This inspection took place on 3 and 4 May 2018 and was unannounced.

Trepassey 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.

During the inspection, there were 12 people living in the home. People had moved to the newly built extension the day before the inspection took place. The new extension provided 15 bedrooms over two floors and a lift was available between the floors. Due to the location, both floors led outside without the need for people to use stairs or the lift. The registered manager told us the older part of the home would now be fully refurbished.

At the last inspection in March 2017, the registered provider was found to be in breach of Regulations due to risks regarding water temperatures and ineffective audit systems. The provider completed an action plan to show what they would do and by when to improve the key questions of whether the service was safe and well-led, to at least good. We found that water temperatures were within safe ranges, however other concerns were identified and although the registered provider was no longer in breach of Regulation, we made a recommendation regarding this in the main body of the report. Systems in place to monitor the quality and safety of the service had improved.

A registered manager was in post and feedback regarding the management of the service was positive. 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.

Not all risks had been assessed appropriately. For example, a fire risk assessment of the new building had not been completed prior to people moving in and risks posed by balconies had not been assessed prior to their use. After the inspection we received confirmation that the fire risk assessment had been completed and no major concerns had been identified. Records showed that there were a range of other internal and external checks that had been completed to help ensure the building and equipment remained safe.

Staff felt supported in their role and had completed a comprehensive induction when they started in post and had access to regular training. However, not all staff had received regular supervisions and annual appraisals had not been completed.

Most safe staff recruitment procedures were followed when recruiting staff. Relevant checks had been recorded and all but one staff member had provided a full employment history. The registered manager agreed to ensure the staff member provided this.

People we spoke with told us they felt safe living in Trepassey. Staff were knowledgeable about safeguarding processes and appropriate referrals had been made to the local authority for investigation. There were sufficient numbers of staff on duty to meet people’s needs and help maintain their safety. Accidents and incidents had been recorded and reported appropriately. The registered manager maintained a log of all accidents and reviewed these every month to help identify and learn from potential themes or trends.

Medicines were ordered and administered safely. Staff had received training and had their competency assessed in this area. However, temperatures were not monitored in all areas where medicines were stored and the registered manager agreed to ensure thermometers were available in all areas. We also found that there were no protocols in place to guide staff when to administer PRN (as and when required) medicines to ensure that people received them consistently and when needed.

People at the home were supported by staff and other external health care professionals to maintain

This unannounced inspection was conducted on 13 March 2017.

Trepassey Residential Home is part of a group of homes owned by Cheshire Residential Homes Trust. The home is situated in lower Heswall, Wirral and overlooks the River Dee. Accommodation is provided over three floors and there is a lift available. There are separate communal lounges and dining areas. Trepassey is registered to provide personal care to a maximum of 24 people. At the time of the inspection 11 people were using the service. This was because there was extensive building work taking place on-site and the provider had restricted admissions until the work was completed.

A registered manager was not in post. However, the acting manager had made an application to become registered. 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.

At a previous inspection in November and December 2015 we identified breaches of regulations relating to; consent, good governance, notifications, safe care and treatment and person-centred care. We returned to Trepassey in September 2016 to ensure that the service was safe. At this comprehensive inspection we assessed the service’s compliance with all regulations.

At the inspection in November and December 2015 we found that the provider was in breach of regulations relating to good governance. Specifically, the provider had not submitted notifications as required and did not have robust systems in place to monitor and manage risk at the service. We saw evidence that notifications had been submitted appropriately since the inspection in November and December 2015 and the service was no longer in breach of regulation in this regard. However, we saw continuing deficits in audit processes which placed people at unnecessary risk of harm.

We were provided with evidence that regular checks were completed on other aspects of the service with regards to people’s safety. For example, electrical safety, gas safety, hoists and water temperatures. However, we saw that the temperature of the hot water accessible from one outlet in the bathroom regularly exceeded recommended, safe limits.

At the inspection in November and December 2015 we found that the service was in breach of regulation because it was not operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). Improvements had been made, but the service was not following best-practice in relation to the assessment of capacity. We made a recommendation regarding this.

At the inspection in November and December 2015 we found that the service was in breach of regulation because care records did not hold sufficient, current, person-centred information to inform care practice. At this inspection we looked at four care records in detail to see if improvements had been made and sustained. We saw evidence of sufficient improvement meaning that the service was no longer in breach of regulation. This breach had been met.

