Trewidden was previously known as Cornwallis Nursing home. The service no longer provides nursing care and had changed its name. Trewidden remains owned and operated by Cornwallis Care Services Limited who operate other services in Cornwall. Trewidden offers care and support for up to 51 predominantly older people. At the time of the inspection there were 34 people living at the service. Some of these people were living with dementia. The service occupies a detached building over three levels, with a passenger lift to provide access to the upper floors.This unannounced comprehensive inspection took place on 27 March 2018. The last inspection took place on 31 January 2017 when the service was not meeting the legal requirements. The service was rated as Requires Improvement at that time. There were some aspects of the premises that required attention, such as re-decoration and carpet replacement. Induction of new staff was not always recorded. Not all staff had received training on the Mental Capacity Act as stated in the service’s policy. The registered manager was not able to take effective action on audit findings due to lack of resources. This meant that identified improvements were not being implemented. Following that inspection an action plan was sent by the provider to CQC stating how they would meet the requirements of the regulations. This inspection was scheduled to review the actions the provider had taken.
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 is required to have a registered manager, and at the time of this inspection there was a manager in post who was in the process of registering with CQC. 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 and associated Regulations about how the service is run.
We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. People told us, “I love it here,” “It’s lovely here, the staff are lovely” and “I am very happy.” Relatives told us, “The staff are lovely and caring, some in particular, [person’s name] is treated really well and is always clean and happy when we come,” “Staff seem to know everyone here really well, they know what people like and don’t like, so it feels really personal and homely” and “It’s such a relief knowing that [persons’ name] is well cared for and I can come and visit any time so it is lovely to see [person’s name] looking happy with everyone here.”
The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. The premises were being maintained. During this inspection there were rooms being renovated and bathrooms updated. However, as noted in our previous report there continued to be tape used to hold down torn/lifted areas of carpeting in places throughout the service. This posed a trip hazard where the tape was lifting in some places. Upstairs carpet was uneven. We were assured this was being addressed with new carpet being laid shortly. Equipment and services used at Trewidden were regularly checked by competent people to ensure they were safe to use.
The service was registered for dementia care, there was some pictorial signage to support people, who were living at the service with dementia, who may require additional support with recognising their surroundings.
Care plans had been recently transferred to an electronic system. Care plans were well organised and contained accurate and up to date information for staff. Some areas of the electronic care planning system were not yet in full use. Care planning was reviewed regularly and people’s changing needs were recorded. Daily notes were completed by staff. Risks in relation to people’s daily lives were identified, assessed and most were planned to minimise the risk of harm whilst helping people to be as independent as possible.
The service used a dependency tool and had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had some staff vacancies at the time of this inspection and these posts were being covered by agency staff. The agency staff used were mostly consistent and were very familiar with the service and the people living there. This helped ensure the care and support for people was provided in a consistent manner.
There were systems in place for the management and administration of medicines. It was clear that people had received their medicine as prescribed. Regular medicines audits were being carried out on specific areas of medicines administration and these were effectively identifying if any error occurred such as gaps in medicine administration records (MAR). We saw no gaps in these records.
Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. People had access to activities. An activity co-ordinator was in post. On the day of this inspection we saw people enjoying a variety of activities in small groups as well as on a one to one basis.
The use of technology to support effective care delivery was limited. Alarmed locks had recently been fitted to all bedroom doors. This provided the opportunity for people to lock their rooms if they chose. One person’s door was locked at all times to ensure that their room was not accessed by other people uninvited. This had been supported by the person’s family as the person was cared for in bed and unable to call for assistance independently. Staff held the key which was required to open this person’s door.
New staff were supported by a system of induction training and this was recorded. Staff received appropriate training and regular updates. The manager had a record which provided them with an overview of staff training needs. Staff records that we reviewed did not contain evidence of all the one to one supervisions the provider stated had taken place. Staff we spoke with did not recall having regular one to one supervision. However, annual appraisals had been completed by the manager.
Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance.
People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.
The manager was supported by the provider and a recently appointed deputy manger. We had mixed feedback from the staff we spoke with regarding the support they received from the manager. Twenty five staff had left the service in the last year for various reasons. Of 19 care staff working at the service nine had begun working since January 2018. This meant the service was going through a process of change which challenged some staff.
There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the manager and the provider who visited regularly to support the manager. Audit findings were acted upon and the service was striving to continuously improve the service it provided.
We made some recommendations in this report, that the service seek advice and guidance from a reputable source regarding the regular provision of one to one support to all staff, to standardise the support provided for people by one to one staff and to review how all care and support is consistently recorded. The service was improved from the last inspection and whilst there were no breaches of the regulations we have judged the overall rating of the service remains Requires Improvement due to concerns found.