Archived: OSJCT Trevone House

During a comprehensive inspection on 1, 2 and 3 June 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Regulation 9 Person centred care and Regulation 17 Good Governance. We asked the provider to complete an action plan to show us what they would do and by when to improve the key questions “safe, effective, responsive and well-led” to at least good. They told us these would be addressed by 31 December 2016 to, ensure people’s care and treatment was delivered in such a way which would meet their individual preferences and choices and to ensure accurate and relevant care records were maintained.

We undertook an unannounced focused inspection of Trevone House on 21 February 2017. This inspection was done to check that the above legal requirements, and improvements, planned by the provider, had been completed. During this focussed inspection the service was inspected against the key questions “safe, effective and well-led”. At this inspection we found the provider was compliant with the prior breaches of Regulation. However, a period of consistent and sustained improvement was required and the rating remained at Requires Improvement.

At this comprehensive inspection completed on 13, 14 and 15 December 2017 we found the service had sustained the improvements we found in February 2017 and this inspection therefore rated the service as Good overall.

Trevone House is a ‘care home’. 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. Trevone House accommodates 47 older people in one adapted building. At the time of the inspection there were 31 people living there.

People are provided with a single occupancy bedroom. Each room has a sink, bedroom furniture and necessary equipment, a window and radiator. Additional communal toilets, bathrooms and rooms to sit and eat in are provided. The accommodation is across two floors; the second floor accessed by stairs or a passenger lift. There is a garden at the front of the home and off road car parking is available near to the building.

A registered manager was in place. 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.

Arrangements were in place to keep people safe from potential abuse, discrimination and risks which could have a negative impact on their well-being. Staffing requirements were monitored and had been adjusted to ensure people’s needs could be met safely. People’s medicines were managed in such a way which ensured they received as prescribed and needed. People lived in a clean environment where there were measures were taken to prevent and minimise the impact of infection. Staff worked with other health care professionals to ensure people’s health needs were both assessed and met. Risks to people’s health were identified and managed.

People’s consent to be cared for and treated was sought. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Where people could not provide consent and make independent decisions about their care and treatment, the principles of the Mental Capacity Act 2005 were adhered to in order to protect them. People were lawfully deprived of their liberty where this was needed to keep them safe and in receipt of the care they required.

People and those who mattered to them were cared for in a compassionate way. Staff supported people in a personalised way to ensure their specific and diverse needs were met. People privacy, dignity and rights were upheld. People were supported to be as independent as possible. People’s care was planned with them and where appropriate, their relatives or representatives could speak on their behalf. Complaints and any areas of dissatisfaction were taken seriously and addressed. People’s end of life wishes were explored with them and advanced care planning ensured these were met at the appropriate time. Staff were experienced and trained to meet people’s end of life needs. Staff were supported by other health care professionals who worked together to ensure a person’s death was dignified and pain free.

The registered manager had provided strong and consistent leadership since being responsible for the management of the home. They had made changes to how the home was run and its culture. Subsequently a far more open and supportive atmosphere existed. People and staff felt able to raise any concerns and they were confident these would be looked at and addressed. Effective communication existed between staff groups and people. Staff and management were working together to improve services for people. Effective monitoring of the service ensured it remained compliant with necessary regulations and continued to improve.

We undertook this focused inspection on 21 February 2017 to check that they had followed their improvement plan and to confirm that they now met legal requirements in relation to breaches of Regulation 9 and 17. This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lypiatt Lodge on our website at www.cqc.org.uk” We found these breaches to legal requirements had been met.

This service is registered with the Care Quality Commission to provide accommodation, nursing and personal care for up to 47 older people. At the time of our inspection there were 25 people living there of whom some also lived with dementia.

There was not a registered manager in post but the provider was addressing this. 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.

Since June 2016 outcomes for people had improved. People’s call bells had been responded to more quickly and effectively. This had helped people to receive care and treatment when they needed it and ensured their safety. Some improvements had been made to how people received their care. Staff were taking a more personalised approach towards people’s care. They were aiming to ensure they met people’s choices and preferences in relation to this.

People’s care records had been reviewed and they gave accurate and up to date information. The content of people’s care plans had also been improved and many had been more personalised. Additional records of the care and treatment provided were well maintained. This had helped senior staff and visiting health care professionals make decisions about how to maintain and improve people’s health.

There were interim management arrangements in place which were providing calm and supportive leadership to staff. Senior staff were visible and available for people and staff to approach if needed. The provider had closely monitored the care home’s progress and its compliance with the necessary regulations. These improvements needed to be sustained moving forward.

The service offers personal and nursing care and can accommodate to up to 47 older people. At the time of this inspection there were 27 people living at Trevone House.

The registered manager in post has managed Trevone House since 2013. 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.

During this inspection we found the provider had not ensured people’s care records were accurately maintained and that they provided the information needed to ensure safe and appropriate care. We also found examples of people’s health needs not being sufficiently monitored to ensure they received appropriate care when they needed it. You can see what action we told the provider to take at the back of the full version of this report.

We also found the arrangements in place for staff to receive the information they needed before they started work not to be effective and we recommended that the provider review these.

People’s risks were on the whole managed in a way which kept them safe. There were some examples where these needed improvement but where it had not had a negative impact on people. We discussed these at the time with the registered manager who told us she would address these. The service had robust safeguarding procedures which staff understood and any concerns relating to any form of abuse were reported and managed correctly. There were enough staff to meet people’s care/nursing needs, albeit not necessarily when people wanted these met. Robust recruitment practices helped to protect people from staff who may be unsuitable. People lived in a clean environment and were protected from avoidable infection.

