Trewan House is a residential family owned 'care home’ located in the Hough Green area of Widnes. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The home specialises in providing accommodation for older adults and adults experiencing different forms of Dementia. The home has 42 ensuite bedrooms and is registered to provide support for up to 44 people. At the time of our inspection, there were 39 people living in the home.At the last inspection on the 7 September 2015, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
There were two registered managers in post at the service, who were also part of the registered provider team, both of whom were on site during our inspection. The registered managers shared responsibilities among themselves for the running of the service, with one being responsible for business and finance matters and the other responsible for overseeing care related duties. 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 2008 and associated Regulations about how the service is run.
Our observations showed people were supported by sufficient numbers of suitably qualified staff and did not have to wait long for support. People told us staff responded to them in a timely manner and call bells were answered promptly. One person commented, “There are enough staff about. The staff don’t take long when I use my call bell.”
Staff recruitment files contained all the relevant pre-employment recruitment checks to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures. The safeguarding policy was available in the staff office for ease of reference.
Care files contained individual risk assessments to assess and monitor people's health and safety in respect of a variety of potential hazards.
Appropriate assessment tools had been used to measure the level of risk and guide staff on what action that should be taken to mitigate this such as the Waterlow assessment tool in respect of pressure area care and the Malnutrition Universal Screening Tool (MUST).
People were happy with how their medicines were managed and staff received training to undertake this practice safely. We saw that medication was stored safely and securely and within their recommended temperature ranges. There was no PRN (as when) protocols in place for people who required as needed medication although staff spoken with had a good knowledge regarding the circumstances in which this was to be administered. The registered manager took immediate action on the inspection day to devise a new protocol template to ensure staff knowledge was reflected in the associated paperwork.
People were supported to live in a safe environment and a series of checks was completed to ensure that equipment did not pose a risk to people living in the home. We identified that the sluice room was not secured by a lock. We brought this to the attention of the registered managers who took immediate action on the day of the inspection to secure a coded lock to the door.
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. The service operated within the principles of the Mental Capacity Act 2005 (MCA). Mental capacity assessments were completed and Deprivation of Liberty authorisations were applied for appropriately.
People told us that consent was sought before providing care and staff described the ways in which they involve people in making decisions for themselves. One staff member told us, “I involve them in everything, whatever their capabilities are. I treat them as equals. People still know what they like and dislike even if they have dementia.”
Staff told us that they received the training and support they needed to carry out their roles effectively. Staff were also supported through supervisions and staff meetings and also felt confident to raise any issues or support needs informally.
The service worked with external professionals to support and maintain people's health. Care plans contained evidence of the involvement of GPs and other professionals. We spoke to two visiting health professionals during our inspection who described staff as ‘positive’, ‘dynamic’ and ‘responsive’ to advice given.
People told us they were given choice regarding meals and complimented the food served at the home. The cook had a good knowledge of people’s individual dietary needs and ensured specific diets such as liquidised or soft diets were catered to.
Care plans documented people's preferred routines and preferences to enable staff to gain a good understanding of the person they were supporting.
A complaints policy was in place and people felt confident in approaching the registered managers if they had any concerns or complaints. Complaints were well managed and documented in accordance with the registered provider's complaints policy.
An activities co-ordinator was employed by the service and provided activities such as new age bowls and tai chi. People told us they enjoyed trips out in the local community to local museums, parks and other towns.
Quality assurance procedures were in place to monitor and improve the quality of care being delivered at the home. These included spot checks and audits on areas such as care plans, DoLS authorisations and checks on the environment. The registered managers had plans to further develop these systems.
People and their relatives knew who the registered managers were and found them approachable. Team meetings and resident meetings took place regularly and annual questionnaires were issued to people’s relatives. A suggestion box was available in the communal area of the home to ensure people’s views were sought regarding the service. This feedback was used to develop the quality of the service.
Staff spoke positively about their experience of working at the home. All the staff we met with told us they would recommend the home. One staff member told us, “It’s family run, that makes a difference, they care, we are very person centred and get good feedback from families.”
The registered managers had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory requirements.
The ratings awarded at the last inspection were displayed in the communal area of the home and on the registered provider’s website.