Archived: Tarrys Residential Home Limited

Tarrys Residential Home is a ‘care home’. 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. Tarrys accommodates 19 people in one adapted building. There were 18 people using the service at the time of our inspection.

The registered manager was also one of the registered providers. They were no longer in day to day charge of the service and had appointed a manager to fulfil this role. The registered manager intended to apply to cancel their registration and the new manager intended to apply to be registered. 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 31 January 2017, we found a breach of regulation as people had not been supported to take part in activities. At this inspection we found the provider had taken effective action and people now took part in occupations and activities they enjoyed. However, the quality of other areas of the service had not been maintained and we found shortfalls in the management of medicines, complaints and informing us of significant events. Although the overall rating remained the same at ‘Requires improvement’ the number of key questions rated as ‘Good’ has decreased since the last inspection.

Medicines were not managed safely. People’s medicines had been found on the floor and action had not been taken to prevent this from happening again. One person had not received their medicine when they needed it because it was out of stock and another person was not offered their medicine as prescribed by their doctor.

Although people told us they were confident to raise any concerns they had with the provider, not all complaints had not been addressed, they did not feel listened to and risks relating to the management of medicines continued. The provider had not consistently followed their complaints process.

Services that provide health and social care to people are required to inform the CQC of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. The provider had not sent notifications about three Deprivation of Liberty Safeguards authorisations when they were required.

The provider and manager did not have oversight of the service and were not aware that the issues with medicine were on going. Checks and audits had been completed but had not identified the shortfalls we found at the inspection. The views of people, their relatives, staff and community professionals were asked for and acted on to improve the service.

The provider had a clear vision of the quality of the service they expected, including privacy and choice. Staff shared the provider’s vision but had not been supported to deliver the service to the standard the provider required. Staff felt supported by the provider, were motivated and felt appreciated. The provider was always available to provide the support and guidance staff needed. Staff worked together as a team to provide the care and support people needed.

Staff were kind and caring to people and treated them with dignity and respect. Staff told us they would be happy for their relatives to receive a service at Tarrys. Staff described to us how they supported people in private and people told us they had privacy. People were encouraged and supported to be as independent as they wanted to be. Staff had not asked people about their end of life wishes and work was planned to make sure staff had all the information they required before they needed it. People’s relatives had complimented the staff on their kindness and care at the end of their relative’s lives. We have made a recommendation about planning for the end of people’s lives. People had been asked about their spiritual needs and were supported to attended services if they wished.

Assessments of people’s needs and any risks had been completed. People had planned their care with staff and received the support they needed to meet their individual needs and preferences. People were not discriminated against. Staff knew the signs of abuse and were confident to raise any concerns they had with the manager and provider.

Accidents and incidents had been analysed and action had been taken to stop them happening again. The provider worked in partnership with local authority safeguarding and commissioning teams, and a clinical nurse specialist for older people and acted on their advice to develop the service and improve people’s care.

Changes in people’s health were identified and people were supported to see health care professionals, including GPs when they needed. People were encouraged to remain active and mobile for as long as possible. People told us they had enough to eat but the food could be ‘tastier’. People were offered a balanced diet, which met their needs and preferences. Staff offered people the support they needed at mealtimes. Records in respect of each person were accurate and complete and stored securely.

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. Staff assumed people had capacity to make decisions and respected the decisions they made. When people needed help to make a particular decision staff helped them. The provider had assessed people’s capacity to make decisions and decisions were made in people’s best interests when necessary. The provider and manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS), and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.

At our last inspection we have made a recommendation for the provider to review their staffing levels at the weekends. This had been completed and there were consistently enough staff to provide the care and support people needed when they wanted it. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The service was clean and staff followed infection control processes to protect people from the risk of infection. The building was well maintained and the environment had been designed to support to move freely around the building.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall of the service.

We found breaches of six regulations. You can see what action we told the provider to take at the back of the full version of the report.

Tarry’s Residential Home is in Herne Bay and has close public transport links. The service provides short and long term residential care for up to 19 older people who need support with their personal care. Some people are living with dementia. Accommodation is arranged over two floors and a lift is available to assist people to get to the first floor. On the day of the inspection there were 18 people living at the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the registered provider. The day to day running of the service was managed and overseen by a manager with the support of a head of care. They were all present during the inspection.

We last inspected this service in January 2016. We found shortfalls in the service and required the provider to make improvements. The provider sent us information about actions they planned to take to make improvements. At this inspection we found that improvements had been made.

