Care Home: Tamar House Residential Home

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What the care home does well The care plans are up to date and have relevant information about people`s assessed needs meaning the care is based on individual need. This information informs the staff what they need to do to ensure people are looked after in a way that is appropriate for them. The staff are friendly and work together to deliver care to the people living in the home. Staffing levels are designed to meet people`s needs throughout the day and night. The registered manager is approachable and manages the home in a style that is open, positive, and inclusive for everyone living there and staff working there. Tamar House is clean and hygienic. What has improved since the last inspection? Tamar House has employed an Activities Co-ordinator to work four afternoons a week at the home. She has consulted with the people living there about their ideas and interests to ensure that the programme of activities meets their preferences and wishes. Since the last inspection there have been modifications to the gardens to improve the home`s security. There are plans to add more handrails around the gardens and more seating so the gardens are more accessible for the people using this service. The bathroom on the first floor has been converted into a wet room. All the bathrooms and both sluice rooms are going to be tiled to make them look less clinical. Mirrors have fitted to the back walls of the bathrooms to preserve people`s dignity when bathing. What the care home could do better: The care staff who have responsibility for handling and administering medications should review their practice of wearing disposable gloves when they are carrying out the mediation rounds. Disposable gloves are for protection from the risk of exposure to blood or other bodily fluids. It is unnecessary to wear them whilst administering medications as the medications should not be touched. The care staff who have responsibility for handling and administering medications should ensure that the medication trolley is tethered securely when it is not in use even though it is kept in a lockable office. Key inspection report Care homes for older people Name: Address: Tamar House Residential Home 11 Brest Road Derriford Plymouth Devon PL6 5XN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Megan Walker     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Tamar House Residential Home 11 Brest Road Derriford Plymouth Devon PL6 5XN 01752510810 01752202545 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Abbeyfield Tamar Extra Care Society Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Tamar House is a care home providing personal care and accommodation for up to twenty eight older people over the age of 65 who may also have a physical disability. The home is not registered to provide nursing care. The home is not registered to provide intermediate care. The home is owned by The Abbeyfield Extra Care Society Ltd, which is a registered charity, affiliated to The National Abbeyfield Society. The fees range from local authority rates starting at £359.28 pwk up to privately funded rates of £525.00 pwk and are according to assessment of the persons individual care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, personal telephone line, etc, all charged at commercial rates. All charges information was Care Homes for Older People Page 4 of 28 Over 65 28 28 0 0 Brief description of the care home provided to the CQC in January 2010. Information about the home and copies of inspection reports can be obtained from the Registered Manager, Mandy Vella. The home is purpose built. It is located on the outskirts of Plymouth, close to the hospital, transport routes and other amenities. It consists of a two-storey building, which is fully accessible by anyone who has any physical disabilities: it has wide doorways and corridors, level access throughout, automatic doors at the front and a shaft lift. All the homes bedrooms are single and the majority have en suite toilet facilities. A bedroom on the ground floor is for short-term respite care or for visitors who require an overnight stay. Bathing, showering and toilet facilities are available on each floor, close to bedrooms and communal rooms. There are lounge and dining room on the ground floor, a smaller lounge room on the 1st floor and a room for the specific use of a visiting hairdresser. A call bell system is installed throughout the home. The home has a large garden that is accessible by the people using this service. There is plenty of parking space at the front of the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. Tamar House was last inspected on 7th March 2007. This was a Key Inspection undertaken by one regulation inspector. The fieldwork part of this inspection was unannounced. It took place on Monday 18th January 2010 between 10:00 and 18:45. This inspection included talking to some of the people who live at the home collectively and two on their own. We also spoke to care staff working at the time of this visit as well as observing interactions between the staff and the people using this service. We conducted a tour of the premises, inspected three care plans, two staff files, medication and other records and documentation. The Registered Manager was available throughout the inspection visit to provide relevant information such as the day-to-day routines as well as the management of the home. Five surveys were Care Homes for Older People Page 6 of 28 returned from people living in the home. Five staff members were spoken with individually and five surveys were received from staff. Two surveys were received from health and social care professionals. In addition we used the last Key Inspection report, the last Annual Service Review and all other information relating to Tamar House received by the CQC since the last inspection to inform this inspection. