Archived: Tarvin Court

Updated 9 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 6 and 7 February 2018 and was unannounced on the first day, announced on the second day.

The inspection team consisted of one adult social care inspector and an inspection manager.

We contacted the local authority safeguarding and contracts teams for their views on the home and we took these views in to account during our inspection planning.

The registered provider had completed and submitted a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the home, what the home does well and any improvements they plan to make. This information formed part of the inspection planning and was used during the inspection visit.

We checked the information we held about the registered provider and home. This included statutory notifications sent to us by the registered manager. A notification is information about important events which occur at the home that they are required to send us by law.

During the inspection we spoke with two people living at the home, one relative of a person living at the home, the registered manager, the care manager, a registered nurse, a senior carer and a carer. We spent time observing staff interactions with people living at the home.

We looked at two people’s care records, three staff recruitment and training records, medication administration records (MARs), and other records relating to the management of the home.

Updated 9 May 2018

We undertook an unannounced focused inspection of Tarvin Court on 6 February 2018 and our visit on the 7 February 2018 was announced.

The inspection was prompted from information the commission received regarding a failure by the registered provider and manager to report safeguarding incidents.

Tarvin Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Tarvin Court accommodates up to 28 people in one adapted building divided in to two units. At the time of our inspection 14 people were living at the home. Tarvin court is a two storey building with a single storey extension to the rear of the property. There are 22 single rooms and three double rooms. It is situated in Littleton.

The service has a registered Manager. 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 the last inspection on 7 February 2017 we found that there were a number of improvements needed in relation to safe care and treatment, staffing, consent and good governance. These were breaches of Regulation 12, 18, 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective and Well-led to at least good. The provider sent us an action plan that specified how they would meet the requirements of the identified breaches.

This inspection was done to check that improvements after our comprehensive inspection on 7 February 2017 had been made. The team inspected the service against two of the five questions we ask about services: Is the service Safe and Well Led? During this inspection we found some improvements had been made, however we found a number of areas of ongoing concerns relating to poor practice that had not been identified or addressed by the manager or registered provider. You can see what action we took at the end of this report.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The registered manager had introduced regular audits that included medicines, infection control, care plans and accidents and incidents. However, although these were regularly completed and some areas for development and improvement had been identified and actioned, trends and patterns had not been identified to keep people protected from future risks.

Accidents and incidents were not analysed by the registered manager to identify trends and patterns. Action had not been taken to mitigate future risks.

Gaps in staff training and skills had been identified but not addressed, which meant all staff were not up to date with the knowledge and skills required for their role. Staff had not completed up to date safeguarding training.

Safeguarding policy and procedures were in place and staff demonstrated some understanding of these. However, investigations had identified that the management team had not consistently reported all safeguarding concerns in accordance with the local agency or registered provider’s processes. There had been a number of safeguarding concerns that had been investigated by the relevant agencies and substantiated.

Staff recruitment procedures were followed. Employment checks had been undertaken that included references from up to date employer and a DBS. However, we found that there were not enough recruited staff to meet the needs of the people living at the home and there was a high level of agency staff use. This meant people were not always supported by staff that fully understood their individual needs.

Staff meetings, supervision and appraisal took place regularly. Daily handover meetings took place to ensure staff had up to date information about each person living at the home. Staff told us they felt supported by the management team. However, we found that there was clear evidence of disharmony within the management team that was causing division within the home.

Improvements had been made to the management of medication. Medicines were managed in accordance with good practice guidelines. There were clear procedures for ordering, storing, administering and disposing of all medicines. Staff had received training and been assessed as competent. People told us they received their medicines on time.

Improvements had been made to minimise the spread of infection. The carpet in the medicines room that had previously been identified as an infection risk had been replaced.

Health and safety checks were regularly undertaken. Equipment was checked and serviced in accordance with good practice guidelines.

The registered provider had policies and procedures in place that were accessible to staff to offer them clear guidance in their role. These were up to date and had been reviewed. The Statement of Purpose and Service User Guide were up to date and available to people and their relatives.

The registered provider lacked effective oversight of the management of the home and they had not ensured all requirements of their registration were being met.

We found that we had not always received notifications in a timely manner to inform us of significant events that had occurred at the home.