This was an unannounced inspection which took place on the 22 May 2018.

At our last inspection we rated the service good overall. 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 on-going 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.

Tamarix Lodge 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.

The service provides accommodation and personal care for a maximum of 37 older people, some of whom may be living with dementia. It is located in the seaside town of Withernsea, in the East Riding of Yorkshire. At the time of our inspection 34 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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.

Systems and processes were in place that helped keep people safe from harm and abuse. People told us they felt safe at the service. The registered manager and staff were aware of their responsibilities for ensuring that people were kept safe. Risks were assessed and managed. Staff were recruited safely and there were sufficient staff to meet people’s needs. Medicines were managed safely.

People received an effective service because their needs were met by staff who were trained and supported to do their job. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were observed being kind to people and respecting their dignity and independence. Feedback from people and their relatives was positive.

People's nutritional needs were met by staff who knew people’s needs well. People's health and wellbeing was maintained and provided through a range of health and social care professionals.

People were involved (where possible) in their personalised care plans and reviews. These plans gave staff the information they needed to provide the care and support people needed. Care plans and daily notes were informative and were kept up to date.

People were encouraged to take part in a range of activities that they enjoyed, some were planned and others were the choice of people at that time. This helped reduce the risk of social isolation.

People and their relatives we spoke with told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

People received a service that was well led because there was a registered manager in post who was approachable and provided good leadership. People and staff were encouraged to share their views about the service being provided. Quality assurance systems were in place to check that the service provided quality care and made improvements where necessary.

Further information is in the detailed findings below.

We carried out this inspection on 12 November 2015. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was unannounced; which meant that the staff and registered provider did not know that we would be visiting.

At the last inspection on 6 October 2014, we asked the provider to take action to make improvements to infection control, the availability of activities and how the service was assessed and monitored, and this action has been completed.

Tamarix Lodge is a care home that provides accommodation and personal care for up to 37 older people, including those with a dementia related condition. On the day of the inspection there were 29 people living at the home.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately in the service.

We found assessments of risk had been completed for each person and plans had been put in place. Incidents and accidents in the home were accurately recorded and monitored monthly.

The home was clean, tidy and free from odour and effective cleaning schedules were in place. It was decorated to a high standard and people’s rooms were personalised.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the home deemed essential, such as safeguarding, moving and handling and infection control and also home specific training such as dementia awareness.

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that Mental Capacity Act (MCA) (2005) guidelines had been fully followed. The home did not use restraint but the registered manager understood the process to ensure that any restraint was lawful.

People’s nutritional needs were met. People enjoyed a good choice of food and drink and were provided with regular snacks and refreshments throughout the day. People told us they enjoyed the food and that they had enough to eat and drink. People were supported to maintain good health and had access to healthcare professionals and services.

People told us they were well cared for. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the home. People were able to make choices and staff supported them to maintain their independence.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported. The home employed activity coordinators and offered a variety of different activities for people to be involved in. People were also supported to go out of the home to access facilities in the local community.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were appropriately actioned. We found the provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support.

Tamarix Lodge is a care home that provides accommodation and personal care for up to 37 older people, including those with a dementia related condition. On the day of the inspection there were 29 people living at the home permanently.

This inspection was unannounced  and took place on 6 October 2014. There was a registered manager in post at the time of this inspection and they had been in post since January 2014. A registered manager is a person who is registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The last inspection took place on 26 November 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

During our inspection we spoke to the registered manager, deputy manager and the area manager. We interviewed four care staff and two domestic staff. We spoke with five people who were using the service and five relatives. We also spoke with a visiting healthcare professional.

We found that people who used the service were not fully protected from the risks of infection.  There was a significant and unpleasant odour in the main corridor area and the corridor carpets and two bedroom carpets were heavily stained. This meant the quality monitoring processes were not effective as they had not ensured that people were provided with a clean environment in which to live.

Although some people chatted and socialised in the lounge areas, there was no activity programme in the home and on the day of the inspection we saw that many people spent their time in their bedrooms. This meant that people who were not able to occupy themselves received limited social stimulation. People who lived at the home, visitors and staff were concerned about the lack of social stimulation.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following robust recruitment and selection processes.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home. People were provided with a range of nutritious snacks, as well as hot and cold food and drinks, during our inspection.

We observed good interactions between people who lived at the home and staff on the day of the inspection. People told us staff were caring and this was supported by relatives and the health care professional who we spoke with.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings. 

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to protecting people by maintaining the home to a clean and hygienic standard, protecting people from inappropriate or unsafe care and treatment (a lack of activities) and not monitoring the quality of the service well enough. You can see what action we told the provider to take at the back of the full version of this report.

At the time of our visit the manager had been in post for three months. They explained they had applied to the Care Quality commission to register as the manager.

Care plans reflected the needs of people as identified in their assessment. People we spoke with told us they were very happy with the care they received. One person told us “I chose to come here as it has such a good reputation and so far I have not been disappointed”.

Menus showed there was a choice of meals with alternatives available on request. People we spoke with also told us they enjoyed the food and were able to order alternatives where they did not want what was on the menu that day.

People told us they were satisfied with the cleanliness of the service. We saw that systems were in place to maintain the required standards of cleanliness and hygiene. Where there were any minor issues these were addressed during our visit.

Staff records showed staff had received appropriate training and were supported through supervision and staff meetings.

The manager worked in accordance with the provider’s quality assurance policy to ensure they monitored the quality of the service provided.

Records were accurate, fit for purpose and were stored securely.

We spoke with three people who lived at the home as part of this inspection. They told us that they could make decisions about their day to day lives and we saw that staff consulted them prior to assisting with personal care. One person said, "Staff let me please myself".

Assessment, risk assessment and care planning information included sufficient detail to inform staff how each person wished to be assisted or supported. We saw that care planning documentation had been kept up to date to ensure that people's current care needs could be met.

People told us that they were happy with the way staff supported them to take their medication and we saw that medication policies and procedures in place at the home had been adhered to.

We checked the complaints log and saw that any complaints made to the home had been dealt with in a satisfactory manner. People told us that they were confident that their concerns and complaints would be listened to by staff and were able to name people they could speak to if they had any problems.

We saw that equipment had been provided for people to assist them with mobility and pressure care and that the equipment was well maintained.

Staff had been recruited safely but more care was needed to ensure that the organisation's polices and procedures had been followed.

We spoke with three people who lived at the home. They told us that they could make decisions about their day to day lives such as what time to get up and go to bed, where to spend the day, where to take meals and whether or not they wanted to take part in any activities. They said that staff were considerate and kind.

People said that staff were respectful and mindful of the need for privacy and dignity and that they encouraged them to be as independent as possible.

People told us that they had never had any complaints about the home but that, if they had any concerns, staff had been very helpful and supportive. They also told us that they felt safe living at the home. One person said, “I don’t think I would still be here if it wasn’t for the wonderful care that I receive at this home.”

We were told that the meals were good and that there was plenty of choice. One person said, “There is a choice at every meal time and I have a cooked breakfast every day.” People said that, if they woke up during the night and wanted a cup of tea, they just had to ring the call bell and staff would bring them a drink. They said, “If they are not too busy, staff stay for a chat.”