Trezela House

Trezela House is a care home without nursing registered to provide accommodation and care for up to 8 people with mental health needs. At the time of our inspection 7 people were using this service.

The home is currently providing support to 1 person living with a learning disability, however, people’s primary need for admission was their mental health diagnosis and personal care. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting maximised people’s choice, control and independence. Staff supported people to make choices about their daily lives and engage in activities, that were tailored to their individual needs and promoted their independence. People were supported to maintain and develop relationships. People were supported by enough staff on duty who had been trained to do their jobs properly. People received their medicines in a safe way. People were protected from abuse and neglect. People's care plans and risk assessments were clear and up to date.

Right care:

People received good quality person-centred care that promoted their dignity, privacy and human rights. Staff knew people well and demonstrated an understanding of people’s individual care and communication needs. This helped ensure people’s views were heard and their diverse needs met.

People were treated in a dignified manner and staff were aware of people’s support needs. Staff were observed talking to people in a respectful way. Staff delivered personal care needed and gained consent prior to providing any support. Care plans informed staff of any specific ways to best communicate with the person.

Right culture:

People were supported by staff where the ethos, values, and attitudes of management and care staff ensured people led confident, inclusive and empowered lives. Staff created an environment that inspired people to understand and achieve their goals and ambitions.

People led lives that reflected their personalities and preferences because of the ethos, values, attitudes and behaviours of the management and staff.

The management and staff knew people well and worked together to help ensure people received a good service.

People’s experience of using this service and what we found

People told us they were happy with the care they received. Comments from people included “I feel really safe here” and another said, “Feel safe here- very much so.” While a relative said; “Absolutely brilliant place.” People looked relaxed, happy, and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met.

People were supported to access healthcare services, staff recognised changes in people's general health and mental health and sought professional advice appropriately.

People were supported by staff who completed an induction and received appropriate training and support to enable them to carry out their role safely. This included fire safety and mental health training.

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.

People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

Staff told us the provider visited the service most days and was available by phone. They went onto say they assisted them daily and helped cover the service when staff supported people to access the community. They went onto say how the provider was approachable and listened when any concerns or ideas were raised. One staff member said, “I absolutely love my job at Trezela House and am very happy here.”

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 19 July 2019).

Why we inspected

We were prompted to carry out this inspection due to concerns we received about the service and care provider.

A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, responsive, 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 not changed and remains good. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, responsive, and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Trezela House our website at www.cqc.org.uk

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.

Trezela House is a residential care home providing personal care to eight people with mental health needs primarily under aged 65 years of age in one adapted building. The service can support up to eight people

People’s experience of using this service and what we found

The service had suitable safeguarding systems in place, and staff had received training about recognising abuse. An external professional said, “I have never witnessed anything of concern regarding Trezela House.”

Appropriate risk assessment procedures were in place so any risks to people, staff or visitors were minimised.

Staff were recruited appropriately. Staffing levels were satisfactory, and people received timely support from staff when this was required. A relative said, “Staffing levels always seem to meet the needs required, and staff seem motivated and positive.”

The medicines system was well organised and staff received suitable training. People received their medicines on time.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. A relative said the home was “Clean and well looked after.”

The service had suitable assessment and care planning systems to assist in ensuring people received effective and responsive care.

Staff received induction, training and supervision to assist them to carry out their work. An external professional said, “Staff appear well trained and appear to be knowledgeable in areas concerning the clients’ conditions and the legal framework around caring for vulnerable adults.”

People received enough to eat and drink. Some people were involved in food shopping and cooking for the household. One person told us, “ Food is excellent.”

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.

The building was suitable to meet people’s needs and maintained to a satisfactory standard.

People received support from external health professionals and were encouraged to live healthier lives. A relative told us, “ Since (my relative) has been at Trezela they have flourished medically and mentally.”

People said they received support from staff which was caring and respectful. Care promoted people’s dignity and independence. People were involved in decisions about their care. People told us, “Staff help as best they can.” An external professional said, “The standard of care is excellent.”

