Tranquil Cross

We carried out a comprehensive inspection of Tranquil Cross on 14 October 2017. This was an announced inspection. We told the provider two days before our inspection visit that we would be coming. This was because we wanted to make sure the registered manager was there, as well as staff and people to speak with and access to records. This was the first rateable inspection for this service since registration in November 2016.

There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run.

We spoke with relatives and professionals working with the people who lived in Tranquil Cross and their feedback about how the service was operating was positive. Staff commented, "Staff and managers treat people as individuals and work with the goal of helping people to achieve what they want to in their lives."

We looked around the service and saw it was well maintained and met people's needs. The garden was large and had an uneven surface in one section where a swing had been removed leaving some divots in the ground. As this posed a potential trip hazard it was discussed with the registered manager. Following the inspection we received information that the holes had been filled to prevent any risk of trips or falls. The boiler, electrics, gas appliances and water supply had been tested to ensure they were safe to use. On the day of inspection we found some inconsistency in the temperature of water from different outlets. This was discussed with the registered manager who immediately arranged for a plumber to visit the home and check the consistency of water temperatures. People’s bedrooms had been decorated and furnished in line with their personal preferences

We noted one person did not have access to laundry facilities at their accommodation. We were told the expectation was that the person would access these facilities from another person's accommodation. This did not uphold one person's right to privacy in their home or a person's ability to exercise their independence to complete their own laundry with support. This was because in reality, staff told us they were undertaking this task for the person. Following the inspection we received information from the registered manager that a proposal had been agreed by the organisation to create a new utility area adjacent to the house which could be used by the person who did not such facilities in their home.

A relative told us, “We are very happy with the care and support [Person’s name] is receiving. They have achieved so much since moving there. It has been a very good move so far.” A professional familiar with how the service operated told us, “The team at Tranquil Cross are very caring towards the individual in that home. Since [they] moved there at the beginning of the year, they've provided very person-centred and proactive support which I feel has then led on to the individual, with the right support, being able to achieve things which other care environments had previously struggled with e.g there has been a reduction in frequency and intensity of behaviours, increase in social activities such as kayaking, holidays etc.”

People were relaxed and busy engaged in their own choice of activities and appeared to be happy and well supported by the service. We saw one person spent time with their family and went out for the day and another person completed some chores before going out for a walk. A relative told us, “[Person} gets out and does so much now and has a very busy life which is lovely to see.”

People had regular routine access to visiting health and social care professionals where necessary. People attended an annual health check with a GP and had access to specialist medical services to ensure their health needs were met.

People had sufficient to eat and drink and choice about what they ate which reflected their personal preferences. A health condition restricted one person's access to food. Appropriate consent was in place for the restrictions around this. We saw the person had access to fresh fruit, snacks and a choice of drinks at all times.

People's safety and well-being had been assessed by the registered and deputy managers. Risk assessments were in place to minimize any hazards and keep people safe. For example, risk assessments had been carried out regarding accessing the local community, particularly busy areas and travelling in a car. One person had risk assessments in place about access to sharps in their kitchen. There were plans in place which minimized restrictions to people’s lives while also keeping safety as a prominent consideration.

Care plans were detailed and personalised to reflect the individual needs of each person. Staff had a good understanding of people’s needs and consistently met these while also upholding people’s independence. For example, a relative told us about the personalised support that had been put into appropriately supporting their relative to cook. This was an activity they loved to do and with appropriate support, the person not only cooked regularly but also prepared a meal for relatives.

The service had effective induction and staff supervision systems to ensure competent and well skilled staff were employed at Tranquil Cross. Staff told us they loved their jobs and felt they had all the support they needed to carry out their role. They told us, “The training and induction were first class. I love working here. It’s a great team” and “I have regular supervision and I find the managers easy to go to and very supportive.”

We saw many positive interactions and people enjoyed talking to and interacting with staff. One person had a visit from family and we heard how much fun the person, their family and staff had working together to create a pumpkin lantern in preparation for Halloween.

There were sufficient staff to keep people safe and meet their needs. The service operated safe recruitment systems to ensure staff were safe to work with people.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People's medicines were administered, stored and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant and accurate records.

Personal monies held by the service were stored securely and accurate according to audited records.

People's human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessment and best interest meetings had been undertaken. Staff were heard to ask peoples consent before they provided support.

Where people's liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person's rights were protected. A professional commented, “The team have been proactive in thinking about ways to reduce restrictions.”

There were robust procedures in place to monitor, evaluate and improve the quality of care provided. Staff were motivated and aware of their responsibilities. The manager understood the requirements of CQC and sent in appropriate notifications. The registered manager made sure there was a focus on continuous development of the service.