10 July 2014
During a routine inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This was an unannounced inspection. The previous inspection took place in 27 May 2014, and there were no breaches with the legal requirements.
Tristford provides care and accommodation for up to 12 people with a physical disability. This may include people who have, for example, had a stroke, or who have illnesses such as multiple sclerosis.
The home is run by a registered manager, who was present on the day of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.
We met all of the people who lived in the home and were able to have conversations with most of them. Some people did not have verbal communication but were able to express themselves using communication books and facial expressions. People said, or indicated to us, that they felt safe in the home; and if they had any concerns they were confident these would be quickly addressed by their key-worker in the first instance, or by the registered manager.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). None of the people in the home had been assessed as lacking mental capacity, although the registered manager told us that a referral was being made to a dementia consultant for a person to be assessed.
Staff had been trained in safeguarding vulnerable adults, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse.
The home had clear risk assessments in place for the environment, and for each individual person who received care. People had restricted mobility and we saw that individual risk assessments had been implemented and were in use for different pieces of equipment.
People spoke highly of the staff and said “The staff are very good”. Another person said “If I call the staff with my buzzer they always come to me straightaway”. Staff were on hand throughout the inspection to assist those who required help in moving around in their wheelchairs. We saw that staff engaged well with people who lived in the home. We found that staff had suitable training and experience to meet people’s assessed needs; and the staff encouraged people to make their own choices and promoted their independence.
Staff files that we viewed contained the required recruitment information. New staff were taken through a comprehensive staff induction programme which included basic training subjects. They worked alongside other staff until they had been assessed as being able to work on their own.
Medicines were managed appropriately, as policies and procedures were carried out correctly. One of the people who lived in the home said “I always get my medicines on time”.
People said that the food was good. The menus provided a varied and nutritious diet.
People and their relatives told us that they were involved in their care planning, and that staff supported them in making arrangements to meet their health needs. Care plans were amended immediately to show any changes, and were routinely reviewed every three months to check they were up to date.
The building had been modernised inside to provide a spacious living/dining area, and the gardens were enclosed and had been adapted for wheelchair users. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished. The home provided a minibus with wheelchair access to support this.
There were suitable numbers of staff to meet people’s needs throughout the day. People said that the staff supported them well, and did not rush them.
People were familiar with the home’s complaints procedure. They were confident that if they raised any concerns or complaints that these would be dealt with promptly by the staff or the registered manager.
The registered manager had a visible presence in the home, and supported the staff on a daily basis. Staff said that the manager gave them clear instructions and guidance for any changes that were needed in the home, or that related to individual people’s care needs.
There were systems in place to obtain people’s views, including meetings and the use of questionnaires. Action was taken in response to people’s views. People said that the registered manager was “Always available” if they wished to speak with her, and they found her approachable. There were quality auditing systems to monitor the home’s progress.