Archived: Tregertha Court Care Home

Updated 24 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 23 November 2016. The inspection team consisted of two inspectors.

We reviewed the Provider Information Record (PIR) before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also reviewed information we held about the home including previous reports and notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with four people who were able to express their views of living at the service. Not everyone was able to verbally communicate with us due to their health care needs. However, we observed care practices during the inspection. We also conducted a complete tour of the premises.

We spoke with two care staff, two kitchen staff, one domestic and the registered manager. We also spoke with two relatives and a visiting healthcare professional. We looked at four records relating to the care of individuals, medicines records, staff training records and records relating to the running of the home.

Updated 24 January 2017

Tregertha Court is a care home that provides personal care for up to 38 older people, some of whom have a diagnosis of dementia. The service is part of the Morleigh group of care homes. On the day of the inspection there were 23 people living in the service.

The service is required to have a registered manager and there was one in place. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

We carried out this unannounced comprehensive inspection of Tregertha Court on 23 November 2016. At this inspection we checked to see if the service had made the required improvements identified at the inspection of 6 April 2016.

In April 2016 we found concerns in relation to recruitment, the heating and hot water system, a faulty stair lift and a lack of assessments to identify any risks to people using the stair lift. There were also concerns that food and fluid charts were inconsistently completed.

At this inspection we found the stair lift, identified as faulty at the inspection in April 2016, had been replaced and was working. However, one of the stair lifts to the top floor was not working. The registered manager had taken appropriate action to ensure people could still come downstairs. However, the provider had not taken any action to arrange for this lift to be repaired.

We also found three bathrooms with baths and sinks that had water with a temperature of 59 degrees Centigrade coming from the hot taps. Three toilets and seven bedrooms also had sinks where hot taps had a water temperature of 59 degrees Centigrade. This included the sinks in the two bathrooms identified at the inspection in April 2016. Hot water at this temperature is a scalding risk, as the recommended water temperature for older people is a maximum of 44 degrees Centigrade.

The registered manager told us that the heating and hot water system worked in such a way that the temperature of the heating and the hot water could not be regulated separately. The heating had been turned up during the week beginning 7 November 2016 because the radiators in some parts of the service were not warm enough for people. It was after the temperature had been increased on the boiler, that the registered manager became aware, two days before our visit, that one bedroom had very hot water. However, an audit of the entire building had not been carried out to check if any other rooms were affected, which was the case when we checked at the inspection. We had not received any assurances from the provider that action was going to be taken to address this serious concern. This meant people were not protected from the risk of water that was too hot or living in a building that was inadequately heated.

Recruitment systems were not robust. At the inspection in April 2016 we found a new member of staff was working unsupervised, even though their Disclosure and Barring Service (DBS) check had not been received. At this inspection records for three new staff, recruited in September and October 2016, showed that they had started to work before their DBS checks had been completed. Staff we spoke with confirmed they had shadowed for a maximum of two shifts before working unsupervised and they had started to work before they received a copy of their DBS check. This was despite the provider telling us after the inspection in April 2016 that recruitment systems had been improved and staff would not start to work unsupervised until their DBS check had been received. The failure to complete necessary checks, before allowing staff to provide care, exposed people to unnecessary risk and did not protect people from the potential risk of harm from being supported by staff who were not suitable for the role.

Where people were identified as being at risk of losing weight staff monitored people’s food and fluid daily intake to ensure they had enough to eat and drink. However, we found there were some inconsistencies in the way this information was recorded. Medicines were mostly safely managed, however, there were gaps in recording that meant it was not clear if one person had received their medicines as prescribed.

People told us they were happy living at Tregertha Court and with the staff who supported them. Comments from people included, “It’s OK living here” and “I like living here. I have my own buggy and I can go out when I want to.” A relative said, “Very happy with Mum’s care.”

Staff had good knowledge of the people they cared for and made appropriate referrals to healthcare professionals when people needed it. Staff worked with GPs and community nurses to ensure health conditions, such as diabetes, were well managed. Visitors told us staff always kept them informed if their relative was unwell or a doctor was called.

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support.

Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. Where complaints had been received these had been dealt with appropriately and resolved to the complainant’s satisfaction.

The provider has overall responsibility for the quality of management in the service and the delivery of care to people using the service. The provider has repeatedly not achieved this at Tregertha Court and has been rated as Requires Improvement since the first rated inspection carried out in March 2015. This inspection was the third inspection the Care Quality Commission has carried out since March 2015. At each inspection there have been breaches of the regulations. Concerns found at this inspection about hot water, with a scalding risk for people, and inadequate recruitment practices, were also raised at the inspection in April 2016.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.