8 February 2022
During a routine inspection
Trewithen provides care and accommodation for up to five people who are autistic. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.
People’s experience of using this service and what we found
The provider had completed appropriate checks when they recruited permanent staff. However, they had not assured themselves a staff member who had been employed via a staffing agency, working long term in the service and also living there, was of good character or suitable to work with vulnerable adults.
A staff member who had been working at the service since December 2021 had only received a one-day induction and no further training.
Risks related to the safety of the service had not always been assessed or acted upon.
Audits and action plans had not identified all the areas for improvement identified during this inspection; for example, fire risks, staff recruitment and training. This meant people were exposed to the risk of harm.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People had been supported to have their medicines reviewed and reduced, where appropriate.
Staff had received safeguarding training, and information about who to contact with any safeguarding concerns was displayed in the service.
Staffing had been used flexibly to help ensure people received the support they needed.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
Staff understood people’s preferences and enabled them to make choices about how they spent their day; however they had not been consulted for their views about a staff member living in the service. People’s records described what support they required to maintain their independence. People’s records described how people needed information presenting to them to help them understand it. Staff had developed personal communication dictionaries for people which helped them develop a more consistent understanding of people.
Right care:
People received person-centred care; however, at times, the language staff used did not reflect this ethos. Staff were aware of the risks of social isolation but balanced this with protecting people’s privacy and dignity. Records showed the aims and ambitions for people, why this would benefit them, steps they needed to take to achieve them, and who they would need to help them. The environment had been reviewed and adapted to meet people’s sensory needs and preferences.
Right culture:
The registered manager was aware of best practice guidance and was supporting the team to identify any improvements that could be made. External professionals had been used to help ensure people were receiving the right care and support for their needs.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 18 April 2018).
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
Enforcement and recommendations
We have identified breaches in relation to reducing risks, training and the running of the service. We have made three recommendations in relation to medicines management and person-centred care. Please see the action we have told the provider to take at the end of the full report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.