Tinkers Hatch

Updated 3 August 2022

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 Health and Social Care Act 2008.

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

Three Inspectors carried out the inspection. They were supported by an Expert by Experience who obtained feedback from friends and family by telephone. 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

Tinkers Hatch is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Tinkers Hatch is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection

The service had a manager 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.

Notice of inspection

This inspection was unannounced

What we did before inspection

Before the inspection we reviewed the information, we held about the service. We sought feedback from the local authority. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We used all of this information to plan our inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually 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

We communicated with eight people who used the service and 11 relatives about their experience of the care provided. We spoke with 18 members of staff including the registered manager.

Not everybody who used the service was able to talk with us. Some used different ways of communicating such as objects of reference and their facial expressions. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spent time generally observing people and their interactions with staff in communal areas.

We reviewed a range of records. This included four people’s care records and medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at further care records, surveys and incident reports, training data and quality assurance records. We received feedback from seven health and social care professionals who regularly visit the service.

Updated 3 August 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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.