Archived: Trelawney House

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.

Trelawney House is a residential care home providing personal care to six people with a learning disability and/or autism. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services 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

The provider had failed to appropriately report and investigate incidents of alleged abuse. This issue had previously been identified in the last inspection of the service on 10 June 2021. The service’s new manager had completed a safeguarding referral following an incident of alleged abuse and this had been forwarded to the provider’s nominated individual. This information had not been shared with the local authorities safeguarding team, or the CQC, and the provider had failed to take necessary action to manage the risks posed by the alleged abuser.

At this inspection we found that the service was short staffed. This had previously been found during the inspection on 10 June 2021. Four agency staff had been allocated to support the service. However, staffing levels were restricting people’s freedoms within the service, where one person was regularly restricted by being locked in their room. Access to the local community was also restricted.

Records showed that the service was regularly aiming only to achieve minimum safe staffing levels within the service, as opposed to the commissioned levels of support designed to enable people to have fulfilling lifestyles and access the community. At night the service was also regularly operated at emergency minimum staffing levels and on one recent occasion the night staffing level had been unsafe. Staffing levels planed for the two days following our first inspection day were judged to be unsafe. There was no information available to staff on staffing arrangements for the following week. We sought assurance from the provider during the first day of the inspection that staffing levels would be increased and a rota developed. This information was then provided.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. This service was unable to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and the environment of the service did not meet peoples’ current needs. Prompt action had not been taken to address and resolve these issued which had impacted on peoples’ independence.

Right care:

• Known issues in relation to the noise level in the service during the day and at night had not been appropriately addressed. This had severely negatively impacted on people’s wellbeing and led to one person becoming increasingly isolated.

Right culture:

• The ethos, values, attitudes and behaviours of the provider and it’s leaders did not enable people using the service to experience empowered lives. The provider did not work effectively with partners to ensure people’s safety.

Medicines were not managed safely, and the provider had not yet addressed the recommendation issued following our last inspection about where medicines were stored.

Incidents where unauthorised techniques were used to support people when anxious or upset had not been appropriately investigated. Poor record keeping meant it was not possible for lessons to be learned following incidents.

People did not receive the support they needed to eat and drink. Prompt action had not been taken to make necessary alterations to the service to enable a person with declining mobility to maintain their independence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Policies and systems in the service did not support this practice. Conditions associated with authorisations to deprive people of their liberty (DoLS) had not been complied with.

We received mixed feedback about the service’s current manager from staff and people ‘s relatives. The new manager had been unable to resolve issues in relation to the lack of rotas in the service before going on leave and the provider had failed to give the service additional support to resolve this issue.

Accurate records of incidents and the support people had received had not been maintained. Information provided by the current manager after the inspection, and about the staffing level achieved in the weeks prior to the inspection, did not match with information gathered during the site visit.

The provider had failed to address and resolve the breaches of regulations identified during our previous inspection in June 2021.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 September 2021). The Commission took enforcement action following that inspection and warning notices were issued in relation to breaches of regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition, the provider was asked to develop action plans detailing how breaches of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 would be addressed.

At this inspection we identified repeated breaches of these four regulations and additional beaches of the regulations were also identified.

The service has now been rated inadequate. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about how the provider was safeguarding people from abuse. A decision was made for us to inspect and examine those risks.

In addition, we undertook this inspection to check whether the Warning Notices we previously served in relation to Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

As a result, we undertook an inspection to review the key questions of safe, effective, caring, responsive and well-led.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified that the warning notices issued following the last inspection in relation to staffing and good governance had not been complied with. In addition, we identified repeated breaches in relation to safeguarding people from abuse and notifying CQC of significant events. new breaches in relation to person centred care, safe care and treatment, meeting nutritional and hydration needs, and premises and equipment, were also identified.

We took legal steps to remove the service from the providers registration. The service is no longer operating.

Follow up

We will meet with the provider following this inspection to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, 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 of 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.

Trelawney House is a residential care home providing personal care to six people with a learning disability and/or autism. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall. Trelawney House is in a rural location, the nearest town is Helston which is approximately four miles away.

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

The service had been understaffed. Staff had worked together to make sure people’s opportunities to go out were not affected by the shortage of staff. This could mean them working long shifts or coming in early, staying on past their planned finish time or coming in on their day off. One member of staff told us; “There have been times when it’s [staffing levels] not been met. We mainly cover it thanks to the team really.” Records of what support each person received from staff showed people were not always provided with their commissioned one staff to one person support time. The provider had recently booked agency to support the service and they started working at Trelawney House the day after the inspection visit to try and address the immediate staff shortages.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

One person’s mobility had decreased, and they were no longer able to negotiate the stairs independently. Although there were plans to move their bedroom to the ground floor this was taking a long time which was further disabling the person.

Not enough had been done to protect people from risk when others were distressed and likely to act in a way which could harm themselves or others. Systems for identifying and reporting safeguarding incidents and other untoward events were not robust or consistently applied. A decision to restrict one person's freedom to move around the premises had not been taken in line with the best interest process.

