We carried out an unannounced comprehensive inspection at HF Trust - Trelawney on 6 June 2018. The previous inspection took place on 23 June 2016. We had no concerns at that time and the service was rated Good. At this inspection we identified some concerns and the rating has been changed to Requires Improvement.

HF Trust - Trelawney is a care home providing care and accommodation for up to six people with a learning disability. At the time of the inspection six people were living at the service.

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.

Care was not being delivered in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Some people did not get along together and this had led to altercations within the service. Staff worked to keep people safe but this had impacted on people’s ability to move freely and independently around the service. People’s behaviour and records showed some people were unhappy.

The service requires a registered manager and there was one in post. 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.

CQC had not been informed of an incident that occurred at the service until 16 days after the event. The same event had not been recorded or reported appropriately and in line with HF Trust’s policies and procedures.

Where risks were identified action was taken to protect people from harm. Staff were aware of their responsibilities under safeguarding and took these seriously. They were able to describe to us the action they would take to keep people safe.

Staff were sympathetic and compassionate in their approach to people. They were clearly saddened by the circumstances within the service and empathised with people’s situation.

Roles and responsibilities were clearly defined and understood by all. Systems for communicating about changes in people’s needs were effective. Staff were supported by a thorough system of induction, training, supervision and staff meetings.

Activities provided were varied and met people’s individual preferences and interests. Family contact was valued and encouraged. Relatives told us they were kept informed of any changes and were invited to take part in care plan reviews.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being in daily logs.

There were a range of quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager, staff and other staff with a national remit employed by the provider.

We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We inspected HF Trust – Trelawney on 23 June 2016, the inspection was announced. This was because it is a small service and we wanted to be sure people would be available to talk with us. HF Trust – Trelawney provides care and accommodation for up to six people with a learning disability. At the time of the inspection five people were living there.

There was a registered manager in post. 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.

The service was last inspected in April 2015. After that inspection we asked the provider to make improvements in respect of care plans, ensuring the rights of people who lacked capacity to make specific decisions were protected and the leadership of the service. The provider subsequently sent us an action plan outlining how improvements would be made and we checked to see this had been completed. We found all the actions had been completed.

There were clear lines of responsibility in place. The registered manager was supported by a senior support worker. People had been assigned key workers and co-key workers with responsibility for their day to day care. Staff members had been assigned responsibility for various weekly and daily checks to help ensure the smooth running of the service.

The premises were well maintained and decorated. There was a large decking area outside where people were able to enjoy barbeques. New garden furniture had been sourced which would help ensure everyone was able to enjoy these events.

Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the registered manager. Other training identified as necessary for the service was updated regularly. Staff received supervision and appraisals. New employees were required to complete a thorough induction which incorporated training, familiarisation with policies and procedures and shadowing more experienced staff.

The provider acted in accordance with the requirements laid out in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). People were able to make every day decisions such as how and where they spent their time and what they ate. Staff recognised and respected people’s rights.

Care plans were personalised, detailed and updated regularly. They contained information about people’s likes and dislikes as well as information regarding their health needs. Staff were aware of people’s preferences and how they wished to be supported. People worked with keyworkers to review care plans on a monthly basis. The care plans were kept on an electronic system and there were no easy read versions available for people to keep.

There were effective quality assurance systems in place to monitor the standards of the care provided. People, relatives and staff were asked for their opinions and suggestions regarding the running of the service.

We inspected HF Trust Trelawney on 14 April 2015, the inspection was announced.

HF Trust Trelawney provides care and accommodation for up to six people with a learning disability. At the time of the inspection five people were living there. We last inspected the service in October 2013, we had no concerns at that time.

There was a registered manager in post. 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. However at the time of the inspection the registered manager was unavailable. Instead we spoke with the service manager and senior support worker who were covering for the registered manager in their absence.

HF Trust Trelawney had been short staffed prior to the inspection and had found it difficult to recruit new staff. This had led to them being reliant on agency staff for a period of time. At the time of the inspection there were several new members of staff in post who were going through their induction period. This involved training and shadowing more experienced members of staff. In order to support this process experienced relief staff were working alongside the staff team. There was always a suitably qualified and experienced member of staff on duty to support the new employees and ensure all the necessary duties were fulfilled. There was a robust recruitment system in place which included carrying out background checks to minimise the risk of employing people who were unsuitable for the role.

Training identified as necessary for the service was being undertaken by staff as part of the induction process. Other staff had already received this training. Some staff had also received additional training specific to the needs of the people living at HF Trust Trelawney. Due to the pressures of training new staff not all had received training defined in risk assessments as being important for people. We have made a recommendation about this in the report.

Senior staff had received training in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Training was booked for the remainder of the staff team. No applications for DoLS authorisations had been made although people were unable to leave the building unsupervised. This meant the delivery of care may have been unlawful. You can see what action we have asked the provider to take at the back of this report.

The senior support worker was running the service on a day to day basis as the registered manager was absent from work. They were supported by a senior support worker from another HF Trust service and a service manager who was the registered manager of another service.

Staff felt well supported by a system of regular supervision and staff meetings. They told us they were able to ask for advice and support when they needed it and the senior support worker was approachable and available. Changes and improvements to support plans were required as some information was out of date or inaccurate. Due to the temporary nature of the management of the service this was not yet being done although it was acknowledged as necessary. We found this was a breach of regulations. You can see what action we have asked the provider to take at the back of this report.

Families said things had improved recently and told us they had confidence in the new staff team. One commented; “There are a lovely, nice lot of people working there at the moment. They are all very good.”

People were relaxed around staff and chatted with them about arrangements for the day and past events. When talking to us about people staff were respectful and demonstrated an interest in people’s well-being and how they could support them to have meaningful lives. People had access to a range of activities which suited their interests.

Peoples’ privacy, dignity and independence were respected.

Care Plans were informative and directed staff as to the care and support people needed.

Suitable arrangements were in place to ensure people were safeguarded from the risk of abuse.

There were robust systems in place to ensure medicines were handled safely, securely and appropriately.

HF Trust Trelawneys’ facilities and furnishings were to a good standard.

HF Trust - Trelawney supported a maximum of six people, in a domestic house, with a diverse range of needs. Some people we met were able to make decisions about their lives. Others had limited communication and needed full personal care and assistance with activities around the home. Subsequently the support people received ranged from prompting with their day to day needs to full assistance with personal care. Some people went out independently whilst others needed more one to one support.

Everyone we met looked well cared for. Typical comments from people who used the service included "the staff are very nice." and “they have helped me when I needed it”.

Documentation we saw was to a good standard. Care plans provided clear information regarding care and what support staff needed to assist people with.

Staffing levels were satisfactory, and there was evidence that staff had received suitable training.

A satisfactory quality assurance system was in place.

We inspected Trelawney on 10 December 2011. People living at Trelawney are not able to express themselves in a way that is easily understood without prior in-depth knowledge of the individual. We observed people interact with each other and with staff in a way that was unrestricted and spontaneous. People were seen to be relaxed with each other.

Staff told us that training was provided, that they enjoyed working at Trelawney, and that they felt they could approach the manager and senior staff if they needed to. Staf told us that they enjoyed their work.