Tregenna House

Tregenna House is a residential care home providing personal and nursing care to up to 49 people. The service provides support to predominately older people requiring nursing care, people living with dementia and people living with mental health needs. At the time of our inspection there were 39 people using the service.

People’s experience of using this service and what we found

People were protected from the risk of abuse and avoidable harm. People told us that they felt safe in the service and risks in relation to people's care were identified and managed to keep them safe. Three relatives collectively told us they felt their family member was safe and protected living at Tregenna House. Comments included, “I am very satisfied with [name of person] living here. I feel [the person] is very safe” and “We can’t praise them enough. Very safe here”.

The premises were clean. Some areas of the service required maintenance. We shared this with the provider and registered manager. We have made a recommendation about this in the safe domain of the report.

The service had effective systems to monitor equipment and utilities. There were certificates in place to support this. Systems were in place to support people in the event of an emergency.

Staff had been recruited safely and during the inspection we observed there were enough staff to respond to people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Peoples medicines were managed safely. Staff responsible had the necessary skills to administer medicines. Oversight was in place to ensure medicines were managed safely.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Two health professionals told us the registered manager and clinical staff worked closely with them.

Incidents and accidents were managed safely. The managers took necessary actions to keep people safe and minimise the risk of reoccurrence. Steps were taken to learn lessons if things went wrong.

The registered manager provided clear direction and good leadership. Feedback about the service was consistently positive. The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals. The service had clear and effective governance systems in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good published (11 January 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tregenna House on our website at www.cqc.org.uk.

Notice of inspection

This inspection was unannounced.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of procedures and precautions being taken, and how to keep people safe. The registered manager worked with the nurses, care staff and housekeeping teams to ensure infection prevention and control measures were followed.

Staffing absences, due to COVID-19 infections had not had a mojor impact on the staffing levels or the quality of support people received. Staff had worked hard to contain the current outbreak, which at the time of the inspection had affected the staff team but not people using the service.

Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised. Changes had been made to the service’s routines to limit infection risks during the current outbreak. We looked at cleaning schedules and audits which showed additional systems had been added to increase infection control procedures during COVID-19 pandemic.

The service was following current guidance in relation to visiting care homes during outbreaks of COVID-19. Essential care givers and visits to people in receipt of end of life care were possible. However, the service was currently closed to other visitors. People understood the need for these restrictions and were confident staff were taking appropriate steps to manage the outbreak of the infection.

PPE was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.

Records showed staff had received all the necessary vaccinations to work in the care sector. The registered manager kept all staff updated on any changes to guidance. Staff had received training in COVID-19 and infection control procedures.

We spoke with a relative who was satisfied with the way their family member was cared for. Comments included, “I am very satisfied with the care,” “[Person’s name] is very well looked after. No concerns from me” and “All the staff are wonderful.”

Tregenna House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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. Tregenna House accommodated up to 49 people. At the time of the inspection 42 people lived at the home.

The service had a registered manager. 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.

At the last inspection, in February 2018, the service was rated as ‘Good.’ At this inspection we judged the registered persons continued to meet the regulations, and have concluded the service should still be rated as ‘Good’ overall.

The service was viewed by people we spoke with as very caring. We received positive comments about the service. For example we were told, "The staff are lovely, really nice indeed,” “ The staff are very kind, they are the right type of people for the job.” Relatives told us,“ The staff are lovely and they have a tough job. You never feel like anything is too much trouble…they are polite, gentle and professional,” and “The staff are good as gold. It has a lovely homely feel.They are all brilliant.” Everyone we observed looked well cared for. People were clean and well dressed.

The service provided a range of activities in the service. Two activities co-ordinators were employed.

People told us they felt safe. For example people told us, “I am very safe here,” and “Look around at all the staff, they are all here keeping us safe.” The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were adequate staff on duty to meet people’s needs. However we did receive some concerns that people did not always receive prompt one to one support, and that staffing levels after 7pm were not adequate. During the inspection we did not observe people receiving unsatisfactory levels of support. Recruitment checks were satisfactory. For example a Disclosure and Barring check was also obtained to ensure the person was suitable to work with vulnerable adults.

Staff members received an induction. The registered provider was aware of the Care Certificate. This is a set of national standards for staff coming into the health and social care sector. Records showed most staff had received satisfactory induction and training although some staff still needed to complete this. Records of staff supervision (one to one meetings with a senior member of staff), were limited. We have recommended the supervision system is improved.

