Tinkers Hatch

About the service

Tinkers Hatch is a residential care home providing accommodation and personal care to 22 people at the time of the inspection. The service is registered for 32 people. However, the registered manager told us that due to changes at the home the number of bedrooms had been reduced and the maximum number of people they would be able to support would be 25.

There is a main house which provides accommodation for up to 18 people. A separate cottage for five people and two units which each accommodate one person.

There was a day centre which people were able to attend to take part in activities. The day centre was also open to people who did not live at the home. Some of these people spent periods of time at Tinkers Hatch as part of respite care packages. This gave people the opportunity to maintain contact with people and staff in between their stays at the home.

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

Based on our review of safe, effective responsive and well-led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture.

Right Support

Tinkers Hatch is a large care home with a separate cottage for five people and two units which each accommodate one person. There was also a day centre which people attended for respite. People living at the home also used the day centre to engage in activities. This model of care does not reflect the principles of Right Support, Right Care, Right Culture. The provider was aware of this and was working to make changes. People who lived at the home were happy within the setting. Staffing issues sometimes limited the activities people could engage with. People’s skills and independence had not always been promoted and developed. People were not supported to set goals, develop and improve daily living skills.

Risks to people were managed safely. However, some environmental risks were not always assessed or identified. This needed to be addressed through the audit and governance system, so they were not missed.

Although activities could be impacted by staffing levels there was an emphasis on providing a wide range of activities which people enjoyed. People were supported to take trips out and enjoy celebrations at the home.

Right Care

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service was not always working within the principles of the MCA.

Improvements were needed to people’s care plans as these were not always person centred and did not always include the information staff may need. People were not always involved in the development of their care plans.

Staff knew people very well, they understood how to communicate with and support each person in the way the person wished. People were protected from the risks of harm and abuse. Staff were aware of their responsibilities and how to report concerns. Feedback from health and social care professionals was consistently positive. Staff worked with them to ensure people’s health needs were met.

Right culture

There was a negative culture within the staff team which meant staff were not always able to work together as a team. The provider and registered manager were working to address these concerns. Staff were clear that they wanted to see change to improve the culture. One staff member sent us a reflective account of the inspection feedback and where they could start to make a difference to the culture.

The quality assurance systems needed to be developed and embedded into everyday practice to help identify areas for improvement and development.

Staff were committed to providing good care to people and enabling them to live their best lives possible,

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating and Update

The last inspection for this service was an infection prevention and control inspection (published 23 February 2021). We did not rate the service at this inspection. The last rating for this service was requires improvement (published 27 January 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right Support, Right Care, Right Culture.

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.

We carried out an unannounced comprehensive inspection of this service on 2 January 2020 where the service was rated requires improvement, there were no breaches of legal requirements. Following the inspection, we met with the provider and they told us what they were doing to improve person centred care and quality assurance.

We undertook this focused inspection to check the actions to improve person centred care and quality assurance had been implemented. The inspection was also prompted in part due to concerns received relating to aspects of people’s care needs, which we looked at in the safe key question. During the inspection, we found evidence to suggest we needed to look at the effective key question and this key question was therefore included in the 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 COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to ensuring consent to care and treatment is in line with law and guidance, person-centred care and the quality assurance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

We found the following examples of good practice.

The home was clean and tidy. There was regular cleaning throughout the day, and this included high-touch areas. During the outbreak an external cleaning company had taken over the day to day cleaning of the home. Staff told us this had worked well. Staff and people received regular testing in line with government guidelines.

Staff were provided with adequate supplies of personal protective equipment (PPE) and were seen to be wearing this. Information about PPE was displayed around the home. Staff risk assessments had been completed and these included information about what was required to keep them safe.

During the outbreak, as far as possible, people who had tested positive for Covid-19, were unwell or self-isolating were cared for in their own rooms to minimise the risk of spreading the virus. Tinkers Hatch includes a main house and a cottage. During the outbreak people from the main house and cottage have been kept separate. There were designated staff teams for each area.

During the outbreak the provider had contracted a meals service to provide people’s main meals. One person told us, “The meals were really good, it was like having a picnic in my room every day.”

