Tamara House

We found the following examples of good practice.

There had been an outbreak of COVID-19 at the service. During this time the manager had communicated with people, staff and families regularly to ensure everyone understood the measures put in place to help keep people safe.

Management, activity and administrative staff provided care to ensure there were enough staff on duty to cover for absences, due to staff having to self-isolate. Care staff also covered extra shifts and as a result agency staff had not been used. The provider paid staff double time when working during the outbreak in recognition of their commitment to supporting the service throughout this difficult period, which had coincided with the Christmas and New Year holidays.

Personal protective equipment (PPE) was available to all staff and visitors. Visiting was taking place according to current government guidance.

Staff and people living at the service were regularly tested for COVID-19 and the service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19.

We spoke with three relatives about the visiting arrangements and staffing levels. Comments included, “The days I am able to visit vary each week and often I ask to visit at short notice, but they always accommodate a time that suits me. I have never been refused a visit and on one occasion I only gave 15 minutes notice of my request to visit”, “I visit every day and staff keep me informed if they are any changes to {person’s] health”, “There always seems to be enough staff, I have no concerns about staffing levels.”

A few days before our visit NHS commissioners had carried out a check of the home’s infection control procedures and had not found any concerns. A recommendation from that visit, to provide wall mounted alcohol-based hand rub pumps in the stairway for staff to use after touching door and keypad, had been actioned.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised. A recommendation made at a previous inspection about cleaning staff working at weekends had been actioned. There were now cleaning shifts for six hours on both Saturday and Sunday.

Tamara House is a residential care home that provides care and accommodation for up to 29 older people, some of whom are living with dementia. At the time of the inspection there were 24 people living in the service.

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

We had received information of concern that there were not always sufficient staff on duty on every shift. The service had been suffering from the challenges being felt across the sector, with difficulty recruiting new staff. We found there had been shifts when there had been only two staff on duty due to short notice sickness absence. The provider assured us, and staff confirmed, that during such occurrences a third staff member was bought in to support the shift as soon as possible.

Staff told us, “I like working here. Yes, there have been difficult times and still is with staffing but we sort of support each other," "It's OK but we are really short staff sometimes" and “It has been disruptive when the previous manager left. I hope the new manager is a good one.”

There had been many changes to the management team, with the manager leaving recently, then the acting manager leaving a few days after this inspection. There was no registered manger in post at the time of this inspection. The provider advised us that a new manager was due to join the service in February 2022. The administrator was providing some oversight of the service during this period and was present in the service during the week.

The providers and registered manager of a sister home had all been abroad on holiday together prior to this inspection. They were awaiting confirmation of negative PCR tests and were unable to physically attend the service to provide support. We spoke with them throughout this inspection via a video conference.

People told us they were happy with the care they received and believed the service was safe. Comments included, "Yes they come whenever I need them and they pop in to check I'm OK" and "I wasn’t looking forward coming into a care home, but I needn't have worried. All the staff are so kind and helpful. Nothing is too much trouble."

Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

There were clear records to show, when assessed as needed, staff were monitoring specific health needs such as people’s weight, nutrition and hydration and skin care. Any changes in people’s health were escalated to the relevant professional and relatives were kept informed.

The electronic medicines system supported staff to manage medicines administration safely. Staff received suitable training. People received their medicines on time.

We had received concerns that some areas of the service were not clean. At this inspection we found the premises were clean and well maintained.

We received concerns that people were not always given a choice about when they got up or went to bed. We checked this with some people and staff. Staff comments included, “Nobody gets up or goes to bed if they don’t want to. I know we are short staffed at times, but it really is run for the residents. Some like to get up earlier and go to bed earlier but it’s their choice.” and “There are a few residents who like to get up around 6am. A few regulars that like to go up around 6pm to their rooms. Staffing levels have not decreased choice in this respect.”

People had access to equipment where needed. However, one person was awaiting a specialised hoist to support them. Pictorial signage was in place to help orientate people living with dementia to areas of the service. Red meal plates were also in use to support people’s independence at meal times.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. However, at the time of this inspection there was no cleaner on duty at the weekends. Staffing levels at weekends had been low and so staff did not always have time to ensure all high contact points and communal areas were cleaned in line with COVID-19 guidance. The provider assured us this would be addressed immediately.