The medicines’ system was appropriately managed. Medicines were stored securely, and there was satisfactory systems to dispose of medicines which were no longer required. Staff who administered medicines received suitable training. Records about the administration of medicines were comprehensive.

The service was clean and hygienic. The building was suitable to meet the needs of the people who lived there. The building was well laid out, pleasantly decorated and homely.

There were suitable assessment processes in place before someone moved into the service. These assisted in helping staff to develop care plans. We were told staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.

People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a good standard. Comments about food included: “ It is lovely I get a plate full,“ and “It is nice and warm.”

The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers. However we have recommended records are improved to demonstrate that when people wanted, needed, and routinely saw some medical professionals such as opticians and dentists.

People lacked mental capacity. Where necessary suitable measures had been taken to minimise restrictions. Where people needed to be restricted, to protect themselves, and/or others, suitable legal measures had been taken. Staff had received suitable training about mental capacity.

The service had a satisfactory complaints procedure. People we spoke with felt they could raise a concern or complaint, and these would be responded to appropriately.

The manager was respected and liked by people, relatives and staff we spoke with. The registered manager had a hands on approach. Relatives told us, “The manager is lovely and works really hard,“ “ The manager is approachable and professional.” Staff members told us, "The registered manager and deputy are responsive to issues. They keep the momentum going,” Staff also said team working at the service was good, and team members were supportive and communicated well with each other.

The service had satisfactory quality assurance systems.

Tregenna House is a ‘care home’ that provides nursing care for a maximum of 49 adults, with a range of health care needs including dementia, nursing and mental health. At the time of the inspection there were 43 people living at the service. 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.

Tregenna is situated in the town of Camborne. It is an extended detached house over two floors and in its own grounds. All rooms were single occupancy. The service is divided into three distinctive units. One for people with dementia conditions, one for males only with other associated mental health needs and a first floor general nursing unit. Each area had its own lounge and dining areas. There were a range of bathing facilities in each area designed to meet the needs of the people using the service. There was a passenger lift serving the upper floor. The gardens were designed to support people with limited mobility.

Some people required specialist equipment to protect them from the risk of developing pressure damage to their skin. Air filled pressure relieving mattresses were provided. However, all three mattresses which were in use at the time of this inspection were set incorrectly for the people using them. There was no evidence of these settings being regularly checked to ensure they were set at the correct pressure. We have made a recommendation about this.

Systems to manage medicines were not always being managed effectively. While the medicine room was locked when not in use, the medicine trolley was not secured to the wall meaning it was at risk of being moved. The medicines fridge temperature in one unit was not always being recorded regularly to ensure medicines requiring colder storage were accurate.

Where hand written entries were being made they were not always countersigned by another staff member. There were no dates being added when creams or eye drops were opened meaning staff would not know the expiration date when the medicine would be effective. We have made a recommendation about this.

Systems were being audited regularly by the registered manager and administrator. However, as stated above some systems required improvement to ensure monitoring was effective. The registered manager was taking immediate action to address this.

The service had sufficient staffing levels in place to provide the level of support people required. The registered manager told us they were currently recruiting more nurses but that, “It can be a lengthy process, so we use a regular nursing agency to meet any gaps.” People told us staff were responsive and available when they needed them.

Staff were sufficiently skilled to meet people’s needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. There was a wide range of training available to all staff which met the diverse needs of people being supported.

Staff were supported by the registered manager through regular updates in handovers and meetings. However the registered manager acknowledged formal supervision had lapsed for care staff but not nurses in recent months. There was a revised supervision and appraisal plan ready to be introduced in order to formalise the support.

People’s risks were being managed effectively to ensure they were safe. Records showed where changes in people’s level of risk were. Care plans had been updated so staff knew how to manage those risks.

Accidents and incidents were being recorded and reported and any lessons learned were shared with staff. The service learned by any mistakes and used this as an opportunity to raise standards. There was a culture of openness and honesty and staff felt able to raise concerns or suggestions.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, Social Workers, Psychiatrists, General Practitioners (GP) and speech and language therapists (SALT). Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

The manager used effective systems to record and report on, accidents and incidents and take action when required.

The service was generally maintained. Maintenance staff were employed and a new first floor bathroom was in construction at the time of the inspection. The registered manager told us, “This is a large old building and areas are continuously being updated.” It was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedure in place to manage infection control risks.

