Tregertha Court Care Home

Social Care Org · South West

Overall Rating
Inadequate Last inspected 23 November 2016
Domain Ratings
Safe
Inadequate
Effective
Requires Improvement
Caring
Good
Responsive
Good
Well-led
Inadequate

View Full CQC Report

5 must-do actions
1 should-do action

Must-Do Actions (5)

Legal requirements based on regulation breaches identified during inspection.

Must Do
Safe
The provider must ensure that premises and equipment are safe, clean, and properly maintained to protect people from risks such as scalding from hot water and inadequate heating, and to ensure all essential equipment like stair lifts are in working order.
Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
We found three bathrooms, three toilets, and seven bedrooms with hot water at 59 degrees Centigrade, posing a scalding risk. The heating system could not be regulated separately from hot water, leading to inadequate heating in some areas. One stair lift to the top floor was not working and had …
Must Do
Safe
The provider must ensure that persons employed are fit and proper for the purposes of the regulated activity, by completing all necessary employment checks, including Disclosure and Barring Service (DBS) checks, before staff commence unsupervised work.
Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014
Records for three new staff recruited in September and October 2016 showed they had started to work before their DBS checks had been completed, with periods ranging from three to seven weeks, exposing people to unnecessary risk.
Must Do
Safe
The provider must ensure that accurate, complete, and contemporaneous records are kept in respect of each service user, specifically regarding the administration of medicines, to confirm that people receive their medicines as prescribed.
Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014
Records showed one person had not been given their teatime medicines the day before the inspection, and for two liquid medicines, it was not possible to be certain if they had been given, meaning we could not be sure the person had received their medicines as prescribed.
Must Do
Effective
The provider must ensure that accurate, complete, and contemporaneous records are kept in respect of each service user, specifically regarding food and fluid intake, including totals and assessed levels, to enable accurate monitoring of nutritional needs.
Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014
Food and fluid monitoring records were inconsistently recorded, had not been totalled, and did not state the assessed level each person needed, making it impossible for staff to accurately monitor intake and take further action when needed.
Must Do
Well-led
The provider must establish and operate effective systems or processes to assess, monitor, and mitigate risks to the health, safety, and welfare of service users, and to ensure the quality of the service provided is monitored and improved, addressing repeated failures in premises, recruitment, and record-keeping.
Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014
The provider had repeatedly failed to ensure good governance, with ongoing breaches of regulations related to premises, recruitment practices, and record-keeping, which were also raised at the previous inspection in April 2016. Audit processes were not effective in identifying shortfalls.

Should-Do Actions (1)

Recommended improvements to enhance service quality.

Should Do
Effective
The provider should ensure that records of staff supervision and appraisals are clear and consistently maintained.

Previous Inspection (4 May 2016)

Rating: Requires Improvement Type: Comprehensive inspection Actions: 3 must-do
3 repeated
Location Details
CQC ID: 1-1015239533
Local Authority: Cornwall
Region: South West
Inspection Report
Type: Comprehensive inspection
Date: 23 November 2016
Rating: Inadequate
Actions: 5 must-do , 1 should-do
AI-extracted 17 Feb 2026