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Inspection carried out on 7 June 2017

During a routine inspection

The inspection took place on 7 and 8 June 2017. It was unannounced. At Treloar College’s last inspection we rated it Good.

The college is a residential further education college specialising in support for students with a physical or other disability. Some students had extremely complex needs arising from their disability. Our inspection looked at the residential accommodation, healthcare provision and the care and support for students outside their educational curriculum.

At the time of this inspection there were 89 students accommodated in four residential houses. There were also 18 day students. Most students were in residence during term time, but a small number stayed in one of the residential houses all year. Each residential house had a registered manager.

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.

There were exceptional arrangements in place to manage risks to students’ safety and wellbeing. Risk management was focused on overcoming obstacles and reducing restrictions on students’ activities. Students’ abilities were enhanced, their independence was promoted, and they were supported to participate in activities safely.

Students were supported by sufficient numbers of suitable staff. Appropriate checks were made before staff started to work to make sure they were suitable to work in a care setting.

Students received their medicines as prescribed. Medicines were stored and administered safely. There were arrangements in place for student who wished to be responsible for their own medicines.

Where students had swallowing difficulties, the college had put in place exceptional arrangements to support them with appetising food which was safe for them to eat and allowed them to feel included. Students were supported to eat a healthy diet with a variety of cafeteria and self-catering options which were adapted to their physical needs.

Students were supported by staff who benefited from a comprehensive training and support programme. Where necessary staff received training relevant to a student’s individual needs and conditions, and specialist equipment used to support the student.

Care and support were provided only with students’ agreement and consent. Staff were aware of the legal requirements in force where people lacked capacity to consent.

Multi-disciplinary teams were in place to support students with their healthcare needs. There was an integrated healthcare centre with dedicated nurses and part-time GP.

There were in-house technicians who adapted and customised assistive technology to enable students more easily to express their views, take part in decisions about their care and be as independent as possible.

There was an outstanding focus on equality, diversity and inclusion. Care and support took into account students’ cultural and religious background and their lifestyle choices. The college was accredited as a “Leader in Diversity” by the National Centre for Diversity.

All staff we spoke with put students at the centre of everything they did. We saw examples of excellent relationships between students and staff.

There were exceptionally thorough arrangements to assess students’ needs before they joined the college, during their stay and to prepare them to move on to the next stage in their lives.

Care and support while they were at the college were based on thorough and detailed care plans which were reviewed regularly and kept up to date with their changing needs.

There was a positive, open and empowering culture shared by staff and students. Care and support were dedicated to helping students achieve their goals and ambitions.

Management and quality assurance systems were in place to drive continuous im

Inspection carried out on 8 December 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 26 and 30 September and 7 October 2014 when the service was rated as ‘good ‘overall. After that inspection in December 2016 we received some information of concern in relation to students receiving their medicines via an enteral feeding tube. As a result we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Treloar College on our website at www.cqc.org.uk. Our findings at this inspection have not changed the current rating of 'good' for the key question of Safe or the rating of 'good' this service overall.

This inspection took place on 8 December 2016 and was unannounced. Treloar College is a residential further education college for up to 115 students with physical and, or learning disabilities aged between 16 and 25. Students stayed in houses and flats on the campus. CQC is responsible for inspecting and regulating the residential accommodation of the college as well as inspecting the health care provision at the health centre. At the time of this inspection 110 students were accommodated at the college.

The service had three registered managers 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.

Enteral feeding refers to the delivery of a prepared feed via a tube directly into the person’s stomach or small intestine. This method supports students who cannot maintain adequate nutrition from an oral intake of food or who cannot eat and drink safely. The enteral device may also be used for the administration of medicines. Some of the students living at Treloar College had enteral feeding devices that were used some of the time or all of the time. For example some students had a combined diet of oral and enteral food. Some students also received their medicines via their enteral device.

Students were supported by an onsite team of healthcare professionals that included; nurses, a nutritional support team, dieticians, occupational therapists, physiotherapist and speech and language therapists (SLT). GP’s from a local surgery delivered on site surgeries for students who may choose to register with this practice or remain with their own GP’s. We found that the staff and healthcare professionals involved in students’ care and treatment worked effectively together to provide safe and person centred support.

Each student had individual and specific guidance available to staff in their care plans and medication administration records. These detailed their needs in relation to enteral feeding and medicine administration. Staff confirmed they checked this guidance on every administration. Students’ needs were regularly reviewed and guidance was updated as required.

