• Care Home
  • Care home

Trelawney House

Overall: Inadequate read more about inspection ratings

Polladras, Breage, Helston, Cornwall, TR13 9NT (01736) 763334

Provided and run by:
Spectrum (Devon and Cornwall Autistic Community Trust)

Important: We are carrying out a review of quality at Trelawney House. We will publish a report when our review is complete. Find out more about our inspection reports.

Latest inspection summary

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Background to this inspection

Updated 15 December 2021

The inspection

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 Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by two inspectors.

Service and service type

Trelawney 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.

The service did not have a manager registered with the Care Quality Commission. A new manager had been appointed to the service in July 2021 and intended to apply to the commission to become registered. Registered managers and providers are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all information available to plan our inspection.

During the inspection

We met and spoke with all six people who used the service. We spoke with eight members of staff, the service’s current manager, the regional manager responsible for the service, and the provider’s Deputy Head of Operations. In addition, we asked to speak with the providers nominated individual, but they were unavailable. We completed observations of the quality of care and support provided in the service’s communal areas during both days of our inspection. This helped us to understand the experiences of people who we were unable to communicate with effectively.

We reviewed a range of records. This included three people’s care records and medication records. We looked at a staff file in relation to recruitment and a range of records relating to the management of the service.

After the inspection

We reviewed documents requested during the inspection and completed an analysis of staffing levels currently in place and the effectiveness of these staffing levels. We spoke with three people’s relatives by telephone and sought and received feedback from four professionals who worked with the service regularly.

Overall inspection

Inadequate

Updated 15 December 2021

About the service

Trelawney House is a residential care home providing personal care to six people with a learning disability and/or autism. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall. Trelawney House is in a rural location. The nearest town is Helston which is approximately four miles away without public transport links.

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

The provider had failed to appropriately report and investigate incidents of alleged abuse. This issue had previously been identified in the last inspection of the service on 10 June 2021. The service’s new manager had completed a safeguarding referral following an incident of alleged abuse and this had been forwarded to the provider’s nominated individual. This information had not been shared with the local authorities safeguarding team, or the CQC, and the provider had failed to take necessary action to manage the risks posed by the alleged abuser.

At this inspection we found that the service was short staffed. This had previously been found during the inspection on 10 June 2021. Four agency staff had been allocated to support the service. However, staffing levels were restricting people’s freedoms within the service, where one person was regularly restricted by being locked in their room. Access to the local community was also restricted.

Records showed that the service was regularly aiming only to achieve minimum safe staffing levels within the service, as opposed to the commissioned levels of support designed to enable people to have fulfilling lifestyles and access the community. At night the service was also regularly operated at emergency minimum staffing levels and on one recent occasion the night staffing level had been unsafe. Staffing levels planed for the two days following our first inspection day were judged to be unsafe. There was no information available to staff on staffing arrangements for the following week. We sought assurance from the provider during the first day of the inspection that staffing levels would be increased and a rota developed. This information was then provided.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. This service was unable to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and the environment of the service did not meet peoples’ current needs. Prompt action had not been taken to address and resolve these issued which had impacted on peoples’ independence.

Right care:

• Known issues in relation to the noise level in the service during the day and at night had not been appropriately addressed. This had severely negatively impacted on people’s wellbeing and led to one person becoming increasingly isolated.

Right culture:

• The ethos, values, attitudes and behaviours of the provider and it’s leaders did not enable people using the service to experience empowered lives. The provider did not work effectively with partners to ensure people’s safety.

Medicines were not managed safely, and the provider had not yet addressed the recommendation issued following our last inspection about where medicines were stored.

Incidents where unauthorised techniques were used to support people when anxious or upset had not been appropriately investigated. Poor record keeping meant it was not possible for lessons to be learned following incidents.

People did not receive the support they needed to eat and drink. Prompt action had not been taken to make necessary alterations to the service to enable a person with declining mobility to maintain their independence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Policies and systems in the service did not support this practice. Conditions associated with authorisations to deprive people of their liberty (DoLS) had not been complied with.

We received mixed feedback about the service’s current manager from staff and people ‘s relatives. The new manager had been unable to resolve issues in relation to the lack of rotas in the service before going on leave and the provider had failed to give the service additional support to resolve this issue.

Accurate records of incidents and the support people had received had not been maintained. Information provided by the current manager after the inspection, and about the staffing level achieved in the weeks prior to the inspection, did not match with information gathered during the site visit.

The provider had failed to address and resolve the breaches of regulations identified during our previous inspection in June 2021.

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 23 September 2021). The Commission took enforcement action following that inspection and warning notices were issued in relation to breaches of regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition, the provider was asked to develop action plans detailing how breaches of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 would be addressed.

At this inspection we identified repeated breaches of these four regulations and additional beaches of the regulations were also identified.

The service has now been rated inadequate. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about how the provider was safeguarding people from abuse. A decision was made for us to inspect and examine those risks.

In addition, we undertook this inspection to check whether the Warning Notices we previously served in relation to Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

As a result, we undertook an inspection to review the key questions of safe, effective, caring, responsive and well-led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified that the warning notices issued following the last inspection in relation to staffing and good governance had not been complied with. In addition, we identified repeated breaches in relation to safeguarding people from abuse and notifying CQC of significant events. new breaches in relation to person centred care, safe care and treatment, meeting nutritional and hydration needs, and premises and equipment, were also identified.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this inspection to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.