We inspected Tregenna House on 3 and 4 December 2018.The inspection was unannounced. The service is for elderly people, some of whom may have physical disabilities, mental health needs or dementia. The service provides nursing care.

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 we

This unannounced comprehensive inspection took place on the 22 February 2018. The last comprehensive inspection took place on the 25 January 2016. The service was meeting the requirements of the regulations at that time.

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 b

Tregenna House is a care home which provides accommodation for up to 49 older people who require personal care. People using the service required specialist nursing care for people with severe dementia, and, or other mental health needs. At the time of the inspection 41 people were using the service. The registered manager said usually only 44 people were accommodated at the service.

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 alw

We observed how people were being cared for, talked with staff, and checked records. We also used our SOFI (Short Observational Framework for Inspection) tool for approximately 45 minutes 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.

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 reviewed all the information we hold about this provider, carried out a visit on 8 September 2012, observed how people were being cared for, talked with staff, and checked records.

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.

We talked to people visiting Tregenna House to spend time with their relative. People said “we’ve never had so much information”, and “they always tell you what is happening”. Staff were described as “wonderful”. We used observations and information received before and after the visit to decide whether the service meets peoples’ preferences and choices. We observed that privacy and dignity were respected during our visit. We saw that people get visitors frequently. People were seen to interact with staff and each other in a free, spontaneous manner.