Staff were knowledgeable about the risks associated with enteral feeding. They had completed training and competency checks by clinical staff to ensure they could support students safely. Specific enteral medicines administration training was undertaken by staff supporting students with medicines and medicines via an enteral route. The provider aimed to complete competency checks of all staff administering medicines and enteral feeding annually we found some staff competency checks required updating.

The service had a robust system in place to monitor and address errors in enteral feeding and medicines. Staff were encouraged to report any near miss, error or serious incident to encourage improvements in practice and keep students safe. Records showed incidents and errors were addressed and improvements were made following analysi

Inspection carried out on 26,30 September and 7 October 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. We last inspected the college in February 2014 and at that time we identified one breach in legal requirements which related to the management of medicines. This has now been addressed.

Treloar Trust is both a registered charity and a limited company. Treloar school and Treloar college are part of the Treloar Trust. Treloar School and the educational side of Treloar College is inspected by Ofsted. CQC inspects: Accommodation and nursing or personal care in the further education sector; Treatment of disease disorder or injury; Diagnostic and screening procedures and personal care. This means CQC is responsible for inspecting and regulating the residential accommodation of the college as well as inspecting the health care provision at the health centre. Treloar College is registered to provide treatment care and accommodation for up to 163 students aged between 16 and 25. At the time of this inspection three houses accommodated a total of 61 students. These were Wessex House , Brewer House and Gauvain House. The health centre could, where necessary accommodate up to four students or children from the Treloar school in the event that they became unwell.

The service had four registered managers 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 and associated Regulations about how the service is run.

Students living at Treloar College had a broad range of needs. We spoke with students who had complex medical conditions and who needed intensive staff support as well as students who were more independent and who needed encouragement or prompting from the staff. We spoke with students who were new to the college and to students who had been at the college for some time. This helped us to form a view of what college life was like for all.

All students said they would recommend the college to others. One student said “I really like Treloar. If there is one thing I could change it would be to make it a forever place or stay as long as I can because it is one of the best places in the country for disabled people.” Students told us about a good staff team who were kind, professional and who built up their confidence. Several described how they had been supported to become more independent. They liked the fact they were not treated differently and said they enjoyed their social life.

Staff spoke very enthusiastically about their roles and clearly described the aims and objectives of the service. They all said they would recommend the college as a good place to study and live. Staff received a good range of training and were well supported by managers. There were enough staff employed to ensure students received effective and safe support. There was a range of staff employed and they worked closely together to assess, plan, and deliver the care, treatment and support to students. Therapy staff included speech and language therapists, dieticians, physiotherapists and councillors. This meant students had prompt access to specialist support and any aids and adaptations they required. Therapists and nurses also provided specialist training to support staff to ensure care provided was effective and safe.

Students felt safe and said there was no bullying at the college. The risk of abuse was reduced because they knew how to report any concerns and were encouraged to do this. Staff were trained to recognise the signs of abuse.

Staff understood the principles of The Mental Capacity Act 2005 and the Deprivation of liberty Safeguards. This helped to protect student’s legal rights.

Students said the college met their care treatment and support needs and they felt involved in the planning and delivery of this. There was detailed written guidance in the form of a ‘Young Persons Plan’ (YPP) for each student. These were updated regularly in consultation with the student concerned to ensure they were accurate. The detailed information within the YPPs helped to ensure staff provided effective and consistent support . This helped to ensure students’ medical care and nutritional needs were met.

The college had detailed transition arrangements in place which helped to ensure they could meet the needs of prospective students and monitor how effective they had been in helping students as they moved on from the college. There were a number of different educational, social and work experiences available to students whilst they were at college and students told us they valued and enjoyed these opportunities.

The culture of the college was open warm and inclusive. Students were at the heart of the service and were encouraged to take part and contribute towards all aspects of the running of the service. Staff took part in research and national interest groups which related to their specialism and used this information to enhance the care and treatment of students at Treloar. There were clearly defined and robust quality assurance and clinical governance arrangements in place which meant the service was continually striving to improve. An example of this was the redesign of some of the residential accommodation to increase student’s opportunities to develop their independence.

