We inspected The Tamarind on the 19 December 2018.

About the service: - The Tamarind caters for up to five people with learning disabilities. At the time of our inspection three people were using the service. The service had spacious living areas and was set over two floors. The service was set in a residential area with easy access to the local community and had a large garden. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

People’s experience of using this service:

People and relatives were very complimentary of the service and staff. One person said, “Everyone is wonderful here, they have helped me more than anywhere else.” A relative told us, “We are really pleased with all aspects of care and their attention to detail.”

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 support this practice.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for the needs of people.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed choices.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. The registered manager had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Rating at last inspection: Good (report published 1 April 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

The Tamarind provides care and support for up to five people who have a learning disability and/or autistic spectrum. There were four people living in the service when we inspected on 17 February 2016.

There was a registered manager in post. 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.

People received care that was personalised to them and met their needs and wishes. Staff listened to people and acted on what they said. The atmosphere in the service was friendly and welcoming.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care. Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs. People were treated with kindness by the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Care and support was based on the assessed needs of each person. People’s care records contained information about how they communicated and their ability to make decisions. People were encouraged to pursue their hobbies and interests and to maintain links within the community.

People or their representatives were supported to make decisions about how they led their lives and wanted to be supported. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. The service was up to date regarding the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were being assessed and they were supported to eat and drink sufficiently. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities. Audits and quality assurance surveys were used to identify shortfalls and drive improvement in the service.

Some of the people living at The Tamarind had complex needs and were unable to discuss their care with us. On the day of our inspection we saw that the people who were at home appeared happy.

We saw that The Tamarind was comfortable and homely; the environment was clean and well maintained.

It was evident that staff knew people well and we saw that there were friendly and caring interactions between members of staff and people living in the home. We saw that staff listened to people and treated them with respect.

People received care and support that met their needs and took into account their individual preferences. Staff were able to demonstrate that they understood people's specific needs and they provided care in a person-centred manner. We found that staff received the training and support they needed to provide care and support safely.

The Tamarind was well managed and there were effective processes to monitor the quality of the service. They consulted with people and took their views into account to make improvements.

Relatives who completed surveys as part of the home’s quality monitoring process were complimentary about the care provided at The Tamarind. One relative said: “We are most grateful to the management and staff for the support, patience and care they give to X.” A health professional stated: “Medication is regularly reviewed” and another said: “I feel that the care team at The Tamarind provide a good and consistent service.”

The majority of the people living in The Tamarind were unable to tell us about the quality of care they received. To enable us to access people’s wellbeing we spent time observing the care they received and the level of staff interaction with the people.

We observed that the staff were attentive to people’s needs. Staff interacted with people in a friendly, respectful and professional manner. Staff sought people’s agreement before providing any support or assistance. The people we saw were relaxed and engaged with their surroundings.

The records we looked at showed that the staff supported people to go out, to follow their favourite pastimes, to be part of the local community and to go on holiday if they wanted to. We saw that people’s bedrooms were comfortable and that they had their own belongings around them.

We also saw that there were Mental Capacity Act (2005) (MCA) assessments in place around people's capacity to make day-to-day decisions.

We saw that appropriate measures were taken to ensure that the people living in the home, their visitors and the staff were protected against the spread of health care associated infections.

People who use the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises.

People were encouraged and supported to make complaints. Staff on duty told us that they tried to ensure that complaints were dealt with informally and in line with the provider’s complaints procedure.

Some of the people living at The Tamarind were not able to communicate with us verbally and some chose not to talk with us. They shared their views through gestures, facial expressions and body language wherever possible. We saw people were relaxed and comfortable with staff and other people using the service.

Relatives who completed surveys as part of the home’s own quality assurance process made positive comments about the service provided at the Tamarind including the care and support provided and the food. They were also complimentary about the manager and staff team both for their professionalism and for the considerate and thoughtful way that staff supported people in the home.