Archived: Tredegar Care Home

Updated 14 May 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection by three inspectors and an expert by experience. It took place on 18 and 19 February 2016.

Before our inspection we reviewed the information we held about the home, including previous inspection reports and the provider’s action plan. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

We met with all the people who lived at Tredegar Care Home, we spoke with five visitors to get their view of the care provided. We observed the care which was delivered in communal areas to get a view of care and support provided across all areas. This included the lunchtime meals. As some people had difficulties in verbal communication the inspection team spent time sitting and observing people in areas throughout the home and were able to see the interaction between people and staff. This helped us understand the experience of people who could not talk with us.

We looked around the home, including the bathrooms, sluice rooms and some people’s bedrooms. We spoke with three agency nurse, one regular nurse, eight care workers, the cook, the maintenance man and the registered manager. The area manager was present for some of the time on the second day.

We reviewed a variety of documents which included six care plans and risk assessments along with other relevant documentation to support our findings. We ‘pathway tracked’ people living at the home. This is when we looked at their care documentation in depth and obtained their views on their life at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection we reviewed the records of the home. These included information in regards to the upkeep of the premises, staff recruitment, training and supervision records, medicine records complaint records , accidents and incidents, quality audits and policies and procedures.

Updated 14 May 2016

We carried out an unannounced comprehensive inspection at Tredegar Care Home on the 3, 4 and 9 March 2015 where we found improvements were required in relation to staffing numbers and staff training, respecting people and maintaining their dignity, consent, people’s records did not accurately reflect the care they needed and there was not an effective system in place to assess and monitor the quality of service. The provider sent us an action plan and told us they would address these issues by July 2015. We undertook an inspection on 18 and 19 February 2016 to check that the provider had made improvements and to confirm that legal requirements had been met.

We found some improvements had been made however not all legal requirements had been met.

Tredegar Care Home provides nursing and personal care for up to 26 people. There were 23 people living at the home at the time of the inspection. They had a range of complex health care needs which included people who have a stroke, diabetes and Parkinson’s disease. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care needs.

Accommodation is provided in single and double rooms and was spread over three floors with a passenger lift that provides level access to all parts of the home. People and visitors spoke well of the home and the staff.

There is a 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.

This was an unannounced inspection which meant the provider and staff did not know we were coming. It took place on 18 and 19 February 2016.

People’s safety had been compromised in a number of areas. There were not enough staff on duty to safely meet people’s needs. People’s needs had not been taken into account when determining staffing levels. People’s medicines were not always managed safely because there was no guidance in place for people who had been prescribed ‘as required’ medicines. Risks were not always safely managed. Although risk assessments and care plans were in place these did not contain all the guidance needed to support people. There was a current reliance on agency nurses at the home who did not know people, therefore clear guidance is essential.

Staff had an understanding of mental capacity and deprivations of liberty and appropriate authorisations were in place or applied for. However, there was no information about how staff should support people who lacked capacity.

People had a choice of meals and snacks throughout the day. However, mealtimes were disorganised and people did not receive support in a timely way.

Staff had not received all the training updates they needed for the provider to be sure they had the appropriate knowledge and skills to look after people. There was no clinical supervision in place for nurses.

Staff were kind and caring. The care staff knew people well and understood the care people needed and how they liked this delivered. However, due to constraints on staff time the care people received was task based and not person-centred.

The audit systems had not ensured that actions identified at the last inspection had been addressed. The systems to assess the quality of the service provided were not always effective. Action was not always taken when areas for improvement had been identified.

The registered manager was seen as open and approachable. People, visitors and staff told us they could discuss concerns with her at any time.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Staff files had a completed application form, references and other appropriate employment checks. Nurses were all registered with the nursing midwifery council (NMC) which was up to date.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.