Archived: Tregertha Court Care Home

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.

The service is required to have a registered manager and at the time of our inspection a manager who was registered for this service was not in post. The manager in charge of the day to day running of the service was a registered manager for another service in the Morleigh group. Shortly after this inspection we were advised that their application to be the registered manager for this service had been completed. 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 inspection of Tregertha Court Care Home on 6 April 2016. At this comprehensive inspection we checked to see if the service had made the required improvements identified at the inspection on 3 March 2015. In March 2015 we found there were not sufficient numbers of staff on duty to keep people safe and meet their needs. People did not have sufficient access to meaningful activities in line with their interests and preferences.

At this inspection we found action had been taken to make the necessary improvements to the areas of concern raised at the inspection in March 2015. There was one extra member of care staff on duty in the morning to meet the needs of a similar number of people as there were at the last inspection. People and their relatives told us they thought there were enough staff on duty and we saw staff respond to people’s needs in a timely manner.

People had access to activities of their choice. Until recently the service had employed an activities co-ordinator for two hours in the afternoon from Monday until Friday but this position was now vacant. Interviews for this post had taken place and the manager hoped to fill the vacancy shortly. We saw people had taken part in craft work, quizzes and reminiscence chats. An external entertainer visited twice monthly and an aromatherapist also visited every other week.

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 about some care records which were not stored securely and food and fluid charts that were inconsistently completed.

Recruitment systems were carried out centrally for the Morleigh group as a whole and these were not robust. Lack of adequate communication had resulted in the manager starting staff working without knowing whether or not a Disclosure and Barring Service (DBS) was in place. This meant people sometimes received care and support from staff without the appropriate pre-employment checks in place.

Some rooms had a lack of heating and the sinks in two bathrooms had water that was too hot to be safely used by people. While some radiators had been repaired on the day of our inspection, two people told us their rooms had not been warm enough for them for several months.

The stair lift to the main staircase broke down in the morning of the day of the inspection. This prevented people in upstairs rooms, who were not independently mobile, from going up or down stairs as this was the only method available. Action was taken to repair the lift later in the day, in time for people to go to bed. However, we were aware that the lift had not been working correctly before it completely broke down and staff indicated there had been problems for some time. While some people made a joke with staff about the lift and whether or not they were going to ‘get to the bottom’ other people were upset by it. One person was clearly distressed by being stuck on the stair lift for 10 minutes just before it stopped working.

Another person attempted to came downstairs without using the lift, after it had stopped working. When it became clear that it was not going to be possible for the person to get downstairs they stopped halfway and be helped by staff to go back upstairs. This meant that appropriate action to ensure the lift was consistently in good working order and to assess the risk to people using the lift or the stairs had not been taken.

On the day of our inspection there was a relaxed atmosphere in the service. We observed people had a good relationship with staff and staff interacted with people in a caring and respectful manner. One person told us, “They [staff] are very kind” and a relative said, “[Person’s name] has physically and mentally improved since moving here three months ago.”

People told us they felt safe living at Tregertha Court and with the staff who supported them. People told us, “I am safe living here” and “I love it here, I chose to come and live in this home and I have not been disappointed.”

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.

People were supported to maintain a balanced diet appropriate to their dietary needs and preferences. Staff asked people where they wanted to eat their lunch and provided respectful support for people who needed help eating their meal. People were provided with drinks throughout the day of the inspection and at the lunch tables. Some people where assessed as being at risk of not eating or drinking enough to meet their needs. Where people were identified as being at risk staff monitored each person’s food and fluid daily intake to ensure they were appropriately nourished and hydrated.

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. Staff had a positive attitude and told us they were supported by the management team.

There were systems in place carry out regular audits to check the quality of the service provided. However, these audits had not sufficiently identified the risks in relation to the stair lift, the very hot water in two bathrooms or the gaps in the recruitment processes.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

From the two outcomes we looked at during this inspection of Tregertha Court we saw evidence to support a judgement that this service was safe.

