Tamar House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to safe care and treatment and good governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed before admission, and managers described visiting people and offering trial visits to help inform decisions. However, several care plans lacked clear, detailed guidance for staff. This included incomplete catheter care guidance and guidance to prevent bowel impaction, putting people at risk of not receiving appropriate care and treatment.

Risk assessments were not always complete or detailed. One person at risk of choking did not have a choking risk assessment, and some risk assessments lacked clear control measures.

Relatives gave mixed feedback about involvement in care planning. Some told us they were not consistently involved or able to see updated care plans.

Staff told us care planning processes were improving and recent changes, including a “resident of the day” approach, were helping to update assessments more regularly, but this was not yet fully embedded.

This contributed to a breach of legal regulation of safe care and treatment and governance.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We found gaps in monitoring and recording. Some continence care was not recorded in line with a person’s assessed needs. For example, one person was assessed as needing to be supported 2-3 hourly with continence care; however, we found some gaps of 7 hours. The provider could not always evidence people’s care was in line with their assessed needs.

This contributed to the legal breach of regulation in relation to safe care and treatment.

Staff worked with health professionals, including GPs, district nurses and speech and language therapy, and we saw referrals were made when people’s health changed. People were offered meal choices, and staff understood modified diets. However, daily records did not always confirm people consistently received care in line with their assessed needs.

Relatives provided mixed feedback. Some told us care met people’s needs well, while others raised concerns. One relative told us, “Things like food textured requirements are not met, left in wet pads and having urine burns”. However, another commented, “No concerns to raise, we are very satisfied with the care here”.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Relatives told us they did not always feel informed or involved when concerns were raised or when care changed. Some staff described previous instability in the management team and a lack of clear systems, which affected continuity and teamwork.

A professional explained, the service would benefit if the internal structure had defined communication, escalation and roles and responsibilities.

Staff worked with external professionals and escalated concerns to GPs, district nurses and specialist services when needed. Professionals told us the manager was open, responsive and sought advice appropriately.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We received mixed feedback from relatives about managing health and wellbeing. One relative told us, “The food isn’t really to (Person’s name) preference. (Person’s name) appetite is not good though”. However, other relatives told us there was information about people’s likes and staff were good at supporting dietary requirements.

People were offered activities and encouraged to remain active, and some relatives spoke positively about meaningful activities and social engagement. Others told us people were sometimes left in their rooms and not always supported to stay engaged.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and

consistent, or they met both clinical expectations and the expectations of people themselves.

The manager told us there was no process to monitor people’s daily records. We found significant gaps where the provider could not evidence people were being monitored in relation to their continence care, putting people at risk of skin damage. Without robust, embedded systems to monitor outcomes and drive improvement, the provider could not always demonstrate that people’s care was improving over time.

This contributed to a legal breach of regulation in relation to safe care and treatment and governance.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Mental capacity assessments were completed, and staff understood capacity was decision‑specific. However, records did not always show decisions had been clearly recorded or people were supported as much as possible to make their own decisions. Mental capacity assessments did not always evidence how decisions were communicated to the person the assessment related to.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff told us training around mental capacity and consent had increased recently. The manager described training and knowledge which was being passed to all staff about the importance and need for detailed mental capacity assessments, they also told us about plans to strengthen recording and oversight, however, these processes were not yet embedded.