Inspection carried out on 3, 10 February 2014

During a routine inspection

At the time of our visits there were 65 students attending college who lived in Wessex, Brewer and Gauvain houses. We talked with students and staff and spent time in each of the houses observing care and looking at care records. We also spent time in the health centre. We looked at policies and procedures particularly those relating to safeguarding and staffing.

We spoke with 14 students.They said they were happy with the service. They felt involved in how their care was planned and liked the way in which the college was helping them to prepare for the future. They understood what to do if they were unhappy about any aspects of their care or treatment. They felt safe at Treloar and described the staff as "respectful," "funny," "joyful", and said they made them feel "comfortable and confident".

Staff demonstrated a strong commitment to providing a good service, one said "we put students first in everything we do." These sentiments were echoed by all staff we spoke with.

We found that health and care staff worked effectively together to ensure that all aspects of students needs were met. Each student had an assessment of their needs and plans of care were detailed and up to date. The service responded quickly when student safety or wellbeing was compromised. There were sufficient skilled and experienced staff to meet students collective needs. Some improvements were needed in the management of medicines, particularly how some medicines were stored and how checks were made to ensure that they had not passed their expiry date.

Inspection carried out on 5, 7 February 2013

During a routine inspection

Students we spoke with were very positive about the college. One student said, �Coming to Treloar was a life changing decision for me. I feel happy and contented here. My confidence is now much better in dealing with life and the staff are the people that have made it happen�. Another said "It caters for a wide range of students and I feel very lucky to be here. It's changed my life" Students in the flats described how they had been helped to improve their independent living skills.

Staff were well trained and supported and they were positive about their role. One said "We all work together to help students achieve"

We found that students privacy and dignity was respected and that students were encouraged to express their opinions. Staff had a good understanding of students health and care needs and these had been accurately recorded. Students felt safe and there were robust processes in place to ensure that their wellbeing was protected.

Good systems were in place to ensure that standards of quality and safety were monitored effectively. There was evidence that a number of improvements had taken place since our last inspection, for example student admission procedures had been enhanced and a number of policies and procedures had been reviewed and updated.

Inspection carried out on 14 January 2012

During an inspection looking at part of the service

The students were very positive about the care and support they receive at college. The students told us, that staff were very good at explaining the care to them and asked their opinions about their care.

Inspection carried out on 13, 30 September 2011

During an inspection looking at part of the service

All the students we spoke with, whether new or returning students, enjoyed being at college. They told us they had the support they needed and they liked the staff and the environment.

The staff told us there had been many improvements over the summer. These included the introduction of the �young person�s plans�, although one manager said these were still being worked on to improve the information they held. The improvements also included the way staff communicated between different areas of the college to keep up to date with the needs of the students and the way safeguarding was managed.

Most of the relatives we spoke with were happy with the service their family member received and the way they could communicate with the staff. However, two relatives were very dissatisfied with the service their family members had received and both these instances were being investigated by the Local Authority.

Inspection carried out on 13, 30 September 2011

During an inspection looking at part of the service

This review is a follow up to the review carried out on the 13, 29 and 30 September 2011. This review only concerns outcomes 8.10.12 and 13 the other outcomes we reviewed are avaiable in the report dated january 24 2012.

This review did not include an additional visit to the college as the evidence was gathered during the September 2011 visits.

Inspection carried out on 11 May 2011

During an inspection in response to concerns

We visited this service on the 11 May 2011, and then carried out further visits on the 15 and 16 June 2011 and the 4 July 2011.

The students we spoke with told us they liked being at the College and they could speak to the staff at any time if they had any concerns. Students said they generally got the care they needed, although some said the staff ,did not always remind them or support them with all aspects of their care.

Two students said the staff were rushed sometimes and could not always spend enough time on their care.

Students said they felt safe at College and they knew who to speak to if they did not feel safe.

The students told us about the activities they enjoyed and the opportunities they had for socialising and seeing their families.

The staff said there were enough people on duty to meet the students� needs and they had the training and support they needed for their roles.

A relative told us they were concerned about several aspects of the care including the number of staff available to carry out care, the standard of care and how this had led to their family member suffering harm and how the staff care for their family member�s clothes. This relative also told us they have made a complaint to the College about the care of their relative.

The local authority told us that there was a lack of communication between different staff at the College which has led to students not receiving the care they need, and a lack of accurate records and risk assessments that reflect the students� needs.

Reports under our old system of regulation (including those from before CQC was created)