We carried out a review of the data available to us about HF Trust - Trelawney on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about HF Trust - Trelawney, you can give feedback on this service.
About the service
HF Trust - Trelawney is a residential care home for up to 6 autistic people or people who have a learning disability. At the time of the inspection 6 people were living at the service. Accommodation was spread over 2 floors. There was a shared dining room/conservatory, living room and kitchen. A small bedroom was used to store medicines staff records and other records relating to the service. This room was also used as a staff sleep-in room.
People’s experience of using this service and what we found
Right Support
Staff supported people to be independent and have control over their own lives.
People were supported by staff to pursue their interests.
The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their physical needs.
People had a choice about their living environment and were able to personalise their rooms.
Staff supported people to take part in activities and pursue their interests in their local area.
Staff enabled people to access specialist health and social care support in the community.
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.
Right Care
Staff understood how to protect people from poor care and abuse. They had training on how to recognise and report abuse and knew how to apply it. However, we identified one occasion when a potential safeguarding concern had not been reported externally.
The service had staff vacancies and was using agency staff to meet people’s needs and keep them safe.
People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.
People could take part in activities and pursue interests that were meaningful to them.
Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.
Right Culture:
Staff knew and understood people well and were responsive to their needs.
Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.
Policies did not guide services to ensure risks of a closed culture were minimised.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 18 June 2019).
Why we inspected
This inspection was prompted by a review of the information we held about the provider. We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HF Trust - Trelawney on our website at www.cqc.org.uk.
Recommendations
We have made a recommendation about the reporting of any safeguarding concerns.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
HF Trust - Trelawney is a residential care home for up to six people who have a learning disability. At the time of the inspection four people were living at the service. Accommodation was spread over two floors. There was a shared dining room/conservatory, living room and kitchen. A small bedroom was used to store medicines staff records and other records relating to the service. This room was also used as a staff sleep-in room.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The atmosphere at HF Trust – Trelawney was relaxed and friendly. People spent time together in shared lounges and we observed them chatting quietly with staff and sharing jokes and laughter. People were able to move around freely and there were no restrictions on people’s movements in the shared areas of the service.
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. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having control over their daily lives and opportunities to take part in everyday routines.
Staff involved people in decisions about how and where they spent their days. They were skilled in communicating with people to help ensure they were able to make meaningful choices. Staff told us some people enjoyed food shopping and explained how each individual got involved in this everyday routine.
Staff and relatives told us the staff team worked well together and communicated effectively. Records were regularly reviewed and updated and were an accurate reflection of people’s needs. When changes were required to how care was delivered this was carried out effectively and in partnership with other professionals.
There were systems in place to continually drive improvement. This included gathering the views of all stakeholders and regular audits of all aspects of the service.
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 June 2018) and there were breaches of regulation. The provider completed an action plan after that inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We found action had been taken to meet the breaches of regulation and this had been effective.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
HF Trust - Trelawney is a care home providing care and accommodation for up to six people with a learning disability. At the time of the inspection six people were living at the service.
People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Care was not being delivered in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Some people did not get along together and this had led to altercations within the service. Staff worked to keep people safe but this had impacted on people’s ability to move freely and independently around the service. People’s behaviour and records showed some people were unhappy.
The service requires 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.
CQC had not been informed of an incident that occurred at the service until 16 days after the event. The same event had not been recorded or reported appropriately and in line with HF Trust’s policies and procedures.
Where risks were identified action was taken to protect people from harm. Staff were aware of their responsibilities under safeguarding and took these seriously. They were able to describe to us the action they would take to keep people safe.
Staff were sympathetic and compassionate in their approach to people. They were clearly saddened by the circumstances within the service and empathised with people’s situation.
Roles and responsibilities were clearly defined and understood by all. Systems for communicating about changes in people’s needs were effective. Staff were supported by a thorough system of induction, training, supervision and staff meetings.
Activities provided were varied and met people’s individual preferences and interests. Family contact was valued and encouraged. Relatives told us they were kept informed of any changes and were invited to take part in care plan reviews.
Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being in daily logs.
There were a range of quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager, staff and other staff with a national remit employed by the provider.
We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.
There was a registered manager 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.
The service was last inspected in April 2015. After that inspection we asked the provider to make improvements in respect of care plans, ensuring the rights of people who lacked capacity to make specific decisions were protected and the leadership of the service. The provider subsequently sent us an action plan outlining how improvements would be made and we checked to see this had been completed. We found all the actions had been completed.
