Background to this inspection
Updated
22 July 2022
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 Health and Social Care Act 2008.
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 carried out the inspection.
Service and service type
Twyford 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.
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
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. This included feedback from the local authority and professionals who work with the service. 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. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
People did not communicate with us verbally. We observed people’s support as provided by staff when people were in shared areas of the service such as the lounge, dining room and kitchen. We spoke to five relatives about their experience of the care provided. We spoke with ten members of staff including the registered manager, deputy manager, operations director, senior care staff and care staff.
We reviewed a range of records. This included parts of five people’s care records and five medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We reviewed further information in relation to risks and staffing levels. We reviewed written feedback submitted to CQC by some staff.
Updated
22 July 2022
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Twyford House is a residential care home providing accommodation and personal care to 11 people at the time of the inspection. The service is registered to support up to 14 people.
People’s experience of using this service and what we found
Right Support
The service did not always support people to have the maximum possible choice, control and independence as possible. Peoples views about the service they received, and the support provide by staff was not sought. People did not always have a voice in their own care.
Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
The size of the service was larger than current best practice guidance. However, was set back from the street and there were no signs to identify it as a service for people with learning disabilities and autism.
Right Care
There were times where there were not enough staff to provide the support people were assessed as needing and people did not receive this support.
Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
Right culture
Staff turnover had been high, which did not support people to receive consistent care from staff who knew them well. Staff recruitment processes had been followed to ensure staff were safe to provide support to people.
Governance processes had not always been effective in ensuring there was up to date information for staff.
There were areas where staff practice could be improved to ensure people were treated with kindness, dignity and respect. For example, how some staff spoke to people.
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 (published 19 February 2019)
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support, right care right culture. We received concerns in relation to staffing levels, the management of the service and the support provided to people in relation to risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.
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.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.