Tynedale House

We inspected the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We found service was not consistently working within these principles, but the new registered manager and management team were proactively addressing this.

People received kind and compassionate care from staff who knew them well. Staff supported people in a respectful way. People told us they felt safe. Medicines and infection prevention and control were managed safely. There was a positive approach to safeguarding, learning from incidents and improving the service.

Staff worked effectively with health and social care professionals and responded promptly when people’s health needs changed. Professionals described staff as approachable, empathetic, responsive and proactive. There was evidence of positive outcomes for people, including improvements in communication, mobility, independence and their ability to make choices. People and relatives felt able to raise concerns, and relatives felt involved and kept informed about their family members’ care.

Although staff had developed positive and trusting relationships with people, the model of support did not always maximise people’s choice, control and independence. Staffing arrangements restricted opportunities for people to take part in activities, access their communities and develop independent living skills. This also meant staff were task-focused, with established routines rather than adapting their support to individual needs and preferences. For example, the night staffing arrangements had contributed to people becoming accustomed to going to bed before 9pm. Also, people could not routinely access unit kitchens, which reduced opportunities to develop everyday skills such as making their own drinks.

Some systems were not sufficiently individualised. Risk assessments did not always give staff person-specific guidance about how to support people to manage risks. People on each unit were offered the same menu choices and were not routinely involved in designing menus. Assessments and care records contained detailed information but did not always clearly explain how staff should use this information to meet each person’s individual needs. Records relating to restrictions and consent also needed to provide clearer evidence of decision-making and how people’s rights, wishes and autonomy were considered.

There was a positive and improving culture at the service. Staff were positive about the registered manager and described them as visible, approachable and supportive. Staff felt able to raise concerns and contribute ideas. The management team had good oversight of the service and had recognised areas requiring improvement. They were in the process of reviewing staffing levels, training requirements, risk assessments and opportunities for people to become more independent. Further work was needed to embed these improvements so people’s everyday experiences consistently reflected 'Right support, right care, right culture’.