Background to this inspection
Updated
7 July 2022
Inspection team
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by two inspectors
Service and service type
Trefula is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.
Registered manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection we reviewed information, we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
During the inspection we reviewed six people's care plans and risk assessments. We looked at the file of the one new member of staff in post since the last inspection. We reviewed staff training and supervision. We also reviewed other records relating to the management of the service, including complaints received. We met with the registered manager, the peripatetic service improvement lead, the clinical lead, eight staff, five people and nine visitors. Following the inspection we received feedback from three healthcare professionals.
Updated
7 July 2022
About the service
Trefula House is a residential care home providing personal care to up to 28 people. The service provides support to older people, some people were living with dementia. At the time of our inspection there were 27 people using the service.
People’s experience of using this service and what we found
Peoples received their medicines as prescribed. Staff had the necessary skills to administer medicines. However, medicine recording, and storage systems and processes were not always robust. Concerns found at the inspection had not been identified prior to our visit. We have made a recommendation about this in the safe section of this report.
There were sufficient staff to support people on the day of the inspection. However, during some weekends staffing levels were seen to drop to below preferred levels. The service had a number of carer and nurse post vacancies. The service was using a high number of agency staff at the time of this inspection. Recruitment was ongoing but there had been very few applications received. We have made a recommendation about this in the safe section of this report.
Pressure relieving mattresses were in place for people who had been assessed as needing them. Some of these mattresses were not set correctly for the person using them. We did not identify any evidence that people had come to harm as a result of this issue. We were assured by the registered manager that immediate action would be taken to address this matter. We have made a recommendation about this in the safe section of this report.
People told us they felt safe with staff. There were systems to help protect people from abuse and to investigate any allegations, incidents or accidents.
People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported to maintain a balanced diet where this was part of their plan of care.
Care plans were completed for each person and contained details of the person's needs and preferences. Risks were identified, assessed, recorded and regularly reviewed. However, some aspects of some people’s care plans had not been updated regularly. The registered manager was aware of this issue and the service were in the process of moving to an electronic care planning system.
There were processes in place to prevent and control infection at the service, through access to COVID-19 testing where necessary, additional cleaning and safe visiting precautions.
People were supported by staff who had been appropriately trained and were skilled in their role. Staff told us they felt well supported. Relatives comments included, “The staff are great, they are looking after (Person’s name). I would like them nearer to home, but I don’t want to move them yet as they are so well looked after” and “I can visit whenever I like.”
Staff were well supported and were able to access the management team whenever they needed any assistance or guidance. Staff comments included, “I love it here, I am very happy” and “The management are really good and supportive. We all get along well.”
Staff were provided with daily shift handovers to help ensure effective communication.
People were supported to engage in some activities.
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 understood the importance of respecting people's diverse needs and promoting independence.
Mental capacity assessments had been carried out where necessary. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for appropriately.
The service had implemented a regular audit and quality assurance process to monitor the quality and safety of the care provided. However, the auditing and monitoring processes in place at the time of this inspection were not always robust. Concerns identified at this inspection had not been identified through the audit cycle. We have made a recommendation about this in the well led section of this report.
People told us they liked staying at Trefula and that the staff were caring and responded when they requested support. Comments included, “The staff are looking after me very well.”
External healthcare professionals told us, “I think that Trefula have certainly improved to a reasonable extent. Management and processes seem stronger, and the nursing staff are by and large excellent,” and “Generally improving with much better leadership and direction.”
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 (and update)
The last rating for this service was requires improvement (published 13 December 2021). Since we awarded this rating, the provider has altered its legal entity. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.
Why we inspected
We carried out this inspection to follow up on action we told the previous provider to take at the last inspection. CQC had also received information of concern about staffing levels, care planning, lack of activities, food provision and the management of the service. We did not substantiate these concerns.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.