We carried out a review of the data available to us about Trenant House Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Trenant House Care Home, you can give feedback on this service.
We found the following examples of good practice:
Checks were completed on visitors to reduce the risk of them transmitting the virus into the home. Staff and people were tested in line with guidance. All staff had been vaccinated and people were due to be vaccinated in the days immediately following this inspection.
The provider had ensured staff were trained in respect of infection control and, their role to keep people safe at this time. Staff were informed of the latest guidance and the provider made regular checks to make sure their practice was safe. Staff and people’s needs had been risk assessed and those at highest risk of developing complications.
The premises had been reviewed and a separate facility had been built outside which enabled staff to put on and take off their uniforms at the start and end of their shift. This area would also allow personal protective equipment (PPE) to be put on before staff entered the building and, for the testing of staff. Staff uniforms were already being washed on site, but the new facility further minimise the risk of possible transmission into the home.
At this inspection we looked at whether the breaches of regulations had been addressed and if improvements highlighted had been actioned. We found improvements had been made in relation to the environment, staffing levels, activities and quality auditing. Improvements had been made in the planning of people’s care and these improvements were on-going. The provider was introducing an electronic recording system, which they felt would further improve the documentation and delivery of people’s support arrangements. We have made a recommendation in relation to personalised care planning for the provider to consider as part of this process.
Trenant is registered with us to provide accommodation and care for up to 24 people. People have a mental health diagnosis or history of such diagnosis. People may also be living with other needs associated with their mental health as well as other conditions such as a learning disability.
Trenant is a ‘care home’. 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.
Trenant is an older Victorian style property with accommodation over two floors. People had access to communal areas, as well as their own bedrooms with communal bathrooms and some en-suite facilities. The home had a large accessible garden area, which people said they enjoyed using during the summer months.
A registered manager was employed to manage the service. 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.
People living at Trenant had a range of complex needs associated with their mental health. Some people had found themselves in a crisis situation before moving to Trenant and had either required admission to hospital or intervention and support at home. Professionals from the local mental health services said they had been impressed with how responsive the registered manager had been supporting people in crisis situations. A healthcare professional said although people they had supported had had numerous breakdowns of previous placements, all had said they were happy to stay living at Trenant.
The environment was well maintained and improvements had been made since the last inspection in October 2017. A large conservatory had been added to the front of the property, which was a large, bright communal space for people to enjoy. A ground floor bathroom had also been renovated and included a new electronic bath for people who chose not to use a hoist but were unable to stand in a bath. This meant more people had access to enjoy a bath as part of their personal care routine.
People were safe, because staff assessed risks associated with people’s needs and understood what to do to minimise them. Staff were well trained and employed in sufficient numbers to keep people safe and meet their needs. Staff said they had time to spend time with people and this was considered an important part of their role. The recruitment of staff was robust and helped ensure all staff were fit and appropriate to work with vulnerable adults.
People’s medicines were managed safely. People’s health was monitored and they had access to a range of health services when required. People’s specific dietary requirements were understood, and people had access to a healthy and balanced diet.
The registered manager and staff knew people well and were familiar with people’s daily routines.
People were supported by staff who cared about them and promoted their rights, privacy and dignity.
People were supported to have maximum control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People had access to independent advocacy services to help them make decisions about their care and lifestyle.
People were able to occupy their time with meaningful activities. Staff spent time with people, sitting and chatting and people went out and about in the community on their own or supported by staff.
People said they knew how to make a complaint and raise concerns. They said they felt confident their views would be listened to and addressed. The provider and registered manager used complaints and other incidents as an opportunity to learn and improve.
The registered manager and provider worked regularly in the home. People, staff and other agencies said the registered manager and provider was supportive and visible in the service. Staff said they felt valued and well supported by their colleagues and management.
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.
The inspection took place on 1 and 3 June 2015 and was unannounced.
Trenant House provides care and accommodation for up to 24 people. On the day of the inspection 21 people were using the service. Trenant House provides care for adults who may live with mental health conditions which includes people living with dementia.
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.
People and staff were relaxed throughout our inspection. There was a very calm, friendly and homely atmosphere. People told us they enjoyed living in the home. Comments included, “I have a good laugh with staff, I couldn’t be happier” and “I find it very friendly, I like it”.
