CQC report explained · a residential care home
What the CQC found at Tigh Coilean
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Guidance for managing anxiety, self-injury and behaviours that could be challenging was not always detailed or consistent. Incident reviews did not reliably identify triggers or record the checks needed after injuries, although staffing, recruitment, medicines and infection control were found to be satisfactory.
- Effective?
- Requires improvement
- Mental capacity assessments and best interest decisions did not always explain how people and others had been consulted. Some health guidance was inaccurate, and staff had not yet received training about two health conditions affecting people at the home.
- Caring?
- Good
- People were treated with dignity and respect. Staff knew people's needs and preferences, used suitable communication methods and supported people to make choices and develop independence.
- Responsive?
- Good
- Care plans reflected people's routines, preferences and needs. People were supported with communication, relationships, hobbies, activities and community involvement, and the complaints process was effective.
- Well-led?
- Requires improvement
- There was no registered manager, and the provider's quality systems had not consistently identified or corrected shortfalls. An improvement plan was in place and the deputy manager was supported by an area manager.
What inspectors found, October 2021
Rated Requires Improvement; inspectors found kind and personalised care, but gaps in risk guidance, staff training and management oversight.
Inspectors carried out a comprehensive inspection on 23 August 2021. Two inspectors visited the home, spoke with one person, managers and staff, and reviewed care, medicine, recruitment and management records. Relatives were also contacted by telephone.
The home provided care for six people with a learning disability and or autism, although it could accommodate up to eight people. People were treated with kindness and respect, supported to make choices, and helped to take part in activities and community life.
Inspectors found weaknesses in guidance about self-injury and behaviours that could be challenging. Incident records did not always show possible triggers or the checks needed after an injury. Mental capacity records and some health guidance were also not detailed or accurate enough.
The overall rating was Requires Improvement. Safe, Effective and Well-led were rated Requires Improvement, while Caring and Responsive were rated Good. The overall rating had fallen from Good at the previous inspection, published on 20 September 2017.
Kind, respectful care
People received personalised support from staff who knew them well. Inspectors found that staff promoted dignity, privacy and independence.
“People received personalised care and support that was respectful and met their individual and diverse needs.” from the report
Choice and independence
People were involved in decisions about their care and daily lives. They were supported to do tasks such as preparing food, laundry and household jobs.
“People were involved in their care and treatment as fully as possible and care and support maximised their choice, control, and independence.” from the report
Activities and community life
People were supported to follow their interests, try new activities and take part in social and community opportunities.
“People received opportunities of social inclusion and support to participate in a variety of leisure and recreational activities they enjoyed.” from the report
Medicines and staffing
People received medicines when required, and medicine systems were safely organised. Staffing levels met people's assessed needs and recruitment checks were completed before staff started.
“Medicines systems were safely organised, and people were receiving their medicines when they should.” from the report
Incomplete risk guidance
seriousStaff did not always have consistent guidance about what could trigger anxiety, self-injury or behaviours that could be challenging. Records did not always explain what checks or medical action were needed after an injury.
“Guidance for staff was inconsistent in detailing how to support people during times of heightened anxiety resulting in self-injury and challenging behaviour.” from the report
Incident reviews
seriousIncidents were recorded and monitored, but the analysis was not strong enough to identify patterns or understand why behaviours happened.
“Incident analysis procedures were not sufficiently robust to identify possible triggers and patterns to behaviors.” from the report
Mental capacity records
needs fixingMental capacity assessments and best interest decisions did not contain enough detail about consultation and decision-making. DoLS support plans were also not available for staff.
“The provider's MCA policy and procedure were not fully reflected or consistently followed in the mental capacity assessments and best interest decisions.” from the report
Health training and guidance
needs fixingStaff had not yet received training about two health conditions affecting people at the home. One support plan also contained incorrect information about hearing aids.
“Staff had not received training to support their understanding and awareness of two particular health conditions that people had a diagnosis of.” from the report
Leadership oversight
needs fixingThere was no registered manager, and the provider's audits and improvement tools had not fully corrected known shortfalls.
“A manager was required to be registered with the Care Quality Commission; a manager was not in place.” from the report
- 01Have all risk assessments and staff guidance about self-injury, anxiety and behaviours that could be challenging been updated?
- 02How are incidents now reviewed to identify triggers, patterns and any further action needed?
- 03Has the training about the two health conditions been completed, and how has staff competence been checked?
- 04Are mental capacity assessments, best interest decisions and DoLS support plans now complete and up to date?
- 05Who is currently responsible for the home, and when will a registered manager be in place?
This was a comprehensive inspection covering all five key questions, including infection prevention and control; the previous Good rating had fallen to Requires Improvement. This explanation was written from the published report of 2 October 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2017
Tigh Coilean was rated Good; inspectors found safe, kind and personalised care, but one medicines record was unclear.
This was an unannounced, comprehensive inspection on 9 August 2017. The home supported six people with learning and/or sensory disabilities. Inspectors observed care, reviewed four people's care records and checked staffing, training, medicines and quality records. They also spoke with staff and two relatives.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines management overall, suitable training, support with food and healthcare, and care that respected people's choices, privacy and dignity.
The report identifies some issues to watch. One person's record did not clearly show whether an as-needed medicine had been offered. The medicines policy also lacked recommended guidance about contacting a pharmacist. One resolved complaint was still waiting to be formally closed.
Safe staffing and recruitment
Inspectors found enough staff to meet people's needs. Recruitment checks, including criminal record checks and references, had been completed before new staff were appointed.
“There were sufficient staff to provide safe care.” from the report
Kind and respectful support
Staff took time to communicate with people, asked permission before helping and responded calmly when someone was distressed.
“We saw that people were treated in a kind and respectful way.” from the report
Good oversight
The provider and manager carried out checks on care, medicines, staff skills and safety equipment. People, relatives and staff were invited to suggest improvements.
“Arrangements were in place for checking the quality of care.” from the report
As-needed medicine record
seriousOne person's medicines record did not make clear whether an as-needed medicine had been offered. Inspectors said this created a risk that the medicine might not be given when needed.
“However we observed in one person's MARs it was not clear whether or not they had been offered their PRN medicine.” from the report
Medicines policy
needs fixingThe medicines policy did not include recommended guidance about contacting a pharmacist when medicines were given without the person's knowledge. The area manager said this would be addressed.
“However, the medicine policy did not include guidance about contacting a pharmacist which is recommended in national guidance about managing medicines (NICE).” from the report
Complaint closure
minorOne complaint had been resolved but was still waiting to be formally closed under a partner agency's policy.
“At the time of our inspection there was one complaint which had been resolved but was waiting to be closed according to a partner agencies policy.” from the report
- 01How do you now record whether an as-needed medicine has been offered, given the unclear record found during the inspection?
- 02Has the medicines policy been updated to include guidance about contacting a pharmacist?
- 03How do you make sure complaints are formally closed after they have been resolved?
- 04How are people's individual communication methods and preferences recorded and shared with new staff?
This was the home's first comprehensive inspection and covered all five rating areas, using observations, four care records, management records, staff discussions and telephone calls with two relatives. This explanation was written from the published report of 20 September 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Tigh Coilean
2 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- October 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2016
Registered with the Care Quality Commission on 6 September 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.