Tarry Hill

About the service

Tarry Hill is a residential care home providing accommodation and personal care to 13 people at the time of the inspection. The service can support up to 26 people. There are five separate homes within Tarry Hill, each with separate entrances with a shared outdoor terrace area at the front of the homes and access to garden areas.

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

When people were supported to take their medicines, the records did not always include all the information required, such as what time people had taken medicines and when to take medicines only required in certain circumstances. Risks to people’s safety were assessed and reviewed but the most recent reviews were not always included in people’s care plans.

There were enough staff on duty to meet people’s needs and ensure people received their care as agreed. Safeguarding processes were in place and staff told us they would feel confident to recognise and report concerns of abuse if they saw this.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People’s individual needs, preferences, beliefs and lifestyle choices were known, valued and respected.

People were supported by staff who were kind and caring. Staff knew people well and ensured people’s privacy, dignity and independence were promoted. Staff communicated effectively with people. Relatives were involved in care planning and delivery.

There were governance and audit systems in place to capture and address any issues that required improvements. The provider and registered manager had demonstrated a continued commitment to ensuring people achieved the best outcomes and quality of life for them. Relatives, staff and external professionals spoke highly of the drive, passion and knowledge of the registered manager and the person-centred culture they had created.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 1 October 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

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

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 www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Tarry Hill is a care home in the New Mills area of Derbyshire. The home is made up of five separate houses in one communal setting. The home is registered to care for up to 26 younger adults and people with learning disabilities and autistic spectrum disorder and older people. At the time of the inspection there were 18 people living there.

The service had been developed and designed before the principles and values that underpin Registering the Right Support had been published. This guidance aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service was larger than current best practice guidance.

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

The service was not safe. People were subject to excessive control and restraint. Staff and managers had not recognised and taken action in relation to safeguarding incidents and potentially abusive practices. The use of physical intervention and restraint was not assessed or planned for and staff did not have appropriate training to enable them to perform physical intervention safely. Staff had been harmed as a result of poor behaviour management. Opportunities to learn from adverse incidents had been missed.

Environmental risks were not managed safely and the environment was not clean and hygienic. Medicines were not always safely managed resulting in some people getting too much or too little medicine. There were not always enough staff to ensure people’s safety in the event of an incident. Safe recruitment practices were followed.

People’s rights under the Mental Capacity Act were not upheld. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Staff had not received the training they needed to complete their role safely and effectively. People’s support was not always provided in accordance with national standards or good practice. The environment was adapted to meet people’s needs.

People were not always treated in a dignified way. Feedback about the approach of staff was mixed. There was a lack of consistency in the quality of support people received. Several staff expressed concern about some people’s wellbeing and told us they were unable to provide appropriate support to some people. The approach to promoting people’s independence was inconsistent. People and their relatives had been involved in developing parts of their support plans.

People did not consistently receive personalised care that met their needs. People were not always provided with opportunity for meaningful activity. There were systems to manage complaints but some relatives told us they had to chase up a response to their complaints or concerns.

Tarry Hill was not well led. The provider did not have effective oversight of the home. Consequently, there had been a failure to identify and address serious issues with the safety and quality of the service. Systems to monitor and improve the quality of the service were not effective. Where audits had identified areas for improvement, action had not been taken to address issues. The provider had not implemented learning from serious incidents. Failings in leadership and governance placed people at risk of harm. The provider was not always open and transparent and did not always meet the duty of candour.

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 Requires Improvement (published November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to gaining person centred care, dignity and respect, consent, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staff training.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This inspection visit took place on 10 October 2018 and was unannounced. It was completed by one inspector, an assistant inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Tarry Hill is set on a large communal site which includes supported living units. This home was registered before the introduction of Registering the Right Support; however, the service aims to adhere to the values set out as best practice. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The 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.

Tarry Hill is five small homes set on one communal site. Each home was independent with their own communal spaces, kitchen and bedrooms for each person. There was a registered manager at this location. 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.’

When people had been identified as being at risk, assessments had not always been completed to provide the details and guidance required. People were not always protected from the risk of infection in relation to cleaning schedules and the use of personal protective equipment. We have made a recommendation in relation to the risk assessments and support people from other associated risks. Medicines were not always managed safely when people required as required medicine or medicine for a specific condition.

The staff were provided to meet the commissioned needs of individuals. However, when new agency staff had been employed to support people they were not given an induction or clear direction for their role in supporting people.

The provider had completed audits in relation to the ongoing improvement however these were not always effective. Notifications had not always been completed in relation to events. People had been encouraged to voice their feedback, however there was no formal process and areas identified in the past had not been addressed.

Staff had received skills to support people’s individual needs. Training was ongoing and new initiatives were being developed. People’s nutritional needs had been met and specific diets observed and supported.

Health care professionals had been regularly consulted to support people to achieve better outcomes for their health care and wellbeing. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The provider worked with a range of internal and external healthcare professionals. They also worked in partnership with a range of organisations.

Staff had established positive relationships with people and knew people well. Staff showed kindness and compassion when delivering care. People’s dignity had been respected.

Care plans for people reflected a lot of detail and included people’s preferences. These included their communications methods and any cultural requirements. People enjoyed activities of their choice.

Complaints had been responded to. People were protected from harm and lessons had been learnt from events to drive improvements in this area. Staff and professionals were positive about the management changes within the home. Partnerships had been developed with a range of professionals to support people’s health had wellbeing.