Archived: Tarn House

The service was a large home, bigger than most domestic style properties. It did not meet current best practice guidance around people who have a learning disability living in domestic style accommodation. The size of the service having a negative impact on people was mitigated by the home being arranged as two areas where small groups of people lived, and a one bedroom flat one person could use.

We found the following examples of good practice.

Staff followed robust infection prevention and control procedures to prevent people visiting the home from catching and spreading infection. There was clear guidance around social distancing and the symptoms of COVID-19.

Staff checked visitors’ temperatures and visitors were asked to complete a health questionnaire. Visitors were asked to show evidence of a negative Lateral Flow Device COVID-19 test, taken on the day of their visit.

Staff had been imaginative in devising activities for people to follow in the home. Activities were provided to support people’s wellbeing during the pandemic.

Staff had supported people to look forward to life after the pandemic. People had been asked what activities they were looking forward to when restrictions were lifted and supported to plan how they would engage in the activities they chose.

People had been supported to maintain relationships that were important to them. When ‘in person’ visits were not possible, staff supported people to use technology to contact their families and friends. The registered manager supported people to access the community in a safe way when this was permitted.

Staff used appropriate Personal Protective Equipment, (PPE), to protect people from the risk of infection. The staff were trained in Infection Prevention and Control and how to use PPE safely.

The provider followed government guidance on COVID-19 testing of staff. People who lived in the home were supported to test for COVID-19. The provider had accessible information for people about COVID-19 testing and the COVID-19 vaccination programme.

The home was clean and hygienic. Additional cleaning had been introduced, including regular cleaning of frequently touched surfaces.

The registered manager had links with appropriate agencies for advice about protecting people from infection during the pandemic. She followed best practice guidance around supporting people who have a learning disability to ensure people’s safety and wellbeing.

Tarn House provides accommodation and personal care for up to 14 adults who have a learning disability and/or a physical disability. The home provides permanent accommodation for people and short-term respite care.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 14 people. There were 12 people using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the home being arranged as three areas where small groups of people lived, and a one bedroom flat one person could use.

People’s experience of using this service:

People were safe and protected from abuse and avoidable harm. There were enough staff to support people. New staff were checked to ensure they were suitable to work in the home. The staff had completed training in how to support people safely. People were protected from the risk of infection. The registered manager analysed accidents and incidents to ensure lessons were learnt and people were safe.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always or consistently applied them.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support because the design of the building did not promote people’s independence and people could not choose how communal areas of their home were decorated. Some people had also told the registered manager they did not like sharing their home with people attending for short-term respite care. The registered manager was aware of the limitations the building posed. She had taken steps to reduce the impact on people as far as the premises design allowed. She had also audited the service against best practice, including Registering the Right Support, and shared this with the provider for them to consider how the service could be improved.

The staff were competent and skilled to provide people’s care. They completed training to meet people’s needs including training in the Mental Capacity Act 2005 and how to respect people’s rights. 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.

People were supported to prepare their meals and drinks and to make healthy eating choices. People’s needs were assessed and appropriate services were included in providing their care to ensure they maintained good health.

People were treated with kindness and respect. Despite the limitations posed by the design of the building they were supported to gain independence and skills of daily living. People were asked for their views about their care. The staff knew people well and gave prompt support if they were anxious.

Care was planned and provided to meet people’s needs. People were supported to maintain relationships that were important to them. They followed a range of activities they enjoyed and were active participants in their community. The provider had a procedure for responding to complaints about the service.

People were involved in all aspects of their care and received high-quality, person-centred care that met their needs and promoted their rights. The registered manager was very experienced and aware of her responsibilities. She and the staff were committed to providing people with a high-quality service. People who used the service, their families and staff were asked for their views and their feedback was used to improve the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated good (published 6 June 2017).

Why we inspected: We carried out this inspection based on the previous rating of the service.

Follow up: We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received, we may inspect sooner.

