We carried out a review of the data available to us about Tramways 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 Tramways, you can give feedback on this service.
We were somewhat assured that staff were using Personal Protective Equipment (PPE) effectively to safeguard people from the risk of infection. PPE supplies were in place and staff were aware of how to use the equipment effectively. However, the registered manager and a senior staff member were seen to be in the office area without masks. We reminded the registered manager of the requirement for all staff to wear masks at all times in all areas of the service to mitigate the risk of transmission of the COVID-19 virus. The registered manager immediately took action to address the issue. They instructed all staff to wear masks at all times and in all areas of the service. This was addressed with immediate effect. The registered manager also provided evidence of updating the current risk procedure, to include use of masks at all times for staff on duty in the home.
We found the following examples of good practice.
The service was clean throughout, and there were procedures to ensure any infection control risks were minimised. The communal areas had seating arrangements which supported safe distancing. Regular discussions took place between staff and people to ensure they understood the reasons for social distancing. People who had communication limitations were sensitively encouraged to safe distance by staff.
Infection control policies and procedures had been updated in line with the national guidance relating to COVID-19 and staff were provided regular updates to ensure they were following best practice recommendations. The training for staff regarding infection control had been updated to include guidance relating to COVID-19.
People had the choice to remain in their own rooms and use communal areas as they wished. Where people wanted to go out they were supported by a staff member and wore masks in the community settings. Staff had increased the choice of daily activities to support people who had their usual daily activities restricted due to the COVID-19 lockdown.
The service was closed to visitors in response to government guidelines. However, some people saw friends and relatives through external windows. Everybody had been provided with an electronic devise to enable them to communicate with family and friends.
Signage and information posters were in evidence at the entrance to the home to inform visitors of the procedures to follow. Plentiful supplies of PPE was in evidence at the entrance to the home and throughout the building.
There was a contingency plan in place to help manage an outbreak of COVID-19 including segregating the home to keep people safe.
Tramways is a residential care home providing personal care for up to eight people with a learning disability. At the time of the inspection there were seven being supported. The service provides care in one domestic style property.
There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
The service had been open for some years and therefore had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People were protected from the risk of abuse. Risks to people had been assessed and were managed safely.
There were enough staff to safely meet people's needs. Staff knew to report any incidents or accidents and the registered manager reviewed incident records to look for trends and reduce the risk of repeat occurrence.
Staff received good training and support to carry out their roles effectively. Staff were positive about working in the service. Staff worked with other professionals to ensure people's healthcare needs were met.
People and their relatives (where appropriate) had been consulted about their care and support needs. The service had a complaints procedure in place.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were supported to maintain a balanced diet and told us they enjoyed the choice of meals and snacks.
Staff treated people with dignity and respected their privacy. People were involved in making decisions about the support they received. Staff were caring and compassionate in their approach.
The home was well led. Systems and checks were in place to ensure that the home was operating well.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published on 11 May 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The service is situated in the centre of Newquay close to the sea front. All the people living at Tramways were mobile and had a good level of independence which meant there was limited use for the need for mobile aids and adaptations. Some people using the service went out independently and used local transport networks.
At the last inspection the service was rated good. At this inspection the rating remained good.
We carried out a comprehensive inspection of Tramways on 11 April 2017. This was an announced inspection. We told the provider one day before our inspection visit that we would be coming. This was because we wanted to make sure there would be staff and people to speak with and access to records.
Risk assessments had been developed to minimise the potential risk of harm to people who lived at the service. These had been kept under review and were relevant to the care and support people required.
Families and people told us they felt safe at the service. They said, “Happy here. Yes safe”, “(Persons name) is so well looked after it puts out minds at rest” and “Always well looked after.” People were supported by staff that were aware of the signs of abuse and the need to report any concerns. People using the service had contact details for local safeguarding support.
People were able to do things they enjoyed and keep in touch with those people who were important to them. Risks to people's safety were understood by staff and people benefited from receiving care and support which took into account their health and welfare. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. Where required people were supported to take their medicines so they would remain well. Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required to administer medicine safely.
Staffing levels were sufficient to meet the individual needs of people using the service. Additional staff were available to support people to appointments or other events when necessary. People were supported to access the local community and take part in a range of activities of their choice.
