Archived: Tresleigh

Tresleigh provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. 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. The registered manager was not available on the day of the inspection visit. However we spoke with them at a later date.

During the day people were supported by sufficient numbers of staff to allow them to take part in activities in the community. When there were unexpected staff absences there were systems in place to minimise the effect of this. At times the service required two waking night members of staff to support people when they were unsettled. One waking night role was often swapped for a sleep-in member of staff. Management said it was not always necessary to have two waking nights as people’s needs fluctuated.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the manager and organisation.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the

Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Staff demonstrated a good understanding of the main principles of the Mental Capacity Act (MCA).

The building was well maintained and decorated to a good standard. There were plenty of shared rooms to enable people to spend time together or on their own as they wanted. There was a TV lounge, a large dining area sometimes used as a games room, a well laid out and modern kitchen, a sensory room and another quiet sitting area. People had free access to all the shared areas and we observed people using different parts of the premises throughout the day.

Staff valued people’s privacy and dignity. Cultural differences were recognised and respected. Spectrum had arranged additional training for staff to improve their understanding of people’s cultural needs.

People’s support plans included clear and detailed information about their health and social care needs. Although care plan reviews were held regularly information was not always up-dated. Some information was repeated and the content varied. This could have caused confusion for staff leading to people not receiving support in line with their plan of care.

Roles and responsibilities were well-defined and understood by the staff team. The registered manager was supported by a deputy manager who had a clear set of responsibilities. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

We were not able to speak directly to the four people who lived in the home as they had complex communication needs. Instead we saw how the individuals interacted with staff and saw that people approached staff without hesitation. We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

On this visit to Tresleigh we focused on the outstanding compliance action to ensure there was appropriate qualified staff at the home at all times. We found that staffing levels had been reviewed and there were sufficient staff on duty at all times. Staff told us the staffing levels had improved as had access to training and supervision.

On our previous visit we advised that signage to the home should be put in place to identify the home. This was particularly important in the event emergency services would be called to the home. We noted that this had not been completed. The registered manager assured us this would be completed immediately.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in domestic tasks at home. Medication systems were satisfactory.

The home environment was maintained to a good standards. Infection control practises in the laundry area need to be improved.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.

Staff were qualified, skilled and experienced to meet people's needs. Minimum staffing levels need to be in place at all times to ensure sufficient staff were on duty to meet peoples care and welfare needs. Staff had received sufficient training and support to enable them to carry out their roles competently.

The care plans we reviewed had recently been updated and contained a lot of information about the person, however we found that the information contained within the documents regarding how to manage certain behaviours, conflicted with what the staff told us actually happened.

People that lived in the home were able to keep personal money safely secured and were able to access it with support, throughout the day.

The home was in a poor state of repair which had been noted in an audit and observed by staff and a family member. Monitoring of the service and the systems used to do so, such as audits and bi-monthly reports, were not effective as details were missed, and the issues and concerns which had been raised from these documents were not resolved in a timely manner.