TrewCare Limited

Updated 10 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by notification of an incident following which a person using the service sustained an injury. This incident was subject to a safeguarding investigation which is on going.

The information shared with CQC about the incident indicated potential concerns about the management of risk of reporting injuries. The actions that Trewcare have taken in line with this incident have been reviewed as part of this inspection. This in particular has looked at care planning, records and staff skill and experience.

This inspection took place on 15 and 20 June 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to help us gain access to the information we required.

The inspection was completed by one adult social care inspector and an Expert by Experience. An Expert-by-Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed information we kept about the service and previous inspection reports. This included notifications of incidents. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing potential areas of concern. We reviewed the Provider Information Record (PIR). The PIR provides key information about the service, what the service does well and the improvements the provider plans to make.

We contacted fourteen people and successfully spoke with eight people who received care and support and five relatives. We also spoke with five members of staff including the registered manager and the provider.

We reviewed three care records of people using the service, medicine records and associated documentation for the operation of the service. We also reviewed three staff files, training records and records relating to the management of the service including quality audits and monitoring information.

Updated 10 July 2018

This inspection took place on the 14 & 20 June 2018.Our last inspection of the service was carried out on 2 and 3 May 2017. At that inspection the service was rated Good.

Trewcare is a domiciliary service providing personal care and support to people in their own homes. Trewcare office is situated on the outskirts of Falmouth and is accessible for people using the service and staff. The service was providing support for people living with Dementia, Mental Health, Older, People, People who misuse drugs and alcohol, Physical Disability and Sensory Impairment. At the time of our inspection 98 people were receiving support from the service.

There was a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We were alerted to a safeguarding incident where a person using the service sustained an injury. This investigation was on going and there have been safeguarding discussions around the reporting procedure and recording of incidents. Due to this the registered provider had provided a series of training to all staff in the importance of ensuring that all incidents are reported, that records are completed accurately and that staff know the correct procedure to follow. This training remains on going and continues to be a regular discussion in staff supervisions and team meetings.

People told us they had been visited by senior staff before their support began who carried out an assessment of their needs. There were procedures in place to protect people from abuse and unsafe care.

Risk assessments were in place which provided guidance for staff. This helped to minimise risks to people. Risk assessments for the environment were limited in the information they held in some instances. This was addressed within the inspection timeframe and evidence of more robust environmental assessments had been put in place.

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working for the service. Staff had the skills, knowledge and experience needed to care for people. They received training to carry out their role and were knowledgeable how to support and care for people. They had the skills, knowledge and experience to provide safe and effective support.

People told us they felt safe and comfortable with staff, they received attentive care and they liked the staff who supported them. They said staff were friendly and respectful, punctual and conscientious. People told us staff had never missed visiting them and that they usually arrived on time and informed them if they were delayed. Staff were generally supported by the same group of staff who they knew and liked. One person said, ''Lovely people, they treat me very well. Always on time, usually the same carers. We have a laugh together, they help me with my medication – always write down when I've had my tablets.'' A relative told us, ''We get an assortment of carers, they are all lovely, very kind, will do anything for us. Help my relative wash, have a shower, dress. They don't use any equipment. I sort the medication.''

People received their medicines as prescribed and when needed and appropriate records had been completed. No-one spoken with raised concerns about their medicines.

Care plans contained a good level of information with guidance to support staff in their role and delivery of care and support. People who wished to be involved in care reviews did so. Care plans were more task based about the delivery of care. We discussed the merits of a person centred approach where the person was at the centre of their care. The registered manager acted on this with immediate effect providing evidence of the change following the inspection. It meant care plans were more meaningful.

Staffing levels were seen to be sufficient to meet the assessed needs of the people. People and relatives told us that staff were consistent and turned up on time.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff we spoke with had a good understanding of protecting and respecting people’s human rights. Staff spoke well about confidentiality, privacy and dignity and this came through when speaking with people.

The service had information with regards to support from an external advocate should this be required by them.

A number of audits were undertaken to ensure the on-going quality of the service was monitored appropriately and lessons were learned from issues that occurred.

The service communicated well with people, relatives and staff. We saw evidence of a number of ways this was done including memo’s, newsletters and spot-checks.