Tremanse House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified a breach of the legal regulations in relation to governance. Processes to follow up on concerns and arrangements to mitigate risk and oversee staff performance had not been completed in a timely manner. However, the registered manager had effective oversight of the service. Staff told us they were well supported and had a shared set of values focused on supporting people to develop skills and maintain their independence.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s experience varied; most people told us they felt safe. One person commented; “It is a lovely place here. This is the first time in my life I have ever felt safe.” However, one person told us they did not always feel safe. The registered manager and provider were aware of this. Following the site visit we were told action had been taken to address the concerns and help reduce the person’s anxieties.

We found systems to identify and investigate safeguarding concerns were not effective. We discussed safeguarding reporting and investigations with the registered manager and provider. They told us delays in investigating a concern had been caused by various factors. However, we were concerned action to ensure people were safe had been slow to initiate and then subsequent investigations had been prolonged. Once the investigation was completed, measures to mitigate risk had not been put in place immediately. Staff told us they knew how to raise concerns both inside and outside of the organisation. Safeguarding training was up to date.

We observed one person seeking reassurance from staff on multiple occasions. They clearly were comfortable with certain members of staff and actively sought them out when they were feeling anxious. Rota's had been arranged to help ensure there were always staff available who the person had built a trusting relationship with. We were concerned not enough had been done prior to our assessment to address their anxieties and provide reassurance. However, we observed other people living at Tremanse were relaxed and engaged positively with staff.

Concerns had not always been raised or dealt with in a timely manner. A potential safeguarding incident had occurred in August 2023 but no referral, to either CQC or the Local Authority, had been made until November 2023. Deprivation of Liberty Safeguards (DoLS) applications had been made where appropriate. However, staff training for the Mental Capacity Act and DoLS was out of date. People were supported to make complaints and these were responded to. Following the assessment visit we received assurances about the systems in place for raising safeguarding concerns.

Staff discussed risks with people to help them understand and manage risks with support from staff when necessary. A relative told us; “They recognize my relative’s risks and help them; they interact really well with them.” Another said; “I think risks are well managed, and the service and care [Name] gets at Tremanse are very good; certainly far better than any other environment they have been in over the years.”

Staff spoke to us about supporting people to recognise and understand risks. One member of staff described how they tried to help people understand specific risks and what they could do to reduce them.

We heard one person discuss plans for the following day with the registered manager. The registered manager checked with the person that they understood what the plan involved and that they were comfortable and felt able to do what was required in order to attend the event.

Care plans contained risk assessments covering a range of areas including people’s physical and mental health as well as risks relating to the environment.

People living in the annex had written to the registered manager on 4 July 2024 asking for improvements to be made to their living area, including improvements to the flooring which they said was ‘dangerous.’ One person asked us; “Have you come to look at the kitchen?” Another showed us how the floor covering shifted underfoot, saying, “You could easily slip.” The maintenance worker told us they would be completing work in the annex once they had finished other jobs in the main house.

The registered manager shared a monthly directors report which confirmed the maintenance worker was completing some work in the main house before starting improvement works in the annex. However, no timescale had not been established for these works, the report stated ‘TBC’ (to be confirmed).

The stair carpet in the main house was heavily stained. Areas of the annex required updating and redecorating. The living room carpet was frayed at the door and flooring in the kitchen was loose. This presented a trip hazard and the state of the kitchen flooring meant cleaning it effectively was more difficult. The provider told us they would take action to address these concerns.

The registered manager produced monthly directors reports for the provider outlining areas for improvement in the environment, but these had not highlighted that the damage to flooring referenced here could pose a risk to people. Following the visit the provider told us the auditing process relating to the environment would be improved. The fire service had carried out an inspection of Tremanse and issued an action plan. Most of the areas had been addressed with plans to complete the remaining points. Utilities were checked by external contractors and improvements made when advised.

People and relatives did not raise any concerns about staffing levels. A relative commented; “There always seems to be someone (staff) available when I need them. They are all very well trained.” The registered manager and deputy were available to provide additional support if needed.

The registered manager and staff told us there were enough staff, at all times, to support people in line with their care plans. Rota's confirmed staffing levels were appropriate and helped ensure people received support as needed. Staff felt well supported in their roles and, apart from Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS), had received appropriate and relevant training.

We observed people were able to request support from staff they trusted and liked. Staff we spoke with were knowledgeable about people and processes.

Recruitment processes were safe. For example, Disclosure and Barring Service (DBS) checks were carried out on staff. DBS checks provide information, including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff received regular supervisions and were encouraged to develop their skills.

People were sometimes reluctant to take part in keeping their personal spaces clean. There were processes for staff to follow when this occurred.

Staff explained to us how they supported people with cleaning their rooms. This reflected the guidance.

Some areas of the home needed refurbishment to promote infection prevention and control. For example, gaps between the kitchen flooring panels in the annex could increase the risk of germs harboring. However, shared lounges and a dining room in the main house was clean. The commercial kitchen was well maintained and had a food hygiene rating of 5. Personal Protective Equipment was stored in people’s rooms when needed and hand gel was easily available throughout the service.

There were policies and procedures in relation to infection control. Cleaning schedules had been developed which provided a clearly set out routine for cleaning bedrooms and communal areas.

People told us they were supported with their medicines appropriately. One relative told us; “When [Name] comes home they will write down the medication for them to take. So I know exactly what medication they need and when they need to take it. They’re so kind to do that for me.”

Staff told us they used an Electronic Medicine Administration Record system (EMAR) which reduced the risk of errors. They were able to describe the process to follow in the event of an error being made. Following any medication errors staff completed a reflective practice exercise to identify any learning.

Systems to ensure people received their prescribed medicines in line with dispensing directions were robust. Some people used medicines ‘as required’ (PRN) such as pain relievers or medicines to help manage anxiety. Staff recorded when and why these had been administered. There were no records to indicate if this had been effective. PRN protocols were not kept with EMARs which did not support a consistent approach to administering these medicines.