CQC report explained · a nursing home
What the CQC found at Trembaths
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- People were protected from harm, medicines were managed safely and staff were recruited safely. However, some call bells were not answered in a timely way, and the high number of falls needed further analysis.
- Effective?
- Good
- Staff were trained and supported. People were offered choices, the Mental Capacity Act principles were followed, food and drinks were provided, and people had access to health professionals.
- Caring?
- Good
- People and relatives described staff as kind. Inspectors observed positive interactions and found that staff protected people's privacy and dignity.
- Responsive?
- Good
- Staff knew people well and met their needs. Activities were available and complaints were handled in line with the provider's policy, although care plans were still being developed to record personal preferences more fully.
- Well-led?
- Good
- The manager had introduced audits, observations, staff support and clearer allocation of work. Staff and people spoke positively about the manager, and the service was making progress in reducing agency staff use.
What inspectors found, August 2018
Rated Good overall; inspectors found kind, effective care, but the Safe rating Requires Improvement because call bell responses and falls needed further improvement.
This was an unannounced comprehensive inspection on 19 July 2018. Inspectors spoke with people living in the home, relatives, staff, managers and health and social care professionals. They reviewed six people's care records and records about how the home was run.
The home was rated Good overall. Effective, Caring, Responsive and Well-led were all rated Good. Safe was rated Requires Improvement because some people experienced delays after staff answered their call bells, and the home needed to analyse and reduce the high number of falls.
The home had improved since the previous inspections. It had been rated Requires Improvement in July 2017 and remained Requires Improvement after a focused inspection in February 2018. Inspectors found that the required improvements had been made by this inspection, although some safety work was still continuing.
Kind and respectful care
People and relatives said staff were kind. Inspectors saw staff speaking warmly with people and protecting their privacy and dignity.
“People and their relatives told us staff were kind and caring.” from the report
Staff training and support
Staff completed relevant training, had their skills checked and said the manager supported them in their work.
“Staff completed an induction programme, during which they received training relevant to their roles, and had their competencies observed and assessed in the work place.” from the report
Choices and activities
People were offered choices about daily routines, food, clothing and where to spend their time. They could join group or individual activities.
“People were supported to make their own decisions and where they were unable, a capacity assessment was completed.” from the report
Call bell delays and staffing
seriousSome people said staff sometimes switched off call bells but did not return promptly. People and staff also raised concerns about staffing levels, particularly on the first floor.
“They [staff] come if they can, they always come and switch off the buzzer and sometimes they are very quick but sometimes it takes 15 minutes or more [to come back].” from the report
High number of falls
seriousThe home monitored falls and made referrals, but falls remained high on the first floor. Its analysis did not yet consider all possible environmental and staffing factors.
“The provider`s system used by the manager to monitor accidents and incidents did not prompt to look at environmental factors such as staffing and deployment, layout of the building, lighting and others when analysing these.” from the report
Care plans needed more personal detail
needs fixingCare plans recorded people's needs and support, but some needed more information about how each person preferred to receive care.
“There were plans to develop these further to ensure they were personalised to each individual and reflective of people`s likes, dislikes and preferences of care.” from the report
Personal care choices
needs fixingThe manager was asked to make sure people were offered daily baths and showers, especially in hot weather. Some people did not know they could have more than one bath or shower in a week.
“However, we asked the manager to emphasise the need for staff to offer daily baths and showers to people especially when the weather was hot” from the report
- 01What are the current call bell response times, especially on the first floor, and how are delays followed up?
- 02What changes have been made to reduce falls on the first floor, including checks of staffing, lighting and the layout?
- 03Have all care plans been rewritten to record each person's likes, dislikes and preferred way of receiving care?
- 04How are people offered baths and showers, and how do you make sure they know they can request them more often?
- 05How much agency staff is currently being used, and is there permanent senior cover at weekends?