Visiting was taking place in line with current government guidance.

People, their relatives and staff had not been asked for feedback on the service’s performance since our last inspection in March 2021. We were assured this was planned in the near future. There was a stable staff team who knew people well and worked together to help ensure people received a good service.

People and staff told us the management team were approachable and listened when any concerns or ideas were raised.

Staff worked well with external healthcare professionals such as GP’s and district nurses.

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 overall good. (Report published 11 November 2021). An inspection was carried out in March 2020 looking just at the key question of safe only and this inspection was not rated. At this inspection the rating for this service remains the same.

Why we inspected

We received concerns in relation to the management of the service, the quality of care provided and the cleanliness and safety of the environment. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

Follow up

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

Tamara House is a residential care home that provides care and accommodation for up to 29 older people, some of whom are living with dementia. At the time of the inspection there were 27 people living in the service. Accommodation is arranged over two floors, there are stairs and a lift to get to the upper floors. Bedrooms have en- suite bathrooms and there are also shared toilets, bathrooms and shower facilities. On the ground floor there is a large dining and living area and access to a patio garden.

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

Some people living at the service were identified as being at risk of falling and there were effective systems in place to manage each person’s individual risks. Management and staff understood the balance between keeping people safe from the risk of harm and injury, due to falling, and enabling people to make informed choices about taking risks.

Advice was sought from appropriate external healthcare professionals about how to reduce the risk of harm for people who had fallen. This included seeking medical attention, in a timely manner, when people were injured from a fall or a suspected medical condition might be the cause of the fall.

However, care records did not always reflect the knowledge staff had about people’s risk levels and the actions staff were taking to help reduce the risk of harm. We have made a recommendation about care records.

Accidents and incidents were recorded and analysed. Falls audits were completed to identify trends. However, these audits did not include any details about the location and day falls took place, which would help to further identify actions that might need to be taken. We have made a recommendation about analysing data.

There were enough staff on duty to meet people’s needs Monday to Friday. However, at weekends care staff had less time to spend with people because domestic and activity staff did not work on these days. Following our visit, the registered manager sent us new rotas that showed domestic and activity staff would be on duty seven days a week.

During our inspection we saw staff were responsive to requests for assistance and recognised when people needed support. One person told us, "I am happy living here and staff are always around to help when I need them."

The premises were clean and well maintained. Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. During our inspection we discussed the lack of domestic staff on duty at weekends and the registered manager made changes to remedy this.

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 good. (Report published on 12 November 2020).

Why we inspected

We undertook this targeted inspection to check concerns raised about the service in relation to falls management and staffing levels.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the Safe section of this report.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

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

Tamara House is a residential care home that provides care and accommodation for up to 29 older people, some of whom are living with dementia. At the time of the inspection there were 29 people living in the service. Accommodation is arranged over two floors, there are stairs and a lift to get to the upper floors. Bedrooms have en- suite bathrooms and there are also shared toilets, bathrooms and shower facilities. On the ground floor there is a large dining and living area and access to a patio garden.

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

There was a relaxed and friendly atmosphere at the service. People told us they were happy with the care they received and believed the service was a safe place to live. People and relatives were positive about staff and told us about their caring attitude, and how they treated people with kindness and compassion. Comments included, “Very kind, caring and genuinely keen to provide the best possible care to the residents”, "They all do a great job" and "It's a very nice place."

Management and staff were open to advice from healthcare professionals and willing to learn when things went wrong. For example, working with the local district nurse team to gain greater knowledge of understanding of how to recognise the early signs of people developing pressure ulcers and make referrals in a timely manner. This partnership working had resulted in improved outcomes for people’s health.

Records of people's care were individualised and detailed their needs and preferences. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

There were clear records to show, when assessed as needed, staff were monitoring specific health needs such as people’s weight, nutrition and hydration and skin care. Any changes in people’s health were escalated to the relevant professional and relatives were kept informed.

The medicines system was well organised, and staff received suitable training. People received their medicines on time.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activity with staff. Staff knew how to keep people safe from harm.

The premises were clean and well maintained. People had access to equipment where needed. Since the last inspection extensive work to upgrade and improve the premises had taken place and was still on-going. These improvements included re-decoration, new carpets and flooring, therapy rooms and a cinema room. Each wing of the premises had been decorated with a specific theme and signage to help people living with dementia to orientate around the home.

Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. During the summer months some families had met people in the garden and new arrangements were being set up for families to meet in a safe area of the home during the winter months.

People, their relatives and staff were regularly asked for feedback on the service’s performance. There was a stable staff team who knew people well and worked together to help ensure people received a good service. People, their relatives and staff told us the management were approachable and listened when any concerns or ideas were raised.

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 overall good. (Report published on 4 December 2017). The safe key question was rated as requires improvement because we identified the need for some improvements.

Why we inspected

We received concerns in relation to the management of the service, the quality of care provided and the cleanliness and safety of the environment. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good and the safe key question has improved to good. 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 Tamara House on our website at www.cqc.org.uk.

Follow up

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

There was a registered manager in post. 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.

Some of the people who lived in the home had limited communication therefore we spent time observing some people. Other people were able to tell us their experiences of living in Tamara House.

At the last inspection, on the 27 and 28 April 2016 the service was rated Good overall. We carried out this inspection because we had received information of concern. This information stated safeguarding issues were not always being investigated or reported to the local authority and CQC as required. Concerns also included allegations that people who had fallen did not receive prompt medical assistance; people were being put to bed fully dressed and without suitable night attire and that medicines, in particular medicines that required additional security, were left in the kitchen for night staff, who hadn’t received the necessary training, to administer. The information of concern stated that staff were unable to access food and drink from the kitchen overnight, which meant people who required or requested additional food and drinks were unable to have any. We heard there could be a lack of infection control management, possibly soiled sheets being put through a normal wash, at normal temperature and being placed back on people’s beds unclean; also that the kitchen was unclean, with dead flies left lying around and people not having water jugs in their bedrooms. Concerns were raised that call bells were not left within people’s reach to call staff for assistance, staff not receiving adequate training and commencing work without completed security checks in place; and staff working extra hours due to shortages of staff.

In response to these concerns we undertook a focused inspection on the 13 September and changed this to a comprehensive inspection and visited on the 18 and 19 October as we needed additional information to assure ourselves that people remained safe.

We spoke to the local authority safeguarding team as this information/complaint had been forwarded to them as a safeguarding alert and we requested the outcome of their investigation. They confirmed they had visited the service and reviewed some care plans for people. They were satisfied the care plans held relevant information including completed risk assessments and evidence of referrals to appropriate healthcare professionals when needed. The safeguarding lead confirmed they had met with the provider and registered manager and concluded the meeting was open and transparent. They stated they were reassured over the concerns raised. For example they felt reassured that people were able to obtain food and fluids at any time, the premises were clean and people remained safe.

On the first evening of our inspection there was a potential risk to people in the event of a fire. This was because there was no information given to staff, who were not completely familiar with the service, relating to the fire processes and procedures of the home. However both care workers were experienced in care and one of them stated they knew people well enough to know how they would need to be supported in an emergency.

During the next inspection on 18 and 19 October, the registered manager, who had not been available during the focussed inspection explained night of 13 September, had been an emergency situation and rather than use agency staff who did not know the service, they had used someone who had worked there previously alongside a new but experienced carer. There was a senior staff member available on call if required which the staff members knew about. The registered manager and staff confirmed that no one currently living in the service required the assistance of two members of staff at night. New staff have now been employed and had completed fire safety training, as required. However there was no process that ensured staff who had not worked in the home before would know the fire procedures and processes.

On the follow up visits, on the 18 and 19 October 2017 staff spoken to on these visits all confirmed they had completed fire safety training and understood and where able to locate the emergency evacuation procedures for people. The training matrix recorded training staff had completed.

People’s medicines were stored safely and securely, including those which legally required additional storage. Medicines were stored in locked trolleys secured to the wall in the main office. People received their medicines safely however not all medicines records had been signed. There was errors in the recording of medicines that required additional security and they had not been investigated. The registered manager took immediate action to investigate the error during the inspection and changed procedures to ensure safe practice on medicines.

At the inspection of the 18 and 19 October we looked at staff rotas and the needs of people currently living in the service. We found the registered manager had taken action to address the issues over staffing levels. We found the service had sufficient staff to meet people’s needs. People, staff, relatives and professionals all agreed the service had sufficient staff on duty.

