Tigh Bruadair

Updated 2 October 2021

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors completed a site visit. An Expert by Experience made telephone calls to relatives to seek their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Tigh Brudair 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.

The service had a manager registered with the Care Quality Commission. 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

We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out and we wanted to be sure there would be people at home to speak with us.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used all of this information to plan our inspection.

During the inspection

We observed staff engagement with people where possible and spoke with three people who used the service. We spoke with the deputy manager and area manager. We reviewed a range of records. This included three people's care records and multiple medication records. We looked at three staff files in relation to recruitment. We looked at a variety of records relating to the management of the service, including audits and checks. We also reviewed the internal and external environment.

After the inspection

Following the inspection site visit, the Expert by Experience contacted relatives by telephone and spoke with six people. Staff were contacted and invited to provide feedback about working at the service. We received six responses from care staff.

We continued to seek clarification from the provider to validate evidence found. This included but was not limited to the provider's training data, policies, procedures and meeting records.

Updated 2 October 2021

Tigh Brudair is registered to accommodate up to 13 people in two adapted buildings within the same grounds. People living at the service had a learning disability and / or autism. At the time of our inspection, 12 people were living at the service.

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

Incident analysis was not sufficiently detailed to fully support staff to identify any themes or patterns of people’s behaviour. The management team had identified improvements were required and were taking action to address this.

Risk assessments associated with people’s individual care and support needs to mitigate known risks had been completed. However, guidance for staff was inconsistent in places. The management team agreed to amend this immediately where required.

Staff turnover was high, the provider was taking action to review staff retention difficulties, and staff recruitment was ongoing. Agency staff were used to cover staff shortfalls. Staff recruitment checks were completed before staff commenced their role. Staff received opportunities to discuss their work, training and development needs.

The provider had safeguarding procedures to protect people against abuse and avoidable harm. Where safeguarding allegations had been made, action had been taken to report these to external agencies and they were investigated.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were involved in their care and treatment as fully as possible and care and support maximised their choice, control, and independence.

Whilst there had been staff retention difficulties and new staff were being recruited, the staff team overall were an established and experienced team. Staff knew people well and understood what was important to them. Staff were respectful and treated people with dignity and respect. People were empowered to live active and fulfilling lives. Opportunities to engage in stimulating and meaningful activities, interest and hobbies including social inclusion were provided.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received their prescribed medicines when required. Some people had experienced positive outcomes in the reduction of their medicines.

Infection prevention and control best practice guidance was followed, the service was clean and hygienic. The environment and layout of the service met people's individual needs.

People’s dietary needs and preferences were assessed and planned for. Healthy eating was encouraged, and people were involved in menu planning. People were supported to access health services.

Effective communication methods were used to support people's different communication needs and preferences.

The provider had systems and processes to assess, review and monitor quality and safety. An action plan was in place to develop the service. Relatives were positive their family member received person centred care. Feedback from people who lived at the service was positive.

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 Outstanding (published 10 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about another service ran by the provider and the concerns raised by the Local Authority, which included poor governance and oversight and inappropriate use of restraint. A decision was made for us to inspect and examine those risks. As a result, we undertook a comprehensive inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Outstanding to Good. 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 Tigh Brudair on our website at www.cqc.org.uk

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.