Tigh Fruin

Updated 2 December 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 consisted of one inspector.

Service and service type

Tigh Fruin is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. 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. At the time of our inspection the registered manager was not available. The provider had arranged for an interim manager to support the service during the registered manager’s absence.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority about 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

During the inspection we observed how care and support was given generally. We got feedback from five relatives. We spoke with four staff, the manager, the area manager, and the provider’s director of adult services. We looked at a range of records including two people’s care records and how medicines were managed for people. We also looked at staff training, and the provider’s quality auditing system. During the inspection visit we asked the provider to give us additional evidence about how the service was managed and they sent this to us.

After the inspection

We continued to seek clarification from the provider regarding the evidence we had. We sought feedback from the local authority safeguarding staff, and quality monitoring team, and from commissioning bodies. We also sought feedback advocacy services who were involved in supporting people.

Updated 2 December 2021

About the service

Tigh Fruin is a residential care home providing personal care to people with learning disabilities and autism. The service is a three-story building in the small village of Hayton. Each person has their own bedroom and ensuite facilities. There are communal spaces for dining, living and creative space for activities. The service can support up to six people, and there were six people using the service at the time of the inspection.

People’s experience of using this service and what we found

There were not always enough staff to keep people safe or to provide them with the individual support they were assessed as needing. People were not always protected from the risk of abuse.

The service was not always well-led. Prior to April 2021, the provider had not ensured that their systems and processes were robust enough to identify a number of issues that potentially put people at risk. Relatives were disappointed with communication during the pandemic and felt that getting information about visiting and updates on their family members was difficult. Not all staff were up to date with training the provider expected them to do.

People were not always involved in reviews of their care, particularly where they were less able to communicate their needs. Relatives said they felt staff, particularly newer or agency staff, did not always consistently support people’s communication effectively.

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. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. For example, people’s support was not always planned with them, and they did not always have a choice about who they lived with.

People’s needs were assessed, and any risks associated with their health conditions documented. Risks associated with the service environment were assessed and mitigated. People received their prescribed medicines safely. Accidents and incidents were monitored to identify trends and to prevent reoccurrences. The service was clean.

People were supported to eat and drink well, and to have a balanced diet. People were encouraged to make choices about decorating their personal space, and their bedrooms were clean and personalised. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People had access to GP, dentist services and other healthcare professionals.

People’s care was provided in ways which promoted their dignity and respected their independence. Staff respected people's right to confidentiality. The provider had a system in place to respond to complaints and concerns. The coronavirus lockdowns had an impact on people’s ability to go out and enjoy places and activities that had previously been part of their normal routines. Staff had worked hard to try and ensure there was still a variety of Covid-safe activities for people to take part in if they wanted. 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.

The manager had a good understanding of their role and responsibilities to manage and lead the service consistently well. Following local authority safeguarding investigations for several people living at Tigh Fruin, the provider worked with local authority staff to ensure lessons were learnt and improvements were made in the way people were supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 15 April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about another service run by the provider and concerns raised by the Local Authority, which included poor governance and oversight. A decision was made for us to inspect and examine those risks.

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 have identified a breach in relation to Regulation 18 (Staffing) as the levels of staff support were not consistently safe. You can see what action we have asked the provider to take at the end of this full report.

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.