This was an unannounced comprehensive inspection covering all five questions; it followed a focused inspection of Safe and Well-led in February 2018 and reviewed progress since July 2017. This explanation was written from the published report of 7 August 2018 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, April 2018
Trembaths: Rated Requires Improvement; inspectors found progress, but medicines, staff organisation and person-centred care still needed improvement.
This was an unannounced follow-up inspection on 7 February 2018. Inspectors checked whether improvements had been made since the comprehensive inspection in July 2017. They looked only at Safe and Well-led.
The overall rating remained Requires Improvement. Medicines were not always managed safely. Some staff did not follow good infection control practice. There were enough staff on duty, but work was not always organised well, so people sometimes had to wait.
There had been progress since the last inspection. Safeguarding concerns were now reported properly, risk assessments were regularly reviewed, call bell response times had improved, and quality checks were being used more effectively.
The home was still developing its management and care culture. The acting manager was visible and approachable, but the long-term management arrangements were uncertain. Inspectors also found that care was not always person-centred, especially on the nursing unit.
Improved safeguarding
Safeguarding concerns, incidents and accidents were reported and reviewed more effectively. The home used this information to identify patterns and reduce the chance of similar incidents happening again.
“When incidents, accidents or falls occurred, these were recorded, cross referenced with care records to ensure appropriate updates were made and analysed effectively to identify themes and patterns.” from the report
Better call bell responses
Call bells were answered promptly on the inspection day. Records showed that response times had improved significantly since the previous inspection.
“Call bell logs we reviewed showed this was typical and that response times had improved significantly since the last inspection.” from the report
Effective quality checks
Audits identified problems in areas such as medicines and infection control. Managers used the results to plan improvements and share learning with staff.
“The provider's systems to monitor the quality of the service were being used effectively and the acting manager, along with the business support manager and the area manager had good management oversight of the service.” from the report
Approachable acting manager
People, relatives and staff gave positive feedback about the acting manager. Staff said leadership had improved and that they could raise concerns.
“The acting manager had a hands-on approach to the role and people knew who she was because she was visible within the service.” from the report
Medicine errors
seriousInspectors found recent medicine errors, including a record showing a medicine had been given when it was still in its blister pack. This meant some people might not have received medicines as prescribed.
“This meant that people did not always receive their medicine as prescribed.” from the report
Poor infection control practice
needs fixingSome staff did not wash their hands before helping people with lunch. Food was also handled without gloves and plates were not covered.
“Although staff we spoke with demonstrated understanding of infection prevention and control measures, we observed several occasions where staff practice did not uphold good infection control practice.” from the report
People sometimes had to wait
needs fixingThere were enough staff, but they were not always deployed effectively. Some people waited for support or could not follow their preferred routines, such as going to the toilet or joining an activity.
“We noted that staff were very busy and not always deployed effectively to ensure people's needs were met in a timely manner.” from the report
Uncertain management arrangements
needs fixingThe registered manager had left and the acting manager was temporary. Relatives were worried about who would manage the home in the longer term.
“However, relatives expressed concerns about the stability of management of the service in recent times and there was uncertainty about management arrangements in the long term.” from the report
Care was not always person-centred
needs fixingSome people remained in wheelchairs with hoist slings in place, and a requested transfer was not completed. Inspectors also heard that staff sometimes spoke to each other rather than directly to people receiving care.
“We observed, and the manager acknowledged, that although improvements in relation to this were clearly in evidence, work was still required to embed a more person centred and open culture.” from the report
- 01What checks are now in place to make sure every medicine is given and recorded correctly?
- 02How are you monitoring staff handwashing, food handling and covered plates during mealtimes?
- 03How will staff be organised so people do not have to wait for toileting, repositioning, activities or transfers?
- 04Who is responsible for the home while the permanent manager is being recruited, and what is the plan for stable long-term management?
- 05How will you make sure people’s choices about seating, transfers, meals and communication are followed every day?
This was an unannounced follow-up inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive carried over from the previous comprehensive inspection. This explanation was written from the published report of 20 April 2018 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 Trembaths
6 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- August 2018Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2017Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Good
- July 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 22 December 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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