Trewan House Care Home

Updated 14 January 2023

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 Health and Social Care Act 2008.

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

This inspection was carried out by two inspectors and a medicines inspector.

Service and service type

Trewan House Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Trewan House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at 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 inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service since the registration date. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service and 8 relatives about their experience of the care provided. We spoke with 8 members of staff including the registered manager, deputy manager, senior care workers, care workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with 1 visiting healthcare professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included 8 people’s care records, and 10 people’s medication records. We looked at staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 14 January 2023

About the service

Trewan House Care Home is a residential care home providing personal care and accommodation for up to 44 people. The service provides support to older people and people who are living with Dementia in one adapted building. At the time of our inspection there were 42 people living at the home.

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

Medicines were not always managed safely. People did not always receive their prescribed medicines at the right times and some medicines were administered too close together, increasing the risk of overdose. The registered manager made immediate improvements to the safety of medicines during the inspection.

Risks to people's health, safety and wellbeing were not always safely managed. Staff did not always have access to information about how to manage people's identified risks and support them safely. The provider was in the process of moving care records to an electronic system which would support improvements in care plans and with oversight of these. However, care plans remained insufficient to guide staff on supporting people safely whilst this transition was implemented. The registered manager updated some care records during the inspection, and on day 2 we were assured about the safety of these care plans. An action plan was put in place to ensure all records could be updated in a timely manner.

Governance processes were in place and the registered manager and provider had oversight of essential aspects of the service. However, these processes were not always used effectively and some issues we identified at this inspection, such as medicines, had not been identified by the providers checks.

People were supported by kind and caring staff who treated people as individuals and with dignity and respect. Staff spoke knowledgeably about the systems in place to safeguard people from abuse. Infection control measures were in place to prevent cross infection. Staff wore appropriate PPE and the home was clean throughout. Visiting was safe and followed current guidance.

The support required by people with nutritional needs was identified and provided. People told us the chef was happy to cook other food if they did not like something on the menu.

Staff knew people well and people received care and support which was responsive to their needs. People’s choices regarding their care and how they were supported were respected, and there were enough staff to support this. We raised concerns about staffing levels on day 1, but the provider and registered manager made immediate changes to the staff rota and staffing levels were much improved on day 2.

People and family members knew how to complain, and they were confident about complaining if they needed to. Complaints were used to improve the service.

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 management of the home promoted a person-centred service. There was an open and transparent culture and good partnership working with others.

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

Rating at last inspection

This service was registered with us on 9 June 2021 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 9 February 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.