We inspected Tinkers Hatch on 28 and 29 November 2018. The first day of the inspection was unannounced.

Tinkers Hatch is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Tinkers Hatch is a care home and provides accommodation for up to 32 people with learning disabilities. At the time of the inspection there were 28 people living at the home. People lived in the 'main house' which accommodated up to 24 people, 'the cottage' which accommodated up to six people, a unit for up to two people and a unit for one person. Most people lived at the home permanently, however people were able to spend short periods of time at the home for respite care.

There was a registered manager at 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 2008 and associated Regulations about how the service is run.

Tinkers Hatch had been designed, developed and registered before ‘Registering the Right Support’ and other best practice guidance was published. Had the provider applied to register Tinkers Hatch today, the application would be unlikely to be granted. The model and scale of care provided is not in keeping with the cultural and professional changes to how services for people with a learning disability and/or Autism should be operated to meet their needs. Improvements are needed to ensure the service develops in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We previously carried out an inspection at Tinkers Hatch in October 2017 where we asked the provider to make improvements to people’s ‘as required’ medicines, record keeping and consistently treating people with dignity and respect. We undertook this unannounced comprehensive inspection to look at all aspects of the service. We found there were breaches of regulation and improvements were needed to ensure the service met the legal requirements. The service has been rated requires improvement.

Risks to people were not always managed safely. Medicine administration records(MAR) did not always demonstrate if people had received their prescribed medicines and a hand-written entry on a MAR left one person at risk of receiving too much medicine. Staff competencies in relation to the administration of insulin had not been regularly assessed and there were no personal emergency evacuation plans in place.

The provider was not working within the principles of the Mental Capacity Act 2005. Mental capacity assessments had not been completed and there was no information to demonstrate how some decisions had been made in people’s best interests.

People did not always receive support that was person-centred. They did not always receive support to identify individual aspirations or goals. Improvements were needed to improve records and ensure the quality assurance system identified and addressed all shortfalls.

Information about what was happening at the home was not always available to people Improvements were needed to ensure people’s needs were met through the design and adaptation of the home. Improvements were also needed to improve staff confidence in the new management team.

Although staff were knowledgeable the training programme did not include all training staff may need to support people with learning disabilities; to ensure staff continued to maintain their knowledge and skills and were following current best practice.

People were consu

Tinkers Hatch is a privately owned care home for up to 32 adult people with learning disabilities and/or physical disabilities. People lived in the 'main house' which accommodated up to 23 people, 'the cottage' which accommodated up to six people, a unit for up to two people and a unit for one person. At the time of inspection there were 29 people living at Tinkers Hatch.

There was a registered manager in post. 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 associated Regulations about how the service is run.

We identified a number of areas of record keeping that needed to improve to document more clearly the running of the home. For example, in relation to recording people’s contributions to staff recruitment and in relation to fire drills. We saw some practices did not demonstrate a caring approach was always used. There were also some shortfalls in the management of medicines prescribed on an ‘as required basis.’

We also saw very positive practices during our inspection. People’s needs were effectively met because staff had very good training opportunities that enabled them to gain the skills they needed to do so. Staff were supported well with thorough induction, training, supervision and appraisal. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Whilst most people had good communication skills, others needed support with communication and were not able to tell us their experiences, so we observed they were happy and relaxed with staff.

People had enough to eat and drink and had been involved in menu planning. Everyone was supported to maintain good physical and mental health. Appropriate referrals were made to health care professionals when needed and there were very good links with local health care professionals.

Staff had a good understanding of the care and support needs of people and had developed positive relationships. People told us they were happy with the support they received and with their day to day activities. They told us they knew who to talk to if they had any concerns or worries. There was a friendly and relaxed atmosphere in the home.

Staff had a good understanding of people as individuals, their needs and interests. Some people attended the onsite day centre, activities were also provided within the home daily. Good use was made of local facilities and amenities and external entertainment was provided regularly. People were supported individually to have their needs met.