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission (CQC). There are no requirements and 2 good practice recommendations made as a consequence of this inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 28 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that their needs will be assessed to ensure that these can be met when they move into the home. Evidence: Four people living at Tamar House who completed and returned a survey about the care home, told us that they had received enough information before they moved in that helped them to decide if it was the right place for them. One person told us that they visited the home on four separate occasions before moving in. The registered manager confirmed that people are encouraged to visit and spend time at the home with the other people who live there. Often people come in for short respite stays so are familiar with the home and the staff. The Abbeyfield Society also has supported houses and some people move from these houses. Anyone considering moving into Tamar house will have pre-assessment completed by either the registered manager or deputy managers. A letter is then sent offering a Care Homes for Older People Page 11 of 28 Evidence: place at Tamar House. This also confirms that the persons assessed needs can be met. People are offered three months trial period when they move in. At the end of the thee months a letter offering full residency is sent. We looked at three care plans. They all had pre-assessments of care needs. Five people told us they have a contract. Each of the care files we looked at had a signed contract. The registered manager told us that a Statement of Purpose and a Service Users Guide is given to every prospective resident. There is also a copy of each in every bedroom. This contains information about the Abbeyfield Society philosophy of care, charges at the home, the Complaints procedure and the fire safety precautions. One person who returned a survey told us I came to Tamar House nearly two years ago. Of the care homes examined Tamar House was one of a short list of three and appeared to be the best, and this has proved to be so. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are involved in their individual plan of care and are supported and encouraged to make decisions as part of an independent lifestyle. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be always be met. Evidence: One person who returned a survey told us I am very happy with the overall care and support I get. Two people told that they always receive the care and support they need. A health care professional told us that the staff look after the residents well, highlighting medical concerns and requesting medical reviews promptly and appropriately. Another health care professional told us Staff always carry out the needs of patients and keen to learn, and give great care between our visits. As we toured the premises we observed daily life at Tamar House. Staff were seen to be courteous and sensitive with people. Two people we spoke to told us that the staff listened and acted on what they say, and that the staff were available when they needed them. Feedback from health care professionals and staff, as well as information contained in personal care files, confirmed that people living in the home Care Homes for Older People Page 13 of 28 Evidence: have access to health care services such as doctors, dentists, chiropodists and opticians. A General Practitioner (GP) from a local health centre near Tamar House visits the home weekly. We chose three people, both men and women, to look at their care files and care generally. Each care file seen stated the name by which the person preferred to be called. Each had a personal screening tool that the registered manager said was completed within a week of the person moving into the home. This provides information from which risk assessments are drawn as it gives a summary of the person and their care needs. The care plan is written over a period of time as the staff get to know the person, and as the person adapts and settles into their new home. This provides the staff with a full assessment of all the care needs. There is a handover at the end of every shift for staff to pass on information to those coming on duty. Each care plan is reviewed regularly and more frequently if the person has a changing care need. A family member/representative is also invited if this is the persons wish. The GP is kept informed of the outcomes of the reviews and if the person has any changes in their capabilities. Daily care plans are kept in peoples rooms. These show changes in physical and/or health condition are monitored and recorded. Body maps are used to document bruises or sores that staff observe when they are assisting with bathing. Treatment charts are also kept in peoples rooms. These include a record of visits by health and social care professionals. We saw evidence of good liaison with health care professionals such as district nurses and GPs. It showed timely action by the care staff, and appropriate interventions by the primary care teams to provide treatment plans for the staff to follow. There was also provision of any additional equipment if it was needed. Allergies, medications, and personal preferences for assistance with personal care were all documented. People are able to choose to have dental checks, eye-sight checks and chiropody services and these can be provided at the care home by visiting contractors. This enables a pro-active approach by staff to provide suitable care for individual health care needs. We looked at Accident records. These were kept securely according to relevant guidelines. All the care staff are qualified first aiders. One of the deputy managers explained the medication system at Tamar House to us. The two deputy managers and senior carers are trained and take responsibility for medication handling and administration. All the medication is kept in a lockable medication trolley. At the time of our visit this was not kept securely tethered when it was not in use. The registered manager explained this was only temporarily due to a rearrangement of the staff office and would be resolved the following day. One person at the time of our visit had prescribed controlled drugs. We saw these securely stored in a separate controlled