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Tralee Rest Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 26 January 2019

We inspected the service on 4 and 5 December 2018. The inspection was unannounced.

Tralee Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

Tralee Rest Home is registered to provide accommodation and personal care for 36 older people and people who live with dementia. There were 23 people living in the service at the time of our inspection. The service is a large detached and extended house situated in a residential area just outside Whitstable.

Our last full inspection of this service took place in October 2017. Following this inspection, the key areas of Effective and Caring were rated as Good, while the areas of Safe, Responsive and Well Led were rated as Requires Improvement, together with the overall rating of the service. This was because more action needed to be taken about people who experienced falls; including more detailed audit processes. Care plans about epilepsy had been produced but needed more detail to make them truly effective. Other care plans were written in a person-centred way but had not always been updated when people’s needs changed. Medicines were generally managed safely but administration practices needed to be more consistent and recording of refused doses improved. Not all concerns raised by complainants had been logged and responded to before they became formal complaints. Audits of care plan reviews had failed to identify that details were incomplete, not always accurate or up to date. In addition, they did not consider impact on individuals in terms of reducing risk and ensuring all had been done provide support for people.

We told the registered provider to send us each month an update about the running of the service, what improvements they had made and intended to make to address our concerns and bring about improvement. The registered provider complied with this requirement.

At this inspection some improvement had been made. Incidents and accidents were all reviewed and the results used to inform any changes needed to reduce the risk of recurrence. Falls were well managed, associated risk assessments were updated and people had received support needed to reduce the risk of repeated falls. Care planning had improved and were mostly reflective of people’s current needs, however reviews of care plans had missed the opportunity to check for completeness and develop best practice procedures. Medicines were generally managed safely, although a piece of equipment used to test blood sugar levels had not been periodically calibrated and the service did not hold a stock of test fluid to allow this to be done. Complaints had been logged and responded to in line with the policy in place. Auditing and oversight had improved; however they had not been used to their expected potential as tools to assess the quality and safety of the service provided or develop best practice and continuous improvement.

As the result of this inspection, the service was rated as Requires Improvement. This is the second consecutive time Tralee Rest Home has been rated as Requires Improvement.

People were protected from harm by staff who were trained to recognise signs of abuse. However, recruitment processes did not ensure risk assessments were completed before the employment of staff for whom cautions, or convictions were recorded. Additionally, a policy was not in place to support such a process.

There were enough staff to meet people’s day to day care needs. However, people’s preferences about when they went to bed were not fully considered in the deployment of staff and may impact on or influence people’s choices.

Pre-assessments for people moving to the service were comprehensive. Staff were able to tell us confidently about the care and support people needed for specific conditions

Inspection areas

Safe

Requires improvement

Updated 26 January 2019

The service was not consistently safe.

People received their medicines safely from staff who were trained to do so, however, blood sugar level monitoring equipment was not checked when it should have been.

There were enough staff available to meet the needs of people, however, night staff arrangements required further consideration to ensure staff availability did not unduly influence people’s decisions about when they went to bed.

Staff were recruited safely, however, processes were lacking in the event that statutory checks revealed cautions or convictions.

People were protected from the risk of abuse.

Risks to people and the environment were assessed, and staff took action to reduce those risks identified.

People were protected by the prevention and control of infection.

The registered manager took steps to ensure lessons were learned when things went wrong.

Effective

Good

Updated 26 January 2019

The service was effective.

People’s needs were assessed with them and their relatives when necessary.

Staff followed the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. People were supported to make their own decisions.

Staff were supported and had the skills they required to provide the care people needed.

People were supported to eat and drink enough to help keep them as healthy as possible.

People were supported to remain healthy.

The building was designed to support people to be as independent as possible.

Caring

Good

Updated 26 January 2019

The service was caring.

People were treated with kindness, compassion and respect.

People were supported to express their views about the support they received.

People had their privacy and dignity respected and promoted.

Responsive

Good

Updated 26 January 2019

The service was responsive.

People had planned their care with staff and received their care how they preferred, however, some care plans were contradictory in places.

People participated in a variety of activities.

Any concerns people had been resolved to their satisfaction.

People were supported in the way they preferred at the end of their life.

Well-led

Requires improvement

Updated 26 January 2019

The service was not consistently well-led.

Checks completed on the quality of the service had improved but required further development and embedding to ensure they drove forward improvement and sustained the changes made.

People, their relatives and staff shared their views and experiences of the service and these were acted on.

Staff shared the provider’s vision of good quality care.

Staff were motivated and led by the registered manager. They had clear roles and responsibilities and were held accountable for their actions.

The managers worked with other agencies to ensure people’s needs were met.