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Archived: Tranquility House Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 14 May 2016

This inspection took place on 1 and 2 March 2016, the first day was unannounced. The previous inspection was carried out on 17 July 2014 and there were concerns around staff recruitment records. At this inspection, we found the provider had met the required actions.

Tranquility House is registered to provide accommodation and personal care for up to 20 people who may have dementia or similar conditions. The premises are a detached house situated on one of the main roads going in to Folkestone. The service has 16 bedrooms, four of which are twin rooms and all of which have a wash hand basin. Bedrooms are spread over three floors, which can be accessed by the use of a small passenger lift. The lift is not suitable for people using a wheelchair. People had access to four assisted bathrooms and a dining room, two lounge areas and a conservatory. There is a small car park and street parking available nearby. 18 people were living at the service at the time of the inspection, four people were sharing two of the twin rooms.

The service provider, Mrs Wratten, also works as the manager. Registered providers 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’s safety was at risk because there was no safety test certificate for the electrical instillation at the service and no processes were in place to safely manage water to safeguard people against the risks of legionella. There were no systems in place to ensure checks had been completed on fire safety systems, gas, electricity and lifting equipment.

People were not always kept safe from abuse, staff were aware of safeguarding procedures, although policies and procedures were not current and not all staff had received appropriate training. Staffing levels were not sufficient to meet people’s needs all of the time and recruitment processes were not always thorough and robust. Accidents and incidents were not analysed to reduce the risk of reoccurrence.

Medicines were stored securely and safely. People received their medicines when they should but there were shortfalls in the recording of topical creams administration and in medicines that are prescribed to be taken ‘As required’.

Elements of care planning were not person centred to reflect differences in people’s individual needs. Some records at the service were contradictory about the support people needed and some support plans did not contain the level of detail needed in order to ensure staff supported people consistently. The arrangement of some activities reflected staff availability, rather than being planned to meet people’s needs.

People were supported to maintain good health as referrals to health professionals were made in a timely way. People’s privacy and dignity was not always fully respected. However staff were kind and caring in their approach to people.

Most risks associated with people’s care and support were assessed. People told us staff acted

with their consent and felt that they were treated respectfully and that their privacy and dignity were

promoted. People were able to choose their food at each meal time, snacks and drinks were always available. The food was home-cooked and people told us they enjoyed their meals, describing them as “Very good” and “First class”.

People or visitors did not have access to an up to date complaints procedure. There were no effective systems for monitoring the quality of care provided or assessing and mitigating risks within the service. Records were not accurate or available during the inspection. Policies and

procedures required review to ensure staff had clear guidance.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

Inspection areas

Safe

Inadequate

Updated 14 May 2016

The service was not safe.

The service was not safely maintained. Servicing and safety checks of equipment had lapsed or not taken place.

Risks to people were not adequately monitored to keep people safe.

People received their medicines when they should, but improvements were required in some records and guidance to ensure risks in relation to medicine management were mitigated.

People were not protected by thorough and robust systems for recruiting new staff.

There were not sufficient staff deployed to meet people’s care and treatment needs.

Effective

Requires improvement

Updated 14 May 2016

The service was not consistently effective.

Staff were not supported effectively through supervision, training and appraisal so they had the skills needed to meet people’s needs.

People did not have mental capacity assessments in place. This did not meet with the principles of the Mental Capacity Act 2005.

Staff ensured people’s health needs were met. Referrals were made to health and social care professionals when needed.

People were supported to eat a healthy varied diet at their own pace.

Caring

Requires improvement

Updated 14 May 2016

The service was not consistently caring.

People’s privacy and dignity was not always respected.

People felt staff were kind and caring and staff demonstrated kindness.

Relatives told us they were made to feel welcome when they visited.

Responsive

Requires improvement

Updated 14 May 2016

The service was not consistently responsive.

Care planning was not always person centred and meaningfully individual.

Activities reflected staff availability rather than being planned to meet people’s needs.

People did not have access to an up to date complaint procedure. People and visitors told us they had not needed to complain.

Well-led

Requires improvement

Updated 14 May 2016

The service was not consistently well led.

Checks and audits had not identified shortfalls found during this inspection or enabled the provider to meet regulatory requirements.

Some records were contradictory and lacked required detail.

Staff did not have access to a set of policies and procedures which were complete, clear and reflected current legislation.

Staff told us that they felt supported by the manager and that there was an open family style culture in the home.