One relative said; “Mum is safer here than at home on her own.” While another said; “Oh definitely safe here! Cannot fault anything about their care.” One person said; “Excellent place. Safe and that’s because of the staff here.”

People were protected by safe recruitment procedures. People were protected from harm as staff had completed safeguarding training. Staff understood how to report any concerns and what action they would take to protect people. Staff told us they felt confident any incidents or allegations would be fully investigated.

People continued to receive effective care and support from a staff team who were knowledgeable and had the skills required to effectively support them. Staff were competent and trained well. People had the support needed to help them have maximum choice and control of their lives and staff supported people in the least restrictive way possible. Policies and systems in the service supported good practice. People's wellbeing and healthcare needs were monitored by the staff and people accessed healthcare professionals when required.

People all agreed that the staff team were very caring. We observed staff being patient and kind. There was a happy relaxed atmosphere in the service. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received. One person said; “Very very happy here. The staff are wonderful and we have a great time.” A relative said; “Very pleased with mums care.”

The staff team remained responsive to people's individual needs. Personalised care and support was provided to each person to help ensure people were able to make choices about their day to day lives. Complaints were fully investigated and responded to. A relative said; “Never had any complaints. Lovely place.”

People were supported to take part in a range of activities according to their individual interests. A designated activities co-ordinator was employed to arrange activities that people enjoyed. Trips out were also being planned for people.

The service continued to be well led. People and staff told us the registered manager was approachable and made themselves available. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Accommodation is arranged over two floors, there are stairs and a lift to get to the upper floors. The home has 26 en- suite bedrooms, 25 of which have their own shower. There are also shared toilets, bathrooms and shower facilities. On the ground floor there is a large dining and living area and access to a patio garden.

The service had a registered manager in post. 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 22 December 2014, we asked the provider to take action to make improvements to the accuracy of their care records and to the way they assessed and monitored the quality of the service. In addition, they did not have a registered manager in place. The provider sent us an action plan which explained how they would address the breaches of regulations. During this inspection we found these issues had been fully addressed.

People were relaxed and comfortable at the service. People told us they were happy at the service and with how their needs were being met. We observed positive and caring interactions between people and staff.

Care records were detailed and personalised to meet people’s needs. People were involved as much as possible in their care planning. People’s risks were monitored and managed well.

People had their medicines managed safely and received their medicines as prescribed. People were supported to maintain good health through regular access to health and social care professionals such as GPs and speech and language therapists.

People were kept safe from discrimination and abuse. Staff had undertaken training on safeguarding adults. They demonstrated a good knowledge of how to report and describe what action they would take to protect people from harm.

People had their needs met by staff who were trained and had the correct skills to carry out their roles effectively. Safe infection control practices were followed.

People were kept safe by suitable numbers of staff who had been safely recruited to their roles.

People were encourages to live active lives. Activities were meaningful and reflected people’s individual preferences and interests.

People were supported to maintain a healthy and balanced diet. People enjoyed the meals offered and had access to drinks and snacks as they wished. People were involved in planning the menus.

There was a system in place to receive, investigate and manage complaints and people and relatives said they felt confident to raise concerns if necessary.

People spoke highly of the registered manager and said they were approachable and took an active role in running the service.

There was an effective quality assurance system in place to monitor the service and to drive improvements.

This is a summary of what we found-

Before our inspection we received some anonymous information of concern about the service. The areas of concerns related to staffing numbers on afternoon shifts, staff training and the induction process for new staff. As part of our inspection we looked at the concerns which had been raised.

Is the service safe?

At the time of our inspection we did not find the service to be safe.

There were not enough qualified, skilled and experienced staff to meet people's needs. We looked at the home's care rota for the month of July 2014 and found that the number of care staff did not consistently meet the provider's own required staffing levels. We were concerned to find that the numbers of care staff working at the weekend was particularly poor.

People we spoke with who lived at Tamara House told as that they did not feel there were enough staff. People shared their experiences and observations with us which included people receiving a delay in their call bells being answered, a delay in their breakfast being served and support with care.

Is the service effective?

At the time of our inspection we did not find the service to be effective.

People's health and care needs were assessed and individual care plans were in place to guide and direct staff to meet a person's health and social care needs. However, improvement was required as care plans did not always give clear direction and guidance to staff about how to meet a person's care needs.

