Archived: Trewartha Residential and Nursing Home

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

Some people were not able to tell us verbally about their experience of living at Trewartha. Therefore, we observed the interactions between people and the staff supporting them.

People said they felt safe. There was enough staff to support people and appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people.

Staff were highly committed to ensuring people lived fulfilling lives and were protected from social isolation. The focus of people's care was individualised and focused on promoting people's independence as well as their physical and mental well-being. People were empowered to make their own choices and staff demonstrated a 'can do' approach which meant they were able to achieve very positive outcomes for people.

People received an extensive range of meaningful activities which focused on the persons individual interests and abilities. There was a comprehensive and varied menu of activities to choose from and people benefited from the development of closer links to their local community.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in people's care plans. Staff followed guidance provided to manage people's nutrition and pressure care.

Care plans contained information about people and their care needs. People were supported to make choices and have their support provided according to their wishes.

People were supported by staff who had received training to ensure their needs could be met. Staff received regular supervision to support their role.

People had good health care support from professionals. When people were unwell, staff had raised the concern and acted with health professionals to address their health care needs. The staff worked in partnership with health and care professionals.

Staff were patient and friendly, and people's privacy and dignity were respected. Staff knew how people preferred their care and support to be provided.

People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Effective governance systems were in place, ensuring people received consistent care.

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 29 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Trewartha is a care home providing nursing care for up to 37 people predominately living with dementia. The service is in the Carbis Bay area of St Ives. It is a single storey purpose built service within a housing area. There are a range of aids and adaptations to support people. The service is close to local amenities and a transport network. There is a large garden area which is not overlooked. At the time of the inspection visit there were 34 people living at the service.

At the last inspection in March 2015 the service was rated overall ‘Good’ with ‘Outstanding’ in the domain responsive.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

The registered manager had systems in place to record accidents and incidents and take action when required. Where sudden and unexpected incidents occurred staff had the knowledge and skills to deal with them safely and effectively. We observed an example of this during the inspection of the service. Staff worked together to ensure there was minimum disruption or change affecting other people.

Recruitment checks were carried out to ensure suitable staff were employed to work at the service. Our observations and discussions with staff, relatives and people who lived at Trewartha confirmed sufficient staff were on duty both day and night. People said, “Always around when you need them (staff)” and “I visit a lot and there are always staff to be seen. They (staff) take time to see what residents need.”

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation if Liberty Safeguards (DoLS).

Staff were supported by a system of induction training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided. For example, care of people living with dementia and for people with specialist dietary needs.

Staff had the skills, knowledge and experience required to support people with their care and meet their social needs. The registered manager had instilled a culture where staff were open to learning and shared new skills with their colleagues. For example, researching meaningful activities and acting as ‘leads’ in areas of infection control.

There were enough staff available to ensure people received prompt and attentive care. Staff had time to chat with people as well as meeting their care and support needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. For example, staff using one to one support for continuity and by having the time to let the person take the lead and control of what they wanted to do.

The service provided a varied range of meals and drinks for people. There was a sufficient choice and people received appropriate support where required. Where people required specialist support with their dietary intake and fluids, systems were in place to monitor and manage their needs.

Medicine procedures at Trewartha were safe. Staff responsible for administration of medicines had the competency and training required. Medicines were stored securely with access only by designated people.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and as people’s changing needs recorded. Wherever possible, people and their relatives were involved in the reviews. A family member told us, they had been thoroughly involved in their relatives care planning and initial assessment. “I look at (person’s name’s) care plan whenever I come. It’s always up to date and I can see what care (the person) had received.” Nursing care plans were comprehensive and regularly updated.

The premises were safely managed. By observing all areas of the service we found it was being well maintained, was clean and hygienic and a safe place for people to live. Equipment had been serviced and maintained as required.

We observed staff engaged with people in a caring and relaxed way. People were spoken with respectfully and their dignity was upheld at all times.

People who used the service and their relatives knew how to submit compliments, raise a concern or to make a complaint. ‘Have your say’ forms’ were available and signposted in the entrance hall to encourage people to make comments. People told us they felt confident they were listened to and that any concern would be taken seriously. Families felt very involved in the service by way of communication through a relative s external quality group.

The registered manager was supported by an area manager as well as senior staff including a nurse. There was an administrator and a team of care and ancillary staff. The staff team were all totally committed to providing an exceptional caring and supportive environment for people living at Trewartha. Staff meetings were held regularly. These allowed staff and management to communicate information and air any concerns or suggestions they had regarding the running of the service.

The registered provider had extremely robust quality assurance process in place to drive improvement in Trewartha. These included regular audits of the service, annual surveys, resident meetings and staff meetings to seek the views of staff and people about the quality of care at the service.

The registered provider demonstrated a positive approach to developing the service by supporting and nurturing staff’s personal development in the work place.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them, a visiting healthcare professional, comments left on the www.carehome.co.uk website about Trewartha and from looking at records.

Is the service safe?

People told us they felt safe. Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives. The registered manager and deputy managers wrote the staff rotas and took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required.

Trewartha alerted the local authority and the Care Quality Commission when notifiable events occurred or when they had any concerns regarding people who used the service.

Trewartha had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them, and it was clear that they were involved in writing their plans of care. We saw people, or their representatives consistently signed care plan reviews to show they had read and agreed to the content of the care plan. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

Is the service caring?

We spoke with one person who lived at Trewartha, a visiting healthcare professional and also received comments from relatives of people at Trewartha. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example “X is treated with love and care, and staff are so kind and thoughtful nothing is too much trouble”, “Excellent and thoughtful care on all counts” and “X has always received the very best treatment from very caring and thoughtful staff”. When speaking with staff it was clear that they genuinely cared for the people they supported.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with. People’s preferences, interests, aspirations and diverse needs were recorded and acted upon.

Is the service responsive?

Many people who lived at Trewartha had complex health needs and were either not able, or chose not to join in group activities. The records showed people were routinely offered one-to-one or group activities.

The service worked well with other agencies and services to make sure people received care in a coherent way. Trewartha gave opportunities for people, their relatives and staff to express views and opinions about the service.

Is the service well-led?

Trewartha had regular support from the district nursing team and GPs from the local GP practices. This ensured people received appropriate care in a timely way.

We saw that the registered manager monitored staffing to ensure it was effective and sufficient, such as, evidence to show that planned and/or unplanned events (such as sickness or training absence) had been managed appropriately ensuring a good quality service and safe service.

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and used their views to improve support for people who lived at the service. Staff told the inspector that Trewartha was a happy place to work.

The service had a quality assurance system, and staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We saw people chatted with each other and with staff and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights. People were protected by the home’s infection control procedures, management of medicines and people were protected by the home’s robust recruitment procedures.

We found staff received appropriate professional development and supervision.