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Archived: Tranquility House Requires improvement


Inspection carried out on 1 March 2016

During a routine inspection

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 carried out on 17 July 2014

During a routine inspection

Our inspection team was made up of one adult social care inspector. We read the care records of three people that used the service. We spoke with five members of staff and spoke with three people that used the service. We also spoke with a relative of a person using the service.

Tranquility House provides personal care and accommodation for up to 20 older people. There were 17 people using the service at the time of our inspection.

We considered our inspection findings to answer questions we ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

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?

People were not safe because staff recruitment records did not contain all the information required by the Health and Social Care Act 2008. This meant that some of the background checks required to be made before staff were employed to work for the service had not been completed. People were at risk of receiving care from staff who may not be suitable to work with vulnerable adults. A compliance action has been set for this and the provider must tell us how they plan to improve.

People who were using the service benefited from safe care and support, due to good decision making and appropriate management of risks to their health, welfare and safety. Equipment at the home had been maintained and serviced regularly. People were protected against the risks associated with medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No applications had been submitted. The manager understood when an application should be made and how to do so.

Is the service effective?

People received effective care and support. People told us that they were happy with the care they received and felt their needs had been met. People had benefited from equipment that was comfortable and safe. We saw that staff understood people's care and support needs and that they knew the people well. One person told us, "They�re really very good; all the staff are friendly and kind. I enjoy a good joke with them�. This was added to by a visitor who said, �...staff understand. They are very kind and patient�.

Is the service caring?

People were supported by staff who were attentive and courteous. We saw that staff were patient and encouraging when they provided people with support. People told us that the staff cared about them. People's privacy, dignity and independence had been promoted.

Is the service responsive?

People�s needs had been assessed before they moved into the home. People told us they had been given the right support and had been helped in areas that were important to them. Records illustrated that people�s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes.

Is the service well led?

The service was well led because it had a registered manager and people and their relatives told us they felt listened to. The manager carried out regular audits including areas such as, care plans, risk assessments, medication, maintenance of the premises and equipment. Staff were clear about their roles, responsibilities and the ethos of the home. Staff told us the manager was very supportive and accessible and that they received regular supervision and support.

Inspection carried out on 29 October 2013

During a routine inspection

At the time of our inspection, there were 14 people who lived at the home. We spoke with four people who used the service and one visitor.

People we spoke with told us that they were happy with the care and support they received. One person told us "staff come in and help; they are a cheerful lot�. Another person said �they look after me very well; they make sure I�m alright�.

People told us that they were supported to make their own day-to-day decisions and were involved in how their care and support was provided.

We found that care plans were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

We found that people enjoyed the food and were able to make choices about the meals provided. Staff were aware of people�s dietary needs and helped to ensure people were protected from the risks of inadequate nutrition and dehydration.

We found that the home had arrangements in place to protect people from the risk of abuse and people told us that they felt safe.

We found that the staff felt supported by the provider and were able to undertake appropriate training and achieve relevant qualifications.

Inspection carried out on 24 January and 4 February 2013

During a routine inspection

People were involved, where possible in making decisions about their care and treatment. Staff treated people with respect, maintained people's dignity and encouraged their independence.

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Some social activities were provided and people had access to health care professionals. People were assessed for any risks associated with the care they received.

People were protected by effective staff recruitment and selection processes. Appropriate checks were undertaken before staff began work. There were enough skilled and experienced staff to meet people�s needs.

The medicines in this service were managed well and the provider had recently changed their supplier, in order to provide more support and staff training.

The provider had taken steps to provide care in an environment that was tidy and adequately maintained.

The provider had taken steps to identify the possibility of abuse, which aimed to prevent abuse from happening. Shortly after our first visit, we were informed of concerns, which were raised initially with the local safeguarding team and then with the provider for investigation.

The provider monitored the quality of the service. The provider told us that there was good communication with relatives and representatives of people who used the service.

Inspection carried out on 8, 14 February 2011

During a routine inspection

People said that they were treated with respect and that they received the personal and medical care they needed. They were satisfied with the social activities they could do and they liked their meals. People said that they felt safe and they were confident that complaints would be acted upon. Some of them thought they should have a more active say on improvements to their care and home.

Reports under our old system of regulation (including those from before CQC was created)