Tarn House provides accommodation and personal care for up to 14 adults who have a learning disability and/or a physical disability. The home is two storey and divided into four units called, Hill View, Sea View, Greenland and Beachwood. Hill View, Greenland and Beachwood units each have a lounge and a separate kitchen with dining area. Sea View is a self-contained flat that one person, able to live with greater independence, could use. There are two fenced garden areas and ample car parking. Tarn House provides permanent accommodation for people and short-term respite care.

There was a registered manager employed in the home. 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.

Our last comprehensive inspection of this home was carried out 15 January 2016. At that inspection we found that the registered provider was meeting the regulations that we assessed. However, we identified areas of the service that required improvement and made recommendations about maintaining the hygiene standards in the home and about improving the environment to promote people’s independence.

When we carried out this comprehensive inspection in March 2017 we saw that the standards of hygiene in the home had improved. We also found that improvements had been made to the environment. Although the premises were based on an outdated model of care, the registered manager had arranged for improvements to be made to the décor and accommodation to provide a more homely feel to the service.

However, there were still aspects of the environment that placed limits on how people’s independence could be promoted and there were areas of the home that were not accessible to people who used a wheelchair. People who lived in the home did not raise any concerns about the environment. They told us they liked living at Tarn House and said it was, “A good place to live”.

People were safe in the home and were protected from the risk of abuse and avoidable harm. They were supported to access appropriate health care services to maintain their health. Medicines were handled safely and people received their medicines as their doctors had prescribed.

There were enough staff to support people. The staff knew people well and treated people in a kind and caring way. People received reassurance and support promptly from the staff in the home and their wellbeing was supported.

People were included in agreeing to the support they received and care was planned and provided to meet people’s needs. The principles of the Mental Capacity Act 2005 were followed and people’s rights were protected. 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.

The staff were trained and supported to provide a high standard of care. The atmosphere in the home was friendly, open and inclusive. People were asked for their views and had been included in planning improvements to the environment.

People were provided with a range of activities that they enjoyed and that took account of their interests and preferences. People enjoyed the meals provided in the home and were supported to make meals and drinks for themselves.

The home was well managed. The registered manager and registered provider carried out checks on the service and had made improvements to the environment and décor to provide a more homely place for people to live.

The registered provider had a procedure for receiving and managing complaints about the service. People were confident that action would be taken in response to any concerns they raised.

As part of our regulatory activity we found that the provider for the service was not registered correctly. We discussed this with Cumbria County Council and they submitted an application to correct their registration details. We carried out an assessment of Tarn House in October 2015 as part of the county council’s registration application. We judged that the service was likely to be safe, effective, caring, responsive and well-led.

Tarn House provides accommodation and personal care for up to 14 adults who have a learning disability and/or a physical disability. The home is two storey and divided into four units called, Hill View, Sea View, Greenland and Beachwood. Each of the units has a lounge and a separate kitchen with dining area. There are two fenced garden areas and ample car parking. Tarn House provides permanent accommodation for people and also short term respite care.

There was a registered manager employed in the home. 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 told us that they felt safe living at Tarn House and told us that they made choices about their lives. Throughout our inspection we saw that people were treated in a kind and caring way that promoted their wellbeing.

There were enough staff to provide the support people needed. The registered manager adjusted staffing levels as required to ensure that people received the care they required.

Tarn House is an older building and we found that some areas of the premises were in need of repair and there were areas which were difficult to clean thoroughly.

Where areas in the home had been recently redecorated, people were provided with comfortable and homely accommodation.

The registered manager and care staff tried to support people to increase their independence, however the premises were institutional and the design and environment placed restrictions on how effectively this could be achieved.

The focus of the service was on promoting people’s rights. People were included in planning their own care and in making decisions about their lives.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards, (DoLS). People’s rights were protected because the principles of the MCA had been followed.

Staff were well trained and supported in their roles. The staff knew the people they were supporting and how they wanted their care to be provided.

The registered manager worked with care staff supporting people and offering guidance. He maintained good oversight of the service and quality of care. Although we identified areas where the service needed to improve, these had already been identified by the registered manager and he had developed an action plan to address the issues which were within his control.

We have made a recommendation about maintaining hygiene standards in the home.

We have made a recommendation that the registered provider seeks advice about improving the environment.