Tamar House Nursing Home

Tamar House Nursing Home is a residential care home providing personal and nursing care to up to 21 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 17 people using the service.

People’s experience of using this service and what we found

Medicine records were not always accurate. Medicines that required stricter controls were not managed and recorded according to legal requirements. The manager took immediate action to audit these medicines and correct the records.

Some people living at the service were cared for in bed due to their health care needs. These people had been assessed as requiring pressure relieving mattresses to help ensure they did not develop pressure damage to their skin. Air filled pressure relieving mattresses were not always set correctly for the people using them. There was no process in place to ensure staff checked these regularly. This was put in place immediately by the manager.

The service did not have a permanent nurse who worked during the day. This post was being covered by agency staff. Whilst the agency staff were mostly consistent there was little continuity of practice regarding medicines management. The manager told us they had appointed a permanent nurse who was due to commence their post in December.

People told us they were happy with the care they received, and people said they felt safe living there. Comments from people included, “Staff always knock and pop in to see me when they are passing by, they always ask if I am ok,” “The staff are funny, lots of great banter, they are very nice” and “Staff are quick at answering the bell.”

People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by sufficient numbers of staff to meet their needs. New staff had completed an induction into their role. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and there was a designated activities staff member to assist people. Staff knew how to keep people safe from harm.

Staff received appropriate training and support to enable them to carry out their role safely, including nutritional support and dementia care.

The environment was safe, with re-carpeting and re-decoration ongoing. People had access to equipment where needed.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified.

People were involved in make meal choice and staff encouraged them to eat a well-balanced diet. The kitchen was due for upgrading but all equipment was in working order and the cook was able to provide freshly cooked meals from scratch for people. The cook was aware of people’s specific dietary requirements. Comments included, “I like the food,” “Plenty to eat and drink,” “Good food” and “Sunday dinner is very good, and we get that twice a week.” We heard on staff member offering many options to one person who had changed their mind about what they wanted to eat for lunch.

Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service.

Staff told us the manager and the provider of the service were available and assisted them daily. They went onto say how they were approachable and listened when any concerns or ideas were raised. Staff comments included, “(Provider’s name and manager’s name) are really good.” “I would be really happy for a loved one of mine to be cared for here” and “One of the best homes I have worked in.”

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (21 February 2022).

At our last inspection we found breaches of the regulations in relation to care provision and deployment of staff, infection control, governance and staff training. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider had made some improvement but remained in breach of regulations. We have made a recommendation regarding the implementation of the Mental Capacity act in the Effective section of this report.

Why we inspected

We received concerns in relation to the availability of Personal Protective Equipment (PPE), the environment, records and staff culture. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements

The overall rating for the service has not changed following this inspection.

We have found evidence that the provider needs to make improvements. We have identified a breach of the regulation in relation to the safe management and administration of medicines and the monitoring of pressure relieving mattresses.

We found no evidence during this inspection that people were at risk of harm from the concerns identified at this inspection. Please see the safe, effective and well-led sections of this full report.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tamar House Nursing Home on our website at www.cqc.org.uk

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tamar House Nursing Home is a residential care home providing personal and nursing care to up to 21 people. The service provides support to older people who are living with dementia or have a physical disability. At the time of our inspection there were 17 people using the service.

The home is on two floors, with access to the upper floors via a passenger lift. There are shared bathrooms, shower facilities and toilets. Communal areas include a lounge, dining room and outside patio area.

People’s experience of using this service and what we found

Staff had not always been recruited safely. Not all staff had completed or updated necessary training relevant to their role.

Staff were not deployed effectively to make sure all tasks were completed to a high standard. The service was not cleaned or maintained to a high standard.

Staff did not always ensure people were in a position that enabled them to eat safely and comfortably. Staff supported people who needed physical assistance to eat but were not available to offer encouragement, assistance or help to people who could eat independently but would benefit from staff checking on their position and checking they liked the food.

The provider had not taken sufficient action to ensure all aspects of the service were of high quality.

Staff and the manager understood how to recognise and report safeguarding concerns.

People’s records had been reviewed and were being updated. Where appropriate relevant charts were completed by staff to monitor people’s health. People’s medicines were managed and stored safely.

Risks relating to people’s health and the environment had been assessed and control measures recorded.

People were given choice about what they wanted to eat and drink and said they liked the food.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The manager had completed checks and audits of the service and completed an action plan to improve certain aspects of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for this service was good (published 22 November 2018).

Why we inspected

We received concerns in relation to infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tamar House Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the running of the service, infection control, recruitment and deployment of staff and staff practice at mealtimes. We also made a recommendation about the premises.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tamar House Nursing Home is a care home with nursing for up to 21 people. On the day of our inspection there were 18 people living at the service. It specialises in care for older people who are living with dementia or have a physical disability.

