We carried out a review of the data available to us about Tremethick House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tremethick House, you can give feedback on this service.
We found the following examples of good practice:
• The service allowed people to meet visitors in a designated visitor’s room. The room had an external door which meant that visitors did not need to enter the rest of the building, subsequently minimising the risk of cross infection. When visitors did need to go around the rest of the building (for example if a person is receiving end of life care, or if contractors visit the service,) rigorous procedures were in place. All visitors were currently required to ring beforehand. Visitors were required to wear masks, and as necessary other personal protective equipment (PPE) to minimise the risk of infection to people and staff. These measures ensured the risk of infection was minimised.
• Staff had helped people to stay in touch with family and friends through phone calls, and through the internet. The owner of the service sent out a newsletter approximately once a month to people’s family and friends to keep them updated about life at the service. Staff assisted people to use IT and the telephone as necessary. Additional IT equipment had been purchased to assist people to keep in touch with family and friends.
• The service had identified an area of the building which could be used for people should they need to isolate, and /or who were admitted to the service. This ensured there was minimal risk from infection to other people at the service.
• Suitable testing routines had been arranged for staff and people who used the service. The registered manager said both staff and people who used the service had been happy to participate in regular testing.
• Robust admission procedures were in place, for example, the service required documentary evidence of Covid-19 test results before people moved in, followed by a period of self-isolation.
• The service was providing a range of social activities for people to help to keep them entertained and occupied. The service had dedicated activities staff to provide one to one, and group activities. Some outings, organised according to government guidelines, were arranged so some people were still able to go out.
• Staff had received suitable training and guidance regarding infection control, and how to respond to the Covid 19 pandemic. During the inspection we observed staff demonstrating suitable knowledge of good infection control practice. Other staff training had also been maintained.
• The service had comprehensive policies and procedures in respect of Covid 19 and its implications on the running of the service. From our discussions and observations these had been effectively implemented.
• The service was clean. Effective cleaning routines were implemented to ensure infection control risks were minimised and people were kept safe. Suitable cleaning routines were in place to help keep hygiene standards to a good standard.
• Suitable staffing levels were maintained at the service. Where necessary bank staff, employed by the registered provider, were used for example to cover staff sickness. Bank staff were required to complete appropriate training, and participate in regular testing, to minimise the risk of cross infection. Staff working across services managed by the provider was kept to a minimum.
This unannounced comprehensive inspection took place on 28 November 2018. This was the first inspection of this service since it re-registered with the Care Quality Commission due to the provider became a limited company.
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 37 people living at the service. Some of these people were living with dementia.
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.
The service is required to have a registered manager and at the time of the inspection there were two registered managers in post. A registered manager is a person who has registered with the Care Quality Commission 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 spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. People told us, "All the staff and the managers do what they can, and very willingly” and "My room is kept spotless.”
The premises were well maintained. There was no pictorial signage at the service to support some people, who were living with some early dementia and may require additional support with recognising their surroundings. The provider agreed that there was a person living at the service who was independently mobile around the building and may benefit from additional signage to help them find their own bedroom. Additional signage would be reviewed. The premises were regularly checked and maintained by the provider. Equipment and services used at Tremethick were regularly checked by competent people to ensure they were safe to use.
Care plans were held electronically and contained accurate and up to date information. However, we found that two people did not have care plans completed. Both had full pre admission assessments and daily notes had been completed by staff detailing all the care and support they had been given. One person had been living at the service for three weeks. The staff knew both people well and visiting district nurses had knowledge of one person from when they previously lived in their own home. Their nursing care needs had been met. We judged this had not impacted on people’s well-being. These care plans were created during this inspection. People told us, "The staff are very caring people," "I love it here because I never feel lonely" and "They help you with absolutely everything.”
Care plans were reviewed regularly and people’s changing needs were recorded. Care plans contained risk assessments which showed risks were identified, assessed and monitored to minimise the risk of harm whilst helping people to be as independent as possible. Relatives told us, “I am happy with the place, the staff are good and it is clean,” "The care is 10 out of 10” and "The staff have bent over backwards to help our relative settle in."
The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had a vacancy for one carer at the time of this inspection.People told us, "There's always somebody around to help me” and "I know I can use my call bell in case of an emergency."
There were systems in place for the management and administration of medicines. It was clear that people had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration however these did not effectively identify an out of date homely remedy which was in use at the time of this inspection. The system for monitoring people who self administered their own medicines was effective. We have made a recommendation about this in the Safe section of this report.
People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Mandatory training was provided to staff with regular updates provided. The manager had a record which provided them with an overview of staff training needs. Some staff did require updates at the time of this inspection and the management team were providing training for these staff. Staff were supported by a system of induction training, supervision and appraisals.
Meals were bought in to the service by an external company. The frozen meals were heated at the service. Food looked appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.
People were asked for their views. However, the process for seeking these views was not always robust and people's requests and suggestions did not always receive a response. We have made a recommendation in the Responsive section of this report in relation to the service seeking and responding to feedback from people who live at Tremethick House.
People had access to activities. There was a programme of varied events each month advertised for each person in their room. There were staff in post with the responsibility for providing activities, however one of these people was away from work at the time of this inspection. People were not able to go out regularly in to the local area to have coffee or visit local attractions, as the service did not currently have a vehicle available. It was not clear from the records if appropriate one to one activity was provided to them in their rooms on a regular basis. The provider confirmed that people would be taken out before Christmas to see the lights in the area. This was being arranged with a local business. We have made a recommendation about this in the Responsive section of this report.
The use of technology used to help improve the delivery of effective care was limited. People did have call bells to summon assistance when needed and some people had alarmed pressure mats in their rooms which alerted staff when the person was moving around.
People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.
The management team was supported by the provider and a team of motivated and many long standing staff. The staff team felt valued and morale was good. Staff told us, “I love my job,” “We provide really good care here” and “We get a lot of support from the managers and Mary, they are always around if we need anything.”
There were quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the management team and members of the senior care staff. This meant the service were constantly reviewing the service provided and were striving to improve it further.