There was good leadership in the home and the registered manager had an open door policy which staff valued. There was a good handover between shifts and staff were kept up to date on the running of the home.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

Tinkers Hatch is a privately owned care home for up to 32 adult people with learning disabilities and/or physical disabilities. On site accommodation is provided in the 'main house' which accommodates up to 24 people, 'the cottage' which accommodates up to five people, 'the flat' which is for up to two people and a unit for one person.

The registered manager, who was present throughout the inspection, has been in their current post for 15 years. 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 2008 and associated Regulations about how the service is run.

We found that Tinkers Hatch was a safe, secure and stimulating environment. People were cared for and supported by sufficient numbers of suitably qualified, dedicated, skilled and experienced staff. We observed staff speaking with people in a kind and respectful manner and saw many examples of enthusiastic but good natured interaction.  Staff were aware of the values of the service and understood the importance of respecting people’s privacy and dignity.   

Care and support provided was personalised and based on the identified needs of each individual. Comprehensive care plans were reviewed regularly and helped ensure that people’s needs were met and they were cared for and supported in a structured and consistent manner. People all had allocated keyworkers and were encouraged and supported to attend meetings, including the regular ‘clients’ forum’ and ‘ideas group.’ This provided further opportunities for people to raise and discuss any issues or concerns and was further evidence of the person centred approach of the service.

We found people were cared for, or supported by,sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).  Where people were unable to make complex decisions for themselves the service had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests, if this was applicable. The manager told us that they had applied for a DoLS authorisation for two people at Tinkers Hatch. We saw documentation to support this, together with records of ‘best interest’ meetings that had taken place.

We spoke with the registered manager, the recruitment manager, the client manager, four members of staff and six people who lived in Tinkers Hatch. We looked at eight care plans, ten personnel files, policies and records relevant to the management of the service.

We found that people's care plans were comprehensive and person-centred, reviewed regularly and updated when changes were identified. We found that people who used the service or their representatives had been involved. Needs and risks in all areas of people’s care and treatment were appropriately described and recorded, with clear action plans in place. A person who lived in Tinkers Hatch told us, "I really like being here, this is my home, the staff are really good and my bedroom is really special".

We found the food provided was of a good standard. We were told, "The menu is brought round every morning and I can choose what I want", "I can only eat certain things, they do it for me", "I like everything", and, "The food is lovely, it tastes nice, the gravy is really good", "The food is really delicious". The meals that were served appeared cooked to a high standard, hot and in generous amount. Staff showed us how they monitored people's food and fluid intake and met any special needs people had.

There were effective recruitment and selection processes in place. The staff were clear about their role and responsibilities. One member of staff told us, "The role is demanding but is really rewarding, I knew what to expect when I started in this line of work".

We found there was a system to address people's complaints and resolve them, where possible, to their satisfaction. People told us, "If I have a problem I speak to my keyworker, she will help me", and "I say it straight away and they hear me, I am loud!".

We found that people's care plans, staff records and other records relevant to the management of the services were accurate and fit for purpose. The client manager told us, "We have a system to check every entry in daily logs to make sure we do not miss a thing". We saw varied records which indicated a high level of clinical governance. The provider maintained records appropriately in relation to the management of the regulated activity. Records were kept for the appropriate period of time and destroyed securely.

All of the people that we talked with spoke very positively about the home. Their comments included phrases such as: “Care is second to none”, “Very friendly and like a big family”, “The carers are very good” and “The care is tailored to the client”.

We talked with a variety of staff, and observed them caring for people. We observed that care and support was delivered with warmth, kindness and dedication. The relationship between the staff and the people who lived there was good and personal support was provided in a way that promoted and protected people's privacy and dignity. We found that people’s concerns were listened to, and action was taken to address any issues identified.

The arrangements for keeping the home clean and tidy were satisfactory. The standard of the accommodation, décor and furniture and fittings were good and provided a clean and comfortable place to live.

Staff received ongoing training, and had regular supervision and appraisals.