Tamar House

Tamar House is a residential care home providing accommodation and personal care to up to 21 people. The service provides support to adults, some of whom may be living with dementia. At the time of our inspection there were 18 people using the service.

Tamar House is an adapted building offering accommodation over two levels. There are various shared living areas in the home which include a lounge, a dining room and shared bathing facilities. In addition, there is a wheelchair accessible garden and patio area to the rear of the home.

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

Care plans and risk assessments were in place. Information was being reviewed and updated to ensure this was person centred and remained reflective of people’s needs. Staff were familiar of people and their needs and were knowledgeable of measures in place to mitigate risk of harm and injury.

Agency staff had been utilised to address the challenges experienced by the provider in staffing. A successful recruitment drive had taken place. Systems were in place to ensure recruitment was safe. Staff received training to equip them for their role. The registered manager conducted daily walks of the home and regular checks of staff competency. This provided assurance of the staff skill, knowledge and safe delivery of care and support.

People and their relatives told us the care provided by staff reassured them and made them feel safe. A relative said, “My [family member] is absolutely safe. The staff and care is second to none. I’ve been in other homes, and I believe this one is the best.”

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.

Quality assurance processes were in place. The registered manager analysed findings of audits and took actions to address shortfalls. An action plan was in place to support with driving continual improvement to the standard of care provided.

People, their relatives and staff found the registered manager to be approachable and were confident they would be listened to. A staff member told us, “[Registered manager] is very approachable and values everybody. They are one of the best we have had.”

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 11 May 2018).

Why we inspected

We received concerns related to the staffing and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 remained good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

The people who lived in the service had assessments on risks to their wellbeing when returning from hospital and had to self-isolate in their bedroom. This was done by consulting their General Practitioner and families. Where this increased risks, such as of them falling or not eating, measures to support them were put in place to good effect.

There was a shelter built against the window of the dining room to protect relatives against the weather when they visited the people who lived in the service.

A restricted social media page had been set up for photographs and videos of activities of people who lived in the service for their relatives to see and keep up to date with how they were.

There were good stocks of personal protective equipment (PPE) with off site storage being sourced so items could be bulk bought.

Shipbourne House is a ‘care home’. People in care homes receive accommodation and 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. Shipbourne House accommodates up to 21 people, some of whom may be living with dementia, in one adapted building. At the time of our inspection there were 18 people living in the home.

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.

People were cared for by staff who had a good understanding of their care needs and personal preferences. Staff supported people to make choices about their care and people were supported to be as independent as possible. The home had been adapted to meet people’s needs and people could access all areas of the home with minimal support from staff.

People who received end of life care were cared for in a way that maintained their dignity and staff took steps to ensure that they remained pain free and comfortable.

Staff had time to talk with people and engage them in activities that people had chosen to do. There were a number of different activities for people to participate in as well as group-based activities provided by outside community organisations.

People and their relatives were involved in the planning of their care and people’s wishes and preferences were detailed in their care plans. People’s individual risks had been identified and steps taken to mitigate these. People’s care plans and risk assessments were reviewed regularly and updated when people’s care needs changed.

People’s medicines were stored, administered and managed in a safe way. Staffs’ competency in the safe management of medicines was assessed regularly. Monthly audits of people’s medicines were also undertaken.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. MCA assessments had been carried out and staff understood when they would have to make a decision in a person’s best interests.

Mealtimes were relaxed and people had a choice of meals. Where there were concerns about a people’s nutritional intake, timely referrals were made to the relevant healthcare professional. People were also supported to access healthcare professionals where there were concerns about their health or wellbeing.

There were no restrictions on when people could have visitors and there was plenty of space in the home where people could enjoy some privacy with their visitors.

Staff understood what constituted abuse and how they would report any concerns of abuse. Staff knew the different types of abuse and had received training in safeguarding. There were processes in place to ensure that staff appropriate to care for people were recruited. Appropriate background checks had been completed before staff commenced their employment.

Staff received training relevant to their role and received regular supervision with the registered manager.

Risks within the environment were assessed and monitored. Regular servicing of the utilities took place and moving and handling equipment was safety tested twice a year.

Accidents and incidents were documented clearly and these were analysed so any trends or patterns could be identified.

The home was clean throughout and staff understood their responsibilities in relation to infection control. Hygiene in the kitchen was monitored daily as well as the temperature of the food being served.

Staff enjoyed working in the service and were supported by the registered manager in their roles. There were regular meetings for people living in the home and staff so they could have a say about how the service was run.

There were processes in place to monitor and assess the quality of service being delivered. The registered manager undertook monthly audits so they could get an overview of the service being provided. In addition to this, an annual questionnaire was given to people, their relatives and healthcare professionals to complete.

Shipbourne House provides accommodation and care for up to 21 people, many of whom were be living with dementia. At the time of our inspection 19 people were living in the home.

A registered manager was in post. A registered manager is a person who is 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.

There were areas of the service which were not safe. The systems in place to monitor and assess environmental risks were not always effective. They did not identify areas which could pose a potential risk to people. There was exposed piping in areas of the home which was hot and some of the radiators were also hot. The building and the decoration looked tired and the carpets were stained. The kitchen was also found to be unclean. The design and décor of the service did not lend itself to a dignified environment in which to live. The registered manager had a comprehensive plan in place for the improvements within the service.

People felt safe living in the home and risks to people’s health and welfare had been identified. Whilst risks to people’s health had been identified, these were not always reflected in people’s care plans.

Staff knew what constituted abuse and were aware of the procedures for reporting any concerns. There were also safe practices in place with regards to staff recruitment. All new staff completed an induction to their role and were further supported through training and regular supervision.

People’s medicines were stored, administered and managed safely in the home and people received their medicines as prescribed.

The service operated in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Appropriate applications had been made to the authorising body for authorisation to deprive people of their liberty in order to keep them safe.

People were supported by staff who were kind and caring. Staff knew the people they were supporting well but people were not always given choices about how they liked to be supported with their personal care. Efforts were made to involve people and their families in the planning of their care as much as possible. People’s care needs were assessed and reviewed regularly. People’s care plans were person centred and detailed people’s preferences.

People enjoyed the food and were supported to have a sufficient amount to eat and drink. Up to date menus were not in place to show people what the choices for that day were. Where concerns had been raised about a person’s health, appropriate and timely referrals were made to relevant healthcare professionals.

Some people reported that there was a lack of activities on offer whereas others felt that there was enough to do. Staff had asked people for their feedback about this and had supported people to set up a knitting group. People’s relatives and friends were welcome without restriction and people were supported to maintain relationships with those important to them.

There was an appropriate complaints procedure in place and people knew who to address their concerns to if they needed to make a complaint.

The service was well run and clear plans were in place to introduce new ways of gaining feedback from people and their relatives about the care provided by the service. Regular meetings took place for people who lived in Shipbourne House, their relatives and the staff. This gave all those involved with the service an opportunity to have a say in how the service is run.