At the time of the inspection the isolation period had passed and people were able to move around their own areas of the home freely. Due to their learning disabilities people did not always understand the need to socially distance. We saw people engaging in a variety of activities with staff.

The registered manager was aware of the impact Covid-19 had and were aware it would take time for people and staff to fully recover both physically and mentally. They told us they were planning a celebration for when Tinkers Hatch left the outbreak period.

Tinkers Hatch is a residential care home providing accommodation and personal care to 28 people living with a learning disability. The service can support up to 32 people. There is a main house which provides accommodation for up to 22 people. A separate cottage for five people and two units which each accommodate one person. There was also a day centre which people attended to take part in activities.

People living in the main house were generally older and a number were living with health related conditions such as diabetes or a stroke and some people were living with dementia. People living in the cottage and individual units were younger and able to live more independent lives.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 32 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were no identifying signs visible outside the home, to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The registered manager and provider had good oversight of the service. They had identified areas that needed to improve and develop the service. Work had started to implement these changes. This included involving people in all aspects of improving and developing the service,

Improvements had been made to the activities people engaged with each day. These were more meaningful and reflected what people liked to do. However, further time was needed to fully implement these changes and embed them into everyday practice.

People were supported by staff who treated them with kindness and care. Staff understood people’s needs, choices and knew what was important to each person. People were enabled to make their own decisions and choices about the care and support they received.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions they should take if they identified concerns. There were enough staff, who had been safely recruited, working each shift to provide the support people needed, at times of their choice.

Risks to people were well managed. Staff understood how to support people safely and risk assessments provided further guidance about individual and environmental risks. People were supported to receive their medicines when they needed them.

Staff received training and support that enabled them to deliver the specific support that people needed. People's health and well-being needs were met. They were supported to see their GP and access healthcare services, in a way that suited them, when they needed to. People were supported to eat and drink a variety of food that they enjoyed and had chosen. Nutritional assessments were followed to ensure people received the support they needed.

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.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Improvements and developments were taking place to ensure the outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 requires improvement (published 17 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. .

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, improvements were still needed to fully implement and embed the changes into everyday practice.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tinkers Hatch 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.

Tinkers Hatch is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Tinkers Hatch is a care home and provides accommodation for up to 32 people with learning disabilities. At the time of the inspection there were 28 people living at the home. People lived in the 'main house' which accommodated up to 24 people, 'the cottage' which accommodated up to six people, a unit for up to two people and a unit for one person. Most people lived at the home permanently, however people were able to spend short periods of time at the home for respite care.

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. 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.

Tinkers Hatch had been designed, developed and registered before ‘Registering the Right Support’ and other best practice guidance was published. Had the provider applied to register Tinkers Hatch today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs. Improvements are needed to ensure the service develops 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.

We previously carried out an inspection at Tinkers Hatch in October 2017 where we asked the provider to make improvements to people’s ‘as required’ medicines, record keeping and consistently treating people with dignity and respect. We undertook this unannounced comprehensive inspection to look at all aspects of the service. We found there were breaches of regulation and improvements were needed to ensure the service met the legal requirements. The service has been rated requires improvement.

Risks to people were not always managed safely. Medicine administration records(MAR) did not always demonstrate if people had received their prescribed medicines and a hand-written entry on a MAR left one person at risk of receiving too much medicine. Staff competencies in relation to the administration of insulin had not been regularly assessed and there were no personal emergency evacuation plans in place.

The provider was not working within the principles of the Mental Capacity Act 2005. Mental capacity assessments had not been completed and there was no information to demonstrate how some decisions had been made in people’s best interests.

People did not always receive support that was person-centred. They did not always receive support to identify individual aspirations or goals. Improvements were needed to improve records and ensure the quality assurance system identified and addressed all shortfalls.

Information about what was happening at the home was not always available to people Improvements were needed to ensure people’s needs were met through the design and adaptation of the home. Improvements were also needed to improve staff confidence in the new management team.

Although staff were knowledgeable the training programme did not include all training staff may need to support people with learning disabilities; to ensure staff continued to maintain their knowledge and skills and were following current best practice.

People were consulted and involved in the development of the service. There was a range of activities taking place and people were supported to take part in these if they wished. Other people enjoyed their own activities and interests.

