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Review carried out on 9 September 2021

During a monthly review of our data

We carried out a review of the data available to us about Tamar House on 9 September 2021. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Tamar House, you can give feedback on this service.

Inspection carried out on 9 March 2020

During a routine inspection

About the service

Tamar House is a residential care home providing personal care for up to 28 people, some of whom are living with dementia. At the time of the inspection 27 people were receiving support.

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

Some people were not able to tell us verbally about their experience of living at Tamar House. Therefore, we observed the interactions between people and the staff supporting them.

Other people and their relatives told us they were happy with the care they received and felt safe living there. One person said; “I’m very safe here” and “Very very happy here!” A relative said; “Can’t speak highly enough of them.” People looked very happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

People's needs were met in an individual and personalised way by staff who were exceptionally kind, caring and responsive to their changing needs. People felt listened to and knew how to raise concerns. The service was responsive and innovative in looking at ways of meeting people’s social needs.

Enough staff who had been recruited safely were available to meet people's needs and we observed staff respecting people's privacy and protecting their dignity.

People were safeguarded from the risk of abuse. People received safe care and treatment from staff who had the knowledge and skills they needed. The environment was safe, with upgrades and redecoration ongoing. People had access to equipment where needed.

People were supported to take medicines safely. Good standards of hygiene were maintained, and people had been helped to receive prompt medical attention when necessary.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in people's care plans. Staff followed guidance provided to manage people's nutrition and pressure care.

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.

Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

Effective governance systems were in place, ensuring people received consistent care.

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 23 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 3 August 2017

During a routine inspection

The inspection took place on the 3 and 4 August 2017 and was unannounced. We last inspected Tamar House on 23 and 24 July 2015 and rated the service as Good overall. Well-led was rated as Requires Improvement as we had not received all information as required in respect of incidents registered people are required to tell us about. At this inspection we found that action had been taken and improvements had been made.

We have continued to rate this service as Good.

Prior to this inspection we received concerns from an anonymous source that people’s money was not being looked after safely. We found there were no concerns in respect of handling people’s money. Records were kept and all money was kept in a safe with limited people accessing it. We have recommended the registered manager and provider review how to formalise the keeping of people’s finances by means of a policy. This would detail how to manage people’s money and what to do if there is a concern. It could also be shared with people and family members so they were clear on how money is looked after.

Twenty five people were living at Tamar House when we inspected. Tamar House provides residential care to up to 28 older people. People may be living with the early stages of dementia, mental health and/or sensory needs. All people living there are the time we inspected had a level of limitation to their physical ability. Nursing support was given by the community nursing service.

A registered manager was employed to manage the service. 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.

Why this service remained good:

People continued to receive safe, effective, caring and responsive care from staff who were knowledgeable and had the skills required to support them. Staff were competent and trained well. People had the support needed to help them have maximum choice and control of their lives in the least restrictive way possible. Policies and systems in the service supported good practice. People's wellbeing and healthcare needs were monitored by the staff and people accessed healthcare professionals when required.

People all agreed that the staff team were very caring. We observed staff being patient and kind. There was a calm atmosphere in the service. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support they received.

Care people received was personalised and was responsive to people's individual needs. Each person was able to make choices about their day to day lives. Any concerns or complaints were quickly acted on and investigated. People were supported to take part in a range of activities according to their individual interests. People’s faith and cultural needs were respected and met.

The service was now well led. People and staff told us the registered manager was approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems in place which enabled them to identify good practices and areas of improvement.

Further information is in the full report which the registered manager will be available to give you a copy of or it can be found on our website at www.cqc.org.uk.

Inspection carried out on 23 & 24 July 2015

During a routine inspection

The inspection took place on the 23 and 24 July 2015 and was unannounced. At our last inspection on 30 April 2014 we found concerns that people’s medicines were not being managed correctly. We asked the provider to put this right. On this inspection we reviewed this and found people’s medicine were being administered and managed safely.

Tamar House provides care without nursing for up to 28 older people who may have physical disabilities. Nursing care is provided from the community nursing team.

A registered manager was 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 registered manager was currently off work due to ill health. When the inspection took place the service was being run by two senior members of staff as a temporary measure.

There was evidence of leadership and governance in place. Tamar House is part of the Abbeyfield Society. They are a charity and managed by a management committee. There was evidence of auditing by senior staff and the management committee to ensure the quality of the service was maintained. People, relatives and staff said the senior managers were approachable. People and relatives were asked their view of the service. Staff said they could contribute ideas of how they felt the service could be improved.

The service had not returned all the required notifications for when people were seriously injured while living at Tamar House. This meant there was no external monitoring of serious injuries involving people living at the service. The senior staff told us they had not realised these needed to be sent to CQC.

People felt safe living at Tamar House and spoke highly of the staff. People felt comfortable speaking to staff if they had any concerns. Staff were knowledgeable about safeguarding people and what action to take if they felt there was a concern. Both people and staff said any concerns would be taken seriously by senior staff and members of the management committee.

Staff treated people with kindness and respect. People’s dignity was protected at all times. Staff were observed treating people as individuals and ensuring their needs were met. People were in control of their care and planning how their care needs were met. People were supported to plan for their end of life. Risk assessments were in place to reduce the risk of them coming to harm. People were involved in assessing their risks and how staff could support them. Relatives or their representatives were also fully involved.

