Background to this inspection
Updated
19 June 2021
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 Care Act 2014.
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 one inspector. Following the site inspection an Expert by Experience contacted relatives of people who lived at the service. 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
Trevern is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. 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.
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. We sought feedback from the local authority and professionals who work with the service. 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.
During the inspection
We spoke with eight people who used the service about their experience of the care provided and two relatives. We spoke with fourteen members of the staff team. 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 reviewed a range of records. This included four people’s care records, medicines records and maintenance records. We looked at three staff files in relation to recruitment and staff supervision and a variety of records relating to the management and monitoring of the service.
After the inspection
We continued to seek clarification from the manager to validate evidence found. We looked at mental capacity records and policies and procedures.
Updated
19 June 2021
About the service
Trevern is a 'care home' with nursing that provides accommodation for a maximum of 40 adults, of all ages with a range of health care needs and physical disabilities. At the time of our inspection there were 38 people living at Trevern. The service is situated in the town of Falmouth. The building is divided into three areas known as The Wing, The Flats and The House. Each area has its own lounge and dining area. People's bedrooms were personalised and were for single occupancy. There were a range of aids and adaptations in place including bathing facilities designed to meet the needs of the people using the service.
People’s experience of using this service and what we found
The service had changed the way staff rosters were calculated. Staff told us rosters were now consistent and they had a clearer work pattern. Additional recruitment had improved staffing levels with less reliance on agency staff. However, agency staff continued to fill gaps as they occurred.
There was a good skill mix on each shift. The service had increased the level of nurses on day shift. Where possible two nurses were on duty. This meant there was more flexibility in service delivery.
Staff were recruited safely. Staff told us they felt supported in their role. There had been gaps in supervision during the COVID-19 pandemic, but all staff had received a recent appraisal and there was a plan in place for regular one to one support. Senior managers provided on call support for out of hours and weekend cover.
Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance about COVID testing for people, staff and visitors was being followed.
Visiting arrangements for people’s families had been facilitated, in line with government guidance at any given time, throughout the pandemic. Nominated relatives were able to make visits to see their loved ones, and this had been welcomed.
People received their medicines safely as prescribed for them. Regular audits identified where errors had occurred. Action was taken in these instances to learn from these errors through additional training and support.
Electronic care planning provided staff with guidance to ensure people’s needs were met. Risks were identified and staff had clear instructions to help them support people to reduce the risk of avoidable harm.
Feedback from people and their relatives about the service’s performance was valued by the registered manger and any issues raised were investigated and action taken where necessary. The duty of candour was understood by the registered manager and relatives told us the service communicated with them effectively.
Rating at last inspection
The last rating for this service was Good (published 13 February 2020).
Why we inspected
We received concerns in relation to management of the service, staffing, the quality of care people received and limited staff support. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The provider had taken steps to mitigate risk by making changes to how the service was being staffed. Recruitment had increased and staff told us management support had improved.
A review of governance systems was continuing, and changes were being made where necessary to ensure they were effective.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Trevern on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.