People were supported to take their medicines as prescribed and, where appropriate, were involved in medicine reviews. There was no evidence people had been consulted about where their medicines were kept. We have made a recommendation about this in the report.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was a core staff team, many of who had worked at Trelawney House for some time. They knew people well and worked hard to support people according to their needs.

Communication tools were used to help inform people of any plans for the day and support their understanding. These were individualised to help ensure they were meaningful.

We requested further information to enable us to analyse how people were spending their time on a day to day basis. This had not been provided two weeks after the inspection visit. Therefore we are unable to make a judgement on whether people were receiving the support they needed to live their lives like any other citizen in line with the principles of Right Support, Right Care, Right Culture. The Responsive section of the report has not been rated.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 October 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made and the provider was no longer in breach of regulation 12. However, further breaches were identified.

The service remains rated requires improvement. This will be the third consecutive inspection that the service has been rated requires improvement.

Why we inspected

We received concerns in relation to staffing and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key question of caring. We therefore did not inspect it. Ratings from previous comprehensive inspections for that key question were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Trelawney House on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, good governance and notifying CQC of significant events. You can read the end of this report for the action we took. This included serving a warning notice.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Trelawney House is a residential care home providing personal care for up to six people with learning disabilities. At the time of our inspection six people were using the service.

The service is a detached two-story building with enclosed gardens. It is located in a very rural area near Helston, Cornwall.

The service supported a small number of people and operated in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who used the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. However, the service’s remote location meant people were unable to access the local community without transport and support from staff.

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

People and staff were not appropriately protected from the risks associated with the Covid-19 pandemic as staff were not using necessary personal protective equipment while supporting people within the service.

The provider had not recognised that current guidance was that all staff should wear face masks while providing support. In addition, information gathered during the inspection indicated that face masks were also not being used in the providers other registered care services. Following feedback at the end of the inspection the provider assured us they would resolve this issue. We were assured that risk assessments would be completed about the use of face masks and after the inspection we were provided with an example of a completed risk assessment. Where people’s individual needs meant staff were unable to use facemasks, alternative infection control measures were introduced and guidance sought from health professionals.

At our previous inspection staffing levels in the service were unsafe. At this inspection we found staffing levels had significantly improved and records showed the service was now staffed safely. Relatives recognised this improvement and told us, “I think staffing levels have come up and I think [The registered manager] is where she wants to be staffing wise now. I have not noticed the low staffing levels recently. They seem to be retaining staff now.” While staff said, “I think it has improved a great deal, the rota is covered. We don’t pull from other houses now, that got stopped with lockdown” and “The team are more stable, staffing issues have declined.”

Actions had also been taken to address and resolve issues identified during our previous inspection where people’s behaviours at night were impacting on others sleep. Noise levels remained an issue at times during the day but the registered manager reported that impacts on people’s wellbeing had reduced.

Medicines were managed safely, and staff understood their role in protecting people from harm.

Accidents and incidents had been investigated and where possible changes made to prevent similar incidents from reoccurring.

Staff had been safely recruited and there were now systems in place to ensure staff training was regularly updated.

People’s care plans had been reviewed and updated since our last inspection and now accurately reflected people’s current support needs.

The staff team knew people well and understood their individual communication preferences and styles.

Internet connectivity issues had been addressed and staff were now able to accurately document details of the care provided and any incident that occurred.

The registered manager had provided consistent and effective leadership to the service. Relatives and staff were confident the changes introduced since the last inspection had impacted positively on people’s wellbeing. They told us, “[The registered manager] has been really determined to pull things together and has made a difference”, “With [the registered manager] at the helm it feels like we are going from strength to strength” and “[The registered manager] is doing brilliantly, when she first came she had a clear idea of what she wanted and how she wanted to go forward, she took the reins and guided us to where we needed to go. Things have improved steadily throughout the house over the last year.”

Quality assurance processes within the service had improved and actions were now taken to address and resolve any issues identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was Requires Improvement. (Report published 14 August 2019)

Why we inspected

We undertook this focused inspection to review the quality of care provided by the service.

We have found evidence that the provider needs to make improvements. Please see the; Safe, and Well led sections of this full report.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to a failure to take necessary measures to prevent the spread of infection within the service and the providers failure to ensure infection control guidance was understood and acted upon.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Trelawney House is a residential care home providing personal care for up to six people with learning disabilities. At the time of our inspection six people were using the service.

The service is a detached two-story building with enclosed gardens. It is located in a very rural area near Helston, Cornwall. This meant people were unable to access the local community without support from staff.

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

Two people were frequently awake in the early hours of the morning and were often noisy. This could adversely impact on others living in the service. People’s sleep was regularly disturbed and this had impacted on their wellbeing. These issues had been identified and reported to commissioners in February 2019 and various changes to people’s routines and medications had been made to attempt to address this situation. These approaches had proved unsuccessful and the service had failed to resolve this situation. We made a safeguarding alert following the inspection as we were concerned about the impact these behaviours were having on other people living in the service.

On arrival on the first day of our inspection the service was short staffed and records showed this occurred regularly. This impacted on both people’s ability to access the community and increased the risk of incidents occurring within the service. Staff comments included, “[Person’s name] is two to one, most evenings you are lone working. You end up getting more injured” and “People get bored as they can’t go out. It caused a vicious circle as behaviours escalate.”