There were systems in place to record accidents and incidents and take appropriate action when required. Recruitment checks were carried out to ensure suitable people were employed to work at the service.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People had access to healthcare professionals and their healthcare needs were met. The service had responded promptly when people had experienced health problems. People were treated with dignity and respect and independence was promoted wherever possible.
People and their relatives were happy with the care provided and told us that staff were kind and caring in their approach. Families were involved in care planning and review to support people’s best interests. Staff were enthusiastic about their role and knew people well and could explain how people preferred to be supported. Care was reviewed at regular intervals. People had been supported to maintain relationships with those who were important to them.
People and relatives knew how to raise any complaints they had and were confident staff would take action if this happened.
There was clear and open communication between the registered provider, registered manager and staff, so they knew what was expected of them. Checks were undertaken on the quality of the care by the registered manager and provider through regular communication, meetings and by seeking the views of people using the service and their relatives.
We inspected Tramways on 20 & 21 November 2014, the inspection was unannounced.
Tramways is a care home which is registered to provide care and accommodation for up to eight people with a learning disability. At the time of the inspection six people were living at the home. We last inspected Tramways in October 2013, at that time we did not identify any concerns with the home.
In the week previous to the inspection the manager had successfully applied to become registered manager at the home. 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 2008 and associated Regulations about how the service is run.
We found there was a calm and friendly atmosphere at Tramways. Everyone we spoke with talked about the service using terms such as; “homely”, “family orientated” and “like a real family home.” Staff knew the people they supported well and worked closely with them to help them reduce any anxieties they had.
People were encouraged to develop and maintain their independence both in and outside of the home. An external healthcare professional told us the service was “Very enabling.” People and their relatives were involved in the running of the home and their views of the service were actively sought out. When any concerns or suggestions were raised these were acted upon.
Arrangements for the administration and storage of medicines were robust. There were no guidelines in place for staff when administering ‘as required’ medicines.
Care records were of a good standard and contained detailed information about how people wished to be supported. They had been compiled with the involvement of the individuals concerned to help ensure they were accurate and meaningful. The records were regularly reviewed so they would reflect people’s changing needs. Staff were knowledgeable about the people they supported. However not all the information regarding people’s personal histories was recorded in the care plans.
Information on a range of subjects was available for people in easy read formats to make this information more meaningful. This included risk assessments, care plans and information in respect of medicines and health checks.
People’s rights were protected because staff were following appropriate guidelines and legal processes. All staff had undergone training on safeguarding adults from abuse. They were confident on what action to take if they suspected abuse. People told us they felt safe.
There was stable staff team in place who had worked at the home for a number of years. They received appropriate training which was relevant to people’s specific needs. They were supported by an effective system of supervisions and appraisals. In addition they had regular contact with the registered manager who they described as “approachable.”
The service had an open and transparent culture. There was an ethos in place which put people at the heart of the service. These values were respected and echoed by staff. Staff were encouraged to voice their opinions about the day to day running of the home and told us they felt valued and appreciated by the provider and registered manager. Friends and family told us they visited whenever they wanted and had no concerns about people’s well-being and happiness.
We visited the home and looked at the care and welfare of those six people who used the service. On the day of the visit we spoke with three people who were at home. We were invited to speak to people in the lounge, rooms and kitchen area. People made very positive comments to us about the service they received. One person said "I am very happy here and I can make my own choices about what I want to do" "another person said" "the staff are very good and I am very comfortable here".
We also made telephone contact with two members of staff who had worked at the home for several years. One member of staff had over forty years in care and nursing and they said "things are really good here with the people coming first".
The manager designate explained that they would be submitting a manager application to register with the Care Quality Commission (CQC). The provider joined us later in the morning and said they visit the home most days to offer their support.
We read the safeguarding and complaints procedures which were supported by a commitment to ongoing staff training.
On the day of the inspection, we spoke with all of the people who lived at Tramways. People were all positive about the care and support they received. People said the food was to a good standard. People said the staff were nice and helpful. People said they were encouraged to make choices regarding what they wanted to do and what they wanted to eat.
When we inspected the home was clean and odour free. The home was well maintained, well furnished and decorated to a good standard. Staff were observed working professionally and doing their best to meet the needs of the people that lived in the home. Quality assurance systems were satisfactory.