We carried out a review of the data available to us about Tamarisk on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tamarisk, you can give feedback on this service.
Tamarisk is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Tamarisk accommodates people with a learning disability and some with complex needs. At the time of our inspection there were 3 people at the service.
The service also provides personal care support for a further five people living independently in the community. This inspection will focus on all eight-people receiving the regulated activity of personal care.
The premises are set in a quiet residential road on the outskirts of Greatstone. There is access to local shops including a pub, hairdressers and newsagents and the beach within walking distance. The service has three bedrooms, a wet room, lounge and kitchen and spacious rear garden.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.
This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Why the service is rated good.
People were protected from abuse and the service had safeguarding procedures that staff understood. Individual risk assessments provided staff with the information they needed to reduce and manage risks whilst ensuring people’s individuality was respected.
There were sufficient numbers of trained staff to meet people’s needs and staff rostering allowed flexibility to ensure that staff could support people’s activities and appointments. Staff felt supported and received regular training and supervision. Robust staff recruitment procedures included statutory checks, induction training and mentoring by experienced staff, prior to starting work.
People received their medicines from trained staff and medicines were stored and recorded safely.
People’s individual needs were met through the design of the building. The service was clean, and people were protected from cross contamination and infection. Incidents had been recorded appropriately with systems for follow up and learning in place.
People’s needs had been assessed and were reviewed to reflect their choices and wishes and their support plans gave staff the information they needed to provide effective care in line with best practice and legislation.
People were supported to eat and drink to maintain a balanced diet and stay in good health and their consent was sought about day to day issues such as what they ate and drank.
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Advocates were available to ensure that the provider worked in line with the principles of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted appropriately.
People had access to routine health care with follow up referrals made to health and social care professionals as required.
People were happy and relaxed with staff and had been supported to express their views. The staff team were long standing members who knew the people well and treated them with kindness and dignity. The staff team had worked hard with other professionals to ensure that people could communicate through non-verbal means.
People had continued to receive responsive care and support that met their individual needs, took account of their choices and respected their wishes. Care plans contained ‘all about me’ documents that provided clear pen-portraits for each person and highlighted the body language people used to express themselves. The documents were written in a factual, respectful manner and were reviewed quarterly.
Staff encouraged people to engage in a range of activities and there were details of places they enjoyed visiting, with photographs of their daily activities and people were supported to maintain strong ties with relatives.
The service had complaints forms and a complaints procedure in place. Staff understood when people were unhappy and supported them to resolve any concerns and issues.
People’s end of life wishes had been discussed and agreed with support from families.
The Registered Manager had an open-door policy and worked hard to support staff on a day to day basis. Staff told us, “I can go to the Registered Manager with anything they are a good boss.” The registered provider had a range of quality monitoring processes and regularly sought the views of relatives and professionals to inform the development of the service.
Further information is in the detailed findings below.
Tamarisk provides personal care and accommodation for up to three people who have a learning disability. It also provides a personal care service to a small number of people living in supported living accommodation within the Greatstone area. The service is in a quiet residential area of Greatstone; within a short walk are the beach, pub, newsagents, hairdressers and shops. There is a local bus service to the nearby towns of Lydd and New Romney.
The service has a registered manager, who was present throughout the inspection. 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 and associated Regulations about how the service is run.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted. They were waiting for the outcome from the local authorities who paid for the people's care and support. There were records to show who people's representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.
People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.
Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. The complaints procedure was on display in a format that was accessible to people.
Before people moved into the service their support needs were assessed to make sure the service would be able to offer them the care that they needed. The care and support needs of each person were different, and each person's care plan was personal to them. People had in detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.
Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff spoke about people in a respectful way which demonstrated that they cared about people's welfare. Staff knew people and their support needs well.
Staff were caring, kind and respected people's privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.
People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they wanted to. Staff understood people's likes and dislikes and dietary requirements and promoted people to eat a healthy diet.
People received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People's medicines were reviewed regularly by their doctor to make sure they were still suitable.
People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.
A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.
Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people's needs. When staff had completed induction training they had gone on to complete other basic training provided by the
company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and autism. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people's care and lives.
Staff told us that the service was well led and that they had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to.
We found that there were robust recruitment procedures in place, in order to protect people who used the service.
People had consented to their care and support and were happy living in supported living. One person said, 'I am happy living here.' People talked about the community activities they were involved in and how they 'do things for themselves'. Another person said, 'I like going swimming, I go on Tuesdays'.
People we spoke with told us they were satisfied with their support. People confirmed that they had been involved in discussions about their support with staff. They said they had attended a review meeting. This was a meeting for them with their social worker, families and staff to discuss their care and support.
People talked about how they did some of the household chores and that the house was always clean and tidy. People spoke positively about the staff. One person said, 'Yes, the staff are all nice.' However we found shorts in recruitment processes. People told us they did not have any concerns, but if they did they would speak with the staff and were confident things would be 'sorted out'.