drugs lockable cupboard. There was also a medication Care Homes for Older People Page 14 of 28 Evidence: refrigerator. Two people were responsible for their own medications. They each have a safe in their rooms in which they keep their medicines. They each have a risk assessment that is reviewed weekly. Prescribed medication is supplied in dosette boxes. Anyone who has a medication prescribed Take as required is kept in a separate medication box, labelled for each individual. Inspection of the medication records found that all had been given correctly and signed for accordingly. We suggested to the deputy manager that a record of all the signatures of those staff who were responsible for administering and handling medications should be kept. This would provide a quick glance way to audit who had signed as having given medication. We also suggested this to the registered manager at the time of our visit as a safety precaution and good practice. We observed medication being given to people during a meal. We were told by the deputy manager that most people had medication at mealtimes however for anyone requiring specific times, these were adhered to. There were clear procedures for staff to follow regarding refused medication, spoilt medication and medication for return to the dispensing pharmacist. There was a clear audit for all drug disposals. The medication sheets had photographs of the individuals to identify them. We observed the person giving medication was wearing disposable gloves. This is unnecessary as the medications should not be touched at all. Disposable gloves would only be used if someone had certain types of drugs that were given intravenously. Gloves should be worn in the event of the risk of exposure to blood or bodily fluids which is not the case when giving medication. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Tamar House are encouraged to exercise choice and control over their lives. People are supported to continue to enjoy familiar supportive relationships with family and friends, and within the local community. Evidence: One person who returned a survey told us that Tamar House Welcomes visitors They also told us that their family is kept up to date by regular contact from the staff. The people living at Tamar House enjoy a leisurely breakfast from about 08:00 in their rooms. We were told that they can have an early morning cup of tea if they wish at about 06:00. Also during the night if someone isnt sleeping too well, they can have a hot drink and staff will sit and chat with them. Breakfast is a choice from eleven sorts of cereal, toast, fresh fruit, fruit juice, tea or coffee. Porridge, boiled eggs and other cooked breakfast options are also available. During the morning people stayed in their rooms or sat in the lounge. Throughout our visit there were several visitors and we were told there is no restriction on times people may visit. We spoke to the Activities co-ordinator who works four afternoons a Care Homes for Older People Page 16 of 28 Evidence: week. She has spoken to everyone living at the home either collectively and/or individually to gather their views about the activities provided for them. Activities include quizzes, musical bingo and cards regularly. There are monthly outings during the summer until October. Also monthly the lounge is transformed into a cinema with a choice for seating in the stalls. Ice creams are provided during the interval. A computer and web cam are available for people to use in the upstairs lounge. The registered manager told us there are plans to purchase a Wii from fundraising events. An external contractor comes in to lead a session of low impact aerobics (gentle excercises seated in an armchair). There are also arts and crafts sessions, pamper days, and fashion shows from which people can buy clothes. The Gardening Club will resume in the spring. There are raised flower beds and currently the registered manager is looking at introducing sensory plants. People have requested more handrails in the garden and more seating outside. They would also like to plant colourful flowers. In the preparations for Christmas, people living at Tamar House assisted with decorating the Christmas tree by telling the staff where to hang the decorations. During the snowy weather, the staff brought snowballs inside for people to touch and hold so they did not have to risk going out in the cold and icy conditions. On the day of our visit a selection of owls from the local owl sanctuary were brought into the home for people to hold and stroke. Lunch is served in the dining room at 12:30 and this is encouraged for people to have social interaction. People can have it taken to them in their room if they are unwell. Drinks and snacks are also provided throughout the day, and staff have access to the kitchen at night. On the day of our visit we saw people being offered a choice of cottage pie or fish cakes, and peas. They were able to help themselves from serving dishes put out on each table. Water and cordial were also provided. Staff were seen gently encouraging people with poor appetites and also offering alternative foods to anyone who didnt want the food on the menu. We also saw that jugs of cold drinks were available in the lounge and in peoples rooms. The chef told us that he talks to new people to find out their likes, dislikes and preferences about food. All the fresh food is bought from local suppliers and where possible it is seasonal. He confirmed that everyone living at Tamar House has a good appetite and he enjoys cooking for them all. He has no food budget so that people can have what they like and he likes to ensure that people have good quality food with a choice. The daily menu is written on a white board in the hall showing lunch and teatime choices. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Tamar House and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. People are protected from abuse, neglect and self harm by the homes policies and procedures, and by a robust recruitment process. Evidence: The five people living at Tamar House who returned a survey about the home all told us that there is someone to whom they can speak informally if they are unhappy. They all confirmed that they know how to make a formal complaint. We saw the Complaints procedure displayed on the notice board near the front door. It was clear however the contact details for CQC were incorrect. The registered manager agreed to up date this. We were shown a revised Statement of Purpose and this had a comprehensive complaints procedure with the correct information to contact CQC. Since the last inspection there have been no safeguarding referrals and the provider has received two complaints both of which were resolved. There is a day to day book where general grumbles and moans are recoded. The registered manager monitors this book for trends. She told us that recently there had been an issue about tea at breakfast time being cold by the time people got it. This was resolved by the purchase of flasks. All the staff working at Tamar House have had training about how to recognise the Care Homes for Older People Page 18 of 28 Evidence: abuse of vulnerable people and how to report it. This included training about whistle blowing. We discussed other training relating to safeguarding vulnerable adults, including the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and what it means for staff working with people in registered care services. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. The registered manager confirmed that two staff have had training on these subjects and this has been disseminated to the other staff. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Tamar House have a comfortable and safe environment that is adapted to promote their independence and meets their needs. Evidence: Tamar House is a purpose built two storey building. There is level access throughout the building. Corridors and doorways are wide enough for people who use wheelchairs or walking aids to move around the home easily. Bedrooms are on both the ground and first floor level. They nearly all have en-suite facilities. They are all single occupancy rooms. Access to the first floor is via stairs or using a stair-lift and there is a shaft lift. We toured the premises and found some people had brought personal items of furniture from their own homes with them. Most people had photographs and other personal items. Each room was decorated in a domestic style. All the rooms seen were personalised to suit individual preferences. All the bedrooms have safety latches on the windows. The bathroom on the first floor has been converted into a wet room. All the bathrooms and both sluice rooms were due to be tiled to make them look less clinical. Mirrors were fitted to the back walls of the bathrooms. The staff told us this was a request because people preferred not to see themselves when they were being assisted to move with use of a hoist. There are hand rails next to the toilets, washbasins and the bathroom doors. We also noted there are handrails along the hall and landing on both Care Homes for Older People Page 20 of 28 Evidence: sides. The front door is automatic and leads into a large entrance hall with seating. From this hallways lead to bedrooms and a large lounge that can be separated from the dining room by curtains. There is a smaller lounge with a small library on the first floor. Both rooms are comfortably furnished and homely in style. There is a hairdressing room. The laundry room is large with two commercial washing machines and two commercial driers. On the day of our visit the laundry room was orderly and clean. Everyone living in the home has a clean laundry box that is labelled with their name in the laundry room. They each have a dirty laundry basket in their rooms. Care staff currently are responsible for the laundry. The registered manager advised us that there are plans to extend the laundry room to provide more storage and worktops. It is also hoped that a laundry assistant can be employed for a few hours each day. The domestic staff have a lockable cupboard to store their equipment and all hazardous materials. Protective equipment such as gloves and aprons are stored on each floor. The kitchen is large and industrial in style. The chef told us the kitchen suits its purpose. It is light and airy although the kitchen staff have to be mindful of open windows/doors not causing a draft into the dining room. There is sufficient storage. The chef and the registered manager complete a quarterly kitchen check. The next Environmental Health inspection is due about May this year. Tamar House has a large garden and a summer house with seating provided for people to use. The home was clean and tidy with no offensive odours. All the staff are trained in Infection Control. One member of staff is the Infection Control Link Worker and they attend quarterly meetings held locally and run by the Health Protection Agency. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Tamar House are supported by well-motivated and caring staff in sufficient numbers to meet the needs of those currently living at the home. Staff training and supervision is carried out regularly for all staff to ensure that the assessed needs of the people living at the home are met. Evidence: We received five surveys from staff. They were all very positive about the home and the support and training they receive from their employer and the registered manager. Comments included: The home is very good to work for and meets all peoples needs. [Good at]Keeping paper work up to date. Residents are kept well and looked after. A health care professional who returned a survey told us Tamar House staff are very caring and always respect the patient and tend to their needs. Staff are very helpful and very trustworthy. Another health care professional told us Well structured and supportive service with a happy and motivated workforce. There is a low turnover of staff and this helps care to be consistent. At the time of our visit three care staff, two catering assistants and two chefs (one working 10:00 until 18:30 and the other from 07:30 until 15:00) and two cleaners, two deputy managers (one working 07:30 until 16:30 with an hours handover