Archived: Trelawney House

Updated 8 September 2022

The inspection

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 three 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. Two inspectors were present in the service on each inspection day while one inspector and the Expert by Experience completed their work remotely.

Service and service type

Trelawney House 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.

Registered Manager

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 not a registered manager in post. A new manager had been recruited and was temporarily providing leadership to the staff team. The new manager did not intend to become the registered manager of the service.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection we reviewed all of the information we had received about the inspection since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

Inspection activity started on 17 May 2022 and ended on 25 May 2022. We visited the service location on 17 and 19 May 2022. During the inspection we met and spoke with everyone the service supports and observed the quality of interactions between people and their support staff. We also spoke with six members of staff and the manager. In addition, we gathered feedback on the service’s current performance from three people’s relatives and four professionals who worked with the service. We reviewed three people’s care plans, staff recruitment and training records as well as the service’s policies and procedures.

Updated 8 September 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Trelawney House is a residential care home providing personal care for up to six people with a learning disability and/or autistic people. Five people were living in the service at the time of this inspection. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services for adults across Cornwall. Trelawney House is in a rural location. The nearest town is Helston which is approximately four miles away without public transport links.

People’s experience of using this service and what we found

People, relatives and staff all reported improvements in the service’s performance since the last inspection.

The service was not able to demonstrate how they were meeting some of the underpinning principles of the statutory guidance Right Support, Right Care, Right Culture.

Right support

The service remained short staffed and low staffing levels continued to restrict people’s freedoms and choices. The provider had not safely managed risks in relation to the quality of care provided by tired staff.

Staffing numbers on shift each day had improved and there were no incidents where staffing numbers had been unsafe in the month prior to our inspection. However, people’s needs in relation to staffing were not fully met and reduced staffing levels continued to restrict freedoms and choices.

The provider had not ensured all necessary recruitment checks had been completed for agency staff working in the service.

We identified issues in relation to the use of personal protective equipment by some staff who were not wearing masks, this was reported to the manager and resolved.

Improvements had been made to some aspects of the service’s environment and soiled carpeting had been replaced. However, faulty emergency lighting had not been promptly repaired, a number of double glassed window required replacement and an area of damp was present in one person’s bedroom.

People were now protected from abuse at Trelawney House and no one was locked in their own rooms during this inspection. People told us they now felt safe in the service and no one had alleged incidents of abuse occurring in the service since the last inspection. The new manager understood how to report safeguarding concerns.

Right care

People’s care plans were lengthy, and protocols used by staff did not consistently reflect guidance contained in care plans. This was raised with the manager on the first day and resolved by the second visit to the service during this inspection.

Issues in relation to the noise levels in the service during the day and at night had improved. People were more relaxed in the home and were now able to rest. This had impacted positively on their wellbeing. The person who had become withdrawn as a result of high noise levels were now comfortable accessing the service’s communal areas.

People now had more control of their lives and this had positively impacted on their wellbeing. Access to the community had improved and people were now regularly supported to engage in a variety of activities they enjoyed.

Risks in relation to people’s mobility were now managed appropriately. A person whose mobility was declining had moved into a ground floor flat. They were now able to access the service’s communal areas and their bedroom interpedently when they wished. Appropriate support was provided to ensure the person’s dignity was protected while accessing vehicles.

People were appropriately supported at mealtime and staff had the skills they needed to meet people needs. Medicines were managed safely. However, we have made a recommendation in relation to systems for administering as required medications.

Right culture

The culture of the service had significantly improved. Staff were well motivated and focused on supporting and enabling people to have choice and control over their lives. The manager was open and honest throughout the inspection and information request was provided promptly.

People were not always supported to have maximum choice and control of their lives and the service had not fully complied with reporting conditions made under the Deprivation of Liberty Safeguards. MCA assessments and best interest decisions remained generic rather than decision specific.

There was no registered manager in post. A new manager had been recruited since the last inspection. Staff and relatives were highly complementary of the manager’s approach and professionals told us communication with the service had improved.

The provider’s quality assurance systems had failed to ensure the service complied with the regulations. The manager had reintroduced the use of paper based daily care records as the provider’s digital recording system was ineffective.

Incident recording had improved, and the manager had reviewed incident records to identify possible areas of learning or improvement.

Senior staff had begun additional training to support people to communicate effectively. Staff were now able to communicate effectively with people which enabled people to have more control over their lives.

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

Rating at last inspection and update:

The last rating for this service was Inadequate (published 16 December 2021) and there were breaches of regulation. At this inspection we found some improvements had been made. However, the service’s rating remains inadequate. A number on ongoing breaches of the regulations were identified at the inspection.

Why we inspected

This inspection was carried out to follow up on the findings of our previous inspection and to provide updated rating for the service.

Enforcement

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.

We have identified breaches in relation to need for consent, premises and equipment, governance, staffing and fit and proper persons employed at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is Inadequate and the service remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.