Tamar House Nursing Home

Updated 26 November 2022

Inspection team

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector

Service and service type

Tamar House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a manager registered in post. However, the manager was in the process of applying to CQC to become the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed information we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

We reviewed two people's care plans and risk assessments. We reviewed staff training and supervision. We also reviewed other records relating to the management of the service. We spoke with six people and one relative. We also spoke with seven staff including the manager and the provider’s representative.

Updated 26 November 2022

About the service

Tamar House Nursing Home is a residential care home providing personal and nursing care to up to 21 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 17 people using the service.

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

Medicine records were not always accurate. Medicines that required stricter controls were not managed and recorded according to legal requirements. The manager took immediate action to audit these medicines and correct the records.

Some people living at the service were cared for in bed due to their health care needs. These people had been assessed as requiring pressure relieving mattresses to help ensure they did not develop pressure damage to their skin. Air filled pressure relieving mattresses were not always set correctly for the people using them. There was no process in place to ensure staff checked these regularly. This was put in place immediately by the manager.

The service did not have a permanent nurse who worked during the day. This post was being covered by agency staff. Whilst the agency staff were mostly consistent there was little continuity of practice regarding medicines management. The manager told us they had appointed a permanent nurse who was due to commence their post in December.

People told us they were happy with the care they received, and people said they felt safe living there. Comments from people included, “Staff always knock and pop in to see me when they are passing by, they always ask if I am ok,” “The staff are funny, lots of great banter, they are very nice” and “Staff are quick at answering the bell.”

People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

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 were supported by sufficient numbers of staff to meet their needs. New staff had completed an induction into their role. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and there was a designated activities staff member to assist people. Staff knew how to keep people safe from harm.

Staff received appropriate training and support to enable them to carry out their role safely, including nutritional support and dementia care.

The environment was safe, with re-carpeting and re-decoration ongoing. People had access to equipment where needed.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified.

People were involved in make meal choice and staff encouraged them to eat a well-balanced diet. The kitchen was due for upgrading but all equipment was in working order and the cook was able to provide freshly cooked meals from scratch for people. The cook was aware of people’s specific dietary requirements. Comments included, “I like the food,” “Plenty to eat and drink,” “Good food” and “Sunday dinner is very good, and we get that twice a week.” We heard on staff member offering many options to one person who had changed their mind about what they wanted to eat for lunch.

Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service.

Staff told us the manager and the provider of the service were available and assisted them daily. They went onto say how they were approachable and listened when any concerns or ideas were raised. Staff comments included, “(Provider’s name and manager’s name) are really good.” “I would be really happy for a loved one of mine to be cared for here” and “One of the best homes I have worked in.”

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.

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

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (21 February 2022).

At our last inspection we found breaches of the regulations in relation to care provision and deployment of staff, infection control, governance and staff training. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider had made some improvement but remained in breach of regulations. We have made a recommendation regarding the implementation of the Mental Capacity act in the Effective section of this report.

Why we inspected

We received concerns in relation to the availability of Personal Protective Equipment (PPE), the environment, records and staff culture. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

The overall rating for the service has not changed following this inspection.

We have found evidence that the provider needs to make improvements. We have identified a breach of the regulation in relation to the safe management and administration of medicines and the monitoring of pressure relieving mattresses.

We found no evidence during this inspection that people were at risk of harm from the concerns identified at this inspection. Please see the safe, effective and well-led sections of this full report.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tamar House Nursing Home on our website at www.cqc.org.uk

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.