and the other deputy manager working 15:00 until 22:00), and the registered manager were working at Tamar House. Additionally there is the Activities Co-ordinator who works two hours Care Homes for Older People Page 22 of 28 Evidence: every day Monday to Thursday and a Handyman who works two and half days each week. Over night from 22:00 until 07:30 there are two care staff awake on duty. There is also a manager on-call. Staff rotate between days and nights. All staff have a handover between each shift. There are monthly senior staff meetings and quarterly whole staff meetings. These all have minutes. We looked at two staff files. They each had two written references, a police check and a staff contract with terms and conditions of employment. One did not have dates of employment. The registered manager confirmed that she was sorting out photographs for all the staff files. Each staff file showed they had followed an induction and had comprehensive training and development records. The registered manager told us that all the staff had up to date mandatory training in First Aid, Food Health and Hygiene, Infection Control, Health and Safety At Work, Moving and Handling, Fire Safety, Protection of Vulnerable Adults and Deprivation of Liberty Safeguards. Staff also had training about diabetes, elderly nutrition and dementia awareness. There is a comprehensive induction training over a period of two to three months, assessment based and uses the Common Induction Standards. All staff have regular supervision based on daily routines and activities. The most recent sessions were about care planning, medications, meals and mealtimes, privacy and dignity, and choices. The registered manager told us that new subjects will shortly be chosen for the next six supervision sessions. The staff group at the time of this visit was both female and male, assorted ages, and the majority are British. The people using this service are all white, British and Christians. The current staff group therefore is able to meet the needs of the people living at Tamar House. They provide care that is unprejudiced and recognises peoples differences and values. Throughout this visit our observation of the staff found they were friendly and caring towards everyone. They were gentle and respectful as they assisted people with daily living tasks, and mindful of preserving peoples dignity and self respect. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager shows a responsible attitude and continues to implement changes and improvements in order to keep improving and achieving positive outcomes for people using this service and staff working with them. Evidence: We were told in a survey returned to us I have found the manager to be very approachable and fair. On the day of our visit the registered manager was present throughout the day. She was willing and able to provide information to assist with the inspection. We saw evidence of quality assurance checks in the regulation 26 visit reports. The Executive Committee has a rotation of its members to undertake these monthly visits of the home, choosing two or three standards each month to check. Every tenth month the deputy manager completes a self- audit of all the reports over the ten months. The people living at Tamar House are periodically given surveys to complete showing consultation about the home, for example, communal areas and individual bedrooms, Care Homes for Older People Page 24 of 28 Evidence: meals, staff and staff attitudes, the manager, activities and events. There are also Residents meetings approximately every two months. The registered manager, the chef and a member of the Executive Committee are invited to these meetings. Minutes are taken. Additionally the people living in the home can tell staff or the registered manager about matters of concern or niggles they may have. These are recorded in a day to day book that is monitored and managed by the registered manager. We inspected the Fire Log and confirmed that the smoke detectors, emergency lighting, emergency exits and fire alarms had been checked regularly, dated and signed. A fire safety audit was completed on 15/12/2009 by the Devon and Somerset Fire and Rescue Service. The outcome was a broadly compliant standard of fire safety based on a variety of aspects of fire safety. The registered manager explained that all the staff have fire safety training every six months with a professional fire safety trainer. Every three months there are in-house training sessions for all the staff who work nights. Everyone living at Tamar House has an individual assessment of need in the event of the need to evacuate the home. Currently the registered manager is working on a fire safety lecture that will be given to the people living in the home. She confirmed that all the staff are very vigilant about reporting faults, for example, electrical equipment. The Accident Book was seen and accidents had been recorded and stored correctly and safely. The CQC is notified of any serious incidents affecting the health, safety or well being of any of the people living at Tamar House. Care plans inspected had risk assessments included in them that were relevant to the individual person. On the day of our visit the home was clean and tidy, free from offensive odours throughout. The registered manager confirmed that all the necessary maintenance checks were correct and up to date. The registered manager and the staff manage issues competently, and in a timely manner. The service continues to provide excellent outcomes for the people who use it. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Staff should review their infection control training and practices to ensure they wear personal protective equipment (PPE) only when it is appropriate and for purposes of protection against the risk of exposure to blood or other bodily fluids. The care staff who have responsibility for handling and administering medication should ensure that the medication trolley is tethered securely when it is not in use. 2 9 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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