Medicines were managed safely, and necessary staff pre-employment checks had been completed. The service was clean and risks had been appropriately assessed.

New staff received appropriate induction training. However, training for established staff was not regularly updated to ensure they had the skills necessary to meet people’s needs. The service was well maintained and people were supported to participate in the planning and preparation of meals.

People were supported to have 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.

Staff were caring and responded promptly to people’s needs. People were valued as individuals and their choices were respected.

People’s care plan’s had not been regularly updated and did not accurately reflect their current care and support needs.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support as low staffing levels meant people were unable to access the community when they wished.

Staff were able to communicate effectively with people using a variety of personalised techniques. Complaints received had been appropriately investigated.

The service used digital systems to record details of the care and support each day and any incident records. There was only one computer available to access this information on the day of our inspection and it was unreliable. This meant it was difficult for staff to input information into the system and for the manager to review completed records of incidents that had occurred.

The provider’ quality assurance processes were ineffective and had failed to ensure compliance with the requirements of the regulations.

The service had experienced significant management changes since our last inspection. A new manager had been recently appointed and was in the process of applying to become the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good. (Report published 15 August 2017 )

Why we inspected

The inspection was prompted in part due to concerns received in relation to staffing levels and the quality of support people were receiving. A decision was made to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the; Safe, Effective, Responsive and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Trelawney House provides care and accommodation for up to six people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. At the time of the inspection six people were living at the service. The service was based in a large detached building set within its own gardens in a rural location. One person lived in a self-contained flat while the remaining five people shared a communal kitchen, two lounge areas, enclosed gardens and a bathroom. Each person’s room had en-suite toilet and shower facilities.

The service is required to have a registered manager and there was a registered manager in post at the time of this inspection.

Not everybody who lived at the service was able to communicate verbally however when asked everyone living at the service indicated that they were happy and cared for. Comments received from people and their relatives included, “I can have a joke with [the staff]” and “I am happy here. It is a nice place to live”. One Person’s relative told us, “The thing that comforts me the most is, I won’t be around for ever and I am confident they will look after [My relative]”.

Staff understood their role in protecting people from abuse and people told us they felt safe and would raise any concerns with the registered manager. Comments included; “I am safe. I would tell the [Registered manager] straight away if I was worried.” The service’s recruitment practices were robust and designed to ensure people’s safety.

There were appropriate systems in place to manage risks both within the service and the local community. The service supported and encouraged people to become more independent and recognised that this included some degree of risk taking. Staff were provided with detailed guidance on how to ensure people were safe and all incidents and accidents had been investigated.

The service was staffed safely. Staffing levels had been recently increased when a new person moved into the service. Our analysis of staff rota’s found that although there were two staff vacancies this had not impacted on the level of support people received. Staff told us, “The staffing is good here. Staffing is really good” and “usually a good staff rate here”.

People were supported to live varied and active lives. On the day of our inspection everybody left the service at some point during the day to engage in activities within the local community. This included attending a work placement, going for rural walks, shopping and attending a day centre. Staff said, “It’s a young adults house and it is very active. People go out all the time” and “I went to the pub with [Person’s name] last night”.

All new staff had received two weeks of formal induction training in accordance with the requirements of the care certificate. In addition, there were systems in place to ensure the training of existing staff was regularly updated. Staff told us, “The training is very good, they are really hot on it to be fair” and “All my training is up to date”.

Staff understood the requirements of the Mental Capacity Act 2005 and where people’s care plans were potentially restrictive necessary applications had been made to the local authority for their authorisation.

Care plans included details of people’s preferred methods of communication and guidance for staff on how to support people to make decision and choices. We observed that staff were able to communicate effectively with everyone and saw that staff provided support in accordance with people’s recorded preferences.

People’s care plans were detailed and provided staff with clear guidance on both how to meet people’s needs and their preference in relation to how support was provided. Where appropriate people’s relative’s had been involved in the care plan review process and accessible versions of care planning documents were available to support people to participate in these reviews.

Staff were well supported by the registered manager and there was a clear management structure within the home. Although the Registered manager was not present of the day of our inspection staff were able to locate all information required. All staff had received regular supervision and team meetings had been held to discuss any significant changes planned within the service.

Staff raised with us concerns in relation to recent changes that had resulted in increases in their workload. They reported that this had led them to become fatigued. We discussed these concerns with the registered manager who was able to provide details of the action they had already taken and intended to take to address and resolve this staff concern.

We spoke with the registered manager and two members of staff. They told us how they supported people to make decisions on a day to day basis.

We examined peoples care files and found they were detailed and well laid out.

We saw people had a choice of suitable and nutritious food.

Spectrum operated an effective recruitment procedure.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care and knocked and waited for permission before entering their bedrooms.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. The records showed that they went out frequently and saw healthcare professionals when they needed them.

Staff said they had received sufficient training and support to enable them to carry out their roles competently and felt there was sufficient staff on duty.

Systems for safeguarding people from abuse were in place. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights