Trevaylor Manor

Trevaylor Manor is a residential care home providing personal and nursing care to up to 81people. The service provides support to older people and people living with dementia. At the time of our inspection there were 59 people using the service.

Trevaylor Manor is part of the Swallowcourt Limited group of services.

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

We toured the premises and found a few doors marked ‘fire door keep shut’ which were propped open. Doors to staircases and to rooms containing items which could be of risk to people were not always secured. We have made a recommendation about this in the safe section of this report.

The provider had effective safeguarding systems in place and staff knew what actions to take to help ensure people were protected from harm or abuse.

People received their prescribed medicines in a safe way. An electronic medicines management system was being used. Regular medicine audits were taking place to identify any areas for improvement.

There were enough staff to meet people's needs and ensure their safety. However, staff told us of short notice staff absences which had led to pressure on staffing, especially at weekends. Some agency staff were being used. However, these were mostly consistent and knew people well.

Many staff members had worked at Trevaylor Manor for years. One staff member told us, “We would not stay if we were not happy. It is a good place to work.”

The service had some vacant posts at this time. Recruitment of new staff was in progress. Processes in place helped ensure safe recruitment.

People were supported to have maximum 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 worked within the principles of the Mental Capacity Act (MCA) and sought people's consent before providing personal care and assistance. Guidance in care plans guided staff to help build independence wherever possible.

Identified risks were assessed and monitored. Care plans contained guidance and direction for staff on how to meet people’s needs.

Food looked appetising and there were staff available to support people where needed. Specific staff were allocated to people who required additional nutritional support. People, relatives and staff told us they enjoyed the food.

Relatives told us, “Since (Person’s name) came here they are so much better, almost like the dementia has decreased. They have confident staff that know how to handle (Person’s name),” “There are always staff around to talk to if you need to. They have worked hard to get (Person’s name) to eat, they are fussy and reluctant to eat,” “My standards are high, and I am happy. I am completely listened to, they communicate well” and “We are always told if anything happens or any changes in their health.”

The registered manager and the provider had effective oversight of the service. There was a robust audit programme in place to help identify any areas of the service that may require improvement.

A visiting healthcare professional told us, "I could not be more supportive of Trevaylor Manor as everything is so much better now than a few years ago. They are quick to ring me and follow any advice I give."

Staff and relatives were asked for their views and experiences at meetings held by the registered manager. Feedback about the registered manager was positive. Relatives were kept informed of any changes in people’s needs or incidents that occurred.

The registered manager understood their responsibilities under the duty of candour.

The registered manager and staff worked closely with local health and social care professionals to meet people’s needs.

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

Rating at last inspection was good (published 12 June 2021). At this inspection the rating remains good.

Why we inspected

This inspection was prompted by concerns received by CQC about this service. Concerns were regarding staff shortages, lack of equipment, poor mealtime support and medicine errors.

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.

Recommendations

We have made a recommendation in relation to fire door checks and securing rooms containing items that could pose a risk to people.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The accommodation is arranged over three floors. People living on the upper two floors were likely to have higher physical needs. There was a downstairs unit, used for people living with more advanced dementia. In addition, there was a separate building within the grounds, known as the Coach House. The Coach House was part of the dementia unit and accommodated up to eight people who required a safe environment but were more physically independent.

People’s experience of using this service:

People, relatives and staff all told us improvements had been made to the running of the service. Effective systems were in place to monitor the quality of the service provided and improvements had been made to records relating to people’s care.

Under the Mental Capacity Act 2005, people can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA, called Deprivation of Liberty Safeguards (DoLS). The service had made DoLS applications appropriately and where there were conditions attached to authorisations these were being met.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. People had access to secure garden areas and we observed staff supporting people to walk around the garden, prompting them to look at the flowers and plants. People and their relatives told us they were happy with the care they received and believed it was a safe environment.

There was a stable team of staff who had the skills and knowledge to meet people’s needs. Staff received regular supervision, training and support from management. Staff spoke passionately about the people they supported and were clearly committed to providing a person-centred service in line with people’s wishes.

Care plans were up to date and reflected people’s current needs. Any risks were clearly identified and effectively managed. Medicines were administered safely.

Staff supported people to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through effective shift handovers.

Recruitment procedures were robust and staff understood their role in protecting people from abuse.

People, their relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service. People and their families were given information about how to complain and details of the complaints procedure was displayed at the service.

Rating at last inspection: Requires Improvement (report published on 17 May 2018). The service had been rated as Inadequate at the previous inspection in October 2017.

