Terrance House

Updated 24 January 2020

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 Care Act 2014.

Inspection team

The inspection was conducted by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Terrance House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Terrance House also operates a Supported Living scheme from the same office location. This service provides personal care support to people living in their own tenancies in one ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager registered with the Care Quality Commission who managed both the Care Home and the supported Living 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.

Notice of inspection

This inspection was unannounced. However, we gave notice at the inspection that we wished to visit the supported living as the service is small and people are often out, we wanted to be sure there would be people and staff available to speak with us.

What we did before the inspection

We looked at the information we had received about the service since the last inspection. This included details about any accidents or incidents that the provider must notify us about, such as safeguarding alerts, serious injuries or incidents that effect the operation of the service.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

Before the inspection we also invited feedback from the local authority commissioning team and health watch. Health watch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used all this information to plan our inspection.

During the inspection

We spoke with nine people using the care home service and four people who lived in the supported living accommodation. We asked them about their experience of the care provided. We observed staff engagement with people in the communal areas of the service, so we could understand people's experiences. By observing these interactions, we could determine if people were comfortable with the staff supporting them. We spoke with the registered manager, nominated individual (The nominated individual is responsible for supervising the management of the service on behalf of the provider), deputy manager, and two support workers in the main house and a senior support worker and support worker in the supported living accommodation. We also spoke with the maintenance person and a member of the kitchen staff who had dual activities as a support worker.

We sampled a range of specific information from five care plans across the care home and the supported living service which told us about people’s specific care needs in some areas and how these were managed. We also looked at two staff recruitment files, made observation of medicine administration and sam

Updated 24 January 2020

About the service

Terrance House is a residential care home providing accommodation and personal care for 48 people living with long term mental health issues. At the time of the inspection there were 45 people living at the service.

Terrance house is also the office location for a supported living service for six people with mental health needs who can live more independently with staff support. The supported living property is attached to the main house. There were six people living at the supported living when we visited.

Not everyone who used these services received personal care. CQC only inspects where people receive personal care. This is tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of inspection 32 people in Terrance House and two people in the supported living needed staff support with their personal care.

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

People spoke positively about living at Terrance house. People within the supported living also commented positively about the support they received. People told us that they felt that staff understood how to support their differing mental health needs and showed kindness and respect towards them.

People were supported by staff who had been recruited safely. Staff received training necessary to give them the skills and knowledge to understand and support people with long term mental health conditions. People and staff told us that there were enough staff to be available to people when they needed support. The atmosphere was relaxed, and staff were able to spend time to sit and talk with people. Staff were mindful of how vulnerable people in Terrance house and the supported living service were, they understood how to protect people from the risks of abuse, discrimination and avoidable harm from others. Medicines were managed safely. Staff ensured people received their medicines regularly and on time to help maintain a stable mental health.

People told us that staff supported them with their health needs and helped them to access appointments. Staff monitored people’s health and sought advice from health professionals as needed. Care plans were personalised to reflect people’s specific needs and preferences, and these were kept updated when changes occurred. People were given a choice of meals and told us that they enjoyed these, there were opportunities for them to get regular drinks.

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.

People were treated with understanding and compassion. People told us that they able to express their concerns to preferred staff and that resident meetings were held at regular intervals. People told us they felt listened to. People had keys to their bedrooms and staff provided support for personal care discreetly to protect people’s privacy and dignity. Levels of motivation varied but where people showed interest staff supported them to develop skills and independence and a programme of activities was provided to aid stimulation and reduce isolation. People had access to all communal areas of the service and could go into the garden which included a smoking shelter which was important to people.

People and staff confidentiality were maintained. People were given important information in a format that suited them best, such as in larger print, pictorial or in a verbal form.

The registered manager promoted an open and inclusive culture where everyone was valued for their contribution There were systems and procedures in place to monitor service quality. People, relatives and professionals were invited to give feedback about the service which was used to inform future service development.

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 (Report published 6 March 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.