Archived: Trefula House

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.

At our inspection on 11 January 2021 we had concerns about infection control procedures and practice. Handwashing facilities, signage, and procedures to screen visitors were not appropriate. Some staff were not wearing masks correctly. Covid 19 policies and procedures were not in place, and some staff told us they had not received appropriate training. At this inspection we found the necessary improvements had been made and the breach of regulations had been met.

We found the following examples of good practice.

There had been a recent outbreak of Covid-19 at the service. During this time people and their families had been kept informed about the measures the service had put in place to help keep people safe.

Staff were observed using the appropriate PPE and wearing masks correctly. The procedure for staff and visitors to enter the premises had been updated and was robust. Supplies of PPE and suitable handwashing and hand sanitising facilities were available at the entrance to the service and throughout the building. Appropriate waste bins were in place for the disposing of used PPE. There was ample signage on approach to the service and at the entrance explaining to visitors the infection control measures in place. There were also posters around the service to prompt and remind staff about the infection control procedures in place.

The design of the service meant zones could to be created, where people who were Covid positive were cared for in designated areas, to prevent the risk of the virus spreading to others. During the outbreak there was a separate staff team dedicated to only working in the zone where people were Covid positive. In the Covid positive zone part of a lounge had been converted into a kitchen area to enable staff to make snacks and drinks for people without having to leave that part of the service. Main meals were brought to the door of the zone and served by the care staff. Disposable plates and cutlery were used to further reduce the risk of cross infection with people and staff in other parts of the service.

Staff used different entrances, depending on which zone they were working in. There were designated bathrooms close to the entrance of each zone for staff to wash and sanitise their hands and to put on and take off their PPE. Staff put on and took off their uniforms in the designated areas. This helped to reduce the risk of infection because staff did not enter areas of the service, where people lived, until appropriate infection control measures were in place and they did not need to move between zones.

All areas of the service were clean and uncluttered. There were appropriate procedures to ensure that infection control risks were reduced. For example, in shared lounges and dining rooms furniture had been re-arranged to create more space to enable people to social distance. Cleaning hours had been increased and cleaning procedures had been reviewed and updated. High contact areas were cleaned regularly throughout each shift.

Staff had received suitable training and guidance regarding infection control, and how to respond to the Covid pandemic. There were regular observations of staff practice and spot checks to ensure all staff understood and were following the correct infection control procedures. During the inspection we observed staff demonstrating a good knowledge of effective infection control practice.

The service had appropriate policies and procedures in respect of Covid 19 and its implications on the running of the service. From our discussions and observations these had been effectively implemented.

Due to the recent outbreak the service was closed to visitors at the time of the inspection. However, staff helped people to stay in touch with family and friends through phone and video calls. Staff were in discussion with people and their families about resuming visiting in line with recent changes to government guidance.

Suitable testing routines had been arranged for staff and people who used the service. We were advised that both staff and people had been happy to participate in regular testing.

Although the service was currently closed to new admissions there were robust admission procedures in place. This included the service asking for evidence of a negative Covid-19 test results before people moved in, followed by a period of self-isolation.

Further information is in the detailed findings below.

Trefula is a care home that provides personal and nursing care for up to 44 people, all who are living with dementia, and / or have other mental health issues. At the time of the inspection 39 people lived at the service. The service primarily caters for people aged 65 and over, although at the time of the inspection some younger people were accommodated. The service was divided into two restricted units; ‘St Mawes’ / ‘Restormel’, and ‘Pendennis’ / ‘Carn Brea’.

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

Although the building was clean, policies and procedures in relation to Covid 19 were not fully in place. The handwashing facility outside the building was untidy and the floor had not been cleaned. Signage on the first day was not clear or not readable as they had faded. No written procedures were available and staff were not aware of them. Despite us stating our concerns on the first day of inspection, procedures were still not fully in place by the third day of the inspection. Some staff told us they had not received appropriate Covid-19 training.

There were enough staff on duty, but there was a high reliance on agency staff. Staff were observed as attentive, kind and caring.

We were informed before this inspection that the Registered Manager was away from work. Interim management arrangements had been put in place. Systems to ensure compliance with regulations for example in regard to audit systems, and infection control, were not consistently applied, or effective to ensure the service was managed to a good standard.

People we spoke with were all happy with the service. For example, comments received included: “Staff treat me nice, the food is good and I have no complaints,” and “Food is pretty good. Care is very good.” Relatives told us “(My relative) seems well cared for,” and “I feel (my relative) is well cared for, and “I am contacted (by the service) regularly.” Visiting professionals told us: “Nursing staff are always polite (and) generally well informed,” and “Communication is good.”

Safeguarding procedures were satisfactory and suitable action was taken to minimise the risk of abuse.

Risk assessment procedures, in respect of the care of people were satisfactory. Documentation detailed risks and how they should be minimised. Environmental risks were generally well assessed. Risk assessment procedures in relation to Covid 19, as outlined, were poor.

Throughout the inspection there was a pleasant atmosphere, people were happy and relaxed, and routines were well organised and not rigid.

People were positive about the food, said they had enough to eat and were offered a choice. People could make a hot or cold drink when they wanted and this was apparent throughout the inspection.

Two activities workers were in post, so there were some activities six days a week. Activities currently provided included arts and crafts, singing, quizzes, bingo, and baking.

The team worked well together and had the shared goal of providing a good service to people who lived at the service. “Staff who work here are passionate about what they do and they stick together and provide the best care they can…we are like family.”

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 05/08/2019 and this is the first inspection.

Why we inspected

This was a planned 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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we have identified breaches in relation to infection control and good governance. 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 to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. Please see the action we have told the provider to take at the end of this report.