Tyrwhitt House

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 inspected Tyrwhitt House on 6 September 2016. The inspection was unannounced. The service was last inspected in September 2014 when it was found to be meeting the requirements of the regulations.

People stayed at the service for either a two or a six week period to undertake therapeutic programmes to assist them to recover from the symptoms of Post-Traumatic Stress Disorder (PTSD) and other mental health difficulties such as anxiety and social avoidance. Four therapy programmes were offered, a two week Trans diagnostic programme, a two week Anger Management programme, and a six week intensive therapy programme. The treatment consisted of individual therapies such as talking treatments such as Cognitive Behaviour Therapy and Eye Movement Desensitisation and Reprocessing; leisure, education and Occupational Therapy; and medicine review.

People told us they felt safe at the service and with the staff who supported them. People told us, “I have the utmost respect and praise for every person who works (at Tyrwhitt House)…together they make (Tyrwhitt House) work in the best way possible,” and “I can honestly rate the service they have provided as excellent. The professionalism and dedication of all the staff…was first class and has helped tremendously in my recovery. ” A health professional told us “Staff seem very caring and the people receiving care seem very happy with the help they have received.”

Most people self-administered their medicines, and there were suitable procedures to ensure this happened appropriately. Where staff were involved in the administration of medicines, people told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as first aid and safeguarding at regular intervals.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner. People said they received enough support from these professionals.

There were enough staff on duty and people said they received timely support from staff when it was needed. We observed staff being attentive to people’s needs.

The service had a suitable therapy programme. People said the treatment programme was of great assistance to them. For example one person said, “I received treatment for many aspects of PTSD. All treatments seemed to have worked and I have learned more strategies…to cope with my symptoms,” and “An amazing course of treatment which from the outset made me feel safe for the first time in many years. Very caring and knowledgeable staff. An amazing stay which I would highly recommend. I praise all staff.” Suitable recreational activities were also available including a library, an occupational therapy workshop, a gym, relaxation room, gardening activities, internet access and TV room.

Care records were managed electronically. Records for each person included a care plan and risk assessments. Records were regularly reviewed. People who attended the programmes on offer needed to have mental capacity, but staff had suitable knowledge about the Mental Capacity Act (2005).

People were very happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included, “The food is of excellent quality and in good supply.”

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management. One person said, “ I was fully informed of the complaints system, and I believe complaints would be dealt with fairly and professionally .”

People felt the service was well managed. We were told the management team were, “Very helpful and approachable. They would also approach us and ask if everything was ok.” There were comprehensive systems in place to monitor the quality of the service.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the information we gathered that supports our summary please read the full report.

This is a summary of what we found:

On arrival for our visit we were informed that the registered manager had left the service in may 2014. This had been notified to the CQC. The provider had been in the process of recruiting a new manager and a member of the senior clinical team had been deputising until the post could be filled.

Is the service safe?

People were cared for in an environment that had been safe, clean and hygienic. Equipment at the service had been well maintained and serviced regularly. When people used equipment they were properly supervised by staff and procedures were in place to minimise the risks of injury. There were enough staff on duty to meet the needs of people and a range of professionals worked during office hours including: clinical psychologists, psychiatrists, occupational therapists, registered nurses and support workers. Out of hours people were supported by a register nurse and two support workers.

Staff we spoke with told us they had completed mandatory training. Records pertaining to mandatory training did not contain up to date information about completion of mandatory training. The senior staff we spoke to were unable to locate this information at the time of our visit. Staff records contained appropriate pre-employment checks.

The service had adequate processes to support safeguarding people from abuse and staff we spoke with were able to locate the safeguarding policy and were able to explain to us procedures for escalating concerns.

CQC monitors the Deprivation of Liberty Safeguards which applies to care facilities. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made.

Is the service effective?

We spoke with three people who were using the service at the time of our visit. They told us they were happy with the treatment they received and told us "It works" and "I can take away what I learn here and use it at home". People told us they felt the staff communicated well and they knew each person's individual needs. People told us support had been provided which took into account people's mental state and creative abilities. People were encouraged to engage in activities that could give them a "purpose" and that they could pursue when they left the service.

