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Tarry Hill Requires improvement

The provider of this service changed - see old profile

Inspection Summary

Overall summary & rating

Requires improvement

Updated 2 October 2020

About the service

Tarry Hill is a residential care home providing accommodation and personal care to 17 people at the time of the inspection. The service is registered to support up to 26 older people and younger adults with a learning disability or autistic spectrum disorder.

The service is set out over five mews style houses behind a locked gate. The service had been developed before the principles and values that underpin Registering the Right Support were published. This is guidance that aims to ensure people using a service can live as full life as possible and achieve the best possible outcomes that include choice, control and independence.

Tarry Hill is larger than current best practice guidelines dictate and is a campus style setting with five houses in close proximity and staff regularly coming and going between each house to complete tasks. The outcomes for people did not fully reflect the values and principles of Registering the Right Support because they lacked independence.

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

Information about risks to people’s safety were not always up to date or clear. Management plans did not always meet current national guidance around the prevention and control of infection in relation to Covid-19. The provider did not always follow relevant national guidance around the administration and recording of medicines. When things had gone wrong, reviews were conducted but did not always identify areas for improvement. The provider had not always spoken with all relevant external professionals regarding people’s care needs.

The registered provider had not taken responsibility for ensuring staff were suitably trained. The physical environment was not adapted to a consistent standard to meet people’s needs. The systems and processes the provider used to assess the safety and quality of the care people received were not effective.

Peoples relatives, staff and external professionals all told us the registered manager had been a positive influence on the service and the culture had improved in time she had been employed. Since the last inspection the registered manager had implemented improvements and restraint, seclusion and segregation were now only used as a last resort. The registered manager adhered to improvement plans suggested by safeguarding professionals.

Some improvements had been implemented since the last inspection, however, some were yet to be fully embedded and further improvements were still required.

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. People exercised choice over their food and drink options and were supported to eat and drink what they wanted.

Rating at last inspection (and update)

The last rating for this service was Inadequate (published December 2019) and the service was placed in special measures. At this inspection enough improvement had not been made or sustained and the provider was still in breach of some regulations, however the rating had improved and therefore the service was no longer in special measures.

Why we inspected

This was a planned focused inspection to follow up on breaches in the previous inspection report. This report only covers findings in the Safe, Effective and Well-led key questions. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tarry Hill on our website at


We are mindful of the impact of the COVID-19 pandem

Inspection areas


Requires improvement

Updated 2 October 2020

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 2 October 2020

The service was not always effective.

Details are in our effective findings below.


Requires improvement

Updated 2 October 2020


Requires improvement

Updated 2 October 2020


Requires improvement

Updated 2 October 2020

The service was not always well-led.

Details are in our well-Led findings below.