Archived: Tralee Rest Home

Updated 26 January 2019

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 inspection took place on 4 and 5 December 2018 and was unannounced. The inspection was carried out by one inspector.

Before our inspection we reviewed the information we held about the service including previous inspection reports. We used information the registered persons sent us in the Provider Information Return. This is information we require registered persons to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

We met and spoke with 11 people who lived at Tralee Rest Home, we observed some people’s care, the lunchtime meal, some medicine administration and activities. We spoke with two people’s relatives. We inspected the environment, including the laundry, bathrooms and some people’s bedrooms. We spoke with one senior carer, two care assistants, the kitchen and housekeeping staff as well as the registered manager.

We observed care provided in communal areas and looked at the care records for seven people. We also looked at records that related to how the service was managed including staff training and supervision records, staff recruitment records, medicines records, risk assessments, accidents and incident records, quality audits and policies and procedures.

To help us collect evidence about the experience of people who were not able to fully describe their experiences of the service for themselves because of cognitive or other problems, we used a Short Observational Framework for Inspection (SOFI) to observe people’s responses to daily events, their interaction with each other and with staff.

We displayed a poster in the communal area of the service inviting feedback from people and relatives. Following this inspection visit, we did not receive any additional feedback.

Updated 26 January 2019

We inspected the service on 4 and 5 December 2018. The inspection was unannounced.

Tralee Rest Home is a ‘care home’. 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.

Tralee Rest Home is registered to provide accommodation and personal care for 36 older people and people who live with dementia. There were 23 people living in the service at the time of our inspection. The service is a large detached and extended house situated in a residential area just outside Whitstable.

Our last full inspection of this service took place in October 2017. Following this inspection, the key areas of Effective and Caring were rated as Good, while the areas of Safe, Responsive and Well Led were rated as Requires Improvement, together with the overall rating of the service. This was because more action needed to be taken about people who experienced falls; including more detailed audit processes. Care plans about epilepsy had been produced but needed more detail to make them truly effective. Other care plans were written in a person-centred way but had not always been updated when people’s needs changed. Medicines were generally managed safely but administration practices needed to be more consistent and recording of refused doses improved. Not all concerns raised by complainants had been logged and responded to before they became formal complaints. Audits of care plan reviews had failed to identify that details were incomplete, not always accurate or up to date. In addition, they did not consider impact on individuals in terms of reducing risk and ensuring all had been done provide support for people.

We told the registered provider to send us each month an update about the running of the service, what improvements they had made and intended to make to address our concerns and bring about improvement. The registered provider complied with this requirement.

At this inspection some improvement had been made. Incidents and accidents were all reviewed and the results used to inform any changes needed to reduce the risk of recurrence. Falls were well managed, associated risk assessments were updated and people had received support needed to reduce the risk of repeated falls. Care planning had improved and were mostly reflective of people’s current needs, however reviews of care plans had missed the opportunity to check for completeness and develop best practice procedures. Medicines were generally managed safely, although a piece of equipment used to test blood sugar levels had not been periodically calibrated and the service did not hold a stock of test fluid to allow this to be done. Complaints had been logged and responded to in line with the policy in place. Auditing and oversight had improved; however they had not been used to their expected potential as tools to assess the quality and safety of the service provided or develop best practice and continuous improvement.

As the result of this inspection, the service was rated as Requires Improvement. This is the second consecutive time Tralee Rest Home has been rated as Requires Improvement.

People were protected from harm by staff who were trained to recognise signs of abuse. However, recruitment processes did not ensure risk assessments were completed before the employment of staff for whom cautions, or convictions were recorded. Additionally, a policy was not in place to support such a process.

There were enough staff to meet people’s day to day care needs. However, people’s preferences about when they went to bed were not fully considered in the deployment of staff and may impact on or influence people’s choices.

Pre-assessments for people moving to the service were comprehensive. Staff were able to tell us confidently about the care and support people needed for specific conditions; potential risks to people’s health and welfare were identified and there was guidance for staff to follow. However, occasionally guidance would have benefitted from further detail to ensure quality of delivery and clearly determine a level for consistency.

Appropriate arrangements were in place to assess people’s needs and choices so that care achieved effective outcomes. This included providing people with the reassurance they needed if they became distressed. Care staff knew how to provide practical assistance for people in the right way and had received training and guidance. People were helped to eat and drink enough to maintain a balanced diet. Suitable provision had been made to help people receive coordinated care when they moved between different services. People had been supported to access all the healthcare services they needed. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People had been supported by relatives and representatives to express their views about things that were important to them. This included them having access to lay advocates if necessary. Confidential information was kept private.

People received practical assistance to complete everyday tasks and suitable arrangements had been made to promote equality and diversity. Suitable steps had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

The building was adapted to meet people’s needs. Staff completed checks on the environment and equipment, these helped to ensure people were safe. Good standards of hygiene were achieved to prevent and control the risk of infection.

The registered manager had promoted an open and inclusive culture in the service. They were actively working in partnership with other agencies to support the development of joined-up care.