CQC report explained · a residential care home
What the CQC found at Trewidden Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Staffing and recruitment had improved, medicines were managed safely, and the home was clean, although some medicine records still needed updating.
- Effective?
- Good
- People's needs were assessed and care plans gave staff guidance. Staff training, nutrition support and access to health professionals had improved.
- Caring?
- Good
- Staff were kind, patient and respectful. Inspectors saw people being treated with dignity and relatives said they were kept informed.
- Responsive?
- Requires improvement
- Care plans reflected people's needs, but the environment and activities did not always offer meaningful stimulation for people with dementia. Four pressure-relieving mattresses were also set incorrectly when checked.
- Well-led?
- Good
- The acting manager was approachable and involved in care. Quality checks were in place, but action following some audit findings was delayed or not clearly recorded.
What inspectors found, May 2019
Rated Good overall; inspectors found kind, safe care, but activities and the dementia environment needed improvement.
The inspection was unannounced and took place on 23 April 2019. One inspector, a medicines specialist and an Expert by Experience visited. They spoke with people, relatives, staff and managers, and checked care records, medicines, recruitment, training, safety and quality checks.
The home was rated Good for safety, effectiveness, care and leadership. Inspectors found enough safely recruited staff, organised medicines, clean premises and caring relationships. People were supported with their health, nutrition, choices and privacy.
The home was rated Requires Improvement for being responsive. Communal areas did not provide enough useful or interesting stimulation for people with dementia. Activities were not always linked to people's past lives and some people risked becoming isolated in their rooms.
There were also problems with four pressure-relieving mattresses being set incorrectly, although inspectors found no resulting harm. The home had improved since its previous Requires Improvement rating in 2018, but some audits still took too long to lead to action.
Kind relationships
Inspectors saw warm and respectful interactions. Staff knew people well and understood their preferences and health needs.
“Throughout the inspection visit we saw many positive interactions between people and the staff and management.” from the report
Safe staffing
Staffing levels had increased and inspectors found enough staff to meet people's needs. Recruitment checks had been completed.
“There were now sufficient numbers of staff to meet people's needs. Staff were happy and morale was good.” from the report
Medicines and premises
Medicines were given as expected and stored safely. The premises were clean and equipment was in good working order.
“Medicine systems were organised, and people were receiving their medicines when they should.” from the report
Personalised care records
Care plans described people's routines, preferences and needs. Daily records were detailed and reflected the care provided.
“Care plans were person centred and provided clear detail and guidance for staff to provide care and support in the way each person preferred.” from the report
Dementia environment
needs fixingCommunal areas had few suitable things for people with dementia to handle or use. People were sometimes inactive for long periods.
“The communal areas lacked sufficient stimulation for people with dementia.” from the report
Activities were not always meaningful
needs fixingActivities were available, but they did not always relate to people's backgrounds and interests. People who stayed in their rooms could become isolated.
“However, people living with dementia were not always provided with meaningful occupation, such as activity that related to their past lives.” from the report
Mattress checks
needs fixingAll four pressure-relieving mattresses checked were set incorrectly for the people using them. The settings were corrected during the inspection and a new checking process was introduced.
“However, all four mattresses were set incorrectly for the person using them at the time of this inspection.” from the report
Delayed action on audits
minorSome identified problems were not dealt with promptly, including kitchen staff training that had been outstanding since November 2018.
“However, there had been delays in action being taken once issues had been identified by an audit.” from the report
- 01What meaningful activities are now available for people with dementia, and how are they linked to each person's past interests?
- 02How do you support people who choose to stay in their rooms so they do not become isolated?
- 03How are pressure-relieving mattress settings checked and recorded every night?
- 04How quickly are problems found through audits now acted on and formally closed?
- 05Who is currently responsible for managing the home, following the recent departure of the registered manager?
