Trewithen

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.
This is the first assessment for this service. This key question has been rated good.
This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

All accidents, incidents or medicines errors were investigated by the manager to identify any areas of possible learning or improvement. Following significant events, the manager met with staff to debrief them, gain a full understanding of what had occurred, offer support and check on the welfare of people and staff. Where learning was identified, this information was shared promptly with staff to minimise the risks of similar events reoccurring.

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 had processes to ensure details of people’s support needs were shared prior to any transfer of care to help ensure those needs were understood and met. Hospital passports had been completed and staff were able to support people in other settings if needed.

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.

People demonstrated they were happy at Trewithen and relatives told us, “[My relative] is well looked after, the staff are excellent” and “[My Relative] appears to be very well cared for”.
Staff were passionate about supporting people’s independence and ensuring they were protected from harm or abuse. Staff were confident any safety concern they raised would be investigated and knew how to make safeguarding alerts should this be necessary. Staff comments included, “People are safe, I have not seen anything to be worried about”, “People are safe and well cared for” and “When concerns are reported, processes are followed”.
Records showed concerns about individual staff members practices had been robustly investigated and staff disciplinary processes used appropriately.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS) which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.
Assessments of people’s capacity to make specific decisions had been completed and where necessary decisions had been made in the person’s best interest. Necessary DoLS applications had been made and any associated conditions complied with. The manager had a good understanding of the legislation.
People had access to money when required and there were systems to help ensure they were protected from the risk of financial abuse. Professionals told us, “They also manage clients' funds responsibly and effectively on their behalf”.
 

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.

Risks had been assessed and care plans included guidance for staff on how to manage and mitigate known risks. Staff knew people well and were able to recognise and understand small changes in people’s actions that indicated they were becoming anxious or upset.
During the assessment, staff successfully used techniques, described in people’s care plans, to help people manage their emotions. Staff told us, “There is no restraint in this house”, “No physical restraint, some redirection and a bit of deflections at most” and “I have a 3 day course in the college in September [on positive behaviour support]. [The Provider] is very keen to keep it fresh and up to date”.

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

The provider had robust systems to ensure risks in the environment were managed and mitigated. The service’s utilities and equipment were regularly serviced and tested by appropriately skilled contractors. Where issues were identified, prompt repairs were completed. Personal emergency evacuation plans (PEEPs) were available detailing the support each person needed during an evacuation.

The service was generally well maintained and carpeting in communal areas had recently been replaced. However, carpeting in upstairs bedrooms was tired and in need of replacement.

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.

The service was safely staffed, and relatives told us, “I think there are enough staff” and “There are always enough staff when I call in”.
Records showed planned staffing levels were normally achieved and staff told us, “There are enough staff”, “We have 3 staff most of the time” and “Nine times out of 10 there are enough staff. Staffing is only an issue when someone is sick but someone else normally comes in”.
Staff were confident they had the skills to meet people’s needs and told us they received regular supervision and support. Staff comments included, “We get plenty of training, I am all up to date” and “My training is all up to date”.
Recruitment practices were safe and all necessary checks had been completed to help ensure prospective staff were suitable for employment in the care sector.

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.

The service was clean and staff had access to appropriate Personal Protective Equipment (PPE) which was used appropriately when required. People were supported and encouraged to participate in household chores and care plans included guidance on how to support people to manage infection control risks.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People’s medicines were managed safely and used as prescribed. Medicines were stored safely and the provider’s digital Medicines Administration Records accurately recorded the support people received with their medicines. Staff competence to manage people’s medicines was assessed and their training regularly updated. Medicines that required stricter controls were stored appropriately and necessary records completed. The temperature of medicine storage areas was monitored and cooling blocks were used to ensure medicines were stored at appropriate temperatures during the summer.

The service worked in line with STOMP, a national initiative aimed at reducing the inappropriate use of medicines used to manage behaviour. Staff and the registered manager had worked with involved health care professionals to reduce, where possible, the amounts of medication people took regularly. Some people were prescribed ‘as required’ medications to help with the management of anxiety. These medicines were used very infrequently, and records of why the medicines were used and their effectiveness had been completed.