and achieve excellent outcomes.

Staff worked with external behaviour specialists to identify reasons for, and address people’s distress and anxiety. This had an extremely positive impact on people’s behaviours that challenged themselves and others. Robust record keeping enabled staff and health professionals to monitor the quality and effectiveness of people’s care and support and analyse any trends.

People were supported to maintain their health and well-being and received advice and treatment when required. People were offered sufficient food to eat and drink to meet their specific dietary needs.

There was a positive, supportive and open culture within the home. This was consistently commented on by relatives who told us that the staff were extremely responsive and provided personalised support that met people’s complex needs. Staff were positive about working at Timaru and felt very well supported by the registered manager. Staff felt listened to and involved in the development of the service.

People were encouraged to take part in a wide choice of activities and educational opportunities, both at home and in the community, which increased their skills and independence. People were also supported to be involved in their local community.

Safe recruitment procedures were in place and sufficient staff were deployed, including one to one and two to one staff support. People were supported by staff who had received appropriate induction, training and supervision and had the necessary skills and knowledge to meet people’s individual, complex needs.

Staff were extremely kind and caring, treated people with dignity and respect and ensured their privacy was maintained. The provider had renovated the home to meet the changing needs of people and provide them with more personal space.

Relatives and staff had opportunities to feedback their views about the home and quality of the service being provided, to help drive improvement. Robust systems were in place to monitor and assess the quality and safety of the home and these were kept under review by the registered manager and senior management team.

Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks. Regular safety checks were carried out on the environment and equipment to keep people safe. Plans were in place to manage emergencies and personal evacuation plans were in place for people.

People and staff told us they felt the home was safe. Staff had received safeguarding training and explained the action they would take to report any concerns. Complaints procedures were available and any concerns were appropriately addressed.

Effective systems were in place for the safe storage and administration of medicines, including controlled drugs. People received their medicines from staff who were appropriately trained to do so.

People’s rights were protected because staff understood the principles of the Mental Capacity Act 2005 and ensured decisions were made in their best interests. The registered manager understood the Deprivation of Liberty Safeguards and had submitted requests for authorisation when required. Other notifications were submitted to the commission when required.

We found that action had been taken to ensure that the home was clean and that infection control procedures were followed. People were supported in a clean, hygienic environment and were protected from the risk of infection because appropriate guidance had been followed.

Since our last inspection staffing levels at the weekends had been increased. This helped to ensure that people were able to take part in planned activities outside of the home and meant there were sufficient staff available at all times to meet people's needs.

The provider had taken action to ensure that records were fully completed. This helped to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

There was an effective system to regularly assess and monitor the quality of service that people receive. The provider had assessed the quality of the service provided and taken action to address any shortfalls that were identified.

We observed staff providing support to people in a friendly and respectful manner. Staff demonstrated a good understanding of people's needs and how to meet them. Staff ensured that people were happy with the support they provided. Where people were not able to consent, the provider took action to ensure that everyone who was involved in the person's support made decisions about what was in the person's best interests. People were supported to follow specific diets were necessary and the home provided a varied and balanced diet for people.

Some areas of the home were not cleaned to an appropriate standard, which increased the risk of cross infection. There were not sufficient staff at the weekends to support people to take part in planned activities outside of the home. The provider had systems for storing records safely; however, records were not always fully completed. This lack of information in the records did not always protect people from the risk of unsafe or inappropriate care and support. We have told the provider to take action to address the concerns in these areas.