This inspection visit took place on 19 February 2018 and was announced. This was because Trefusis is a small service where people often go out. We therefore needed to be sure people and staff would be available. The last inspection took place on 15 December 2015 when the service was meeting the legal requirements. The service was rated as Good at that time. Following this inspection the service remains Good.

Trefusis is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Trefusis is a detached dorma bungalow and is registered to accommodate three people. At the time of the inspection three people were living at the service. It is part of Spectrum (Cornwall Autistic Community Trust), an organisation providing support and care for people with autism living in Cornwall.

The service has three bedrooms one being on the first floor. There is a lounge and open plan dining and kitchen area. There is one bathroom with bath and shower as well as a toilet and a separate additional toilet. There is a rear outdoor area and raised garden. People living at Trefusis did not require any aids or adaptations to support them. Trefusis is situated in a residential area of the town of Redruth . It is close to the town centre and there is on-street parking.

We spoke with two people living at Trefusis. They told us they had lived at the service for a long time and liked living there. They told us they were supported to maintain their independence and do things they liked, such as taking part in activities and interests of their choice. They said, “Like living here,” “I go out on my own which I like doing” and “The staff help me.”

There were times when staff were directed to support other services during a shift which reduced the numbers available at Trefusis. This was usually managed so it did not impact on what people living at Trefusis did. However there had been occasions when activities had been missed. We have made a recommendation about this.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff who had responsibility for the administration of medication had completed appropriate training. Medicines were administered safely by staff and the arrangements for storage and recording were satisfactory.

People were supported to make decisions and their rights were protected in line with relevant legislation and guidance. People were supported to access healthcare services. We saw that advice and guidance from healthcare professionals was incorporated into care plans to ensure that staff provided effective care and support. People’s nutritional needs were met; their likes, dislikes and special diets were known by staff and were catered for.

The service had an effective recruitment process and this ensured only people considered suitable to work with vulnerable people had been employed. We saw that there were sufficient numbers of staff employed to meet the needs of people who lived at the home.

Staff told us they were happy with the training provided for them, and we saw that there were effective induction training and refresher training programmes in place.

There was an emphasis on promoting dignity, respect and independence for people who lived at the service. People told us staff treated them as individuals and delivered person centred care. People living at Trefusis had lived together for a number of years. However, each person had their own lifestyle ch

We inspected Trefusis on 18 December 2015, the inspection was unannounced. The service was last inspected in September 2013, we had no concerns at that time.

Trefusis provides care and accommodation for up to three people who have autistic spectrum disorders. At the time of the inspection three people were living at the service. 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.

Trefusis is part of the Spectrum group. It is located on the outskirts of Redruth within walking distance of the town. There are good local transport links to the nearby city of Truro. People were able to access the local community and amenities easily. An external professional we contacted prior to the inspection noted; “The staff are very proactive in taking the residents out in the local community so I hope you find them at home for your visit!”

The atmosphere at Trefusis was relaxed and welcoming. People approached us on arrival and introduced themselves. Throughout the day we chatted with people as they popped in and out of the office between trips out and daily chores. Interactions between staff and people were friendly and supportive. One person preferred not to spend time with the others and staff described to us how they worked to support them according to their preferences. We heard staff asking people when and how they wanted to be supported. Bedrooms had been allocated to give the person as much personal space and privacy as possible within the house. In addition staff had worked with them to develop their independence so they were able to spend short periods of time alone. Risk assessments were in place relating to people’s support needs and lifestyle. They reflected the actions needed to minimise risk while promoting well-being and independence.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the manager and organisation.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Staff demonstrated a good understanding of the main principles of the Mental Capacity Act (MCA).

Staff had access to regular training, supervision and appraisals. It was a small staff team and they communicated well sharing knowledge and information effectively. Staff meetings were an opportunity to contribute to the development of the service and individuals.

People’s support plans included clear and detailed information about their health and social care needs. Although care plan reviews were held regularly information within the plans was not always up-dated in a timely manner. A new member of staff told us they had gained most of their knowledge about people from more experienced staff.

Roles and responsibilities were well-defined and understood by the staff team. The registered manager was supported by two deputy managers who were in a job share role. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual.

There were effective quality assurance systems in place to monitor the standards of the

We spoke with three people who used the service. They told us they liked living at Trefusis and liked the staff. They told us they had opportunities to pursue their interests and had a say in how their home looked and was run.

We observed staff interact with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined two people’s care files and found the records were up to date and reviewed as the person's needs/wishes changed.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff said they had received sufficient training and support to enable them to carry out their roles competently and felt there was sufficient staff on duty.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people’s rights

We were able to speak with the three people that live in the home. People all said they were happy living in the home and they had no concerns about their care, the activities provided, the staff that worked with them or the food that they assisted in preparing. From our observations people seemed happy living in the home, and there were positive interactions between staff and people using the service.