Archived: Tarry Hill

Tarry Hill is registered to provide personal care for up to 26 people, which may include some people living with learning disabilities. This inspection was unannounced and took place on 12 July 2016. At the time of our inspection there were 13 people living there.

The service did not have a registered manager. 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. The manager had applied to CQC for registration.

There was sufficient trained staff to meet people’s needs and wishes. However some staff worked long hours and there was no system in place to ensure this working pattern did not have a detrimental effect on people or staff.

During our inspection visit we observed that staff were friendly and approachable. They spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual needs and which supported them in a respectful and appropriate way.

There were training and processes in place for staff to follow to keep people safe and staff followed these. People’s physical and mental health was promoted. Staff were trained to care for people living with learning disabilities. Medicines were stored appropriately and were administered and recorded as prescribed.

We saw staff ensured people were stimulated and had a varied social life and had the opportunity to pursue their hobbies. We saw people were supported in a relaxed and unhurried manner. Staff were caring and communicated well with people. People were offered a variety of healthy food and drinks.

There was sufficient staff to care for people and they focused on people they were caring for rather than the task they were carrying out. Staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support.

People’s privacy was respected and when people needed private time it was promoted. People also had their independence and dignity promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day. Staff responded to body language of people who were without verbal communication.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time. At the time of our inspection visit there were no visitors to the service.

Records we looked at were personalised and included decisions people had made about their care including their likes, dislikes and personal preferences. There was a varied activity programme for people based on individual preferences, or time in pursuit of personal hobbies or interests

The service was managed in an inclusive manner. People and staff had their wishes and knowledge respected. Staff were aware of their roles and responsibilities for people’s care. The manager had systems in place to review the service and to ensure the service responded to people’s on going needs.

As part of our inspection we spoke with four people receiving care and one of their relatives. A new manager had been recruited for the service in February 2014 and had made an application for registration with the CQC. We spoke with manager and staff working at the home. We observed people receiving care and also examined care files and other records.

Below is a summary of what we found.

Is the service safe?

We observed people were treated with respect by care staff. We found systems were in place for managing risks and monitoring the quality of care at the home. Although some temporary arrangements were still in place due to vacancies, sufficient staff were provided to deliver people's care. Systems in place helped ensure that managers and staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve. Staff were trained in safeguarding people from abuse and knew how to respond if any concerns arose. The manager was aware of correct procedures to follow if restrictions needed to be used, for example locked external doors or physical restraint, to keep people safe. This included using the Deprivation of Liberty Safeguards (DoLS). DoLS is a law that requires restrictions that could deprive someone of their personal freedom to be avoided, and if this is not possible, an application to be made for the restrictions to be assessed and properly authorised.

Is the service effective?

We found that people's needs were assessed and care files included information about people's health conditions or disabilities. Systems were in place to ensure care files were up to date so that people received care that protected their welfare and safety. Procedures were in place to ensure people continued to receive safe care in the event of an emergency occurring. People's consent was obtained for their care and the provider followed procedures that met legal requirements if someone was unable to make decisions for themselves due to their learning disability. We looked at the way staff were trained and supported and found that although some training was still required, courses had been arranged. Staff received adequate supervision and support from the manager.

Is the service caring?

People told us they were happy with the care they received at Tarry Hill. One person told us they liked the staff and their room. Another person said, "It's alright here. I like going out with the staff." One person's relative said most of the staff were very good. We observed that staff communicated well with people and encouraged them to develop their skills when helping with activities and tasks.

Is the service responsive?

People's preferences, personal characteristics and background were recorded so that their care could include their interests and lifestyle choices . A complaints procedure was in place and records kept of formal written complaints and responses. Although the views of people living at the home were obtained, including through meetings with the manager, the way they expressed their feelings about their care was not included in systems for monitoring the quality of care at the home. The manager had plans to begin to address this, however, to ensure people's views were fully responded to.

Is the service well-led?

The manager completed regular checks and audits of medication, staff training, health and safety and practice at the home Quality assurance systems were in place for recording and reviewing incident and accidents to identify any risks and trends so that these could be better managed. Systems were in place to obtain the views of people's representatives, staff and other people connected with the home to enable the manager to continue to improve the service.

We found that people's care was assessed and that care plans were in place at the home. We saw that staff were knowledgeable about people's needs. Care planning did not always ensure sufficient information was available to provide appropriate support, however, and risks were not being adequately managed. We found that consent was not being obtained for people's care and their medication was not being managed in a way that fully ensured their safety.

Staff were aware of procedures to protect people from abuse or neglect. We found that people were not always receiving safe support with behaviours described as 'challenging', however, particularly where they could require physical restraint.

Although some systems were in place for assessing and monitoring the quality of the service at Tarry Hill, we found that these were not fully effective to ensure that risks were identified and managed.

We found that although the provider was recruiting staff that there were insufficient suitably experienced and skilled staff to safely provide people's support. We also found that training and supervision was not fully ensuring staff were able to appropriately meet people's care needs.