21 September 2017
During a routine inspection
We carried out this inspection on 21 September 2017. At the last inspection, in October 2015, the service was rated Good. At this inspection we found the service remained Good.
People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. Comments from people included, “I am very happy living here”, “Staff make me feel safe”, “Everyone is safe living at the home. We trust staff implicitly” and “I am very happy that he lives at Tresillian. They are brilliant.”
We spent most of the inspection in the communal lounge observing and talking with people. The atmosphere in the service was calm and relaxed and people happily chatted to us as they went about their day. People's independence and wellbeing was promoted because staff had developed positive and meaningful relationships with people. There was plenty of friendly and respectful interactions between people and with staff. Staff interacted with people in an unhurried way and supported people at a time and pace convenient for them.
People were encouraged and felt confident to make decisions about their daily lives. Routines were led by the people living at the service. It was clear the service was run for and by the people who lived there. The culture in the service was one where there were no unnecessary rules or routines, put in place to suit staff, rather than the people that used the service.
Risks in relation to people’s care and support were identified and when systems were put in place to manage any risks these were agreed with people. People were encouraged to be as independent as possible and because of this people managed their own risks with minimal intervention from staff. A relative told us, “They encourage people to do things for themselves while still keeping them safe.”
People were able to take part in activities of their choice and staff supported people to develop goals and aspirations about how they wished to live their life. Each person decided what activities they wanted to pursue and this included setting monthly goals. People had individual activities that they took part in every week and there were other days where everyone decided together where they would all like to go out. The service arranged regular holidays for either the whole group or a smaller group depending on the type of holidays people wanted to go on. During our inspection people spoke at length about the holidays and leisure pursuits that they had taken part in, including a recent holiday to Exmoor.
Care plans were well organised and contained personalised information about the individual person’s needs and wishes. These had been developed with people and were reviewed regularly with the individual person’s involvement. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.
People had access to healthcare services to help them maintain good health. They saw their GP and attended other necessary appointments such as the hospital visits, dentists and opticians when they needed to. Staff supported people to access annual health screening checks to maintain their health. Specialist services such as occupational therapists and dieticians were used when required.
Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.
Staff supported people with their food choices to help them maintain a balanced diet. People were involved in meal planning and this was done in a way which combined healthy eating with the choices people made about their food. Where people had specific dietary needs staff supported them to plan meals that met those needs.
There were sufficient numbers of suitably qualified staff on duty. Shift times and rotas were flexible to fit in with the activities people wanted to take part in. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.
Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to apply the principles of the MCA in the way they cared for people.
People and staff worked together as a whole team with staff and people equally contributing to the culture of the service. Staff had a positive attitude and told us the registered manager provided strong leadership. There was a stable staff team where most staff had worked at the service for many years. Comments from staff included, “I love my job”, “We are all open with each other and share ideas”, “Communication is good” and “It’s not like coming to work, we are all good friends.”
People and their families were given information about how to complain. People and relatives all described the management of the home as open and approachable. Relatives told us, “My admiration goes out to [registered manager] and the staff they do such as good job” and “Never come across an establishment like it, truly amazing.”
There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered manager worked as part of the staff team and this enabled them to observe staff practice and check if people were happy and safe living at Tresillian. People were involved in all aspects of the running of the service and were clearly comfortable in sharing their views with the owners.