Archived: Tredegar Care Home

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.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We saw that people's assessments, care plans and risk assessments were not accurate and did not reflect the current needs of people who lived at the home.

People had been cared for in an environment that was safe. We saw that regular electrical and gas servicing took place. There were regular call bells, fire alarms, hoists and lift checks.

Staff were able to tell us about their understanding of, and what actions they would take if they believed people in the home were at risk of abuse.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and knew people well. One visitor told us, 'I can't fault the care here.'

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were kind and gave encouragement when supporting people. People told us they were able to do things when they wanted to. Our observations confirmed this. One person told us, 'I'm very happy here, staff do little extra's which makes all the difference.'

Is the service responsive?

People's needs had been assessed before they moved into the home. However these had not been reviewed and did not reflect the current needs of people.

Is the service well-led?

There had been recent management changes at Tredegar Care Home. At the time of our inspection one person told us, 'I am much happier now X is in charge.'

Feedback surveys had been undertaken earlier in the year and these showed people were satisfied with the service. People we spoke with told us they could raise their concerns with staff and the manager. They said they were listened to and action was taken appropriately.

We found that the provider was now compliant. People's records were up to date and accurate and they reflected people's individual needs.

People who lived at the home told us they were happy living at the home. One person told us "Staff look after me well." Another person told us, "I get all the care I need."

We found that staff knew people well, and the care people received was good. However, not all of the records were fully completed.

We looked at the systems and processes in place for the safe management of medicines and found they were in order.

There were sufficient staff on duty to meet the assessed needs of the people living in the home.