Why we inspected: This was a planned inspection based on the rating at the last inspection to check if the required improvements had been made. We also checked if the positive conditions applied to the provider’s registration were met. Positive conditions were applied at a previous inspection in October 2017 and remained in place after the inspection in April 2018. At this inspection the service had embedded changes sufficiently to improve the overall rating to Good and the conditions were met.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The full details can be found on our website at www.cqc.org.uk

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the service. We carried out this inspection to check they were complying with their action plan and monthly reports.

Trevaylor Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 is part of the Swallowcourt group and is a registered nursing home for 81 older people. At the time of the inspection, 62 people were living at the service, some of whom were living with dementia.

The accommodation at Trevaylor Manor is arranged over three floors. People living on the upper two floors were likely to have higher physical needs. There was a downstairs unit, used for people living with more advanced dementia. In addition, there was a separate building within the grounds, known as the Coach House. The Coach House was part of the dementia unit and accommodated up to eight people who required a safe environment, but were more physically independent.

Trevaylor Manor is required to have a registered manager and there was one in post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and will no longer be rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection we found that, while there were systems in place to monitor the quality of the service provided, these systems had failed to identify the concerns found at that inspection. At this inspection improvements had been made to the auditing systems and this meant the monitoring processes were more effective in identifying where action needed to be taken. We found improvements had been made in relation to the safety of the environment, infection control, the management of medicines, risk management, people’s privacy and dignity and the use of inappropriate restraint and control. The service was submitting notifications of significant events to CQC as is required by law. This meant the service had met four of the six outstanding requirements from the last inspection.

We had concerns in respect of how the service was meeting the requirements of the legislation as laid out in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Some people had DoLS authorisations in place which had conditions attached to them. These conditions were not consistently met meaning people were being potentially deprived of their liberty without proper legal authority.

We found monitoring records to document people’s health and the care and treatment they had received were not consistently completed in all areas. This meant, if people’s health deteriorated staff might not be aware of the increased risk to their well-being.

During the inspection we observed staff were caring and friendly in their approach to people. There was a busy and sociable atmosphere throughout the service. People were supported to take part in activities and these were in line with their interests. Staff were quick to respond to any requests for assistance. Some people became anxious at times and staff reassured them, staying with people until they became settled. Some people were cared for in bed or chose to stay in their rooms for long periods. We observed staff regularly checking on these people to ensure their comfort and safety. There were enough staff to meet people’s needs and staff were effectively deployed throughout the building.

People and relatives were positive about the care and support provided at Trevaylor Manor. Comments included; “They do look after you well, they are all good, very good” and “If there’s anything you need or want, you only have to ask. I go to bed and get up again when I want, but a carer comes in to check to make sure I’m ok.” We heard one person talking to a member of staff. They asked; “How did I get here?” The member of staff said; “I think your daughter found the home for you.” The person answered; “She did well then!”

Improvements had been made to the premises which meant people living with dementia were more able to find their way around the building independently. More improvements and decoration was planned for the near future. People had access to outside areas and we observed many taking advantage of this.

Systems for the management of medicines were robust. People received their medicines on time and had access to additional pain relief if needed. Some people had their medicines administered covertly. This was done in line with the relevant legislation.

People’s care records had been updated and were reviewed regularly. As well as guidance about health needs they contained information about people’s backgrounds and personal histories. This meant staff were able to engage meaningfully with people about subjects that mattered to, or were of interest to them.

The service had worked with external health care professionals to introduce a new system to quickly identify when a person’s health was deteriorating. This was in response to an incident when one person’s health needs were not met in a timely manner.

Staff received a comprehensive induction and regular refresher training. Supervisions were taking place and a new system of yearly appraisals was being introduced. Morale was positive and staff told us they enjoyed their work.

We found two repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report. The condition of registration imposed after the last inspection remains and we have asked the provider to continue to send monthly reports to the Care Quality Commission. We have asked the provider to include actions taken to make the necessary improvements, to address both breaches, in their monthly reports.

Trevaylor Manor is part of the Swallowcourt group and is a registered nursing home for 81 older people. At the time of the inspection, 73 people were living at the service, some of whom were living with dementia. Trevaylor Manor comprises a main building arranged over three floors. People living on the upper two floors were likely to have higher physical needs. There was a downstairs unit, used for people living with more advanced dementia. In addition, there was a separate building within the grounds, known as the Coach House. The Coach House was part of the dementia unit and accommodated up to eight people who required a safe environment, but were more physically independent.