People were cared for by staff who were not supported to deliver care and treatment safely and to an appropriate standard. We saw from the provider's training records that some staff had not received training relating to their role. It was a concern given staffing shortages that rotas could be effectively managed to ensure staff working on each shift held the necessary skills.

There was a system in place to provide staff with supervision. Supervision is a formal process to help discuss working practices and addresses any improvements or ongoing training that may be required. Supervision processes were in place at Tamara; however, we saw from documentation that it was difficult to establish the frequency of when supervision was carried out. The administration of supervision documents was chaotic.

Is the service caring?

At the time of this inspection we did not find the service to be caring.

We observed good interactions from staff when speaking with people and supporting them.

People we spoke with told us they were generally happy living at Tamara House. Comments included, 'I'm looked after alright', 'on the whole very good 'and 'The staff are very good what we got, they can't always do what they would like to do'.

We spoke with people about the staff who supported them, although people told us they were happy and felt safe living at Tamara House, some comments included 'I know they are busy, some of them have awkward tones', 'some of them are lovely, they get their off days' and 'they are all very good, they do what they can'.

People told us that the lack of staff was impacting on the care that they received.

Is the service responsive?

At the time of our inspection we did not find the service to be responsive.

We spoke with people about whether staff came promptly when they rang their call bell. One person told us, 'When you want something they sometimes take a while to get it'. Another person told us, 'They're supposed to come up within five minutes to see if you are all right, but it doesn't happen very often'. One person told us they were concerned that they did not have access to a call bell in the communal lounge.

The provider had a policy in place to manage complaints.

We saw from the complaints folder that a recent complaint had been raised by a relative; we looked at the associated documentation which showed the complaint had been responded to promptly and dealt with effectively by the management of the home. This demonstrated people had their comments and complaints listened to and acted on.

We were told that complaints were discussed as part of residents' meetings; this demonstrated that the provider valued people's feedback and was willing to listen to positive and critical comments about the quality of the service delivered at Tamara House. One person who lived at Tamara House told us, 'If things aren't right, I tell them how it is'.

Is the service well-led?

At the time of our inspection we did not find the service to be well-led.

The provider had systems in place to monitor the quality of the service being provided, however, these systems were not always effective in identifying areas which required improvement.

The manager who had been registered with the Care Quality Commission had recently resigned.

It is a requirement of the Health and Social Care Act 2008 that providers inform us of particular incidents when they occur. We found that the provider had been informing us of incidents; however, they had failed to report to us the impact of staffing at the home.

Staff we spoke with told us they felt 'supported' however, we received comments that 'management could be more supportive'.

Not everyone was able to tell us their experiences of living in the home or if they felt safe. However from our observations on the day of our visit, people appeared happy and at ease in the home. One person we spoke with was able to tell us they felt safe living in the home and with the staff.

There were suitable safe storage facilities for medication including storage for medication which required refrigeration.

Throughout the day we saw that staff were competent and cheerful. There was a relaxed atmosphere and everyone had opportunities to take part in activities according to their abilities and interests.

The home carried out an annual quality survey inviting the people who used the service, relatives and other professionals to respond to a questionnaire. They reviewed the quality of service through a monthly audit of the cleanliness of the home, medication, maintenance, and equipment used.

There were fifteen people living at Tamara house on the day of our visit. We spoke with nine people who lived at Tamara House. We also spoke with the registered manager, catering manager and six staff members.

We saw that people were offered choices about how their care was delivered and how they spent their time. We observed staff being kind and respectful. One person told us, 'it's very nice here' and another 'staff look after me pretty well'.

The care plans were detailed so that staff had enough information to support people to meet their needs in the way that people chose.

People we spoke with were very complimentary about the meals they had. One person we spoke with after lunch told us 'The food is very good ' I can't grumble at all'. People's care records demonstrated a comprehensive assessment of people's needs.

People told us that they did not have to wait too long for their call bells to be answered and that people were supported with their personal care.

We found staff were not consulting and encouraging people who were confused or had memory loss.

We found care plans were not up to date so necessary changes were not being made to ensure the person was receiving safe and appropriate care and support.

We found people using this service were not always protected from the risk of abuse because staff were not identifying possible abuse and taking measures to prevent it from happening or recurring.

We found there were inadequate systems to assess and monitor the service that people received, or to identify, assess and manage risks to people's health, safety and welfare.