Background to this inspection
Updated
7 September 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
On the first day of inspection there was one inspector, and one specialist medicines inspector. On the second day of inspection, there was one inspector and one inspection manager.
Service and service type
Tamarisk House is a ‘care home’. People in care homes receive accommodation and nursing and or personal care as a single package under one contractual agreement dependent on their registration with us. Tamarisk House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
Both inspections were unannounced, and the second inspection was completed out of hours.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We sourced feedback from the local authority and used information we held about the service on our system, this information was all considered as part of the inspection planning process.
During the inspection
We spoke with four members of care staff, one agency staff member and two regional managers. After our first inspection visit, we liaised with the nominated individual in the absence of a registered manager. (The nominated individual is responsible for supervising the management of the service on behalf of the provider).
We reviewed a range of records, including five people’s care and medication records. We looked at staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with one person's relative by telephone, about their experiences of the care provided. We sourced feedback from health and social care professionals who had regular contact with the service, and with people's relatives. We liaised with the local authority quality assurance team, and made onward referrals to external agencies, including Norfolk Fire and Rescue Service.
Updated
7 September 2022
About the service
Tamarisk House is a residential care home providing personal care and support to up to five people with a learning disability and or autistic people. At the time of our inspection there were five people using the service. The service consisted of one large bungalow, with shared communal spaces, and each person had their own bedroom with en-suite bathrooms.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support: The standards of care provided, did not support people to have choice and control over their own care and lifestyles. This was compounded by the level of staff available to meet people’s assessed needs, and to give them regular access to the community. Adherence to guidance and provision of equipment by health care professionals needed to be implemented into practice to ensure people received the correct levels of dignified care and support.
Right care: People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Gaps in staff training and competency checks did not ensure staff had the necessary skills, knowledge and expertise to safely meet people’s needs. Care records did not demonstrate people were involved in the development of these documents, or that their individual wishes and preferences were consistently reflected.
Right culture: With no registered manager, there was a lack of leadership within the service. Members of the provider team visited the service but did not complete meaningful records to support ongoing improvement of the service. Inspection findings highlighted that where shortfalls were being identified, timely action was not being taken to address these and make improvements to the quality of people’s care or the condition of the care environment. People were not being empowered to lead meaningful lives, or to be part of their local community in line with the provider’s own Right Support, Right Care Right Culture position statement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 01 December 2020 and this is the first inspection. The last rating for the service under the previous provider was Good, published on 06 July 2019.
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels and people’s quality of life at the service. A decision was made for us to inspect and examine those risks. We found evidence during this inspection that people were at risk of harm from the concern. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full 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 COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tamarisk House on our website at www.cqc.org.uk.
Enforcement and Recommendations
As an outcome of our first day of inspection, we served an urgent letter of intent to the registered provider, under Section 31 of the Health and Social Care Act 2008. This required the registered provider to give written assurances of the action they would take in response to the serious risks and concerns we identified, as well as timescales for issues to be addressed. We completed a second inspection to determine if sufficient action had been taken by the provider to improve and maintain people’s safety and welfare.
We have identified breaches in relation to person-centred care, consent, safe care and treatment including in the use of medicines, staffing and good governance and oversight of the service at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.