Trevaylor Manor is required to have a registered manager and there was one in post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Trevaylor Manor was last inspected in January 2016 and rated as ‘Good’ overall. However, the service was rated as ‘Requires Improvement’ under the caring domain. During that inspection, we found that slings and continence products were communally used and interactions between people and staff were largely task based. At this inspection, we found that slings and continence products continued to be communally used. We continued to observe task based interactions between people and staff.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made 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 to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. 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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People were not always treated with dignity and respect. Some people were ignored by staff for long periods of time. Staff did not always try to establish why people were calling out, for example if they were in pain, distressed or wanted to move. Some people were left alone for long periods of time, for example in quiet areas which they could not move away from independently People’s privacy and confidentiality was not always protected. Confidential information was left on display. People were not always able to alert staff when they needed help. Some people did not have access to call bells.

People were not always kept safe within their environment. Potentially hazardous items were not securely stored. The sluice room was not lockable and was situated in a corridor where people were independently mobile. We saw a heavy sash window propped open with a cup. This could have caused serious injury if the cup had been moved. This was reported to staff and removed. We saw unnamed items left in bathrooms such as toiletries, continence products and slings. This placed people at risk from cross infection. People were moved using unsafe moving and handling practices.

Areas of the service were not dementia friendly. There was little to distinguish one area of the home from another. This is important for people living with dementia who might not be able to orientate themselves. Seating arrangements were not consistent for people living with dementia. People sat in a circle in armchairs situated around the edge of the rooms. One person's bedroom was sparse and not homely. Action was taken by the service following our visit to address this.

People’s health needs were not always effectively monitored. Food and fluid charts were inconsistently completed and did not specify people’s target amount. There was no guidance for staff on managing some health concerns, Some people living at the service were at risk from choking. There had been a death at the service following a choking episode, which had in part prompted this inspection. There was no choking protocol or policy in place and people’s care plans and risk assessments around choking were basic.

People’s medicines were not always managed safely. The medicines room air temperature regularly exceeded 25 degrees Centigrade, meaning the efficacy of the medicines may have been compromised. There was no stock of homely remedies such as paracetamol, meaning people may have had to wait too long for effective pain relief. There were minimal audits of medicines and staff were unclear of what action to take in the event of a medication error.

People’s rights were not always protected as the principles of the Mental Capacity Act (MCA) were not followed. Mental capacity assessments were generic and required updating. Deprivation of Liberty Safeguards (DoLS) paperwork was out of date and there was no system for informing the Supervisory Body if restrictions in people’s care plans changed. People’s consent was not routinely sought. Family members had given consent to elements of people’s care and treatment without the correct legal authority to do so.

People had care records in place. Whilst some were detailed and comprehensive, others were not accurate. Some care records contained insufficient guidance for staff on meeting people’s needs. Information in people’s records did not match what staff told us about them. Some people had life story books in their records which contained details about their background, history, likes and dislikes, whilst other people’s life story books had been left blank.

People had access to activities at the service but these were not always personalised. People had personal activity plans in place which detailed their hobbies and interests, but the activities they were offered did not often reflect this. One person’s file indicated that they enjoyed fishing, but there was no evidence to suggest staff had tried to help them maintain this hobby, either by actual participation in it, or for example subscribing to a magazine about it.

There were systems in place to monitor the quality of the service at Trevaylor Manor, however these systems had failed to identify or to or address in a timely way, many of the areas of concern identified at the inspection. There were minimal opportunities for people and relatives to provide feedback on the service. There were no residents’ meetings or relatives’ meetings and there had not been a recent quality assurance survey.

People were supported by staff who had received an induction. Staff who were new to care undertook the Care Certificate, a nationally recognised set of standards for staff working in the health and social care sector. Staff received training in subjects identified by the provider as mandatory and there was a system to remind them when it was due to be renewed or refreshed. Staff told us that they did not receive regular supervision or appraisals and did not always feel supported by management. Morale amongst staff was generally low.

Staffing levels on the day of the inspection were suitable. There had been a successful recruitment drive and there were few vacancies. Staff however told us they felt pressured and short staffed. During the inspection we saw that there were sufficient staff on duty, however they did not always interact with people.

People using the service told us they felt safe. People were supported by staff who received training in safeguarding adults and who knew how to make a safeguarding alert. People were supported by staff who had been safely recruited and had undergone all of the required checks to ensure they were safe to work with people who were vulnerable.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Trevaylor Manor is part of the Swallowcourt group and is a registered nursing home for up to 81 older people. At the time of the inspection 74 people were living at the home some of whom were living with dementia. Trevaylor Manor is required to have a registered manager and there was one in post. 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.

