We inspected Tregenna House on 3 and 4 December 2018.The inspection was unannounced. The service is for elderly people, some of whom may have physical disabilities, mental health needs or dementia. The service provides nursing care.Tregenna House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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. Tregenna House accommodated up to 49 people. At the time of the inspection 42 people lived at the home.
The service had 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.
At the last inspection, in February 2018, the service was rated as ‘Good.’ At this inspection we judged the registered persons continued to meet the regulations, and have concluded the service should still be rated as ‘Good’ overall.
The service was viewed by people we spoke with as very caring. We received positive comments about the service. For example we were told, "The staff are lovely, really nice indeed,” “ The staff are very kind, they are the right type of people for the job.” Relatives told us,“ The staff are lovely and they have a tough job. You never feel like anything is too much trouble…they are polite, gentle and professional,” and “The staff are good as gold. It has a lovely homely feel.They are all brilliant.” Everyone we observed looked well cared for. People were clean and well dressed.
The service provided a range of activities in the service. Two activities co-ordinators were employed.
People told us they felt safe. For example people told us, “I am very safe here,” and “Look around at all the staff, they are all here keeping us safe.” The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.
People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.
There were adequate staff on duty to meet people’s needs. However we did receive some concerns that people did not always receive prompt one to one support, and that staffing levels after 7pm were not adequate. During the inspection we did not observe people receiving unsatisfactory levels of support. Recruitment checks were satisfactory. For example a Disclosure and Barring check was also obtained to ensure the person was suitable to work with vulnerable adults.
Staff members received an induction. The registered provider was aware of the Care Certificate. This is a set of national standards for staff coming into the health and social care sector. Records showed most staff had received satisfactory induction and training although some staff still needed to complete this. Records of staff supervision (one to one meetings with a senior member of staff), were limited. We have recommended the supervision system is improved.
The medicines’ system was appropriately managed. Medicines were stored securely, and there was satisfactory systems to dispose of medicines which were no longer required. Staff who administered medicines received suitable training. Records about the administration of medicines were comprehensive.
The service was clean and hygienic. The building was suitable to meet the needs of the people who lived there. The building was well laid out, pleasantly decorated and homely.
There were suitable assessment processes in place before someone moved into the service. These assisted in helping staff to develop care plans. We were told staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.
People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a good standard. Comments about food included: “ It is lovely I get a plate full,“ and “It is nice and warm.”
The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers. However we have recommended records are improved to demonstrate that when people wanted, needed, and routinely saw some medical professionals such as opticians and dentists.
People lacked mental capacity. Where necessary suitable measures had been taken to minimise restrictions. Where people needed to be restricted, to protect themselves, and/or others, suitable legal measures had been taken. Staff had received suitable training about mental capacity.
The service had a satisfactory complaints procedure. People we spoke with felt they could raise a concern or complaint, and these would be responded to appropriately.
The manager was respected and liked by people, relatives and staff we spoke with. The registered manager had a hands on approach. Relatives told us, “The manager is lovely and works really hard,“ “ The manager is approachable and professional.” Staff members told us, "The registered manager and deputy are responsive to issues. They keep the momentum going,” Staff also said team working at the service was good, and team members were supportive and communicated well with each other.
The service had satisfactory quality assurance systems.