People spoke highly about the care and support they received, one person said, “Staff are deeply compassionate”. Another stated: “I receive good care”. Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected. A visitor commented, “I am updated on any issues since my last visit; I feel we are kept up to date”.
Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff were highly motivated, creative in finding ways to overcome obstacles that restricted people’s independence, and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity.
People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful and reflected peoples interests and individual hobbies. A visitor commented that people were actively involved in activities and felt people really enjoyed it.
People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, community psychiatric nurses and speech and language therapists.
People told us they felt safe. Comments included, “I feel safe” and “I feel safe, this place saved my life”. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.
People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.
Relatives and friends were always made to feel welcome and people were supported to maintain relationships with those who mattered to them. People and those who mattered to them knew how to raise concerns and make complaints. Nobody told us of any concerns or complaints they had and no written complaints had been made to the service.
Staff described the management to be supportive and approachable. Staff talked positively about their jobs. Comments included: “I love my job, if I didn’t like it I wouldn’t be here. It is a happy and friendly environment; I want to come to work” and “I love it here, I’m always happiest when I’m looking after people. I’m really happy here”.
Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. A staff member said: “Training is really good and regularly takes place”.
Staff understood their role with regards the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. Applications were made and advice was sought to help safeguard people and respect their human rights.
There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.
We observed that staff spoke with people in a friendly and respectful manner. People told us that they were able to make choices about their day to day lives. One person told us 'It's brilliant here.'
The care plans we looked at were personal to the individual and gave staff clear information to follow. This made sure that people received care and support which met their individual needs.
There were suitable safe storage facilities for medication and we observed staff administering medicines competently and safely.
The home kept a log of all complaints and concerns raised. One person told us 'I have no complaints, but I could talk to staff if I did.' We read the log and saw that all concerns were responded to.
Everybody we spoke with told us that they liked living at the home. One person told us that 'I am very happy here' and another person told us 'I like living here'.
A visiting professional told us 'the staff are always helpful'. and that they visited the home twice a week.
People appeared to be happy and at ease in the home. One person was cleaning the tables and laughing with staff, others were sat either in the dining area or the lounge. One person we spoke with told us that they felt safe living in the home and with the staff. Throughout the day we saw that staff were competent and cheerful in their roles.
We completed this review on 10 February 2012. We spoke in private with two people living at the home, the manager, three staff, two representatives of people living in the home and a healthcare professional.
Because of the complexities of their illnesses, some people were unable to tell us about their experience of living at the home. Therefore both direct and indirect observation was used to assess the wellbeing and happiness of people in the home, as well as speaking with them.
Staff told us how people were encouraged to make their own decisions, especially in relation to how they received the care they needed. We heard people being offered choices about how they wanted to spend their time.
We heard staff speaking with people in a kindly, friendly way and people that we spoke with confirmed that staff always treated them with respect. We saw staff respond promptly, discretely and sensitively to people when they asked questions or needed help. People told us, "..get on well with staff, always plenty around", "can speak with them about anything" and another told us they were "glad to be here".
We spoke with two representatives of someone living at the home, and they told us that the home always kept them informed about their relative's care.
Each person had a care file that contained a wide range of documents relating to their care and support needs. Each file we looked at contained detailed pre-admission assessments that included details of next of kin and some of the individual's preferences. A range of risk assessments had been completed including those for pressure areas nutrition and moving and handling. Although everyone who lived at the home had a care plan that set out their needs the care plans did not always contain sufficient information for staff about how to meet these needs.
The home employed an activities organiser and we saw people enjoying a craft session. People told us there was always something going on and they could pick and choose whether they joined in.
During our visit we looked at the communal areas of the home and some bedrooms. Areas that we saw were generally clean and tidy and there were no unpleasant odours.
Staff told us that Trenant House provided staff with a thorough ongoing training programme, which included mandatory training such as First Aid, Food Hygiene and Health and Safety as well as additional specialised training which related more directly to the individual needs of people who lived in the home such as dementia.
Staff that we spoke with told us that they had received training on safeguarding people and they were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring.
Regular meetings were held for people that lived at the home (and people who support them) so that they could discuss any concerns they might have.