We carried out a review of the data available to us about Tregarland on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tregarland, you can give feedback on this service.
The care service is aware of the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. There were currently no plans to reduce the size of the service or amend the current registration at Tregarland but people using the service were living as ordinary a life as any citizen because the home is divided into two halves, independent of each other.
Rating at last inspection.
At our last inspection we rated the service Good. At this inspection we found the evidence to show that the service was overall Outstanding.
Tregarland is where people are treated with great respect by the registered manager and staff. This gives them dignity, self esteem and value. People said they are happy and feel safe. Health care professionals used the phrases: “Passionate about their patients”, Fantastic advocates for people”, “An enablement of respect” and “Staff make (my client) feel valued.” People using the service were relaxed, happy, confident and fully engaged in the running of their home and activities in the local community.
The management of Tregarland promotes people’s wellbeing. Each staff member takes a turn to organise and monitor the service when they are the ‘officer in charge’. It is their responsibility, for that day, to ensure people are fully supported, in a safe way. Staff grow in confidence, learning organisational skills, whilst knowing the registered manager is there for advice and support. There is very little turn over of staff at the service, several of whom had worked at Tregarland for more than 15 years. Staff said they loved working at the service. They receive training, supervision and support which help their success in the role.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Every opportunity to provide meaningful activities is explored. This included the recent acquisition of an allotment and achieving one person’s goal of flying an aeroplane. People are supported to be active in the way the service is run. This includes being involved in staff recruitment, shopping, cooking and laundry. The registered manager facilitates how the home is run and always gives people the opportunity to come up with ideas and support each other. Innovative ideas help people learn, such as ‘stick on’ cardboard ‘germs’ to demonstrate the importance of hand washing.
Staff recognised where a lack of understanding affected people’s ability to use information to their advantage. To overcome this, staff would find different ways of presenting the information, using objects of reference, for example. This showed that staff understood and worked towards meeting the Accessible Information Standard, which is to help people with disability or sensory loss access and understand information they are given.
The service has a long history of working closely with agencies for the good of people using the service. This includes the local authority safeguarding team and health care professionals. One said, “(The registered manager) sees things ahead of time and tries to use preventative strategies.” People are safe at Tregarland through good management of staffing, medicines, infection control, individual risk management, and safety of the premises.
People receive a nutritious diet, which they enjoy. Health promotion is through a proactive approach to meeting people’s physical and emotional health care needs.
Further information is in the detailed findings below.
Tregarland is registered to provide accommodation and personal care to 20 adults with a learning disability. The home is divided into two halves so the home feels personal to individuals. They are not registered to provide nursing care.
There was a registered manager in post. 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.
People felt safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed.
Staff understood how to protect the rights of people who had limited capacity to make decisions for themselves. People were supported to be involved in decisions about their care and treatment using communication systems that were appropriate to their needs.
People received personalised care and support, which was responsive to their changing needs. They were supported by staff who knew them well and were passionate about enhancing people’s well-being and quality of life. There was a wide range of activities on offer to make sure people’s needs were met. People’s health needs were very well managed and health promotion was encouraged. People were supported to lead a full and active lifestyle and were actively encouraged to engage with the local community and maintain relationships that were important to them. There were creative and innovative ways to promote people’s health and well-being.
The registered manager and staff were committed to a strong personalised culture. Kindness, respect, dignity, and attention to detail was integral to the day-to-day practice of the service. People were treated with respect by staff who were kind and compassionate. Relatives were encouraged to visit regularly, were supported and involved in the service.
There were effective staff recruitment and selection processes in place. People were encouraged to be involved in the recruitment process. Staffing arrangements were flexible in order to meet people’s individual needs.
Staff were highly skilled in meeting people’s needs and received ongoing support from the registered manager through regular supervision and training. Mandatory and specialist training was based on best practice and guidance, such as that from the British Institute of Learning Disabilities (BILD), so staff were provided with the most current information to support them in their work.
There was a positive culture within the service. There were clear values that included involvement, compassion, dignity, respect and independence. People were able to express their opinions and views and were encouraged and supported to have their voice heard. The management team provided strong leadership and led by example.
The registered manager had very robust and effective systems in place to assess and monitor the quality of the service. The quality assurance system operated to help develop and drive improvement.
The home had a homely, friendly and welcoming atmosphere. Throughout our visit we saw that people appeared comfortable and at ease with the staff who supported them. People told us they were very happy and comments included "like living here", "am happy - like it here" and "nice - looked after well".
Staff treated people in a respectful, dignified and professional manner. People were asked for their consent before any care or treatment carried out.
Staff worked well as a team and felt supported.
People's rights to independence were maintained.
Each person had a plan of care that contained all the information required. Staff knew each person's needs well. The home sought advice from specialist professionals when necessary. People enjoyed taking in a range of activities suitable to their needs.
People had homely and varied meals which they chose for themselves. They lived in a home that was safe and suitable to their needs, choices and abilities.
The home had a comprehensive complaints procedure in place.
During our inspection we spoke with four people using the service, talked with a relative on the telephone, observed staff interaction with people using the service and spoke with three staff on duty.
We observed that people were comfortable with staff and had choices in all aspects of their daily living. We saw staff interacting and supporting people in a respectful and positive manner.
The staff we spoke with told us that they had worked at the home for a number of years and they knew the people they supported well. Two people told to us they were being well looked after. Other people indicated to us through smiling and gestures they were happy with the service.
We looked at safeguarding procedures; this is how the service ensured people using the service were protected from harm. We saw suitable systems were in place to support and protect vulnerable adults.
We found disclosure and barring service checks had been carried out. This meant people using the service were appropriately protected.
We checked records were stored safely and correctly and systems were as required. This was to ensure people's confidential information was stored appropriately.
People were very keen to tell us about the activities they enjoyed on a regular basis. The day of our visit this included horse riding and arts and crafts. We were also told about theatre visits, membership of a football club, meals out, shopping and parties. There was an extensive range of activities available to people and they also had 'jobs' to do within the home, such as cooking and cleaning. One person described what to do if the fire alarms went off. One made the lunch and others cleared up.
There were many ways in which people were involved in the home and able to ensure their preferences were known. They help interview prospective staff, have meetings, regular care plan reviews, there is a yearly questionnaire covering all aspects of their lives, including: 'Do you feel safe?' and 'Do you want to go to church?' Different methods of communication were used by care workers who have good knowledge and understanding of peoples' individual needs.
People were very supported to maintain good physical and mental health and we found that people who have behaviour that is a challenge had plans describing the steps to be taken to help them deal with difficult situations.
People were safeguarded from abuse and their human rights protected through the relationship people have with care workers and the manager, who takes a very proactive role in how the service is planned and delivered. Care workers were fully aware of how to respond should they suspect abuse and the home keeps us fully notified of events, as they are required to do.
Some care workers have been at the home for many years providing consistency. There was good communication, clear leadership and health care professionals told us about the consistent and reliable approach of care workers. Supervision, support and training for staff was in place and care workers were proud and enthusiastic about their work, citing peoples' progress in overcoming their problems.
Servicing, maintenance, health and safety, individual and general risk were properly assessed and managed at Tregarland.