Archived: Tarrys Residential Home Limited

Updated 2 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14 and 15 March 2018 and was unannounced.

The inspection team consisted of two inspectors 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. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Before the inspection we reviewed the information about the service the provider had sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We looked at complaints we had received and notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.

We looked at four people’s care and support records, associated risk assessments and medicine records. We looked at management records including three staff recruitment, training and support records and staff meeting minutes. We observed people spending time with staff. We spoke with the provider, the registered manager, the manager, seven staff, and 17 people who use the service and their relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 2 May 2018

This inspection took place on 14 and 15 March 2018 and was unannounced.

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.