This was an unannounced planned inspection covering all five CQC questions; the previous inspection was published on 1 May 2018. This explanation was written from the published report of 14 May 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2018
Trewidden Care Home is rated Requires Improvement; inspectors found kind, personalised care but concerns about safety, staffing support and decision records.
This was an unannounced comprehensive inspection on 27 March 2018. Inspectors spoke with people living in the home, staff, visitors and a healthcare professional. They observed care, looked around the building and checked care plans, medicines records, staff files and other records.
People were treated kindly and with respect. Care plans were generally up to date, medicines were given as prescribed, meals met people's needs and there were varied activities. The home was clean and comfortable, although some carpets were torn, worn or rucked and could cause trips.
The home was rated Requires Improvement overall. Safe and Effective were also Requires Improvement, while Caring, Responsive and Well-led were rated Good. The home had improved since the previous inspection, and inspectors found no breaches of regulations, but they said further work was needed.
Kind and respectful care
Staff knew people well and treated them with kindness, compassion and respect. Inspectors saw calm, patient and reassuring interactions.
“Staff were kind and compassionate and treated people with dignity and respect.” from the report
Personalised support
Care plans reflected people's needs and preferences and were reviewed when needs changed. People were supported to make choices about daily life.
“People received personalised care and support which was responsive to their changing needs.” from the report
Food and activities
People were offered varied food suited to their preferences and dietary needs. The home provided group activities and individual support, including trips into the local area.
“The activities coordinator was positive, enthusiastic and had made considerable efforts to provide inclusive and stimulating activities” from the report
Improved records and systems
Care records had moved to an electronic system and medicines records showed that people received their medicines as prescribed. Audits had led to several improvements.
“There were effective quality assurance systems in place to monitor the standards of the care provided.” from the report
Trip hazards and window risk
seriousSome carpets remained torn, worn or rucked, with tape lifting in places. Inspectors also found no clear evidence of how the risk from objects being thrown from a first-floor window was being managed.
“The service was not entirely safe. Risks such a trip hazards due to rucked and torn carpets, and the risk to people and property on the ground below a person's window had not been managed robustly.” from the report
Staff support and staffing pressure
needs fixingSome staff did not feel valued or supported and did not recall regular one-to-one supervision. Staff views about staffing levels were mixed, with some saying they did not always have enough time to talk with people.
“Some staff felt that as there were eight people who required two staff for all care, that there were not sufficient staff to enable them to have time to chat with people.” from the report
Best-interest decisions
seriousRecords did not always show that capacity assessments and best-interest processes had taken place before some decisions about care, restrictions or covert medicines.
“There was no evidence of the best interest process having been carried out to ensure this was the least restrictive action and in the person's best interests.” from the report
Inconsistent one-to-one records
needs fixingOne-to-one staff did not always provide or record support in the same way. Some used paper records and others used the electronic system.
“We recommend that the service standardise the support provided by one to one staff and how all care and support is recorded to ensure consistency of care.” from the report
Weight recording
needs fixingOne person's records showed a possible weight loss of more than five kilograms, but the home said this was a recording error and had no records to confirm this.
“We recommend the service reviews the systems and processes used to monitor and record people's weight.” from the report
- 01Have all the torn, worn and rucked carpets now been replaced, and what is the current plan for preventing items being thrown from the first-floor window?
- 02How do you check that staffing levels are enough for people who need two staff, including time for conversation and activities?
- 03How often does each staff member now receive one-to-one supervision, and how is this recorded?
- 04How do you complete and record capacity assessments and best-interest decisions before using restrictions or giving medicines covertly?
- 05How do you make sure one-to-one staff provide and record support consistently, including agency staff?
This was an unannounced comprehensive inspection covering all five key questions and reviewing actions from the previous inspection. This explanation was written from the published report of 1 May 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Trewidden Care Home
4 rated inspections over 4 years: the service has held its Good rating throughout.
- May 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- May 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- March 2017Requires improvementdown from GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 30 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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