Tremanse House Care Home

Tremanse House Care Home is a residential care home providing personal care to up to 23 people with mental health needs. The service provides support to older people and people living with dementia. At the time of our inspection there were 22 people using the service. The service was made up of two buildings. The main house, where people were offered additional support, and the annexe, where people required less support and were preparing to move out to live independently.

People’s experience of using this service and what we found

Tremanse was fully staffed. There were enough staff to meet people's needs and ensure their safety. Staff were happy and told us they were well supported by the management team.

Recruitment processes were effective. However, we have made a recommendation in the safe section of this report regarding ensuring that start and end dates of previous employment were recorded and checked against their references. New staff were provided with induction and support prior to working alone with people.

There was a robust audit programme in place to help identify any areas of the service that may require improvement. The manager, deputy manager and the provider had effective oversight of the service, with the exception of staff training which was not accessible, via the electronic system, at the time of this inspection. Staff had attended a variety of training however we were unable to evidence when updates may be due. We have made a recommendation about this in the effective section of this report.

People received their medicines as prescribed. An electronic medicines management system was being used by staff. Regular audits were taking place.

We toured the premises and found the service to be clean and decorated to a good standard. People were involved in decisions to change furniture or décor.

The provider had effective safeguarding systems in place and staff knew what actions to take to help ensure people were protected from harm or abuse.

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.

Staff worked within the principles of the Mental Capacity Act and respected people’s decisions. Guidance in care plans helped staff to help build independence wherever possible. Some people were being supported to live independently with a view to leaving the service to live with minimal support.

Identified risks were assessed and monitored. Care plans contained guidance and direction for staff on how to support people well. Some people smoked cigarettes inside the service. The risks associated with this had been identified and assessed and steps were being taken to reduce potential risks further.

Food was cooked on the premises and was well received by people and staff. Some people worked alongside the cook when preparing meals. Staff were able to enjoy a meal when on shift.

People were free to come and go from the service as they wished. People were happy living at Tremanse and were positive about the staff and management.

People and staff had regular meetings with management, at which information was shared and the management team could seek their views.

The manager understood their responsibilities under the duty of candour. Notifications were sent to CQC appropriately.

The manager and staff worked closely with local health and social care professionals to support people’s needs.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (14 June 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

The service had suitable safeguarding systems in place, and staff had received suitable training about recognising abuse.

Appropriate risk assessment procedures where in place so any risks to people, staff or visitors were minimised.

Staff were recruited appropriately. Staffing levels were satisfactory, and people received timely support from staff when this was required.

The medicines system was well organised and staff received suitable training. People received their medicines on time.

The buildings were clean, and there were appropriate procedures to ensure any infection control risks were minimised.

The manager was able to demonstrate the service learned from mistakes to minimise them happening again.

The service had suitable assessment and care planning systems to assist in ensuring people received effective and responsive care.

Staff received suitable induction, training and supervision to assist them to carry out their work. However record keeping for some staff could be improved.

People received enough to eat and drink. Some people were encouraged to cook for themselves to improve their independence skills. The service could develop further opportunities to enable people to develop skills and do more for themselves so they could become more independent.

Buildings were suitable to meet people’s needs and maintained to a satisfactory standard.

People received suitable support from external health professionals, and were encouraged to live healthier lives.

Staff encouraged people to have choices about how they lived in line with legal guidance.

People said they received support from staff which was caring and respectful. Care promoted people’s dignity and independence. People were involved in decisions about their care.

People had the opportunity to participate in activities and to spend time with the wider community

People felt confident raising any concerns or complaints. Records showed these had been responded to appropriately.

The service was managed effectively. People and staff had confidence in the manager.

The service had suitable systems to monitor service delivery and bring about improvement when necessary.

The team worked well together and had the shared goal of providing a good service to people who lived at the home.

The service worked well with external professionals, and other organisations to provide good quality care.

Rating at last inspection: Rating at last inspection: ‘Requires improvement.’ (published on 10 May 2018.)

The service was last rated ‘Good’ in the report dated 5 May 2017.

Following the last inspection, asked the provider to complete an action plan to show what they would do and by when to make improvements to the service.