Prior to this inspection we received information of concern which alleged that staff were not completing the necessary safety checks on people throughout the night. People spoke positively about their safety and the night-time checks. The frequency of checks was recorded in people’s daily notes. Records indicated that all checks had been completed as required.

Prior to the inspection we received information of concern which alleged that staff were reluctant to raise concerns and that when concerns were raised, the provider did not always respond to them appropriately. We saw that staff were vigilant in monitoring safety and acting to protect people from harm. The staff that we spoke with had completed training in adult safeguarding and knew what action to take if they su

Trepassey Residential Home is registered to provide personal care and accommodation for up to 24 people. The home is a detached three storey building in Heswall, Wirral.

The home had a new registered manager since our last inspection. 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.

We carried out an unannounced comprehensive inspection of this service on 27 November and 1 December 2015 during which we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have suitable systems in place to ensure the proper and safe management of all medicines in the home; the provider did not have suitable procedures in place to do all that is reasonably practicable to mitigate the risks associated with fire in order to protect people from risk; people’s plans of care did not fully meet their needs or manage risks to their health and welfare.

After the comprehensive inspection, we served a warning notice and told the provider to make improvements in relation to the breach.

We undertook a focused inspection on 7 September 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Trepassey Residential Home’ on our website at www.cqc.org.uk.

On 7 September 2016 we found that major building work was underway to extend and improve the premises and the home was currently able to accommodate a maximum of 12 people. There had been no admissions to the home since our last inspection.

We found that new storage for people’s prescribed topical medication had been provided and nobody was administering their own medication. People’s care plans had been re-written by the deputy manager. Staff had received fire safety training and appropriate procedures were in place.

We spoke with four people who were resident in Trepassey Residential Home. They told us that staff always consulted them about their individual needs and involved them in decisions about their care and support.

People were very happy with the care and support provided. One person said "I am very satisfied and feel very lucky to be here." Another told us "It's very good, on the whole, very nice indeed."

We spoke with one visiting health professional who told us they had no concerns about the care and welfare of people who lived at the home. This person said "It's a lovely home. I would be happy to have one of my relatives here".

We also contacted the local authority who told us they had no concerns about the care provided.

People who used the service said they thought staff were well trained to do their jobs. One person staying in the home said, "The staff are very pleasant and are interested in you as an individual". Another said "The staff are very helpful, friendly and polite".

Staff said that they felt well supported by the manager, that they thought they had received the necessary training to carry out their role and that they received regular supervision. One said "It's a good place to work, I've been supported to do other training and I don't feel that I'm pressured or overworked."

The home was well maintained and people who lived there were provided with opportunities to give their feedback on the quality of service received.

We spoke with three people who lived at the home who were very happy with the care and support provided. One person said “I am very satisfied indeed with the care provided.” Another told us “The staff make this place, they are wonderful. I am more than happy with the care here.”

We found that Trepassey Residential Home had procedures in place for safeguarding vulnerable adults. However, the home had a policy for providing staff training for safeguarding vulnerable adults every two years but we found that some staff had not received this training.

We found there was enough experienced staff to meet people’s needs.

We found there were systems in place to monitor quality assurance. There were quality assurance surveys and residents’ meetings to gain people’s views which were taken into consideration.

We spoke with four people who were living in the home. All said they had been asked what their needs were before admission and the manager had discussed with them the care the home could provide. They told us staff always consulted them about their individual needs and involved them in decisions about their care and treatment.

They also told us there was a range of activities they could participate in.

People said they could do as they pleased and that there were no restrictions. Two people told us they regularly went out to visit family and friends.

All the people we spoke with said they received the help they needed and received their medication as prescribed. Comments included "I've never had any complaints about the care. It couldn’t be any better”; "I like it here very much”; “I’m lucky to be here”.

People also said that overall the meals were very good. In addition, one person said “The meals are adequate in quantity for me and if there’s anything I don’t want they’ll find me an alternative”. Another person said “We can have our meals in our rooms if we like and they will also cater for visitors”.

