HF Trust - Trelowen

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were recorded and email alerts sent to managers to make them aware of the event. All events were investigated to identify what had gone wrong and any learning from the event which could mitigate future risk. During the inspection one person had a minor accident. Staff described how this would be recorded and what action they would take immediately to help ensure the person’s well-being.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service communicated with other agencies to help ensure continuity of care. Hospital passports contained essential information to inform hospital staff how best to support people if they needed to be admitted.
One person had recently moved to live at a different service within HF Trust. The move had been well planned to help ensure the person was comfortable and did not suffer any unnecessary stress. The person’s family had been involved in the decision. Staff who knew the person well had moved to work in the service to help provide consistent care and support. A relative commented, “For the first few weeks of [Name’s] transition several members of Trelowen staff spent time at [Name of new service] passing on information and little tips on [Name’s] care and understanding how they may show different moods and needs.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Capacity assessments were completed when people lacked capacity to make specific decisions. For example, we saw capacity assessments relating to finance and medicines. Deprivation of Liberty Safeguards (DoLS) applications had been made appropriately and reapplied for once they expired. The registered manager followed up on the progress of applications when there were delays. There were processes to monitor any restrictions so the DoLS team could be alerted to any changes.

Staff had completed training in the MCA and safeguarding. Safeguarding issues were discussed in supervisions and staff meetings. People and relatives did not raise any concerns about safety. Relative’s comments included; “No concerns whatsoever”, “[Name] loves it there, they say it’s their house” and “Staff are there for the people, everyone there seems happy.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

When any potential risks were identified risk assessments were completed so staff would be aware of the risk and have guidance on how to support people safely. There were systems to help ensure people were protected from the risk of financial abuse.
Staff had identified a potential risk for one person. The registered manager had discussed this with the person, and they had found a solution which would minimise the risk without restricting their choices. This had worked well.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Since our previous inspection improvements had been made to the premises and garden area. A new bathroom and kitchen had been installed. The garden had been tidied and was more user friendly.
Checks of utilities and equipment were regularly carried out by external contractors. Staff completed weekly and monthly checks such as vehicle checks and fire safety equipment. Any defects were reported to an internal maintenance employee and staff told us these were dealt with quickly. Improvements had been made to the garden area so people were able to enjoy it safely.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

New staff were recruited safely and completed an induction before starting work at Trelowen. There were sufficient staff to meet people’s needs and enable them to take part in any pastimes or hobbies they enjoyed. Two people went to a social group in the evening once a week. Staff shifts were organised to enable them to do this. One relative did comment people‘s choices were sometimes limited due to a lack of staff who were able to drive. However, they said, “When funds allow, they have paid for a taxi or car shared.” Following the inspection a senior manager confirmed an automatic vehicle would be provided at Trelowen. This meant more members of staff would be able to drive the vehicle.
Agency staff were sometimes used to cover gaps in the rota. The service had the information they needed to help ensure agency staff had the necessary skills and experience to support people living at Trelowen. Where possible the same agency staff were booked to help provide consistent care.
Staff received regular supervision and yearly appraisals. Staff told us they were well supported.
A training matrix showed staff had completed training in relevant areas including supporting people with a learning disability and autistic people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Daily cleaning schedules and schedules for deep cleans had been developed. Monthly water checks were completed remotely to check for legionella. Staff wore aprons and gloves when supporting people with personal care needs and medication.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medicine Administration Records (MARs) were kept to evidence people received their medicines as prescribed. Some people had prescribed creams and these were recorded on the MARs. However, the creams had not been dated when opened and expiry dates had not been noted.
Medicines were stored in the office and not in people’s bedrooms. The registered manager told us there were plans for 1 person to have their medicines kept in their room. One person disliked closed cupboards and would not like a medicine cabinet in their room. They felt the other 3 people would not gain any value from this and would not have an opinion on it. However, there was no evidence this possibility had been explored with people.