Care plans were well organised and contained personalised information about people’s needs and wishes. Care planning was reviewed regularly and whenever needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

Meals were appetising and people were supported with their meals by staff where necessary. Special diets were catered for. Some people told us there was no choice of meal displayed on the daily menu board. Staff told us if people did not like the food there was always an option and we observed this was the case, with some people making regular daily choices. When we pointed this out to the chef they recognised the importance of including a choice and agreed to address this issue immediately. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Some people living at Tregenna were living with dementia and were independently mobile around the service. The service had clear pictorial signage to help people who needed additional support to recognise their own rooms which looked like front doors with a letter box. Toilets and shower rooms also had signage.

There were a range of quality assurance arrangements at the service in order to raise standards and drive improvements.

All levels of staff engaged with all stakeholders of the service. People’s views were taken into account through regular communication and surveys. The results of the most recent survey had been positive.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We inspected Tregenna House 25, 26 and 27 January 2016. The inspection was unannounced. The service was last inspected in May 2013 when it was found to be meeting the requirements of the regulations.

The service is divided into three separate living environments. Cactus unit for 13 men, Bluebell unit for 16 people and Primrose unit for 17 people.

We were told by people, and external professionals, that people were safe at the service, and with the staff who supported them. People told us, “Yes I feel safe here.” A health professional told us “They work with some very challenging people here, and they cope very well.” Staff received satisfactory training about adult safeguarding procedures. Staff told us they felt certain that management would act appropriately if any allegations of abuse were reported.

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff induction and training were organised and delivered to a good standard. There was evidence that most staff had received training about for example moving and handling, dementia, infection control and first aid. However there were some gaps, in records, for some training. The registered persons said they would address this matter.

Recruitment processes were to a good standard. Appropriate pre-employment checks had been completed to help ensure people’s safety. This included two written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals. We received positive comments from health professions such as, “The home is well run, communicate well and provide excellent patient care.”

There were enough staff on duty and people said they received timely support from staff when it was needed. There was always a registered nurse on duty. We observed staff responding promptly to help people with their care needs so people did not need to wait too long if they needed assistance with anything. The people we spoke with were positive about staff attitudes. For example one person said “Staff are charming.”

The service had a programme of organised activities. These activities included musicians, group activities such as bingo, and arts and crafts. Some external activities were available. The service had a vehicle to enable people to go out.

Care files were organised to a good standard and contained comprehensive information, such as a care plan, to enable staff to provide good and consistent care. Care plans and risk assessments were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were happy with their meals although we received a comment that there was only limited choice, and sometimes ‘soft diets’ (for people with swallowing difficulties) could be more carefully prepared. The registered manager said they would address this matter. Everyone said they always had enough to eat and drink, and we observed people regularly being offered drinks and snacks. People said they received enough support when they needed help with eating or drinking.

The service’s complaints procedure was visible and was publicised for example at relative meetings. Staff and external professionals said the service was well managed. We were told by a staff member, “Managers are approachable and listen to our concerns.” Staff said there was a positive culture in the staff team and the staff worked professionally together. There were satisfactory systems in place to monitor the quality of the service.

We saw people's privacy and dignity being respected and staff being helpful. We spoke with a visitor to the home and a visiting health professional. Both were complimentary of the care provided to the people who lived at Tregenna House.

We saw people were spoken with in an adult, attentive, respectful, and caring way. We saw staff respond appropriately and respectfully to requests for assistance.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because most of the staff were confident in their knowledge of the safeguarding process.

The equipment in use was effectively maintained.

We saw there were sufficient staff to meet people's care needs, although there were a number of staff off sick at the time of the inspection.

Staff had started to receive professional development and supervision, although the latter was yet to be established.

We also used our SOFI (Short Observational Framework for Inspection) tool for approximately one hour in the Primrose lounge/dining area. The SOFI tool allowed us to spend time watching what was going on and helped us record how people spent their time, the type of support they got and whether they had positive experiences.

Some of the people who used the service were not able to comment in detail about the service they receive due to their healthcare needs. We saw people's privacy and dignity being respected and staff being helpful.

We saw that people were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw and heard one staff member talk with a resident about a photo displayed on the wall and then discuss their forthcoming birthday, asking them if they liked birthday cake. We saw and heard staff greeting people in passing, 'hello Mr *' or 'hello sir'.

Staff told us that training was provided, and also that staff numbers were sufficient, though some days were busier than others. Staff told us that supervision was provided, but that this had lapsed.