We spoke with three staff who told us they were provided with training to meet the needs of people. People who used the service confirmed to us that the staff were knowledgeable about their mental health needs and about their military background. People told us the staff "do not judge us" and enabled them to gain "insights" into their condition. One person told us they "know what to look out for" when they felt challenged by their condition. This meant staff were supporting people's individual needs and ensured actions were initiated to minimise stressful situations.

Is the service caring?

People were cared for by kind and attentive staff. We saw staff were respectful of people and knocked on doors before entering rooms. During our visit many people were engaged in therapy sessions and they told us the staff had made them feel comfortable. People we spoke with told us they were allocated a key worker and co-keyworker which they met with weekly . They told us they could approach any of the staff if they wanted to and said "The staff are looked upon as friends". One person told us that "Without combat stress, I wouldn't be here today" they told us they were always available to speak even after they had gone home and they were a "lifeline" who understood the military.

Is the service responsive?

People's needs were assessed before they commenced treatment at the service. Staff within the service worked closely with other providers and met with people in their out patient service before they were commenced on a treatment programme. People told us they met daily with their key workers or co-keyworkers and felt they had a "good" relationship with them. Therapy sessions happened daily and people were encouraged to access more than one session per day.

We reviewed the care records for three people. The records contained assessments and notes from each member of the multi-disciplinary team and daily notes completed by all specialties were kept in chronological order. Staff told us this enabled them to keep up to date with each person's progress. Assessments included information regarding people's mental health needs and their physiological well-being. This meant the staff were supporting people with all of their health needs and not just their mental health requirements.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. The provider had been developing a revised strategy for the service as they had changed the service's main focus from providing respite care to active treatment for post traumatic stress disorder (PTSD). Staff were able to confidently explain the challenges they had faced with people who had been using the service before the change. Strategies were in place to support people through the changes.

People were asked for their feedback in a variety of contexts. An exit survey had been completed in August 2014. The provider's findings had not been published on our visit but we saw some of the completed surveys. People had made positive comments about the service and the abilities of the staff. Several people had commented on the security of the home as the front gates did not lock. Staff were aware of the comments and had escalated this to their senior managers. Feedback from therapy sessions had been gained after each module of treatment. People told us they felt the staff listened to them and gave examples of changes including: WiFi access and improved safety to the woodwork room in the occupational therapy room.

Staff we spoke with were clear about their roles and responsibilities. Regular staff meetings were held and changes were communicated to the team. One staff member felt communication sometimes came "late" but felt this had changed since the previous manager had left. Staff were supported to gain further education and training and met regularly with their supervisor. Many of the staff had commenced in post within the last year and had not had appraisals. Senior staff were unable to locate the staff appraisals for people who had been in post for longer than one year during our visit.

We spoke to six people who used the service and ten staff members, which included the registered manager. One person who used the service told us 'My Keyworker is fantastic' they also said 'I can always approach staff to talk to them.'

We saw that systems were in place that ensured staff worked with the consent of people who used the service. People told us 'They always ask before doing things.' They also said 'They put what I wanted in my treatment plan.'

People had been involved in the planning of care. We saw that risks had been identified that protected the welfare and safety of people.

There were systems in place that safeguarded people from unsafe premises.

The majority of staff we spoke with said they felt supported to do their job. They received regular supervisions, and training that enabled them to carry out their roles.

We saw that the provider had systems and procedures in place that dealt with complaints.

During our visit we spoke with five people, seven members of staff, and the registered manager. We spent time observing people and how staff interacted and supported them. We looked around the location. Activities and therapy on offer were appropriate to the people who used the service.

People told us that care staff 'Were good' and that 'Staff are friendly'. They also told us that 'The best thing was the camaraderie' and that "The therapy is fantastic.' Three people told us that they 'Feel safe with people and staff'.

Peoples needs had been assessed prior to staying at the service. Examples were seen where issues such as allergies had not been taken into account when care planning. Therefore the welfare and safety of these people had not been taken fully into account when planning their care.

Two people told us that they were not having regular reviews of the care provided with staff. These people said they felt staff were unavailable to talk about how they were progressing, or if they felt changes were needed in the support they were receiving

New short term support programs had been introduced over the last twelve months, in addition to the longer term service available. This had resulted in an increase in the throughput of people using the service. Issues around staffing levels to support these people and the staff teams were identified.