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.

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 inspection was the service’s planned comprehensive inspection. We have received notification of an incident following which a person using the service died. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident.

At the last inspection on 27 June 2017, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

We met and spoke with most of the people living in the service during our visit. However, some people were not able to fully verbalise their views, so staff used other methods of communication, for example pictures. Others could tell us about the care and support they received. Due to people’s needs we spent time observing people with the staff supporting them.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff, relatives and professionals said the registered manager was approachable and had made many improvements since being in post. Staff said the registered manager was involved in the day to day running of the service. One professional commented; “It is always a pleasure to go to Tamar house, the staff are professional, caring, friendly and approachable.” One staff member said; “It’s a lovely home and I cannot think of anything that would improve it. I think the people that live here really like being here.”

People remained safe at Tamar House. People who were able to told us they felt safe living there. One person said; “Yes I feel safe, I always have someone to help me.” A relative said; “Yes, I do. If they (their relative) can’t live at home this is the next best place.”

People received their medicines safely from suitably trained staff. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff agreed there were sufficient staff to keep people safe. Staff said they were able to meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. Robust systems were in place to assess risks and ensure measures were put in place to further reduce those risks to protect people.

People lived in an environment that was clean and hygienic. Parts of the environment had been refurbished, taking into account people’s needs.

People received care from a staff team who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People's capacity to make important decisions about their lives had been assessed in accordance with the Mental Capacity Act 2005 (MCA). The provider and staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and met them. People were not all able to be fully involved with their support plans. For example, due to living with dementia. Therefore, family members or advocates supported staff to complete and review people’s support plans in their best interests. People’s preferences were sought and respected. Care plans held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service was responsive to people's individual needs and provided personalised care and support. People’s equality and diversity was respected and people were supported in the way they wanted to be. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

People had access to organised and informal activities which provided them with mental and social stimulation.

People’s end of life wishes were documented. People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained. The staff worked with other organisations to make sure high standards of care were provided and people received the support and treatment they wished for at the end of their lives.

All significant events and incidences were documented and analysed. The evaluation and analysis of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from other agencies and the staff team.

Tamar House Nursing Home provides care and accommodation for up to 21 people. On the day of the inspection 17 people were living at the care home. Tamar House Nursing Home provides care for older people who may live with a dementia or physical difficulty. The home is on two floors, with access to the upper floors via a passenger lift. There are shared bathrooms, shower facilities and toilets. Communal areas include a lounge, dining room and outside patio area.

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.

At our last inspection on 22 and 24 April 2015 we told the provider to take action to make improvements to how people’s care was recorded, how the Mental Capacity Act 2005 (MCA) was implemented, and how people’s consent in respect of their care was obtained. During this inspection we looked to see if improvements had been made and we found that action had been taken.

People told us they felt safe living at the service. People were protected from avoidable and harm and abuse because staff knew what to do, if they were concerned someone was being abused or mistreated. People were protected from risks associated with their care, and the environment was assessed to ensure its safety. People told us there were enough staff to meet their individual needs. People received their medicines safely, and were supported at the end of their life to have a comfortable and dignified death.

People received care from staff who had received training and support to meet their needs. People’s consent to their care had been sought and their human rights were protected by the Mental Capacity Act 2005 (MCA) and the associated deprivation of liberty safeguards (DoLS). People were supported to eat and drink enough and when concerns were identified action was taken to contact relevant health professionals. People told us they had access to their GP and staff were prompt in calling them.

People told us staff were kind and caring. Staff showed kindness towards the people they cared for. People’s views were sought to ensure they were involved in decisions about their own care. People’s privacy and dignity was respected.

People received individualised care, and had care plans in place to provide guidance and direction to staff about how to meet their needs. People told us they would feel confident about speaking to the registered manager if they had any complaints. People’s complaints were investigated and used to make improvements to the service.

People and staff had confidence in the management and leadership of the service. The registered manager kept her own training up to date and felt supported by the provider. The registered manager was aware of her legal obligations to notify the Commission of significant events, such as expected and/or unexpected deaths. There was a culture of honesty and openness which reflected the requirements of the duty of candour.

This is a summary of what we found-

Is the service safe?

At the time of this inspection the service was safe.

People told us they felt safe living Tamar House Nursing Home.

We found Tamar House Nursing Home to be clean and there were no unpleasant odours.

People were treated with dignity and respect. We spoke with people who lived at the care home they told us staff were, 'kind, considerate, nothing is too much trouble for them' and 'they look after me'.