At the last inspection we recommended the provider involve people in planning activities for people with dementia. At this inspection people were not supported to maintain their hobbies and interests. People and their relatives told us there was not enough to do and that they were often bored. The provider had not ensured people’s care and treatment was designed to reflect their preferences and ensure their hobbies and interests were supported. This was a breach of Regulation 9(1)(c)(3)(b) of the Health and Social Care Act 2008 (Regulated Activities) 2014.

At the last inspection the provider had failed to assess risks to people’s health and safety. At this inspection risks to people had been assessed. People said they felt safe living at the service. They were protected from harm and abuse and staff knew what to do if they suspected any incidents of abuse. Staff were confident that any concerns raised would be investigated to ensure people were kept safe. They knew how to whistle blow and take concerns to agencies outside of the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks. The breach in regulation found at the previous inspection had been met.

At the last inspection the provider had not taken action to make sure that people’s medicines, including ‘when required’ (PRN) medicines and creams, were managed safely at all times. At this inspection received their medicines safely and on time. Medicines were managed, stored and disposed of in line with guidance. The management team had worked closely with their local pharmacist to address the previous shortfall around recording PRN medicines. The breach in regulation found at the previous inspection had been met.

At the last inspection the provider had failed to operate effective systems to assess people’s capacity to make decisions. At this inspection staff understood how the Mental Capacity Act 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications for DoLS had been made in line with guidance. The breach in regulation found at the previous inspection had been met.

At the last inspection the provider had failed to make sure that all staff received the appropriate training and development to enable them to carry out their duties effectively. At this inspection people received effective care from staff who were trained in their roles. Staff completed regular training, had one to one meetings and appraisals to discuss their personal development. The breach in regulation found at the last inspection had been met.

The provider had recruitment and disciplinary policies and procedures; however these were not consistently followed by the management team. The registered manager agreed this was an area for improvement and told us they would audit the staff files to ensure they contained the correct information.

There were consistent numbers of staff deployed to meet people’s needs. There were contingency plans to cover a shortage of staff in an emergency. However, due to comments received from people and their relatives during the inspection we have made a recommendation for the provider to review their staffing levels at the weekends.

At the last inspection the provider had failed to operate effective systems to monitor people’s health needs and take all the necessary action to keep them as well as possible.

At this inspection people had access to specialist health professionals when they needed it. People’s health was assessed and monitored and staff took prompt action when they noticed any changes or a decline in health. Staff worked closely with health professionals, such as community nurses and GPs, and followed any guidance given to them to ensure people received safe and effective care. The breach in regulation found at the last inspection had been met.

At the last inspection assessments of people’s needs had not been completed to find out what they could do for themselves and what support they needed from staff to keep them safe and healthy. Action had not been taken to identify changes in people’s needs. At this inspection when people were thinking of moving into Tarry’s Residential Home a pre-assessment was completed so the manager could check they could meet people’s needs. From this information a care plan was developed to give staff the guidance they needed to look after the person in the way they preferred. The breach in regulation found at the last inspection had been met.

At the last inspection we recommended that the provider review the statement of purpose to make sure it was up to date and included information for people about the aims of the service and the level of quality they could expect. At this inspection a new statement of purpose was in place. The provider had a clear vision about the quality of service they required staff to provide which staff understood. The management team led by example and supported staff to provide the level of service they expected. Staff understood the culture and values of the service.

At the last inspection we recommended the provider review the policies and processes in operation to seek and act on feedback from relevant people, such as people who used the service and their relatives, to make sure they continually evaluated and improved the service. At this inspection the registered manager had been working with a consultant to review and renew the policies. This was in progress. Quality surveys were used to gain feedback from people, their relatives and health professionals.

At the last inspection the provider failed to maintain an accurate, complete and contemporaneous record in respect of each person. At this inspection records about people’s care and support were accurate. Care and support plans were updated as people’s needs changed and were regularly reviewed to make sure they were up to date, the breach in regulation found at the last inspection had been met.

People enjoyed a choice of healthy, home-cooked, food and told us they had enough to eat and drink.

People told us they were happy living at the service and that their privacy and dignity were respected. Staff spoke with people in a patient, kind, and caring way. People were involved in the planning of their care and support and told us care was provided in the way they chose. Each person had a descriptive care plan which had been written with them and their relatives.