Why we inspected: We completed this inspection to check whether suitable action had been taken following the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Tremanse is a ‘care home’. This is a service for people who have mental health needs, and who were primarily under 65 years old at the time of the inspection. 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. Tremanse accommodates 23 people: 17 people in the main building, and five people in an adjacent building. The main building consisted of a shared house and a self contained flat for one person. The adjacent building known as the ‘annexe’ had been commissioned for approximately one year. The objective was this would provide more independent living accommodation for people who could live more independently. At the time of the inspection, there were 16 people who lived at the service.

The service did not have a registered manager. 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. The previous registered manager has left the service, and although CQC has informed the registered provider that the person needs to cancel their registration, this has not been done. A new manager has been recently employed and an application has been submitted for the person to be registered.

The service had satisfactory safeguarding policies and procedures. Staff were trained to recognise abuse, and what to do if they suspected abuse was occurring. Suitable risk assessment procedures were in place, and risk assessments were regularly reviewed.

We were concerned that health and safety checks on the premises and other equipment were not always carried out appropriately. For example, we had concerns about checks on fire equipment, and procedures to minimise the risk of legionnaires disease.

We were also concerned there was not always enough staff on duty to meet people’s needs. Some people needed significant support with personal care, and with observation or help outside the home. The service was funded to provide this support but it was difficult to see how suitable support was being provided with the staffing levels currently provided.

Recruitment checks for new staff were satisfactory. Staff said they received satisfactory support when they started their roles, but there was no evidence staff received opportunity to undertake the Care Certificate. Generally staff were provided with adequate training opportunities, but not all staff had completed the training which was required of them. There was a supervision and appraisal system in place but records did not always demonstrate staff received this support.

Medicines procedures were satisfactory, and the medicines system worked well. However, although we were told staff received formal training and competency checks regarding their ability to administer medicines, there was limited evidence this had taken place.

The service was clean, and there were suitable procedures to minimise the risk of infection.

There were satisfactory procedures to assess people to check they were suitable to live at the service and they wanted to do so. Subsequently staff developed comprehensive care plans for people and these were regularly reviewed.

People were happy with the food they were provided with and there was some choice of food available. Where necessary people were provided with suitable support if they needed help with eating.

People received suitable support with their health care. However, records to demonstrate people received suitable checks for example going to the dentist or optician were limited.

Where people lacked capacity to make decisions for themselves, suitable systems were in place to meet legal requirements and ensure people’s rights were protected.

Although we did receive positive support about staff attitudes, we received several reports that staff were not always respectful towards people and worked with them in a supportive manner. We did also receive mixed reports from external professionals about staff approaches. Where people required help with personal care, staff provided this support discreetly and professionally. Staff worked with people, to some extent, to maximise people’s independence, although there was significant further scope to support people in a manner which helped them to improve their skills so they did not have to rely on staff.

Some activities were available for people although there were no designated staff to provide this support, and we were told activities could be cancelled if there were staff shortages or the service was especially busy.

The service had a complaints procedure. People said they would approach staff or management if they had a concern.

The manager of the service had recently been appointed and had submitted an application to be registered with CQC. The manager was viewed positively by the people who used the service, staff and professionals who we contacted.

The staff team said they worked well together. External professionals generally were positive about how the team worked with people who used the service, and were viewed as caring.

Quality assurance processes were not sufficient to adequately pick up and address shortfalls in service provision.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

Tremanse House Care Home is a residential service providing care, rehabilitation and support for up to 23 people with mental health needs. At the time of the inspection 19 people were living at the service. Tremanse comprises a main house and an additional five bedroomed annexe. A new self-contained flat had also been built attached to the annexe. This flat was almost ready to be occupied.

Tremanse has a registered manager. 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. The registered manager had not been at work for several months. In the interim, the service was being led by the deputy manager, who was an experienced member of staff. The deputy manager was being supported by a stable staff team.

At the last inspection, we found that people were not being assessed in line with the principles of the Mental Capacity Act (MCA), despite some people being subject to authorisations under the Deprivation of Liberty Safeguards (DoLS). At this inspection we found that improvements had been made. People’s rights were protected by staff who understood their responsibilities under the Mental Capacity Act (MCA). People’s capacity was assessed when required and best interest processes were followed. Some people were subject to other orders, such as community treatment orders (CTO). CTO’s are part of the Mental Health Act. Staff were knowledgeable about what this meant for the person. People’s records contained details of any conditions attached to the order and about when they were due to be renewed.