People’s medicines were administered safely. Staff followed safe infection control policies and practices.

Staff were recruited safely and trained to meet people’s needs effectively. Staff underwent training to ensure they could meet individual needs. Staff said they could ask for training and guidance was always available from senior staff and local health care professionals.

People’s nutritional and health needs were met. People said staff responded to their needs quickly and ensured they saw health professionals as required. People said staff explained what healthcare professionals said if they did not understand and supported them to make choices about what they wanted to happen.

Activities were provided to keep people mentally and physically stimulated. People’s personal histories were gathered to ensure activities were person centred. People’s faith needs were met.

People’s concerns and complaints were investigated and only closed once people were happy with the outcome.

Inspection carried out on 1 May 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff were properly recruited and their personnel records contained all the information required by the Health and Social Care Act 2008. This meant that the provider had taken all reasonable precautions to ensure that they only employed people who had the right attitudes to be able to carry out their role in caring and supporting vulnerable adults. We saw that the home had a good training programme in place that meant that staff were taught the skills needed for their jobs. We were told that the training was regularly refreshed. One member of staff told us "I did not start work straight away, first I did many shifts shadowing a more experienced member of staff, then I did induction training. Now I do training every six to twelve months, I've done end of life and first aid training."

We monitored the administration of medication. We noted that this was done efficiently and we heard that only staff who had done their medication administration training were authorised to distribute the medication. However we also noted there were some lapses in the procedures to ensure security of medication. This meant that the home could not be sure that medication was always stored safely and we have asked the home to tell us what they plan to do to rectify the situation.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager knew when she needed to apply for a DoLS and told us that at the time of our inspection there was no one who needed this protection.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person who lived at the home told us "You don't need to inspect this home, I think they're pretty good carers." Another said "They mended my dress for me." A relative who was visiting told us "The care here is fantastic and so are the people who work here."

Is the service caring?

People were supported by kind and attentive staff. We saw that the care workers were patient and gave encouragement when supporting people. We also observed that staff had good relationships with people, sharing jokes and exchanging conversation as they passed. One visitor told us that their relative had become considerably more dependent since moving into the home. They described how there was always a member of staff available to help their relative with eating and to ensure that they drank enough. They went on to say "We've never seen any member of staff getting annoyed. We've never seen any unkindness, and there are always sufficient staff on duty. They have patience."

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences and that care and support had been provided that met their needs. These were regularly reviewed and amended if necessary. A comprehensive verbal handover was given at the shift change-over. The handover demonstrated the real affection that people were held in by the staff team. One visitor explained how their relative was always supported to be ready if they let staff know when they planned to arrive. They went on to explain that they were encouraged to visit whenever they liked.

We were told that call bells were answered quickly. We observed that the bell was answered within a couple of minutes on two occasions.

Is the service well-led?

We were shown the home's internal quality assurance file that was regularly monitored by members of the management committee. This meant that the service was checked against the standards of the committee, so any shortcomings should be found at an early stage.

Equipment at the home had been well maintained and with one exception had been serviced regularly. (The testing of gas equipment was two months overdue. The manager was aware of this and was "chasing" for the tests to be done.) This meant that people were cared for in an environment that was safe.

We were told of an event held a few days before our visit. During the event people living at the home, their friends and families, and staff all mixed in small groups to discuss the running of the home. Senior staff moved from group to group listening to what was said and responding. The relatives we spoke with told us that "The management are approachable. They listen and deal with things. No fobbing off." People living in the home confirmed this saying "I think they really listen."

Small changes to the care home had been introduced as a response to feedback from the regularly held surveys and other information gathering events.

People living at Tamar House, and their visitors told us that they felt that the management of the home was honest and approachable and that they listened to their concerns.

Inspection carried out on 22 May 2013

During a routine inspection

We met twelve people who used services, spoke to two relatives, talked with the staff on duty and checked the provider's records. One person using the service said, �The staff are lovely and plenty of people around if I need them�. We looked at surveys sent out and returned to the home for further information.

We observed that people living in Tamar House had their privacy and dignity respected at all times. We heard the care staff speak to people in a way that demonstrated a good understanding of people�s choices and preferences. One relative said, �They leave notes for me to let me know what is going on�.

We looked at the care records for four people, observed the staff assisting them and spoke to the staff about the people they cared for.

The care records we saw showed that people�s care needs were well documented and how these needs were to be met by the staff in the home. People had their mental capacity assessed to determine if they were able to make particular decisions.

As part of the quality monitoring system, people who lived in the home, and their relatives, were sent surveys to complete, that asked their views about the home.

Inspection carried out on 8 January 2013

During a routine inspection

We met fifteen people who used services, spoke to three relatives, two visiting professionals, talked with the staff on duty and checked the provider's records. One person using the service said, �They (the staff) are delightful�. We looked at surveys sent out and returned to the home for further information.

We saw people�s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people�s choices and preferences. One relative said, �This is the first place my relative has settled in�. One person living in the home said, �They deserve a medal�

Staff were clear about the actions they would take should they have any concerns about people's safety.

We looked at care records for four people. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them. The two visiting health professional we spoke with confirmed that the staff at the home were helpful.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine if they were able to make particular decisions.

As part of the quality monitoring system, people who lived in the home, and their relatives, were sent surveys to complete, that asked their views of the home.

Reports under our old system of regulation (including those from before CQC was created)