The inspection took place on 31 October 2017 and the 7 and 8 November 2017. The first day was unannounced. Trenant House Care Home (Known as Trenant) is a residential home providing care and support for up to 24 people who may be living with needs associated with their mental health such as dementia. The home offers accommodation over two floors. Bedrooms are mainly single occupancy, with some offering an en-suite facility. People have access to two communal lounges and large dining area. Gardens are located to the front and side of the property.
At this inspection there were 21 people living at the service.
At the last inspection in June 2015, the service was rated Good. At this inspection we found some aspects of the service required improvement.
During the inspection we received anonymous concerns about the service. These concerns related to some aspects of people’s care, staff recruitment, and the cleanliness of equipment and parts of the environment. We looked at these concerns as part of the inspection, and also asked one of the directors for the service to look into the issues and report back their findings. Although we did not find concerns in relation to the recruitment of staff, we did find concerns regarding the general upkeep and cleanliness of the home. The feedback from the director assured us that the issues relating specifically to people’s care had been looked at and any required action taken.
Staffing levels were planned dependent on people’s needs and risks. Staffing levels had recently been increased during the busier times of the day to help ensure people’s needs were met. However. Some of the care staff said they felt staffing levels were not always sufficient to keep people safe, particularly when people needed close monitoring and supervision. We raised these concerns with the deputy manager and the director as part of the feedback following the inspection. We were told the staffing levels in relation to these particular people would be discussed with staff and addressed as a matter of priority.
Parts of the environment were unclean and poorly maintained. Parts of the environment did not create a warm and welcoming atmosphere for people using the service. We saw some improvements were being made at the time of the inspection and we were told plans for refurbishment were in place. However, some fixtures, fittings and furnishings were very old, which gave an air of general neglect, and indicated a lack of sufficient maintenance for improvement and repair.
A quality auditing system was in place, which included a range of regular audits completed by staff and a global audit completed by the provider. We were told information from these audits fed into an on-going improvement plan for the service. We saw some improvements were being made in relation to the environment and records, however, the system had not been sufficient in identifying the concerns we found during the inspection.
The service had a registered manager 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 2008 and associated Regulations about how the service is run. The registered manager was absent from the service at the time of the inspection. The deputy manager was overseeing the day to day running of the service during their absence and was being supported by other senior staff within the organisation and the registered provider/owner of the service.
Staff completed an induction programme when they first started working in the home. This included a thorough recruitment process and checks of their suitability to work with vulnerable people. An on-going training programme was in place, which included completion of the Care Certificate for staff who had not worked in care before. The Care certificate is a nationally recognised qualification to improve consistency in the skills of staff working within a care setting.
Some of the staff we spoke to said they felt the quality of training could be improved and was not in all cases detailed enough to reflect the complex needs of people they supported. Staff said they did feel well supported by their colleagues and management.
People and relatives said they felt activities in the home were very limited and did not always reflect people’s particular interests and needs. Comments included, “Activities used to be good when we had an activities coordinator, now they rarely happen”. Staff said they wanted to spend time with people, but very often didn’t have the time due to staffing levels and care tasks. A director for the organisation told us they were in the process of recruiting a new activities coordinator to the service.
Support plans were in the process of being updated and contained a range of information about people’s social, emotional and health needs. Some of the support plans we looked at lacked detail and had not been updated sufficiently when people’s needs had changed. We made the deputy manager aware of these gaps in records during the inspection and they took immediate action to update them.
People were supported by staff to raise concerns about the service and people said they felt issues were addressed promptly. A policy and procedure was in place detailing how people could raise a formal complaint and how this would be addressed. However, this information was not easily accessible to people using the service.
Staff were caring and respected people’s privacy and dignity. Staff knew people well and were able to respond promptly when people became unwell or if they showed signs of distress or confusion. Staff spoke fondly of people and respected their differences and personal lifestyle choices.
People were protected by staff who understood how to recognise and report signs of abuse. Risks in relation to people’s health and well-being were understood and managed effectively. People told us they felt safe living at Trenant.
People had their medicines managed safely, and were supported to maintain good health and a sufficient diet.
People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected. The service followed the processes which were in place which protected people's human rights and liberty.
The staff team and management were open and listened to advice and guidance from colleagues and professionals. The deputy manager and director made themselves available throughout the inspection process and were positive and responsive to discussions about further improvements required within the service.
We found a breach of the regulations. You can see at the end of the full report on our website what action we have told the provider to take.