People told us they felt safe living at Tremanse. People were supported by staff who had undergone the necessary checks, prior to commencing their employment, to ensure they were suitable to work with vulnerable people. Staff knew how to recognise and report any signs of abuse or mistreatment. Staffing levels were safe and allowed people to be supported in an unhurried manner.

People were encouraged to live active and independent lives. Some people accessed the community independently. Staff supported people to attend appointments and recreational activities if they required. There were daily planned activities in the service as well as day trips to local places of interest. People were encouraged to assist with household chores.

People's medicines were managed safely. People received their medicines as prescribed and on time. Staff were trained and understood the importance of safe administration, management and disposal of medicines. There were regular audits of medicines to ensure any errors were quickly identified and reported.

Staff underwent a thorough induction period during which they were supervised so that any learning needs could be identified. Staff were supported by an ongoing programme of training, supervision and an annual appraisal. Staff told us they felt well supported in their role.

People’s health was monitored at the service. Staff were vigilant to the signs of people becoming unwell or experiencing a relapse in their mental health. Staff made prompt referrals to external health care professionals if they suspected a person’s mood had changed and they may need support.

People had enough to eat and drink. The food appeared plentiful and people were involved with planning the menus. People told us they enjoyed the food. Throughout the day people were able to independently access hot and cold drinks.

People’s care records were personalised documents which gave guidance for staff on how to meet their needs. Records were comprehensive, detailed, easy to navigate and regularly reviewed. Where possible, people had been involved in their care planning.

We observed kind and compassionate interactions between people and staff. People were cared for by staff who knew them well and who spoke about them with fondness and affection. People’s confidential information was securely stored. Staff maintained people’s dignity by ensuring that they knocked before entering their rooms and asked consent before providing them with assistance.

Infection control practices kept people safe. The service was clean, hygienic and free from adverse odours. We saw there were hand-washing facilities, antibacterial gel and paper towels prominently sited in areas that could be used by people to prevent cross infection.

The manager operated a cycle of quality assurance questionnaires to invite feedback on the service and to drive improvement. There were regular quality audits and any actions required were dealt with promptly. People knew how to raise a complaint and were confident that any concerns would be listened to. Accidents and incidents were recorded and details were shared with the healthcare professionals involved with the person where appropriate. There were regular staff and residents’ meetings so that suggestions on the service could be raised.

Tremanse House Care Home (known locally as Tremanse) is a residential service providing care, rehabilitation and support for up to 23 people with mental health needs. At the time of the inspection 19 people were living at the service. Tremanse comprises a main house and an additional five bedroomed annexe.

Tremanse has a registered manager. 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 that, despite some people being considered to lack the mental capacity to make their own decisions, no mental capacity assessments had been completed. Referrals had been made to the local authority for authorisation to restrict some people’s liberty without these assessments being done.

People and staff were relaxed and content; the atmosphere was calm and pleasant. One person commented; “All staff are lovely to me, they have helped me so much and I want to thank everybody”. Another person said, “I feel absolutely safe here”. One health care professional described Tremanse as; “Home from home”.

People were encouraged to live active and independent lives. Accessing the local shops, pubs and leisure facilities was promoted. Staff supported people to attend appointments and recreational activities when required.

People’s medicines were managed safely. People received their medicines as prescribed and on time. Staff were trained and understood the importance of safe administration, management and disposal of medicines.

Staff recruitment processes were safe. Staff underwent a thorough induction period during which they were supervised so that any learning needs could be identified. There were sufficient numbers of suitable staff on duty.

Infection control practices kept people safe. The service was clean, hygienic and free from offensive odours. We saw there were handwashing facilities, antibacterial gel and paper towels prominently sited in areas that could be used by people to prevent cross infection.

There were effective quality assurance systems in place. People knew how to raise a complaint and were confident that any concerns would be listened to. Accidents and incidents were recorded and details were shared with the healthcare professionals involved with the person where appropriate.

People, relatives and professionals spoke positively about the service. Feedback was sought through staff meetings, residents meetings and the compliments and complaints folder and was used to develop the service and drive improvement.

You can see what action we told the provider to take at the back of the full version of the report.