The people we spoke with said they were happy with and confident in the staff working there. Comments included “The staff are very nice and very kind. You only have to ask and they’ll do anything for you” ; “The staff try very hard to keep us happy”; “The staff are extremely good, very cheerful and obliging”.

The local authority told us they had no concerns about the care provided.

Trepassey Residential Home provides personal care and accommodation for up to 24 people. Nursing care is not provided. The home is a detached three storey building in Heswall, Wirral. A small car park and garden are available within the grounds. There are twenty four single bedrooms with ensuite toilet facilities. There are also communal bathrooms on each floor. A passenger lift enables access to bedrooms located on upper floors for people with mobility issues and specialised bathing facilities are available. On the ground floor, there are two communal lounges and a dining room for people to use.

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.’ 

We reviewed four care records. Some risks associated with people’s personal care were assessed and managed. We found that some people’s risks in relation to skin integrity, behavioural needs and some physical health conditions were not properly assessed and managed. This meant staff had no clear guidance on how to manage these conditions to prevent further decline. These incidences were a breach of Regulation 12 of the Health and Social Care Act 2014 Regulations as people’s plans of care did not fully meet their needs or risks so that safe and appropriate care was provided.

Where people had mental health issues, care plans lacked adequate information on how this impacted on their day to day lives and decision making. There was also little guidance for staff on how to support people’s mental well-being. This was a breach of Regulation 11 of the Health and Social Care Act 2014 Regulations as people’s right to consent had not been considered in accordance with the Mental Capacity Act 2005.

The care plans we looked at lacked person centred information. Person centred information enables staff to understand the person they are caring for so that personalised support can be provided. For example, staff had no information on people’s preferences in day to day living. This made it difficult for staff to know how to respect them. Care plans contained no information on the possible causes or solutions to people’s emotional distress or challenging behaviours. This meant staff had little guidance on how to support the person appropriately and in a person centred way when distress or challenging behaviours were exhibited.

People who lived at the home said they were happy and well looked after. They said they were treated with dignity and respect and had choices in how they lived their lives at the home. We saw that people had access to sufficient quantities of nutritious food and drink and were given suitable menu choices at each mealtime.

During our visit, we observed that staff treated people kindly and supported them at their own pace. People looked relaxed and comfortable with staff. From our observations it was clear that staff knew people well and had the skills and knowledge to care for them. We saw however that staff were often too busy tending to people’s personal needs and other tasks, to have time to just sit and chat with people on a social level. An activities co-ordinator was employed at the home and provided a range of activities for people to join in with.

Staff at the home were recruited safely and received regular training and support in the workplace. Staffing levels were adequate and people’s support needs were responded to promptly.

People told us they felt safe at the home and they had no worries or concerns. The home had a safeguarding procedure in place and staff received safeguarding training. We looked at the provider’s safeguarding records. We found that some safeguarding incidents had not been appropriately reported to the Care Quality Commission in accordance with legal requirements.

People were provided with information about the service and life at the home. There was a complaints policy and procedure in place and it was displayed within the home. People we spoke with said they had no complaints about the service. We reviewed the provider’s policy and saw that it did not contain the contact details of the organisations people could contact in the event of a complaint. This meant people at the home lacked sufficient information about who they should contact in the event of a complaint being made. We reviewed a sample of complaint records and saw that the manager had responded to these complaints appropriately.

Equipment was properly serviced and maintained and the premises were safe. The home was clean, free from offensive odours and well maintained. There were sufficient supplies of personal and protective equipment around the home which promoted good infection control standards.

The arrangements and information in place to assist staff and emergency services personnel in the event of a fire or other emergency evacuation required review to ensure it was up to date, safe and did not place people or staff at risk of harm. 

There were quality assurance systems in place to assess the quality and safety of the service but some of these systems were ineffective. We also found that some of the provider’s policies and procedures, designed to ensure safe and appropriate care, were not being followed. This impacted on the quality of the service and demonstrated that managerial improvements were required. 

We saw there were regular opportunities for people to express their views about the home.  The manager organised regular resident meetings and ensured that the provider’s annual satisfaction survey was sent out to people each year.  We saw that the survey and people’s feedback was analysed to enable the provider to come to an informed view of the standard of service provided. People’s feedback was also displayed openly at the home for people who lived there and visitors to the service to see.