Tigh Grianan

Updated 16 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 15 June 2018 and was announced. The provider was given 48 hours’ notice because the location was a small care home for younger adults who are often out during the day; we needed to be sure that someone would be in. The previous inspection was carried out on 12 May 2016. We rated the service Outstanding in responsive.

The inspection was carried out by two inspectors.

Prior to our visit we used information the provider sent us in the Provider Information Return (PIR) this is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information included in the PIR along with other information we held about the service. This included notifications we had received from the service. Services use notifications to tell us about important events relating to the regulated activities they provide.

We contacted seven health and social care professionals as part of our planning process and invited them to provide feedback on their experiences of working with people at the service. We received a response back from four of them.

We met and spoke with all six people who lived at the service. Some people were able to talk with us about the care they received. We also carried out observations of people and their interactions with staff.

We spoke with the provider’s group operations manager, registered manager, a manager, and three staff. We looked at the care records of two people living at the service, three staff personnel files, training records for staff, staff duty rotas and other records relating to the management of the service. We looked at a range of procedures including safeguarding, mental capacity and deprivation of liberty, accidents and incidents and equality and diversity.

After the visit we spoke to four relatives.

Updated 16 October 2018

Tigh Grianan is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Tigh Grianan specialises in providing supports to people with learning disabilities such as Autism whilst living with other complex needs such as epilepsy and mental health issues. These conditions made daily tasks an increased challenge.

At the time of our inspection there were six people living at Tigh Grianan. Most of the people living at the home were unable to engage in a full discussion. We were able to briefly speak with them at the home and observe how they interacted with staff.

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

At our last inspection we rated the service outstanding in Responsive and good in all other domains. At this inspection we found that evidence continued to support the rating of outstanding in Responsive and good overall.

People were at the heart of the service and their influence was seen throughout the home. The provider's philosophy was understood and shared across the staff team. People's right to lead a fulfilling life was enshrined in the ethos of the home. People and relatives felt valued by the staff team. They felt that staff often go ‘the extra mile’ for them, when providing care and support in response to people’s needs and life goals. As a result, they felt cared for and that they mattered.

The registered manager had a positive approach to support people to achieve their goals. They ensured that risks were taken into account whilst upholding people’s rights to make choices to enhance their lives and seek new activities. People had access to activities that were important and relevant to them, both inside and outside their home. They were protected from social isolation because of the support and opportunities offered by staff. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes.

Care plans were person centred with the involvement of people’s relatives and health and social care professionals. Care staff respected people's individuality and encouraged them to live the lives they wanted. People's progress towards life goals was monitored and celebrated.

People and those important to them were encouraged to voice their concerns or complaints about the home and there were different ways for their voices to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the home. Planned improvements were focused on improving people's quality of life.

People and their relatives were involved in making decisions about their end of life care. Staff were trained to understand and support people’s needs to have a comfortable, dignified and pain free death. Care plans documented people’s wishes.

There were systems and processes in place to protect people from harm. People had their medicines administered safely. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. Robust systems were in place to protect people from unsuitable staff. There were arrangements in place to prevent and control infection and to keep people safe from harm.

People were happy and felt safe, their confidence and ability to be as independent as possible had grown since being at Tigh Grianan. Risks were managed effectively and people felt confident meeting new challenges with the support of the staff. There were sufficient staff to support people to take part in the activities they wished and be supported in meeting their individual needs safely.

People’s needs were assessed before and when they moved into the home and on a continuous basis to reflect changes in their needs. Arrangements were in place for people moving into the service which helped to reduce anxiety about this change.

Staff were supported and received training that enabled them to ensure they could provide the care and support that met people’s needs.

People had control and choice about their food choices. Staff supported people to be involved in food planning and preparation and supported them to eat when this was needed. People were supported to understand their own health and to have access to healthcare services. The staff worked with healthcare professionals and were effective in referring people for assessment or treatment when needed.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff understood and knew how to apply legislation that supported people to consent to care and support. Information about the home was given to people and consent was obtained prior to any care given. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of DoLS and the MCA as well as their responsibilities in respect of this.

Relatives said they were happy with the kindness, thoughtfulness and compassion of staff. One relative said that the service is, “Truly a home and not just a house” whilst another said, “It is a warm and friendly environment.”

People were cared for by staff that knew them well and understood how to support them. Staff treated people with compassion, kindness and respect. Relatives and friends were able to visit when they wished. People were encouraged to maintain and develop friendships in and outside of the home. Privacy and dignity were respected and promoted for example when personal care was undertaken.

The service had a strong leadership presence with a registered manager who had a clear vision about the direction of the service. They were committed and passionate about the people they supported and were constantly looking for ways to improve. Staff understood the values of the provider, that they worked as a team and for the benefit of the people living at the home. The staff and the registered manager had support and guidance from the provider. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the most responsive way possible.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.