People’s health needs were predominantly met, although one example of not following one person’s condition put this person at risk of potential and unnecessary health complications. People who were not able to make decisions independently were supported to do so. People who lacked mental capacity were protected as staff followed the principles of the relevant legislation. However, the necessary and required records of this process were not always present. Arrangements had been made to improve the delivery of people’s medicines to the home and how and when people received these.

People received care from staff who were kind and genuinely interested in their well-being. We observed kind and caring interactions from staff although when they were busy these sometimes lacked compassion. People’s privacy and dignity were maintained. Where people had needed to wait for support their dignity had not been compromised. People who mattered to those receiving care were appropriately involved and welcomed at all times. People’s complaints and dissatisfactions had been investigated and the management team had aimed to resolve these to the person’s satisfaction.

The management of the service had improved since our last inspection but it had not been effective enough to maintain full compliance with the relevant health and social care regulations. Overall the service felt more organised and people told us the management team were more approachable. The provider had provided supported and had guided the management team through a period of improvement and they continued to monitor the service’s progress closely.

Some of the issues identified in this inspection had been identified through the service’s quality monitoring process but had not always been effectively resolved.

People and staff had been better involved in plans to improve the services provided. Their ideas and suggestions had been sought and acted on.

As part of this inspection we spoke with nine people who use the service, five relatives, the registered manager, eight staff and observed how people were being cared for. We also reviewed records relating to the management of the service which included, six care plans, daily care records, quality assurance systems and staff rosters.

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

Is the service safe?

People were safe because staff used both formal and informal methods to share information on risks associated with their care, treatment and support. Hazards were minimised and procedures were in place to keep people safe.

The service installed, used, maintained and serviced equipment. Equipment had been provided to keep people safe and comfortable.

People were safe because staffing levels were assessed and monitored to ensure they were sufficient to meet people's identified needs at all times. The provider had strategies in place to respond to unexpected changing circumstances. The service considered and ensured staff had the competencies, knowledge, qualifications and experience when arranging staffing so that people's individual needs were met. People told us, 'Staff are ok, they are very good', 'It makes such a difference when staff are cheerful', "Some are very young, they are willing to grasp and learn'.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People received an effective service because their individual needs, choices and preferences were reflected in their care plans. People's likes, dislikes and routines important to them had been recorded in their care plans. Staff spoken with had a good understanding of people's needs.

People's identified needs were not always monitored accurately. Their individual care records did not always reflect the care and support being provided. A compliance action has been set for this and the provider must tell us how they plan to improve.

People were supported by care staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices. The provider had responded to demands on the staff team by reassessing their responsibilities. Training had been provided and further training was scheduled to equip them with the skills and knowledge they needed.

The service was effective because people's diverse care, cultural and support needs were met by the equipment supplied. Equipment had been provided to keep people safe and to promote their independence.

Is the service caring?

People did not have the privacy they needed. At times people were not treated with dignity and respect. This meant the service was not always caring because people's right to privacy and dignity when being supported with care and treatment had not been respected. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The service was caring because people could be as independent as they wanted to be. Staff encouraged people to maintain their mobility and to feed themselves.

The service was caring because staff actively asked for, listened to and acted on people's views and decisions. Staff were observed offering people choices about the way in which their care was provided.

Is the service responsive?

People received the care and support they needed in accordance with their consent and individual preferences, interests, and aspirations. Staff provided individualised care and support recognising people's diversity. They treated people amiably and politely.

The service was responsive because people's health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were made to health care professionals when people's needs changed.

The service was responsive because people had their individual needs regularly assessed. Staff understood the care and support needs of people they were responsible for.

The service was responsive because people knew how to share their experiences or raise a concern or complaint. They said they would talk to the registered manager. Actions had been taken in response to complaints to improve the service.

Is the service well led?

Feedback from people who live in the home, their relatives and staff was encouraged through surveys, meetings and complaints. Action had been taken in response to their feedback. People told us, "Excellent, I can't complain", "We have choice, I can't fault it".

The service was well led because it had a system to manage and report accidents and incidents. These were monitored and action taken to make sure they did not happen again.

The service was well led because management were aware of the day to day culture in the service and they kept this under review. Strategies were in place to make improvements to the quality of service provided.

Our inspection of 19 November 2013 found six monthly reviews of people's care had not taken place and assessments and monitoring charts had not been kept up to date. The provider wrote to us and told us what action they intended to do to resolve the concerns we found. This action included making staff responsible for updating the care files with monitoring from the senior staff. The provider told us the date they expected to have completed this work. We did not speak to people who used the service during this inspection because we were reviewing the actions taken by the provider. We looked at the care files for eight people who used the service (four files that we had looked at during our visit in November and four new files).

During this inspection we found that the six monthly reviews of people's care and risk assessments were up to date. We checked care charts, in particular charts used to record the re-positioning of people and their fluid in-take. We found that overall these had been completed appropriately.

We observed the home to be clean and effective measures were in place for prevention and control of infections. The provider had systems in place for obtaining, storing and administering medicines. The majority of staff had received supervision and had completed training deemed necessary by the provider.

We spoke to three people who used the service and one of their relatives. The comments they gave us included 'it's very good here, the staff help you in any way they can'. 'The staff are all very kind'. 'I really like it here; they look after me very well'. 'I have no concerns; I know they look after my mother very well'. We also observed excellent interactions between staff and people who used the service. This was friendly but respectful and showed that the staff knew each person very well.

We were also told that they received enough input from staff for their needs. One person told us they were "quite happy" with the care they received.

People we spoke to told us that they felt safe in the care home with one person saying 'I feel quite safe'.