The inspection took place on 3 January 2018 and was unannounced. Tynefield Care Limited is a care home that provides accommodation with personal care and nursing and is registered to accommodate 45 people. The service provides support to younger and older people who may have a specific neurological disorder, nursing needs or living with dementia. The accommodation at Tynefield Care Limited is on the ground floor and over three separate wings. There is one shared lounge and dining room and a smoking room for people to use. The home is located outside of the village of Etwall and accessed from a private road. There are no public facilities or public transport services within easy reach of the home.

Tynefield Care Limited 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. At the time of the inspection there were 30 people using the service.

At the time of the inspection the service had a manager who had submitted their application to register with us. However since concluding our inspection we have been made aware that the situation has changed and the new manager is no longer in place. 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. This report reflects our findings from 3 January 2018 and the service remains under review.

Tynefield Care Limited was last inspected on 30 March 2017 and the service was rated as Requires improvement. We identified concerns that they were not meeting standards to support people to manage individual risks; consent was sought where people did not have capacity, although it was not always evident how capacity had been assessed to support how specific decisions were being made. People were not always happy with the choice of food available to meet their cultural preferences and there was a limited range of activities available for people to suit their interests and develop living skills. At this inspection, we saw that improvements had been made although further improvements were still required. This is the third consecutive time the service has been rated ‘Requires Improvement’.

Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not effective. Medicines were not managed safely as the provider had not considered how all medicines could be safely administered to people. The provider had systems in place to assess risk although how risks were managed was not always understood, as information was not always clear. This meant actions were not always put in place to reduce identified risk and information in people’s care records did not always match the care they needed. There were limited opportunities for people to engage in activities that interested them. People had mixed views about how they were supported to do the things they enjoyed in the home and to have opportunities to go out. The staff recognised where people may be at risk of harm although following our inspection, it had been identified that suitable action had not been taken to ensure people remained safe. People used different ways to communicate and accessible information about the service provision was not always available. We have made a recommendation about ensuring people are able to understand information provided.

Staff received training and support to enable them to fulfil their role and they were encouraged to develop their skills. People felt

This inspection took place on 30 March 2016 and was unannounced. Our last inspection took place in 21 June 2016 and we rated the service as requires improvement; the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care and some people were subject to restrictions and the provider had not identified where their support needed to be reviewed. Social and leisure based activities were not consistently promoted and provided and people were not always supported to maintain and develop independent living skills. We also saw that call bells were not always responded to in a timely way although staff were available, and risks to people were not always minimised to prevent harm. On this inspection we found improvements had been made, however further improvements were required.

Tynefield Care Limited provides residential care for up to 45 older people and younger adults with a physical disability. At the time of our inspection 34 people were receiving a service. This report reflects our findings from 30 March 2017. However since concluding our inspection we have been made aware that the situation has changed and the new manager is no longer in place. The service remains under review.

There was a registered manager although they were not working in the service at the time of our inspection. 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.

Staff now understood what constituted abuse and how to report concerns. New support plans had been developed for some people and contained relevant information for staff to help them provide the care people required. Other people’s care still needed to be reviewed. The new plans included procedures to manage identified risks with people’s care and for managing people’s medicines safely.

Staff sought people’s consent before they provided care and support. However, where people lacked capacity, information about how capacity had been assessed for specific decisions was not recorded. There were limited opportunities for people to engage in activities that interested them or to be involved with developing living skills. People enjoyed the food provided although felt more choice was needed to meet specific cultural preferences.

Under the new management arrangements, people felt staff were caring and kind and treated them with respect and dignity. Staff understood the importance of treating people with kindness and compassion. Where changes in people’s health were identified, they were referred to other healthcare professionals. Information about making a complaint was available for people and people knew how to complain if they needed to. Staff said they could raise any concerns or issues they had with the new manager, knowing they would be listened to and information would be acted on.

People and staff thought the new manager was open and approachable. The manager supported staff well to provide good quality care to people. People were provided with opportunities to comment on the quality of the service provision and felt the new manager listened to what they had to say. The new manager was working with commissioners of the service to develop systems to ensure people received safe and effective care.

This inspection took place on 21 June 2016 and was unannounced. Our last inspection took place in April 2013 and at that time we found the provider was meeting the regulations we looked at.

Tynefield Care Limited provides residential care for up to 45 older people and younger adults with a physical disability. At the time of our inspection 41 people were receiving a service.

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 2008 and associated Regulations about how the service is run.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. Standards to improve infection control were being addressed following concerns raised by commissioners of the service, however, one person’s chair was in a poor state of repair and dirty and some rooms needed cleaning. This meant that where improvements were needed this was not always identified by the registered manager and provider.

Staff sought people’s consent before they provided care and support although some decisions were made by others when people had capacity to make decisions themselves. Some people were subject to restrictions and the provider had not identified where their support needed to be reviewed.

Social and leisure based activities were not consistently promoted and provided, and people were not always supported to maintain and develop independent living skills.

Staffing had been organised to meet people’s needs and staff spoke kindly with people although interactions with people often occurred when people were supported with personal care needs. On occasions, the call bells were not always responded to in a timely way although staff were available. Risks to people were identified although some identified risks were not always minimised as the assessments were not followed to reduce the risk of preventable harm.

Staff received training and support that provided them with the knowledge and skills required to work at the service. There was a homely and relaxed atmosphere and people were treated with care and compassion. However, some interactions were not dignified as staff did not speak to people when they supported them to eat at lunch time.

Health care professionals visited the service regularly to provide additional healthcare services to people. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People knew how to complain about their care and complaints were managed in accordance with the provider’s complaints policy. People were confident they could raise any concerns with the registered manager or staff and were complimentary about the registered manager and staff. They told us the registered manager was always available and was approachable.

We found 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 the report.

We spoke with one person who was visiting their relative on the day of our visit and five people that were using the service. All of the people we spoke with were positive in their comments regarding the services and support provided by the staff team. The person visiting their relative told us, “I’m very happy with the care, staff are very welcoming and always keep me informed if there are any problems.”

To help us understand the experiences people have we can use our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We used the SOFI tool for a forty minute period in the dining area. Our SOFI observation involved five people during the lunch time period. Our overall observation was that people were supported appropriately throughout the lunch time meal, staff were polite and helped people in an unhurried way, this enabled people to have a relaxed and positive experience.

Evidence was in place to demonstrate that all of the compliance actions left at our last visit in December 2012 had been met.

People were complimentary about the support provided by the staff team and told us they were happy living at the home. Comments included, “the staff are very supportive” and “I like it hear, the best decision I ever made to come here.”

One visitor said that there were not enough activities to stimulate their family member. Another visitor confirmed that they had not seen any activities taking place when they visited. We observed that no activities were taking place on the day of our visit, although people told us about the external entertainment that had taken place the previous weekend and said that they had enjoyed this.

Staff were observed supporting people appropriately and staff told us they enjoyed their job and felt well supported.

Essential training was provided to staff but not all staff had received training that was specific to the needs of people using the service, which meant that not all staff had been given training that enhanced the care provided to people.

This was a focused visit to check if the compliance and improvement actions made following our previous visit in January 2011 had been addressed.

Therefore we did not speak to people using the service at this visit. People that we spoke with at our visit in January 2011 confirmed that they were happy with the support and services provided to them.

Due to the concerns identified we pathway tracked three people with complex needs. These three people due to their needs were unable to verbally converse with us. We spoke to the three people pathway tracked and observed the support staff provided to them. Other people using the service were spoken with throughout the day. They were positive in their comments regarding the services and support provided by the staff team.