This unannounced inspection took place on 28 September 2017. Trelana provides nursing care for up to 50 older people. At the time of our inspection 44 people were living at Trelana. The service is split into two units. One of these is situated on the lower floor of the building and is for people who are living with dementia. The service was last inspected 4 February 2016 when it was rated Good in all areas. At this inspection we found that the service remained Good overall but that improvements were required in relation to our key question; "is the service safe?"

The home had a registered manager. 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 registered manager was aware of their responsibilities to inform the Care Quality Commission and local authority of any safeguarding concerns or incidents where people might have been at risk. One person had recently moved into Trelana and was unsettled and could become agitated. This had left other people feeling anxious. We found that action to improve people’s experience of the service had not been taken in a timely manner and we have made a recommendation about this in the report.

A recent recruitment drive had taken place and the service was fully staffed. People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People had their medicines managed safely. People received their medicines as prescribed and on time.

New staff received a comprehensive induction programme. Staff were appropriately trained and had the correct skills to carry out their roles effectively. They were supported by a robust system of supervision and regular training updates.

The registered manager and staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. People were 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.

People chose the meals they wished to eat and decided where to eat them. Special diets were available for people with particular dietary needs.

The registered manager told us of plans for improvements they intended to make. We found they acted quickly to address any issues identified during the inspection process. Staff described the management as supportive and approachable.

There were a series of quality assurance systems in place. Incidents were appropriately recorded and analysed.

Further information is in the detailed findings below.

This was an unannounced inspection which took place on 4 February 2016. Trelana provides nursing care for up to 50 older people. At the time of our inspection 42 people were living there. This is this service’s first comprehensive inspection since the provider took over running the service in April 2015.

The home had a registered manager. 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.

Trelana had recently been bought by a new provider and the registered manager had been in post for four months. The registered manager explained how they had both worked hard to ensure people received a good quality service that was reflective of their needs. Most of the staff team were new and had been trained to reflect this ethos in their work; and people and relatives felt the changes had improved the care people received. The registered manager told us of their vision and the plans for further changes they intended to make, which included more regular ways of seeking people’s views and opinions of the service.

People and their relatives spoke highly of the care and support people received. Care and support focussed on the person, their individual needs, their likes, dislikes and the routines that were important to them. When people’s needs changed staff reacted promptly, involving other social and health care professionals if needed.

People were provided with adequate food and fluids to maintain their nutritional health. Staff supported people as needed. Where concerns were raised action was taken. People chose the meals they wished to eat and decided where to eat them. Special diets were available for people with particular dietary needs. People who were at risk of choking had their meals prepared in line with their care plan to reduce the risk.

People told us they felt safe. All staff had undertaken training on safeguarding vulnerable adults from abuse. They demonstrated good knowledge of how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People had their medicines managed safely. People received their medicines as prescribed andon time. Staff supported people to understand what their medicines were for.

Relatives and friends were always made to feel welcome by staff who treated them with respect. People and those who mattered to them knew how to raise concerns and make complaints.

New staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.

Staff described the management as supportive and approachable. Staff talked positively about their jobs. Comments included: “I love it, every day is different.”

The registered manager and staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards.

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.