CQC report explained · a nursing home
What the CQC found at Tramways
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. The home had enough staff, risk assessments, safe recruitment checks and systems for checking and storing medicines.
- Effective?
- Good
- Care plans described people's mental health needs and how staff should support them. Staff received training and supervision, and worked with health and social care professionals.
- Caring?
- Good
- People described staff as warm, caring and helpful, and inspectors saw support that respected privacy, dignity and independence. One person said staff ignored them, and this was passed to senior management.
- Responsive?
- Good
- Support plans were personalised and included people's preferences, interests, cultural needs and communication needs. People knew how to complain and said their concerns would be listened to.
- Well-led?
- Good
- The home had an effective management structure, regular staff meetings and systems to monitor quality. The manager reviewed complaints, incidents, risks and feedback to identify improvements.
What inspectors found, August 2019
Tramways was rated Good in every area; inspectors found safe, kind and personalised care, with one person saying they felt ignored.
This was an unannounced inspection on 28 July 2019. One inspector spoke with four people, three care staff and the shift leader. They reviewed two care plans, medicines records, audits and other records.
Inspectors found enough staff, safe medicines systems and suitable risk assessments. Staff supported people's mental and physical health and worked with healthcare professionals. Care plans described people's needs, choices, interests and communication.
People were treated with kindness, dignity and respect. The home had regular checks on care quality and a clear management structure. The overall rating was Good, and all five areas were also rated Good. This was unchanged from the previous inspection in March 2017.
Safe medicines and staffing
Medicines were stored securely and checked regularly. Inspectors also found enough staff to meet people's needs safely.
“People were well supported to stay safe. People continued to receive safe support with their medicines.” from the report
Mental health support
Care plans clearly described people's mental health needs and how staff should respond. Staff worked with district nurses, community psychiatric nurses and other professionals.
“Support plans contained clear ways for staff to support people with their mental health needs.” from the report
Kind and respectful care
People gave positive feedback about staff. Staff supported privacy, dignity, independence and people's personal choices.
“People were supported by staff who were kind and caring towards them.” from the report
Personalised support
Support plans included people's likes, dislikes, interests, hobbies, cultural needs and preferred ways of communicating.
“The support plans were person-centred and included details about people's likes and dislikes, interests, hobbies and personal qualities.” from the report
Quality monitoring
The home had regular audits, staff meetings and feedback from people and their representatives. The manager used these systems to look for improvements.
“There were systems in place to monitor and improve the quality of the service.” from the report
One person felt ignored
minorOne person told inspectors that staff ignored them. The comment was passed to senior management, who agreed to speak with the person.
“One person did say "They ignore me ". This comment was passed onto the senior manager” from the report
- 01What action was taken after one person told inspectors, "They ignore me"?
- 02How do you decide whether there are enough staff for each person's one-to-one support?
- 03How are medicines checks recorded, and what happens if a discrepancy or error is found?
- 04How will you support my relative if their mental health begins to deteriorate?
- 05How are people involved in reviewing their support plans and making daily choices?
This inspection covered all five CQC areas and looked at both the care and the premises; the inspector spoke with four people and reviewed two care plans and other service records. This explanation was written from the published report of 29 August 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2017
Tramways rated Good; inspectors found safe, kind and responsive care, with some records and staff supervision needing attention.
Inspectors visited the home without notice on 21 February 2017. They spoke with four people, three care staff and the registered manager. They reviewed three care plans, medicines records, audits and meeting notes.
The home cared for 13 people, with space for up to 14 people who needed nursing care and accommodation for mental health concerns. Inspectors found good standards in all five areas: safe, effective, caring, responsive and well-led.
People received safe support with medicines and there were enough staff. Staff were kind and respectful. Care plans gave useful information about people's needs, routines and communication. Complaints were now being recorded and answered, after this had been a problem at the previous inspection.
Inspectors noted some weaker areas. One risk assessment had not been reviewed for 10 months, some health records were incomplete, and some staff had long gaps between formal supervision sessions. The home was rated Good overall, meaning inspectors found the service meeting the required standards at this inspection.
Safe medicines support
Medicines were locked away, stock checks were carried out and records checked by inspectors were accurate. There were also arrangements for returning unused medicines to the pharmacy.
“People received safe support with their medicines.” from the report
Kind and respectful staff
People spoke positively about staff. Inspectors saw that privacy was respected and people were supported in a dignified way.
“People were supported by staff who were kind and caring in their approach.” from the report
Improved complaints handling
The home had addressed the complaints problem found at the previous inspection. Concerns were recorded and people received responses explaining what action had been taken.
“We saw evidence that people's concerns were recorded on a form and there was a letter of response from the registered manager.” from the report
Enough staff
Inspectors found enough staff to keep people safe and meet their needs. Staff said staffing levels allowed them to spend time with people beyond care tasks.
“There were sufficient numbers of staff to ensure people's safety and meet their needs.” from the report
Risk assessments not always reviewed
needs fixingOne person's risk assessments had not been reviewed for 10 months. Inspectors said the home needed to record why reviews were not taking place and when a person declined them.
“However in one case, we saw that they had not been reviewed in 10 months.” from the report
Incomplete health records
needs fixingRecords did not show the latest clinic visit for one person, and it was not clear why blood monitoring had stopped. The GP later confirmed that the monitoring was no longer necessary.
“It wasn't clear from the records why this was the case.” from the report
People's involvement in care plans
minorSome people had not signed their care plans and were unsure what the plans were. Inspectors asked the home to record the opportunities people had been given to take part, including when they declined.
“People were unsure about what we were referring to although did acknowledge they had been involved in meetings about their care.” from the report
- 01How do you make sure every person's risk assessments are reviewed on time, including when someone declines to take part?
- 02How do you check that clinic appointments, blood tests and other health monitoring are recorded correctly?
- 03How often will staff receive formal supervision, and how are missed sessions followed up?
- 04How will you record and support each person's involvement in their care plan?
- 05What activities are currently available, and how will the planned activity staff member improve opportunities for people who want to take part?
This was an unannounced inspection covering all five key questions and the overall rating; inspectors reviewed three care plans and spoke with four people and three care staff. This explanation was written from the published report of 29 March 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Tramways
3 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- August 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 11 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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