Archived: Trefula House

Updated 10 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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide 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 team consisted of two inspectors.

Service and service type

Trefula House is a 'care home'. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at on this inspection.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We also reviewed information that we held about the service such as notifications. These are events that happen in the service that the provider is required to tell us about. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

Most people were unable to tell us about their experiences of living at the service, so we observed how people spent their time and how staff interacted with them. 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 spoke with the manager, the nurse in charge, four care staff, the cook, a housekeeper and a visiting healthcare professional.

We reviewed a range of records. These included four people’s care records and multiple medication records. We looked at three staff recruitment files. A variety of records relating to the management and monitoring of the service, including maintenance and fire safety checks.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We reviewed the documents we had requested from the manager and obtained feedback from four healthcare professionals and two relatives. We had a video call with the manager and the clinical lead to provide feedback.

Updated 10 December 2021

About the service

Trefula is a care home that provides personal and nursing care and is currently registered for up to 44 primarily older people. The top floor of the building is no longer being used by the service and previously had 14 bedrooms. The provider is in the process of changing the number of beds the service is registered for, although the exact number is still under discussion. Some people living at the service were living with dementia and/or had other mental health issues. At the time of the inspection 17 people lived at the service. The service was divided into two units, one for people living with dementia and the other for people with a range of nursing and mental health needs.

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

Since the last inspection there had been management changes at the service. A new manager started in March 2021, shortly after the previous manager had left, and they had left a few weeks before our visit. An operations manager, who was already supporting the service, took over as the acting manager six weeks before this inspection. There were plans to advertise and recruit a new manager.

Systems to assess and monitor the quality and safety of the care provided had been developed since the last inspection. However, these systems were still being implemented and were not yet fully effective in assessing quality or identifying and driving improvement.

Since taking over the service the new provider had completed a consultation process with staff about shift patterns and working hours. The process concluded at the beginning of November 2021, and although it had taken up a lot of management and staff time, it had been necessary in order to move forward with the running of the service and have rotas that fitted with people’s needs. However, this had resulted in some staff leaving and while new staff had been recruited, it had been necessary to use agency care staff and nurses for several months.

We found there were enough permanent and agency staff on duty and rotas showed staffing levels were adequate. However, on the day of the inspection one person, who usually got up for part of the day, had stayed in bed because there was only one care worker available, in that unit, and the person needed two staff to hoist them out of bed. We observed that there were free staff in the other unit and they were not asked to help. Staff also told us there have been other days, especially at weekends, where some people have stayed in bed due to there not being enough staff working in a particular unit.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and responded to calls for help from people in a timely manner. Staff knew how to keep people safe from harm.

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 premises were clean and there were no malodours. At the time of our inspection an extensive programme of work was taking place to replace fire doors, emergency lighting, door alarms and other general repairs to ensure the premises were safe and met fire regulations.

Information about people's care needs, and any changes to those needs, were individualised, informative and shared effectively within the staff team. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through effective shift handovers and records of the daily care provided for people. People were offered a range of healthy meal choices.

Feedback from professionals and families were positive about staff and how well they cared for people. They also told us that improvements to the service had been made, commenting, “The home is better than what it was”, "In all my dealing with the home I have found them to be fair and helpful", “Regular staff are good and really caring”, “There seems to be more regular staff” and “I can see improvement and changes for the better.”

Staff had received appropriate training and support to enable them to carry out their role safely and effectively. Some training and supervision had fallen behind. However, plans were in place to bring training, supervision and appraisals up to date.

We were assured that risks in relation to the COVID pandemic had been managed appropriately. Staff had access to appropriate PPE and hand washing facilities, which they used effectively and safely.

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 (report published on 1 October 2021) and there were two breaches of regulations. The provider completed an action plan after that inspection to show what they would do and by when to improve. We carried out a targeted infection control inspection on 23 March 2021 to check on one of the breaches in relation to infection control. Enough improvement had been made and that breach of the regulations was met.

Why we inspected

We carried out an unannounced inspection of this service on 11 January 2021. Breaches of legal requirements were found. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this report.

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

Enforcement

At this inspection we have identified breaches in relation to auditing and monitoring systems and how staff are deployed.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.