There were clear lines of responsibility in place. The registered manager was supported by a senior support worker. People had been assigned key workers and co-key workers with responsibility for their day to day care. Staff members had been assigned responsibility for various weekly and daily checks to help ensure the smooth running of the service.
The premises were well maintained and decorated. There was a large decking area outside where people were able to enjoy barbeques. New garden furniture had been sourced which would help ensure everyone was able to enjoy these events.
Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the registered manager. Other training identified as necessary for the service was updated regularly. Staff received supervision and appraisals. New employees were required to complete a thorough induction which incorporated training, familiarisation with policies and procedures and shadowing more experienced staff.
The provider acted in accordance with the requirements laid out in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). People were able to make every day decisions such as how and where they spent their time and what they ate. Staff recognised and respected people’s rights.
Care plans were personalised, detailed and updated regularly. They contained information about people’s likes and dislikes as well as information regarding their health needs. Staff were aware of people’s preferences and how they wished to be supported. People worked with keyworkers to review care plans on a monthly basis. The care plans were kept on an electronic system and there were no easy read versions available for people to keep.
There were effective quality assurance systems in place to monitor the standards of the care provided. People, relatives and staff were asked for their opinions and suggestions regarding the running of the service.
We inspected HF Trust Trelawney on 14 April 2015, the inspection was announced.
HF Trust Trelawney provides care and accommodation for up to six people with a learning disability. At the time of the inspection five people were living there. We last inspected the service in October 2013, we had no concerns at that time.
There was a registered manager 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. However at the time of the inspection the registered manager was unavailable. Instead we spoke with the service manager and senior support worker who were covering for the registered manager in their absence.
HF Trust Trelawney had been short staffed prior to the inspection and had found it difficult to recruit new staff. This had led to them being reliant on agency staff for a period of time. At the time of the inspection there were several new members of staff in post who were going through their induction period. This involved training and shadowing more experienced members of staff. In order to support this process experienced relief staff were working alongside the staff team. There was always a suitably qualified and experienced member of staff on duty to support the new employees and ensure all the necessary duties were fulfilled. There was a robust recruitment system in place which included carrying out background checks to minimise the risk of employing people who were unsuitable for the role.
Training identified as necessary for the service was being undertaken by staff as part of the induction process. Other staff had already received this training. Some staff had also received additional training specific to the needs of the people living at HF Trust Trelawney. Due to the pressures of training new staff not all had received training defined in risk assessments as being important for people. We have made a recommendation about this in the report.
Senior staff had received training in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Training was booked for the remainder of the staff team. No applications for DoLS authorisations had been made although people were unable to leave the building unsupervised. This meant the delivery of care may have been unlawful. You can see what action we have asked the provider to take at the back of this report.
The senior support worker was running the service on a day to day basis as the registered manager was absent from work. They were supported by a senior support worker from another HF Trust service and a service manager who was the registered manager of another service.
Staff felt well supported by a system of regular supervision and staff meetings. They told us they were able to ask for advice and support when they needed it and the senior support worker was approachable and available. Changes and improvements to support plans were required as some information was out of date or inaccurate. Due to the temporary nature of the management of the service this was not yet being done although it was acknowledged as necessary. We found this was a breach of regulations. You can see what action we have asked the provider to take at the back of this report.
Families said things had improved recently and told us they had confidence in the new staff team. One commented; “There are a lovely, nice lot of people working there at the moment. They are all very good.”
People were relaxed around staff and chatted with them about arrangements for the day and past events. When talking to us about people staff were respectful and demonstrated an interest in people’s well-being and how they could support them to have meaningful lives. People had access to a range of activities which suited their interests.
Care Plans were informative and directed staff as to the care and support people needed.
Suitable arrangements were in place to ensure people were safeguarded from the risk of abuse.
There were robust systems in place to ensure medicines were handled safely, securely and appropriately.
HF Trust Trelawneys' facilities and furnishings were to a good standard.
Everyone we met looked well cared for. Typical comments from people who used the service included "the staff are very nice." and 'they have helped me when I needed it'.
Documentation we saw was to a good standard. Care plans provided clear information regarding care and what support staff needed to assist people with.
Staffing levels were satisfactory, and there was evidence that staff had received suitable training.
A satisfactory quality assurance system was in place.
Staff told us that training was provided, that they enjoyed working at Trelawney, and that they felt they could approach the manager and senior staff if they needed to. Staf told us that they enjoyed their work.