We carried out this inspection of Terrys Cross House on 26 September 2017. The visit was unannounced and started at 07.30am to allow us to meet with the night staff before they went off duty and see how duties were allocated for the day. Terrys Cross House is a care service originally registered with the Care Quality Commission (CQC) in 2015 to provide accommodation and personal care to clergy from the Anglican community, their siblings or spouses. The service will also now accept people without this link. The service is overseen by Terrys Cross House Trust which is a registered charity, and has a committee of Trustees who oversee the service. Terrys Cross House is registered for up to 12 people needing personal care. The service does not provide nursing care; this is provided by the community nursing team if needed.
Eight people were living at the service at the time of the inspection with one person staying on a short term basis. On the inspection we identified that only two of the people living at the service were receiving personal care. Most people living at the service were independent and active, and had chosen to enjoy living in a community of likeminded people with a similar spiritual background. For some of these people, although they were not yet receiving personal care, the service monitored their wellbeing discreetly and would escalate any concerns about their health or welfare to supporting agencies.
As people not receiving personal care would fall outside of CQC regulation, we have only included information relating to people receiving personal care in this report. However some information relating to the maintenance of the building, although only affecting people not receiving care at this time, had the potential to affect those receiving care in future, as they related to part of the registered premises. As a part of the inspection we also received comments from people not receiving personal care, who were keen to share their positive experiences of the service.
This was the first inspection of the service since their registration in 2015.
The service has a registered manager. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.
The service had quality monitoring systems in place to ensure care and support provided continued to meet the needs of people, and that they received consistent quality care. However we identified a number of instances on the inspection where improvements were needed. Not all of these had been identified by the service’s quality assurance or management systems, which told us they were not always working effectively.
People were supported by sufficient numbers of staff to meet their needs, however, improvements were needed to the staff recruitment processes to ensure decision making regarding any risks identified during the recruitment process was recorded. Photographs of staff were not all in place in their files, and the service had not ensured a full employment history was available for each staff member employed. However we did not identify any harm had occurred as a result of this. The registered manager took immediate action to resolve this while we were at the service, and confirmed they would be asking staff to complete these retrospectively.
Terry’s Cross House is a period property set in extensive grounds. The building has large and gracious rooms; however this came with challenges for the Trust in keeping on top of repairs and renovations. We were told new boilers had been installed in the last year to heat the whole building. We were informed there were currently some issues with the roof. The registered manager and a trustee confirmed this work was due to be done but had been held up because of a bat colony in the roof that had been identified during an ecological survey. This was protected by law. We were told there was a small leak "only when it rains very hard and the wind is in a certain direction" in one person's room. This repair was due to be completed as soon as legally allowed.
Some areas within the service, such as the respite room were in need of additional cleaning and refurbishment. The registered manager told us this was due to commence after the inspection when the room being used for a weeks stay became vacant, and later sent us evidence to show this had been carried out. We have made a recommendation about ensuring accommodation is kept clean and well maintained in future. The environment was adapted to enable people with physical challenges to move as freely as possible around the service and the grounds, and there was a passenger lift to access the first floor.
People received their medicines as prescribed. The systems in place for the management of medicines protected people who lived in the service from harm. This included the use of Oxygen for one person.
Risks to people’s health or well-being had been identified and action had been taken to minimise these risks. These included those in relation to long term health conditions. People’s assessments and care plans were personalised with their individual preferences and wishes taken into account. Staff were responsive to people’s individual needs and these were regularly reviewed. For example staff were flexible in their routines to ensure people were supported to get up when they wished. Staff told us they enjoyed working in a service where they had time to support people in ways they felt demonstrated good individualised care.
People were protected from the risks of abuse as staff understood the signs of abuse and how to report concerns. People or their supporters had information to enable them to raise any complaints or concerns they had about the service. The registered manager agreed to add to this document additional information about resources who could review complaints from outside of the service’s management structures. People felt any complaints would be dealt with in a timely way, and told us they would have no concerns about raising any concerns, either to staff or relatives. People were also regularly visited by Trustees of the charity, with whom they could raise any issues.
People’s rights were respected. Staff had clear understanding of the Mental Capacity Act 2005, and issues regarding capacity and consent, which were reflected in the service’s polices and care plans. Staff ensured people were encouraged to make informed decisions where they were able. Where people’s capacity was limited, staff understood who to speak with as the person’s representative, and of the need to undertake ‘best interest’ decisions. Staff displayed caring attitudes towards people and spoke about people with affection and respect. Staff knew people’s histories, and likes and dislikes and told us they were respected.
Staff had completed training to give them the skills they needed to meet people’s individual care needs, and received the support they needed from the registered manager and Trustees. Staff told us they were confident in delivering care and support; those we spoke with were experienced in care work and could speak confidently about people’s needs and how they liked to be supported.
People were supported to have enough to eat and drink, and no-one at the service was identified as being at risk of poor nutrition. Meals could be taken communally or in people’s rooms. Meals were home cooked and people told us they ate well.
People told us they enjoyed living in a community with a shared faith. People were encouraged to remain involved in the local community, including attending services either at the chapel in the service or at local churches and maintaining contact with family and friends. For those people whose needs were greater, staff ensured they spent time with them individually, as in one instance when we saw staff supporting the person to go outside and enjoy the garden. People could participate in activities which reflected their interests, and visitors were encouraged.
People were treated with dignity and respect. All care was delivered in private in people’s rooms and there were policies in use about maintaining confidentiality of people’s information. Records were written respectfully and were well maintained. Some policies and procedures were due to be reviewed.
People and staff were positive about the registered manager, the Trustees and the overall management of the service. Trustees had an active involvement and oversight of the service, and were recruiting additional members to increase their management skills with regard to social care. The service cultivated a warm, welcoming and inclusive culture and atmosphere. People were encouraged to have a say about the operation of the service, through regular meetings and questionnaires.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.