People had the opportunity to participate in activities and to spend time with the wider community. A relative said, “ I think they (the staff) are amazing how they involve all the residents in the community and also take them on outings and holidays.”

People felt confident raising any concerns or complaints. Records showed these had been responded to appropriately.

The service was managed effectively. People and staff had confidence in the registered manager. A staff member told us, “(The manager) is very approachable,” and a relative said, “The home is very well led and run.”

The manager was able to demonstrate the service learned from mistakes to minimise them happening again.

The service had suitable systems to monitor service delivery and bring about improvement when necessary.

The team worked well together and had the shared goal of providing a good service to people who lived at the home. A staff member told us, “We are a good little team. Everyone is nice. Any issues get sorted early on.”

The service worked well with external professionals, and other organisations to provide good quality care. An external professional said, “I truly wish there were more care settings like Trezela House in Cornwall.”

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 20 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out this unannounced inspection on 28 February 2017. At the last inspection, in January 2015, the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe living at Trezela House and with the staff who supported them. People told us, “I am happy here” and “I like it here, this is my home.” Relatives said, “[Persons’ name] is very happy living at Trezela House”, “Brilliant it’s like a home from home” and “It’s an incredible place.”

Care and support was provided by a consistent staff team, who knew people well and understood their needs. People were supported to access the local community and take part in a range of activities of their choice. Staff arranged regular holidays and day trips for either the whole group or a smaller group depending on the type of holidays and outings people wanted to go on.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People were supported to eat and drink enough and maintain a balanced diet and were involved in meal planning. Menu planning was done in a way which combined healthy eating with the choices people made about their food.

People were supported to maintain good health, have access to healthcare services and receive on-going healthcare support. Staff supported people to arrange and attend appointments to see their GP and other necessary healthcare appointments.

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. People who received care, or their advocates, were involved in decisions about their support and consented to the care provided. Risk assessment procedures were designed to enable people to take risks while providing appropriate protection.

Where people did not have the capacity to make certain decisions staff acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. The registered manager and owner were visible in the service, regularly working alongside staff to provide care and support for people. There was a positive culture within the staff team and staff said they were supported by the registered manager and owner.

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. People and their families were involved in the running of the service and were regularly asked for their views through on-going conversations with staff and surveys.

People we spoke with were happy with the home's standards. The comments we received included 'they look after us pretty well,' and 'I am very happy, the staff are lovely.'

Everybody was happy with the staff support they received. People said the staff always had time to talk with them if they had a problem, staff had positive attitudes and were always friendly and kind. A couple of people expressed a wish to move on although this was due to personal reasons rather than to specific concerns about the home. Nobody who we spoke with had any concerns or complaints about the service provided by the staff at the home.

The accommodation was furnished, decorated and maintained to a satisfactory standard. The home was very clean and there were no offensive odours. Health and safety standards were well maintained.

The medication system was well organised and operated effectively. There were satisfactory numbers of staff on duty. Staff training provision was to a satisfactory standard. The service had a suitable quality assurance system to ascertain the views of people and ensure good standards of care were maintained.

One person told us they did not want to live at Trezela as they would have preferred to live in their own home, but added they liked their room, which was personalised, warm and comfortable and that they felt safe at Trezela.

People who used the service were seen to make choices about what they did during the day. For example, we saw people chose to access community based activities, people chose whether to stay in their rooms or use the communal areas or whether to get up or stay in bed. We saw staff were polite and respectful during conversations with people. People who used the service freely approached staff during our inspection to request support or to spend time with them chatting.

People were safeguarded against abuse by the home's policies, procedures and training for staff.

The home was clean and tidy on the day of our inspection and communal areas were decorated and furnished in a homely and comfortable style.

The home had a robust recruitment procedure that was consistently followed to ensure that people received care and support by staff who were suitable to work at the home.