Background to this inspection
Updated
29 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
The inspection team included two inspectors and one Expert by Experience who made phone calls to people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in a number of supported living settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service had two managers 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. Where we spoke to the two registered managers we have referred to ‘the management team’ in the report. One of the registered managers was the lead for the schemes in the south area and the other for the west area. There was currently no registered manager solely for the schemes in mid-Essex and Suffolk. These services were overseen by one of the registered managers and an area manager.
Notice of inspection
We gave a short period of notice of the inspection because some of the people could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interest’ decision about this. We also needed to be sure that the registered manager would be in the office to support the inspection.
Inspection activity started on 08 September 2021 and ended on 23 September 2021.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
Two inspectors carried out an office visit on 8 September 2021. They met with the two registered managers, and office staff. An inspector visited three schemes in Essex and Hertfordshire on 15 and 16 September. We met with seven people, the area manager, three senior staff, six care staff and a positive behaviour advisor.
We reviewed a range of care records, including seven people’s selected care and medicine records. We looked at eight staff files in relation to recruitment, staff supervision and training. We reviewed a variety of records relating to the management of the service.
After the inspection
After the office and home visits, we continued to collect information from the provider. We received email feedback from four professionals, three family members and three staff members.
The expert by experience spoke with 11 relatives and one person who use the service to gather their views about the care and support provided.
Updated
29 October 2021
About the service
TLC Care Homes Limited (Summer House) is a supported living service providing personal care to approximately 22 people. Support is primarily provided to people with learning disabilities and autistic people. People live in individual flats and shared houses. The service is currently divided into three distinct clusters, South (Essex and Southend), West (Hertfordshire and West Essex) and Mid (Essex and Suffolk). Some people live in the grounds of Blamsters Farm, in Halstead, where there are also offices and training rooms.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
We received largely positive feedback from people and their families, staff and external professionals about the care people received from TLC Care Homes Limited (Summer House). We observed people were at ease when interacting with staff.
There had been significant challenges to the service over recent years. In addition to the COVID-19 pandemic and staffing shortages, there were ongoing changes at senior management level. The two registered managers were committed and enthusiastic, however the management structure meant change was not always implemented consistently. In particular, this had affected communication, the roll out of electronic records and the oversight of information from quality assurance checks. We were told by the provider that planned improvements would address these concerns, however further time was needed to ensure improvements were implemented effectively.
Due to the level of commitment by senior and care staff, people experienced minimal impact from the issues at management level. People were supported by small clusters of staff who knew them well and were committed to providing safe, personalised care.
Staff supported people to manage risk safely. There was a focus on maximising independence and minimising restrictions. There was an open culture where safeguarding people was a priority. Learning from mistakes was used to improve the care people received. There were enough safely recruited staff to support people.
People received support to take their medicines safely. Staff worked with people to minimise the use of medicines when they were distressed. The provider had effective measures to minimise the spread of infection, especially in relation to COVID-19.
Staff worked well with professionals to promote people’s health and wellbeing. People were supported to eat and drink in line with their preferences.
Staff received the required training to meet people’s varied needs. The provider was supporting stagg to develop an increased understanding of how to support people who became distressed.
People had a say in the care they received. Care was personalised and adapted in response to changing needs and preferences. Staff supported people to develop their skills and interests. People received information in a way they could understand. People and their representatives felt able to complain and be confident their concerns would be listened to and acted upon.
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.
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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. However, there was room to improve how they reviewed and maximised people’s right to live an integrated life in their local community.
Right support:
The model of care promoted people’s choice, control and independence. However, some of the settings people lived in were not fully integrated into the local community and did not meet best practice outlined in Right support, right care, right culture. Some people had lived in these locations for years and were very settled. The provider agreed to work with people and other parties, such as landlords, to consider what measures could be taken to promote a more inclusive physical environment across all the settings.
Right care:
Care was person-centred and promoted people’s dignity, privacy and human rights. People were treated as individuals and care was provided flexibly in line with their preferences.
Right culture:
The ethos, values, attitudes and behaviours of staff and management ensured people using services lead confident and empowered lives. Despite the physical limitations of some of the settings people lived in, staff promote an inclusive life where people were encouraged to be part of their local community.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection
This service was registered with us on 23 July 2020 and this is its first inspection. The service had been previously registered under a different registration.
Why we inspected
This was a planned inspection of a newly registered service. The timing of the inspection was prompted in part by concerns received about some of the providers other supported living services. A decision was made for us to inspect TLC Care Homes Limited (Summer House) to assure ourselves people were receiving safe, good quality care.
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.