Care plans were personalised to the individual and gave comprehensive information about how the person wanted their care and support to be provided.

There was a safe and robust recruitment process in place which ensured people who lived at the care home were not placed at risk.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies to care homes. The home considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards. The legislation regarding DOLs is part of the Mental Capacity Act 2005 (MCA) and requires providers to seek authorisation from the local authority if they feel there may be restrictions or restraints placed upon a person who lacks capacity to make decisions for themselves. At the time of our inspection the home had not made any applications to restrict people's liberty under DOLS.

We found that people's care plans contained risk assessments to support staff to reduce and prevent a risk to the person or to themselves.

Is the service effective?

At the time of this inspection the service was effective.

People's health and care needs were assessed and individual care plans were in place to guide and direct staff to meet a person's health and social care needs.

Is the service caring?

At the time of this inspection we found the service to be caring.

People who lived at Tamar House Nursing Home told us staff were kind and caring. Comments included, 'very kind and helpful', 'they look after me' and 'they know exactly what I need'

During our inspection we found staff to be attentive to peoples care needs.

We found staff engaged in friendly conversation with people.

Is the service responsive?

At the time of this inspection we found the service to be responsive.

We found in people's care records that staff involved external health care professionals such as GP's, speech and language therapists (SALT), and psychiatric nurses (CPN's) to support people with their changing care needs.

During our inspection we observed staff to respond to people's need when requested.

The manager carried out an annual quality survey to assist in recognising where improvement was required and we saw the manager took action to address any shortfalls.

Is the service well-led?

At the time of this inspection we found the service to be well-led.

The service had a manager who was registered with the Care Quality Commission.

It was clear from our observations that the manager and provider were actively involved in the care and support of people who lived at Tamar House Nursing Home.

Staff we spoke with told us they enjoyed working at Tamar House Nursing Home, the staff we spoke with had worked at the home for many years. Staff were complementary of the manager and told us that she was 'approachable' and 'supportive'.

We found the manager had effective systems in place to monitor the quality of the service being provided. We found the monitoring or medication and the environment required improvement.

We talked with six people who lived at the home. They all told us that they were happy with the service provided by Tamar House. They told us, 'I am happy here, I have everything I need' and 'You would go a long way to find a better place than this. '

People told us that staff treated them kindly and with dignity and respect at all times.

We spoke with three staff who said that they felt supported in their role and that they had sufficient training in all areas to help them do their jobs well. They told us that the manager was approachable and accessible both during the week and out of regular work hours to support them if needed. Supervision and appraisal were not regularly provided by the manager to support and ensure the development of good staff practice.

Staff demonstrated a good understanding of signs of abuse and explained the actions they would take to raise any concerns they may have.

The environment, care planning and medication were all monitored to develop the service being provided. The monitoring of care records had not been effective to ensure they were updated and relevant to each person.

Records relating to people's care were not sufficiently detailed and personal to ensure that people's choices and preferences would be met for areas including personal care and communication.

We talked with one person who lived at the home, they told us that they were warm, comfortable and felt well looked after.

Most staff had worked at the home for many years. The nurse in charge told us that they had worked at the home for years and "loved every bit of it ".

We looked at the records for four people; records were seen to be accurate and fit for purpose. Since our last visit initial care plan records had been developed as a learning experience and staff confirmed this had been a positive development.

We saw that the areas of the home previously identified as needing repair or renovation had all been addressed and a maintenance plan put into place to monitor areas previously seen to be non compliant.

We looked at the systems in place to monitor the quality of the service. We found that auditing systems were in place and efforts had been made by the registered manager to monitor the service and address any problems found. We saw that systems to monitor the environment and care planning had been developed to ensure that all areas and aspects of care were part of an ongoing monitoring plan.

We talked with eight people who lived at the home. One person told us, 'I am very lucky, they are all very kind and I feel safe', another person said 'I am definitely treated with dignity and respect, they couldn't be nicer'. Other people told us that the food was of a good standard and that they had choices about how they spent their day. We spoke with two visitors to the home who were complementary about the care the home provided.

We spoke with six staff who all told us they enjoyed working at the home. Many staff had worked at the home for many years. People using the service and staff told us that they felt there were sufficient staff on duty to meet people's needs.

We looked at the records for four people, met with those people and observed how their care was provided. Whilst care provided met people's needs, not all records were accurate and fit for purpose.

We looked at the systems in place to monitor the quality of the service. We found that auditing systems were in place and efforts had been made by the registered manager to monitor the service and address any problems found. However, some areas of the home were seen to be in need of repair and reorganisation to ensure the safety of people using the service.