Trembaths

Updated 7 August 2018

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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2014 and to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out a focused inspection on 07 February 2018 and found that the provider had made improvements in the areas we found concerns in our comprehensive inspection on July 2018. This inspection was unannounced and took place on 19 July 2018. It was carried out to check that the service had improved further and sustained the improvements made.

The inspection team was made up of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed information we held about the service including statutory notifications. Statutory notifications include information about important events which the provider is required to send us. We also reviewed the provider information return (PIR) submitted to us. This is information that the provider is required to send to us, which gives us some key information about the service and tells us what the service does well and any improvements they plan to make.

During the inspection we spoke with eight people who used the service, four relatives, nine staff members, the manager, the regional manager, and the provider`s quality improvement manager. We received information from service commissioners and health and social care professionals. We viewed information relating to six people’s care and support. We also reviewed records relating to the management of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us due to their complex health needs.

Updated 7 August 2018

This unannounced comprehensive inspection was carried out on 19 July 2018. During our last comprehensive inspection on 11 July 2017 we rated the service requires improvement as they were not meeting the required standards. On 07 February 2018 we carried out a focused inspection to check that improvements to meet legal requirements planned by the provider after our inspection on 11 July 2017 had been made. The team inspected the service against two of the five questions we ask about services: Is the service well led, and is the service safe? Following the focused inspection, the rating remained requires improvement. Further improvements were needed to achieve Good rating. At this inspection we found that they were meeting the standards.

Trembaths is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Trembaths is registered to provide personal and nursing care for up to 51 older people, including people living with dementia. At the time of the inspection there were 46 people living there.

The service had a manager who had applied to be registered with the Care Quality Commission (CQC). 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.

The manager had been in post since March 2018 and they had been quick in identifying all the areas which needed improving for people to receive a good service. We saw that they were actively supporting staff on the floor, coaching and mentoring them to ensure staff delivered personalised care and support and were not task led.

Staff were trained and supported to carry out their roles effectively. They gave us positive feedback about the manager and their approach towards them, people and relatives.

People told us they felt safe at the home and they were cared for by staff who were kind and protected their privacy and dignity. However, people and relatives reported that at times staff turned call bells off promising they would be back soon to meet peoples` needs but waiting times had been up to 15 minutes on occasions. They also told us that there were times when they felt there was a shortage of staff. The manager had identified these issues and carried out observations and updated people`s dependency assessments to ensure at all times there was sufficient numbers of staff allocated to meet peoples` needs. They also observed staff answering call bells and monitoring if staff met people`s needs in a timely way.

Staff showed an understanding of safeguarding and issues of consent and capacity. They were aware of preventing and recognising the different types of abuse and neglect and told us they would feel confident reporting concerns to the manager and external safeguarding authorities.

People`s medicines were administered safely by trained staff who had their competencies checked. There were processes in place to deal with emergencies and staff were knowledgeable about these.

Staff were aware of the need to assess and manage risks whilst allowing people freedom to make choices about their lives. There were risk assessments in place for any identified risk to people`s well-being.

Staff adhered to the principles of the Mental Capacity Act 2005. People had regular access to health and social care professionals. People enjoyed a variety of foods and the mealtime experience observed was positive.

People and relatives told us that staff were kind. People shared mixed views about whether they were involved in planning their care. Confidentiality was promoted and there were regular links to the community.

New care plans were being rolled out by the provider and people’s care plans were in the process of being rewritten in the new format. We found that care plans contained all the assessments and plans to detail people`s needs and what support they needed, however these needed more personalisation to ensure staff knew how people preferred their needs to be met. We found that the manager arranged for reviews to take place with people and their families where appropriate so they could capture people`s voice in the care plans.

The manager when they commenced their employment ensured that the provider’s governance systems and processes were well known to staff and used consistently to provide good quality service for people. They carried out observations, introduced monitoring charts and also carried out regular audits to assess the quality and the safety of the care provided to people. This approach led to significant improvements to the safety of the care provided.