We inspected on 4 April and 9 April 2018. The inspection was unannounced. At the last inspection, in April 2017, the service was rated Good. At this inspection we have rated the service as ‘Requires Improvement.’ This was because we had concerns about some attitudes of staff, staffing levels, health and safety precautions, and quality assurance systems.

Tremanse is a ‘care home’. This is a service for people who have mental health needs, and who were primarily under 65 years old at the time of the inspection. 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. Tremanse accommodates 23 people: 17 people in the main building, and five people in an adjacent building. The main building consisted of a shared house and a self contained flat for one person. The adjacent building known as the ‘annexe’ had been commissioned for approximately one year. The objective was this would provide more independent living accommodation for people who could live more independently. At the time of the inspection, there were 16 people who lived at the service.

The service did not have 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. The previous registered manager has left the service, and although CQC has informed the registered provider that the person needs to cancel their registration, this has not been done. A new manager has been recently employed and an application has been submitted for the person to be registered.

The service had satisfactory safeguarding policies and procedures. Staff were trained to recognise abuse, and what to do if they suspected abuse was occurring. Suitable risk assessment procedures were in place, and risk assessments were regularly reviewed.

We were concerned that health and safety checks on the premises and other equipment were not always carried out appropriately. For example, we had concerns about checks on fire equipment, and procedures to minimise the risk of legionnaires disease.

We were also concerned there was not always enough staff on duty to meet people’s needs. Some people needed significant support with personal care, and with observation or help outside the home. The service was funded to provide this support but it was difficult to see how suitable support was being provided with the staffing levels currently provided.

Recruitment checks for new staff were satisfactory. Staff said they received satisfactory support when they started their roles, but there was no evidence staff received opportunity to undertake the Care Certificate. Generally staff were provided with adequate training opportunities, but not all staff had completed the training which was required of them. There was a supervision and appraisal system in place but records did not always demonstrate staff received this support.

Medicines procedures were satisfactory, and the medicines system worked well. However, although we were told staff received formal training and competency checks regarding their ability to administer medicines, there was limited evidence this had taken place.

The service was clean, and there were suitable procedures to minimise the risk of infection.

There were satisfactory procedures to assess people to check they were suitable to live at the service and they wanted to do so. Subsequently staff developed comprehensive care plans for people and these were regularly reviewed.

People were happy with the food they were provided with and there was some choice of food available. Where necessary people were provided with suitable

This inspection took place on 5 and 6 April 2017 and was unannounced.

Tremanse House Care Home is a residential service providing care, rehabilitation and support for up to 23 people with mental health needs. At the time of the inspection 19 people were living at the service. Tremanse comprises a main house and an additional five bedroomed annexe. A new self-contained flat had also been built attached to the annexe. This flat was almost ready to be occupied.

Tremanse has 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. The registered manager had not been at work for several months. In the interim, the service was being led by the deputy manager, who was an experienced member of staff. The deputy manager was being supported by a stable staff team.

At the last inspection, we found that people were not being assessed in line with the principles of the Mental Capacity Act (MCA), despite some people being subject to authorisations under the Deprivation of Liberty Safeguards (DoLS). At this inspection we found that improvements had been made. People’s rights were protected by staff who understood their responsibilities under the Mental Capacity Act (MCA). People’s capacity was assessed when required and best interest processes were followed. Some people were subject to other orders, such as community treatment orders (CTO). CTO’s are part of the Mental Health Act. Staff were knowledgeable about what this meant for the person. People’s records contained details of any conditions attached to the order and about when they were due to be renewed.

People told us they felt safe living at Tremanse. People were supported by staff who had undergone the necessary checks, prior to commencing their employment, to ensure they were suitable to work with vulnerable people. Staff knew how to recognise and report any signs of abuse or mistreatment. Staffing levels were safe and allowed people to be supported in an unhurried manner.

People were encouraged to live active and independent lives. Some people accessed the community independently. Staff supported people to attend appointments and recreational activities if they required. There were daily planned activities in the service as well as day trips to local places of interest. People were encouraged to assist with household chores.

People's medicines were managed safely. People received their medicines as prescribed and on time. Staff were trained and understood the importance of safe administration, management and disposal of medicines. There were regular audits of medicines to ensure any errors were quickly identified and reported.

Staff underwent a thorough induction period during which they were supervised so that any learning needs could be identified. Staff were supported by an ongoing programme of training, supervision and an annual appraisal. Staff told us they felt well supported in their role.

People’s health was monitored at the service. Staff were vigilant to the signs of people becoming unwell or experiencing a relapse in their mental health. Staff made prompt referrals to external health care professionals if they suspected a person’s mood had changed and they may need support.

People had enough to eat and drink. The food appeared plentiful and people were involved with planning the menus. People told us they enjoyed the food. Throughout the day people were able to independently access hot and cold drinks.

People’s care records were personalised documents which gave guidance for staff on how to meet their needs. Records were comprehensive, detailed, easy to navigate and regularly reviewed. Where possible, people had been involved in their care planning.

We observe

This inspection took place on 9 February and 19 February 2016 and was unannounced.

Tremanse House Care Home (known locally as Tremanse) is a residential service providing care, rehabilitation and support for up to 23 people with mental health needs. At the time of the inspection 19 people were living at the service. Tremanse comprises a main house and an additional five bedroomed annexe.

Tremanse has 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

We found that, despite some people being considered to lack the mental capacity to make their own decisions, no mental capacity assessments had been completed. Referrals had been made to the local authority for authorisation to restrict some people’s liberty without these assessments being done.

People and staff were relaxed and content; the atmosphere was calm and pleasant. One person commented; “All staff are lovely to me, they have helped me so much and I want to thank everybody”. Another person said, “I feel absolutely safe here”. One health care professional described Tremanse as; “Home from home”.

People were encouraged to live active and independent lives. Accessing the local shops, pubs and leisure facilities was promoted. Staff supported people to attend appointments and recreational activities when required.

People’s medicines were managed safely. People received their medicines as prescribed and on time. Staff were trained and understood the importance of safe administration, management and disposal of medicines.

Staff recruitment processes were safe. Staff underwent a thorough induction period during which they were supervised so that any learning needs could be identified. There were sufficient numbers of suitable staff on duty.

Infection control practices kept people safe. The service was clean, hygienic and free from offensive odours. We saw there were handwashing facilities, antibacterial gel and paper towels prominently sited in areas that could be used by people to prevent cross infection.

There were effective quality assurance systems in place. People knew how to raise a complaint and were confident that any concerns would be listened to. Accidents and incidents were recorded and details were shared with the healthcare professionals involved with the person where appropriate.

People, relatives and professionals spoke positively about the service. Feedback was sought through staff meetings, residents meetings and the compliments and complaints folder and was used to develop the service and drive improvement.

You can see what action we told the provider to take at the back of the full version of the report.