People were supported to eat and drink a choice of food that met their individual needs and preferences. People’s health and well-being needs were met. They were supported to have access to healthcare services when they needed them.

Staff had a good understanding of the risks associated with the people they looked after. Risk assessments were in place and provided guidance to support staff. There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the home. People were protected from the risks of harm, abuse or discrimination.

People were supported by staff who knew them well. They had a good understanding of people as individuals, their personal histories and likes and dislikes. Staff were kind and caring and committed to providing good care and support to people. They treated people with kindness, understanding and patience. People’s dignity and privacy was respected. They were supported to make decisions and choices about what they did each day.

There was a complaints policy and people spoke to the registered manager or staff with any concerns.

You can see what action we told the provider to take at the back of the full version of the report.

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 associated Regulations about how the service is run.

We identified a number of areas of record keeping that needed to improve to document more clearly the running of the home. For example, in relation to recording people’s contributions to staff recruitment and in relation to fire drills. We saw some practices did not demonstrate a caring approach was always used. There were also some shortfalls in the management of medicines prescribed on an ‘as required basis.’

We also saw very positive practices during our inspection. People’s needs were effectively met because staff had very good training opportunities that enabled them to gain the skills they needed to do so. Staff were supported well with thorough induction, training, supervision and appraisal. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Whilst most people had good communication skills, others needed support with communication and were not able to tell us their experiences, so we observed they were happy and relaxed with staff.

People had enough to eat and drink and had been involved in menu planning. Everyone was supported to maintain good physical and mental health. Appropriate referrals were made to health care professionals when needed and there were very good links with local health care professionals.

Staff had a good understanding of the care and support needs of people and had developed positive relationships. People told us they were happy with the support they received and with their day to day activities. They told us they knew who to talk to if they had any concerns or worries. There was a friendly and relaxed atmosphere in the home.

Staff had a good understanding of people as individuals, their needs and interests. Some people attended the onsite day centre, activities were also provided within the home daily. Good use was made of local facilities and amenities and external entertainment was provided regularly. People were supported individually to have their needs met.

There was good leadership in the home and the registered manager had an open door policy which staff valued. There was a good handover between shifts and staff were kept up to date on the running of the home.

We found that people's care plans were comprehensive and person-centred, reviewed regularly and updated when changes were identified. We found that people who used the service or their representatives had been involved. Needs and risks in all areas of people's care and treatment were appropriately described and recorded, with clear action plans in place. A person who lived in Tinkers Hatch told us, "I really like being here, this is my home, the staff are really good and my bedroom is really special".

We found the food provided was of a good standard. We were told, "The menu is brought round every morning and I can choose what I want", "I can only eat certain things, they do it for me", "I like everything", and, "The food is lovely, it tastes nice, the gravy is really good", "The food is really delicious". The meals that were served appeared cooked to a high standard, hot and in generous amount. Staff showed us how they monitored people's food and fluid intake and met any special needs people had.

There were effective recruitment and selection processes in place. The staff were clear about their role and responsibilities. One member of staff told us, "The role is demanding but is really rewarding, I knew what to expect when I started in this line of work".

We found there was a system to address people's complaints and resolve them, where possible, to their satisfaction. People told us, "If I have a problem I speak to my keyworker, she will help me", and "I say it straight away and they hear me, I am loud!".

We found that people's care plans, staff records and other records relevant to the management of the services were accurate and fit for purpose. The client manager told us, "We have a system to check every entry in daily logs to make sure we do not miss a thing". We saw varied records which indicated a high level of clinical governance. The provider maintained records appropriately in relation to the management of the regulated activity. Records were kept for the appropriate period of time and destroyed securely.

We talked with a variety of staff, and observed them caring for people. We observed that care and support was delivered with warmth, kindness and dedication. The relationship between the staff and the people who lived there was good and personal support was provided in a way that promoted and protected people's privacy and dignity. We found that people's concerns were listened to, and action was taken to address any issues identified.

The arrangements for keeping the home clean and tidy were satisfactory. The standard of the accommodation, d'cor and furniture and fittings were good and provided a clean and comfortable place to live.

Staff received ongoing training, and had regular supervision and appraisals.