Archived: Tremethick House

Updated 24 August 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.

We undertook an unannounced focused inspection of Tremethick House on 20 July 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our April 2017 inspection had been made. The team inspected the service against three of the five questions we ask about services: is the service safe, responsive and well-led? This is because the service was not meeting some legal requirements in these areas

Before the inspection we reviewed information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.

We spoke with six people living at the service. Not everyone we met who was living at Tremethick House was able to give us their verbal views of the care and support they received due to their health needs. We looked around the premises and observed care practices. We spoke with three staff, two acting managers, the operational manager for Anson Care and the provider. We also spoke with two visiting healthcare professionals.

We looked at care documentation for five people living at Tremethick House, medicines records and other records relating to the management of the service.

Updated 24 August 2017

This unannounced focused inspection took place on 20 July 2017. The last inspection took place on 11 April 2017 at which time we identified two breaches of the regulations. The breaches related to medicines management, care plan and risk assessment reviews, monitoring records not always completed, and failure to display their last inspection report for the public. Two warning notices were issued against the provider with regards to these breaches. The service was rated as Requires Improvement. We carried out this focused inspection to check on the action taken by the provider to meet the requirements of the warning notices.

This report only covers our findings in relation to “Is the service Safe, Responsive and Well-led?”. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tremethick House on our website at www.cqc.org.uk

Tremethick House is a care home which offers care and support for up to 42 predominantly older people. At the time of the inspection there were 35 people living at the service. Some of these people were living with dementia.

At the last inspection we were concerned about the medicines administration processes at the service. Since the last inspection the service had reported two further medicine errors. The service use an electronic medicines management system and staff had been trained in its use. At this inspection we found there had been improvements in the processes and practices of medicines administration. Regular audits of the medicines management were helping to identify any errors and reduce the risk of future issues. However, we continued to find prescribed liquids, Gaviscon and Lactulose, in the medicines trolley and prescribed creams in people’s rooms that had not been dated when opened. This meant staff were not aware when the item should be disposed of.

At the last inspection we were concerned that care plans were not always effectively reviewed to take account of any changes in a person’s needs. Risk assessments were not always completed where a risk had been identified. Some people who required monitoring of their position, their weight or their food and drink intake did not always have this recorded by staff. Pressure relieving mattresses used to help reduce the risk of skin damage were not regularly checked to ensure they were set appropriately for each person. The service was not displaying its most recent inspection report as they are legally required to do.

At this inspection we found the service had taken action to help ensure each review of a persons' care plan led to a review of their risk assessments. Risk assessments were in place when concerns had been identified. Staff had improved the recording of when they provided care and support for people, such as re-positioning, food and drink recording and monitoring of peoples' weights. Pressure relieving mattresses were now audited each month following a check of peoples weights to help ensure they were set correctly. The services most recent inspection report was clearly displayed in the entrance hall of the service.

The service had two vacancies for care staff at the time of this inspection. The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. Staff and people told us they felt there were sufficient numbers of staff. The service audited their call bell response times. The report for the week prior to this inspection showed people waited between two and nine minutes for staff to respond, this had improved from the previous two weeks reports showing waits of up to 12 minutes.

People had access to some activities. Activity co-ordinators were in post who arranged regular events for people. These included music and quizzes and some trips out to the local community. However, some people told us that they felt there was not enough to occupy them during the day and at weekends. The management team confirmed they were reviewing activity provision to ensure it was what people enjoyed.

The two acting managers were supported by the operations manager and the provider. The staff told us that morale had improved and that they were working well together. Healthcare professionals told us they had noticed recent improvements in the service provided at Tremethick House and that they felt it was a safer service since the provider had taken action to address concerns.

We found the provider had taken effective action to address the concerns in the two warning notices. However, we still had concerns about the management and administration of medicines.

We have not changed the rating of this service as a period of sustained improvement is required before we can judge the service is entirely safe.

We found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.