Background to this inspection
Updated
13 July 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 2 inspectors 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
Trevarna is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We visited Trevarna care home on the 8 June and the 15 June 2023. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We spoke with 8 people who used the service about their experience of the care provided and 2 visiting relatives. We spoke with 12 members of staff including the registered manager, regional and deputy manager, team leaders, care staff, domestic staff and chef.
We reviewed a range of records. This included 5 people's care records and medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
We spoke on the telephone to four relatives. We received feedback via email from 3 staff members and a health and social care professional about their experience of Trevarna.
Updated
13 July 2023
Trevarna is a care home with nursing which provides care and support for up to 53 predominantly older people. People at Trevarna had physical health needs and or were living with dementia. At the time of this inspection there were 39 people living at the service.
Trevarna is a single storey purpose built service. It is divided into 5 separate areas known as ‘households’, each named after a flower. Each ‘household’ contained an open plan living, kitchenette and dining area with people’s rooms leading off the main connecting corridors. There is a secure central courtyard garden and side garden area. Most rooms have en-suite facilities and there were sufficient numbers of bathrooms and toilets.
In October 2022 Cornwall Care ltd was purchased by Sanctuary Care and is now part of the Sanctuary care group.
People’s experience of using this service and what we found
People, relatives and health and social care professionals spoke positively about the changes made to the service. This had resulted in the standard of care for people improving, staff skills, knowledge and support increasing and relatives feeling more assured that their family members were being cared for safely. Some comments from people and relatives included " I can't fault them”, “I'm happy and family are happy too”, “Its peace of mind that I know he's there and safe” and “I'm completely satisfied with the care [person name] receives” and “I will give them 10 out of 10 with everything.”
The managers of Trevarna spoke positively about the support they had received since the take over of Cornwall Care by Sanctuary care. They acknowledged there had been changes in the service, such as a review of staffing levels, quality audits and changes in systems and processes which had been unsettling for some staff. The changes had been communicated with staff so that they had the opportunity to share their views on the upcoming changes to the service.
Prior to the inspection we had received a concern around staffing levels. Staff varied in their view as to if there were sufficient staff on duty. People and relatives told us they felt there was sufficient staff to meet their family members care needs. The provider had implemented a ‘staffing ladder’ tool which calculated the necessary staffing levels to ensure each person’s health and care needs were met safely. Rotas evidenced that sufficient staff were on duty to meet people’s current needs.
People’s views on the quality of food and drinks were mixed. Our observations of food on the first day of the inspection was not positive. This was feedback to the provider who took immediate action. On our second unannounced visit the food was appetising, and a review of catering services was being undertaken. We have made a recommendation that the provider should seek advice on how to provide choices of food and drink to meet people’s diverse needs, making sure the food and drink they provide is nutritionally balanced and supports people’s health.
The provider had invested in the environment and had a plan of works for future changes to be made at the service. Comments from people, relatives, staff and health and social care professionals were positive about the changes.
The provider had implemented new systems and processes that had improved the standard and quality of the service. For example, systems to assess and monitor the quality and safety of the care provided were more robust and were driving improvement. The service had clear and effective governance systems in place.
The service had an electronic application to record people’s care plans, their risk assessments and people’s daily notes. Care plans were person centred and had detailed information about people’s backgrounds, history, social, physical and mental health needs. Care plans provided information for staff on how to meet people’s identified needs.
People, and their relatives were involved in the development and review of their care plans which detailed their needs and preferences. Staff knew people's care needs well. People were supported to engage in activities.
Staff told us that they had received the training they needed to meet people's needs safely and effectively. Staff were supported in their roles through a plan of supervision. Staff told us they felt supported by the registered manager and her team.
People’s medicines were managed safely. Staff responsible had the necessary skills to administer medicines. Oversight was in place to ensure medicines were managed safely.
There were processes in place to manage infection control risks and there were regular cleaning procedures in place. Visiting was encouraged and their were systems in place to enable relatives to visit safely.
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.
The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Last rating and update
The last rating inspection found that the service was good (published 28 November 2018). We also carried out an infection control inspection in 2022 which did not provide a rating.
At this inspection we have again rated the service as good .
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
Recommendations
We have made a recommendation in relation to the provision of food. We will check if the provider has acted on this recommendation at our next inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.