Trevaylor Manor was last inspected in July 2014, there were no concerns at that time. Since that inspection the service had grown and another building, previously registered as a separate service had been become part of the care home. This building, known as The Coach House, and the lower floor of the main building were used to accommodate people who required a secure environment. People in The Coach House had the opportunity to participate in day to day activities independently, for example there were tea and coffee making facilities. These areas were run by a unit manager and staffed separately. The Coach House was completely self-contained with its own kitchen and laundry facilities. It was a light and airy building with a high standard of décor, friendly and open staff and people appeared happy and well cared for.

The registered manager had oversight of the rest of the service which comprised of the middle and upper floors. People in this part of the service were more likely to have higher physical needs and need support to move around. This was done safely and staff used the appropriate equipment when necessary. However, we saw some incidences where staff did not communicate with people while supporting them to move. The interactions we observed throughout the day were largely task based apart from during an organised activity session and the lunch time period.

The registered manager was supported by a deputy manager and the unit manager. Nursing staff were supported by trained specialist health care assistants who helped with the administration of medicines. There was also a keyworker system in place. Keyworkers are members of staff with responsibility for managing and arranging care for a named individual. There were sufficient numbers of staff to meet people’s needs.

People and relatives told us they considered Trevaylor Manor to be a safe environment and that staff were skilled and competent. The premises were in a good state of repair, clean and odour free. There was signage around the building to support people to move around independently. Systems in place for the ordering, administrating and storage of medicines were robust.

Pre-employment checks such as disclosure and barring system (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people’s needs. Additional training was being organised for supporting people whose health needs might lead to them behaving in ways which could be difficult for staff to manage.

People were supported and encouraged to take part in a wide range of activities organised in the service. There were three full time activity co-ordinators employed who had responsibility for organising activities both within the service and outside. People were supported to maintain personal important relationships. If people did not have any family or close friends efforts were made to identify an advocate to represent their views if required.

Systems were in place to monitor people’s health and well-being regularly and effectively. When there were changes in people’s health this was quickly identified and action taken to address the issue. Staff were confident the systems in place to keep them up to date with people’s changing needs were effective.

There were systems in place to assess and monitor the quality of the service. These included regular audits of all aspects of the service, care reviews and staff meetings. Swallowcourt were working to make links with the local communities.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was safe.

People were treated with dignity and respect by the staff. During our inspection we observed about 30 of the 67 people living in the home and we spoke with one visiting relative. Everyone we spoke with told us they felt safe. One person told us 'I like living here and my room is nice'. A relative told us 'All the staff are 100%, and accidents are dealt with immediately. If I had any complaints about my wife's care they would be dealt with immediately'.

People were safe because staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm.

We saw Trevaylor Manor understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people's needs. We were told the service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

Is the service effective?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with one visitor and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was caring.

Some of the comments received from people who lived at Trevaylor Manor included 'The staff are patient and caring, they have been very kind to me' and 'It is as good as it can get, but you can't please everyone all the time'. We observed staff responded to people in a kind and sensitive manner.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people's families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people's wishes.

Is the service responsive?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was responsive.

In the dining room during lunch we observed about 30 of the 67 people who lived at Trevaylor manor and nine care staff. The carers were attentive. For example, aids were brought for several people and staff were helping people with their meals, some gave one to one care when a person had difficulties eating.

Two people did not want the pudding so were offered tea and biscuits. A selection of biscuits and tea was quickly brought for people.

People were able to take part in a range of group and individual activities such as card games, listening to music, outings in the local community and craft work.

Best interest meetings had been held to ensure the care and support provided was still meeting the needs of the person.

People who used the service and their representatives were asked for their views about their care and treatment.

Is the service well-led?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was well-led.

We were able to talk with eight members of staff and, apart from one who had only been at the home for eight months the other members of staff had been at the home for some time, one 10 years and one for 23 years. They were all positive in their attitude on how the home was organised and run and we were told by several carers that it was the best run home they had experienced.

During our inspection, we found people's privacy; dignity and independence were largely respected.

We saw people were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw people assisted by staff and equipment being used properly, for example, wheelchairs with footrests in place.

We saw care plans were in place to direct staff as to the care and support people needed. People's records were personalised and provided clear information about the person's wishes and abilities.

Trevaylor Manor adhered to robust recruitment practices in order to protect people.

People had confidence they could express any concerns they may have, although records of complaints made were not kept.

Records were in place to demonstrate the safety and management of the service, and these were stored securely.

During our inspection, we found people's privacy, dignity and independence were respected. People's views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us that training was provided, and also confirmed that staff supervision took place.

Care plans and associated documentation did not provide sufficient detail, and did not always direct and guide staff of the action they needed to take in order to meet people's assessed care needs. People's records were personalised and provided clear information about the person's wishes and abilities.