People knew how to complain and told us they had no complaints about the quality of service or the support they received from the staff team. The provider had a complaints policy and procedure, a copy was given to each person at the service.

People, their relatives and staff felt the service was well-led. There was effective and regular auditing and monitoring. The registered manager regularly met with people, their families and staff to encourage them to input into the day to day running of the service.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

Tarrys Residential Home provides accommodation for up to 19 older people who need support with their personal care, some people are living with dementia. Accommodation is arranged over two floors. A lift is available to assist people to get to the upper floor. The service has 19 single bedrooms with ensuite toilets. There were 16 people living at the service at the time of our inspection.

A registered manager was in post but was not leading the service on a day to day basis, they were also the registered person. The deputy manager was in day to day charge of the service and was supported by the registered manager and the registered manager of another service owned by the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager did not provide strong leadership to the staff and did not have oversight of all areas of the service. Staff were not always clear about their roles and responsibilities and did not have a clear vision of the aims of the service.

People were treated with dignity and respect most of the time. For example, staff explained the care and support people would receive before they received it and asked them what they would like staff to do and when.

There were enough staff, who knew people well, to meet their needs at all times. The needs of the people had been considered when deciding how many staff were required on each shift.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff were not consistently supported to provide good quality care and support. An effective plan was not in place to keep staff skills up to date and some staff had not completed the refresher training they required. Some staff held recognised qualifications in care. Staff met regularly with the deputy manager to discuss their role and practice and any concerns they had.

Staff knew the signs of possible abuse and were confident to raise concerns they had with senior staff or the local authority safeguarding team. Plans to keep people safe in an emergency required reviewing to make sure that they were effective.

People’s needs had not been assessed to identify the care they required. Care and support was not planned with people and reviewed to keep them safe. Detailed guidance had not been provided to staff about how to provide people’s care. This had a limited impact on the care people received because people’s needs were generally known by staff. Staff said that they were not confident that they all provided people’s care in the same way.

People got the medicines they needed to keep them safe and well. Action was not always taken when people’s health needs changed. People were supported to attend health care appointments and have regular health checks.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Applications had been made to the supervisory body where they were necessary.

Consent to care had been obtained from people. People who had capacity were supported to make decisions and choices. Processes were not in operation to assess if people were able to make decisions. Decisions were made in people’s best interests when they were not able to make the decision themselves. The requirements of the Mental Capacity Act 2005 (MCA) had not been fully met.

Some people chose not to participate in the activities on offer at the service as they did not like them. Action had not been taken to change the activities when people had told the staff they did not enjoy them.

Possible risks to people had not been consistently identified. Action had not always been taken to keep people as safe as possible, such as assessing their moving and handling needs and providing guidance to staff about how to move people safely.

People told us they liked the food Tarrys. They were offered a balanced diet that met their individual needs, including low sugar diets for people who wanted them. A range of foods were on offer to people each day and they were provided with regular drinks to make sure they were hydrated.

People and their representatives were confident to raise concerns and complaints they had about the service with staff and had received a satisfactory response.

Regular checks on the quality of the service people received had not been completed to make sure that it was to the required standard. Shortfalls had not been identified so they could be addressed to prevent them from happening again. People and their representatives had not all been asked about their experiences of the care to improve the service. Views shared with the provider had not been acted on.

The environment was safe, clean and homely. Maintenance and refurbishment plans were in place. Appropriate equipment was provided to support people to remain independent and keep them safe. Safety checks were completed regularly.

Records kept about the care and support people received were not always accurate. For example, one person’s change in mood had not been recorded so it could be monitored.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People that used the service told us they were well looked after. One of them said that some staff were better than others but all said that they were satisfied with the standard of the service provided. One said that, 'The staff are lovely, always cheerful and smiling and happy to help'. This comment was reflected in comments made by both relatives we spoke with.

Relatives we spoke with said that they were confident their relative had been well looked after and that their welfare and safety had been promoted. One relative said that they, 'could not have made a better decision', with regards to the decision to support their relative to be cared for by the service.

We found the service had provided a clean, hygienic and welcoming place to live for those people that used the service. One person that used the service said that the home was, 'always clean and tidy'. This view was shared with us by the relatives and the visiting health care professional that we spoke with.

People who used the service benefited from good practice in relation to the management and administration of medication.

We found that the service listened to and acted on comments they received. A relative we spoke with said that they had recommended the service to others. Another told us that they were happy with the service and that the service had, "Got it right".