During this inspection we spoke with eight people living in the home. People we spoke with told us they were happy living in the home and staff were caring and attentive to their needs. People told us 'I am happy here' and 'it's very nice here'.

Care plans were personalised to the individual and gave clear guidance for staff to follow to ensure people's needs were met.

There was evidence the home considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards (DoLS). The home had not made any applications to restrict people's liberty under DoLS.

There were enough qualified, skilled and experienced staff to meet people's needs. The service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

Is the service effective?

From one of the outcomes we looked at during this inspection of Tregertha Court we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

Is the service caring?

From one of the outcomes we looked at during this inspection of Tregertha Court we saw evidence to support a judgement that this service was caring.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. We saw staff provided support in accordance with people's wishes. We observed staff responded to people in a kind and sensitive manner.

Is the service responsive?

From one of the outcomes we looked at during this inspection of Tregertha Court we saw evidence to support a judgement that this service was responsive.

The home had an activity co-ordinator who worked three days a week. There were a range of activities on offer, some facilitated by the co-ordinator and others with external entertainers. These included: bingo, arts and crafts, sing-a-longs, crosswords, darts and board games. We observed people taking part in a variety of activities on the day of our inspection, including knitting, general knowledge quiz and word games.

Is the service well-led?

From one of the outcomes we looked at during this inspection of Tregertha Court we saw evidence to support a judgement that this service was well-led.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs and district nurses.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

People were treated with dignity and respect. We spoke with seven people living in in the home and they all told us they enjoyed living there and felt safe. Care plans were personalised to the individual and gave comprehensive information about how the person wanted their care and support to be provided.

Tregertha Court had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). There was evidence the home considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards.

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in an environment that was safe, clean and hygienic.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Systems were in place to ensure managers and staff learnt from events such as accidents and incidents, complaints and concerns. This meant the risks to people were reduced and this learning helped to continually improve the service.

Is the service effective?

People's health and care needs were assessed and where possible they were involved in developing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

People who used the service, and their representatives, were involved in their care plan reviews. We saw people, or their representatives, had signed care plan reviews to show they had read and agreed to the content of the care plan.

We spoke with four visitors and they all confirmed they were able to visit the home whenever they wished and were able to see people in private. One visitor told us 'I am always made to feel welcome and can see X either in their room or in the lounge'.

Is the service caring?

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. We saw staff provided support in accordance with people's wishes.

People we spoke with told us they were very happy living in the home and staff looked after them well helping them to make choices about their daily living. One person told us 'very nice here and I like the carers'. Visitors we spoke with told us 'staff are gentle and caring' and 'people are looked after well and staff are good'. We observed staff responding to people in a respectful, kind and caring manner.

Is the service responsive?

The home had an activity co-ordinator who worked 25 hours each week. There were a range of activities on offer, some facilitated by the co-ordinator and others with external entertainers. These included: bingo, arts and crafts, sing-a-longs, crosswords, darts and board games. We observed people taking part in a variety of activities on the day of our inspection. Some people went out independently to the local shops and other people went out with their visitors.

Tregertha Court gave clear information to people about how to complain. The home had not received any complaints in the last year. People living in the home and their visitors told us they knew how to complain and would be happy to raise any concerns if they had any.

Is the service well-led?

The home worked with external health professionals to ensure people's health needs were met. We spoke with a community nurse who was visiting the home on the day of our inspection. They told us there was a good working relationship with the home and staff made appropriate referrals to them in relation to people's pressure care management.

The home had a quality assurance system in place, records showed that any identified shortfalls were promptly addressed. The home carried out regular surveys of people living in the home and their families and used comments from the surveys to improve and develop the service. We looked at recently completed surveys and all scored the home as good or excellent and made positive comments about the service.

The home had regular meetings with people and used these meetings to ask people about activities, outings and meal planning. We saw notes from the last two meetings and saw people had the opportunity to share their views about their experience of living in the home. Where suggestions had been made by people these had been implemented.

As a result the quality of the service provided to people was continuingly improving.