Trewithen

Updated 6 October 2022

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 included checking the provider was meeting COVID-19 vaccination requirements. 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

Two inspectors carried out the inspection.

Service and service type

Trewithen 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 had a manager registered with the Care Quality Commission. 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.

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 sought feedback from the local authority. 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 used all this information to plan our inspection.

During the inspection

We met all four people who were living at Trewithen. They were not able to tell us about their experience of the service, so we observed how they spent their day and how staff interacted with them. We spoke with eight staff members including the registered manager. We looked at two people’s care records and medicines records, as well as records relating to the management and oversight of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and staff recruitment records. We spoke with two relatives and received feedback from one professional.

Updated 6 October 2022

About the service

Trewithen provides care and accommodation for up to five people who are autistic. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

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

The provider had completed appropriate checks when they recruited permanent staff. However, they had not assured themselves a staff member who had been employed via a staffing agency, working long term in the service and also living there, was of good character or suitable to work with vulnerable adults.

A staff member who had been working at the service since December 2021 had only received a one-day induction and no further training.

Risks related to the safety of the service had not always been assessed or acted upon.

Audits and action plans had not identified all the areas for improvement identified during this inspection; for example, fire risks, staff recruitment and training. This meant people were exposed to the risk of 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.

People had been supported to have their medicines reviewed and reduced, where appropriate.

Staff had received safeguarding training, and information about who to contact with any safeguarding concerns was displayed in the service.

Staffing had been used flexibly to help ensure people received the support they needed.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Staff understood people’s preferences and enabled them to make choices about how they spent their day; however they had not been consulted for their views about a staff member living in the service. People’s records described what support they required to maintain their independence. People’s records described how people needed information presenting to them to help them understand it. Staff had developed personal communication dictionaries for people which helped them develop a more consistent understanding of people.

Right care:

People received person-centred care; however, at times, the language staff used did not reflect this ethos. Staff were aware of the risks of social isolation but balanced this with protecting people’s privacy and dignity. Records showed the aims and ambitions for people, why this would benefit them, steps they needed to take to achieve them, and who they would need to help them. The environment had been reviewed and adapted to meet people’s sensory needs and preferences.

Right culture:

The registered manager was aware of best practice guidance and was supporting the team to identify any improvements that could be made. External professionals had been used to help ensure people were receiving the right care and support for their needs.

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

Rating at last inspection

The last rating for this service was good (published 18 April 2018).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 monitor the service and will take further action if needed.

Enforcement and recommendations

We have identified breaches in relation to reducing risks, training and the running of the service. We have made three recommendations in relation to medicines management and person-centred care. Please see the action we have told the provider to take at the end of the full report.

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.