CQC report explained · a residential care home
What the CQC found at Twyford House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found gaps in risk management, staffing and agency staff induction. Medicines and infection control were handled well, but there was an increased risk that people could be harmed.
- Effective?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- Management checks had not always led to improvements. People were not asked for their views, records were not always accurate or up to date, and some staff practice and leadership needed improvement.
What inspectors found, July 2022
Rated Requires Improvement; inspectors found unsafe gaps in staffing, risk records and management oversight.
This was an unannounced focused inspection on 30 May and 7 June 2022. Two inspectors observed support, spoke with five relatives and ten staff, and checked care, medicine, recruitment and management records.
The home did some things well. Medicines were managed safely, infection control was effective, staff knew how to report abuse, and recruitment checks were completed.
However, people did not always receive the support they needed because staffing was not sufficient. Some risk assessments and care guidance were out of date, agency staff did not always receive enough information, and management checks had not consistently led to improvements.
The overall rating fell from Good at the previous inspection to Requires Improvement. Only Safe and Well-led were inspected during this visit. The other ratings were carried forward from the previous comprehensive inspection.
Medicines
Staff followed processes to assess and support people with their medicines. The home also followed guidance intended to avoid excessive use of medicines to control behaviour.
“Staff followed effective processes to assess and provide the support people needed to take their medicines safely.” from the report
Infection control
Inspectors found good arrangements for cleanliness, protective equipment, infection testing and managing possible outbreaks.
“The service used effective infection, prevention and control measures to keep people safe, and staff supported people to follow them.” from the report
Safeguarding
Staff had been trained to recognise and report abuse. Safeguarding concerns were reported to the local authority and investigated where needed.
“Staff had training on how to recognise and report abuse and they knew how to raise concerns where this was appropriate.” from the report
Recruitment checks
The home completed checks to help ensure new staff were suitable to work with people.
“People were supported by staff who had been safely recruited.” from the report
Not enough staff
seriousThere were not enough staff to provide all the support people had been assessed as needing. Agency staff sometimes arrived late, left early or did not arrive.
“The service did not have enough staff employed.” from the report
Out-of-date risk information
seriousSome risk assessments and support guidance were inaccurate or out of date. This included information about falls, emotional distress and emergency evacuation.
“Guidance for staff about the risks for people was not always up to date.” from the report
Weak agency induction
seriousNew agency staff did not always receive enough information about people's risks before supporting them. One agency worker supported someone to go out without knowing about their risk of falls.
“The management team had failed to ensure new agency staff had received a sufficient induction necessary to keep people safe.” from the report
Poor management oversight
needs fixingAudits did not consistently lead to improvements. The home did not seek people's views, and some records were incomplete or not kept up to date.
“Governance processes were not always effective.” from the report
People's voice and staff communication
needs fixingPeople were not involved enough in developing their support or the service. Inspectors also saw and heard some staff interactions that were not sufficiently positive, kind or respectful.
“People did not always have a voice in their own care.” from the report
- 01How do you now make sure there are enough staff to provide each person's agreed one-to-one or two-to-one support?
- 02What information and supervision do agency staff receive before they support someone with falls, choking or emotional distress risks?
- 03Have all care plans, risk assessments and fire evacuation plans been reviewed and updated since this inspection?
- 04How can people who do not communicate verbally give feedback, and how is that feedback acted on?
- 05What evidence can you show that management audits now lead to improvements?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and their previous ratings carried over. This explanation was written from the published report of 22 July 2022 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, February 2019
Twyford House was rated Good in all areas; inspectors found safe, kind and personalised care, with the home larger than current best practice guidance.
Inspectors made an unannounced visit on 29 January 2019. They spoke with staff and two relatives, observed people and staff together, and reviewed support plans, medicines, recruitment, complaints, meetings, accidents and safety records.
The home was supporting 11 younger adults with learning disabilities, autism and emotional support needs. Inspectors found enough staff, safe medicines management, suitable training, detailed risk plans and a clean, well-maintained environment.
People were treated kindly and supported to communicate, make choices and build independence. They took part in activities, used community facilities and were supported to maintain family relationships.
The home was rated Good for Safe, Effective, Caring, Responsive and Well-led. This was the same overall rating as at the previous inspection on 14 July 2016.
Communication
People were supported to express their views using pictures, social stories, signs, objects and electronic tablets. Their communication needs were recorded and shared appropriately.
“People were supported to express their views in a way which suited them.” from the report
Independence
People were encouraged to learn skills, take part in household tasks and make everyday choices. Staff also supported people to access activities and the local community.
“People were encouraged to increase their independence. The service supported people to maintain family relationships.” from the report
Safe medicines
Inspectors found medicines records complete and accurate. Medicines were stored safely and staff had guidance about medicines taken when needed.
“Medicine administration records (MARS) were complete and accurate and people received their medicines as prescribed.” from the report
Personalised support
Staff knew people's likes, dislikes and support needs. Support plans were reviewed and people could choose activities, food and where to spend their time.
“People regularly reviewed their support with their keyworkers.” from the report
Size of the home
minorThe home was registered for 14 people and was supporting 11. Inspectors noted that this was larger than current best practice guidance, although they found no signs that the size was having a negative impact.
“This is larger than current best practice guidance.” from the report
- 01How would you support my relative to communicate their choices, especially if they do not use speech?
- 02How would you manage my relative's emotional or behavioural support needs, including any use of physical restraint?
- 03How would you help my relative build independence and take part in activities in the community?
- 04How many people are currently living at the home, and how do you make sure its size does not affect people's experience?
- 05How would you involve our family in support planning, reviews and communication about any incidents?
This was an unannounced scheduled inspection covering all five CQC questions and the overall quality and safety of the home; the previous overall rating was Good in 2016. This explanation was written from the published report of 19 February 2019 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 Twyford House
3 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- July 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2019Goodstayed GoodSafe: GoodWell-led: Good
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2014
Registered with the Care Quality Commission on 14 April 2014.
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.
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Most charge £980 to £1,260 a week. 33 can care for a couple. 12 years' experience on average.
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