Trewidden Care Home

Updated 14 May 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

This inspection was carried out by one inspector, a member of the medicines team and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

Trewidden is a ‘care home’. 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. The service did not have a manager registered with the Care Quality Commission. The registered manager had recently left. The deputy manager had stepped in to the manager role and was applying to the CQC to be the registered manager. Registered managers like providers are legally responsible for how services are run and for the quality and safety of the care provided.

Notice of inspection: This inspection was unannounced.

What we did:

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider returned the PIR and we took this into account when we made judgements in this report. We reviewed other information that we held about the service such as notifications. These are events that happen in the service that the provider is required to tell us about. We also considered the last inspection report and information that had been sent to us by other agencies.

During the inspection, we spoke with five people who used the service, and three relatives. We also had discussions with five staff members and the manager and the operations manager. An external therapist was spoken with during their visit to the service.

We looked at the care and medication records of four people who used the service, we undertook a tour of the premises and observed information on display around the service such as information about safeguarding and how to make a complaint. We also examined records in relation to the management of the service such as staff recruitment files, quality assurance checks, staff training and supervision records, safe guarding information and accidents and incident information.

Updated 14 May 2019

About the service: Trewidden provides accommodation with personal care for up to 39 people. There were 37 people using the service at the time of our inspection.

People’s experience of using the service:

¿ People were not all able to fully express their views therefore they were not able to tell us verbally about their experience of living at Trewidden. Therefore, we observed the interactions between people and the staff supporting them.

¿ The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were listened and responded to.

¿ Staff showed a true fondness for the people they cared for and there was a warm, friendly and welcoming atmosphere. People’s wellbeing was promoted.

¿ The environment lacked appropriate stimulation for people living with dementia. Activities provided were not always meaningful and relevant to people’s backgrounds and interests. We have made recommendations about these issues in the Responsive section of this report.

¿ People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. However, the process for ensuring these mattresses were always set correctly was not robust. We did not evidence any impact on people due to using incorrectly set mattresses. The manager assured us that night staff were going to be asked to sign each night following the checks of these mattresses. We have made a recommendation about this in the Responsive section if this report.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ Staff were recruited safely in sufficient numbers to ensure people’s needs were met.

¿ The environment was safe and people had access to equipment where needed. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

¿ Quality monitoring systems were in place. However, there was some delay in actioning some audit findings. A recent survey sent out to people and their families had positive responses.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement (report published 1st May 2018) There were no breaches of regulations. However, we were concerned about some aspects of staff support, records kept and support provided to some people by agency staff, staffing deployment and details of people’s lasting powers of attorney were not always clearly recorded. Recommendations were made in the last report due to these concerns. At this inspection the service had made improvements and was rated as Good.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk