We carried out an unannounced inspection of Trevaylor Manor on 23 and 24 April 2018. We last inspected Trevaylor Manor on 24 October 2017. At that inspection we identified six breaches of the regulation and rated the service as Inadequate. The breaches were in respect of the safety of the environment, infection control, auditing systems, the management of medicines, a lack of clear guidance for staff on how to support people safely, privacy and dignity, inappropriate restrictions on people, failure to follow the processes and principles contained in the Mental Capacity Act (2005) and a failure to submit notifications about significant events to CQC. Enforcement action was taken against the provider and the service was placed into Special Measures after a rating of Inadequate. Conditions of registration were imposed requiring the provider to review staff competencies and training, review people’s needs and submit monthly reports to the Care Quality Commission stating the improvement actions taken at the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the service. We carried out this inspection to check they were complying with their action plan and monthly reports.

Trevaylor Manor 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. The service is part of the Swallowcourt group and is a registered nursing home for 81 older people. At the time of the inspection, 62 people were living at the service, some of whom were living with dementia.

The accommodation at Trevaylor Manor is arranged over three floors. People living on the upper two floors were likely to have higher physical needs. There was a downstairs unit, used for people living with more advanced dementia. In addition, there was a separate building within the grounds, known as the Coach House. The Coach House was part of the dementia unit and accommodated up to eight people who required a safe environment, but were more physically independent.

Trevaylor Manor is required to have 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and will no longer be rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At the last inspection we found that, while there were systems in place to monitor the quality of the service provided, these systems had failed to identify the concerns found at that inspection. At this inspection improvements had been made to the auditing systems and this meant the monitoring processes were more effective in identifying where action needed to be taken. We found improvements had been made in relation to the safety of the environment, infection control, the management of medicines, risk management, people’s privacy and dignity and the use of inappropriate restraint and control. The service was submitting notifications of significant events to CQC as is required by law. This meant the service had met four of the six outstanding requirements from the last inspection.

We had concerns in respect of how the service was meeting the requirements of the legislation as laid out in the Me

We inspected Trevaylor Manor on 24 October 2017. The inspection was unannounced.

Trevaylor Manor is part of the Swallowcourt group and is a registered nursing home for 81 older people. At the time of the inspection, 73 people were living at the service, some of whom were living with dementia. Trevaylor Manor comprises a main building arranged over three floors. People living on the upper two floors were likely to have higher physical needs. There was a downstairs unit, used for people living with more advanced dementia. In addition, there was a separate building within the grounds, known as the Coach House. The Coach House was part of the dementia unit and accommodated up to eight people who required a safe environment, but were more physically independent.

Trevaylor Manor is required to have 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Trevaylor Manor was last inspected in January 2016 and rated as ‘Good’ overall. However, the service was rated as ‘Requires Improvement’ under the caring domain. During that inspection, we found that slings and continence products were communally used and interactions between people and staff were largely task based. At this inspection, we found that slings and continence products continued to be communally used. We continued to observe task based interactions between people and staff.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People were not always treated with dignity and respect. Some people were ignored by staff for long periods of time. Staff did not always try to establish why people were calling out, for example if they were in pain, distressed or wanted to move. Some people were left alone for long periods of time, for example in quiet areas which they could not move away from independently People’s privacy and confidentiality was not always protected. Confidential information was left on display. People were not always able to alert staff when they needed help. Some people did not have access to call bells.

People were not always kept safe within their environment. Potentially hazardous items were not securely stored. The sluice room was not lockable and was situated in a corridor where people were independently mobile. We saw a heavy sash window propped open with a cup. This could have caused serious injury if the cup had been moved. This was reported to staff and removed. We saw unnamed items left in bathrooms such as toiletries, continence products and slings. This placed people at risk from cross infection. People were moved using unsafe moving and

We inspected Trevaylor Manor on 26 January 2016, the inspection was unannounced.

Trevaylor Manor is part of the Swallowcourt group and is a registered nursing home for up to 81 older people. At the time of the inspection 74 people were living at the home some of whom were living with dementia. Trevaylor Manor is required to have 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.

Trevaylor Manor was last inspected in July 2014, there were no concerns at that time. Since that inspection the service had grown and another building, previously registered as a separate service had been become part of the care home. This building, known as The Coach House, and the lower floor of the main building were used to accommodate people who required a secure environment. People in The Coach House had the opportunity to participate in day to day activities independently, for example there were tea and coffee making facilities. These areas were run by a unit manager and staffed separately. The Coach House was completely self-contained with its own kitchen and laundry facilities. It was a light and airy building with a high standard of décor, friendly and open staff and people appeared happy and well cared for.

The registered manager had oversight of the rest of the service which comprised of the middle and upper floors. People in this part of the service were more likely to have higher physical needs and need support to move around. This was done safely and staff used the appropriate equipment when necessary. However, we saw some incidences where staff did not communicate with people while supporting them to move. The interactions we observed throughout the day were largely task based apart from during an organised activity session and the lunch time period.

The registered manager was supported by a deputy manager and the unit manager. Nursing staff were supported by trained specialist health care assistants who helped with the administration of medicines. There was also a keyworker system in place. Keyworkers are members of staff with responsibility for managing and arranging care for a named individual. There were sufficient numbers of staff to meet people’s needs.

People and relatives told us they considered Trevaylor Manor to be a safe environment and that staff were skilled and competent. The premises were in a good state of repair, clean and odour free. There was signage around the building to support people to move around independently. Systems in place for the ordering, administrating and storage of medicines were robust.

Pre-employment checks such as disclosure and barring system (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people’s needs. Additional training was being organised for supporting people whose health needs might lead to them behaving in ways which could be difficult for staff to manage.

People were supported and encouraged to take part in a wide range of activities organised in the service. There were three full time activity co-ordinators employed who had responsibility for organising activities both within the service and outside. People were supported to maintain personal important relationships. If people did not have any family or close friends efforts were made to identify an advocate to represent their views if required.

Systems were in place to monitor people’s health and

We gathered evidence against the outcomes we inspected to help answer our five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was safe.

People were treated with dignity and respect by the staff. During our inspection we observed about 30 of the 67 people living in the home and we spoke with one visiting relative. Everyone we spoke with told us they felt safe. One person told us “I like living here and my room is nice”. A relative told us “All the staff are 100%, and accidents are dealt with immediately. If I had any complaints about my wife’s care they would be dealt with immediately”.

People were safe because staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm.

We saw Trevaylor Manor understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people’s needs. We were told the service regularly monitored people’s needs and adjusted staffing levels to meet people’s needs if they changed.

Is the service effective?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was effective.

People’s health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

The home worked with other services to ensure people’s health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with one visitor and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was caring.

Some of the comments received from people who lived at Trevaylor Manor included “The staff are patient and caring, they have been very kind to me” and “It is as good as it can get, but you can’t please everyone all the time”. We observed staff responded to people in a kind and sensitive manner.

People’s individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people’s families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people’s wishes.

Is the service responsive?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was responsive.

In the dining room during lunch we observed about 30 of the 67 people who lived at Trevaylor manor and nine care staff. The carers were attentive. For example, aids were brought for several people and staff were helping people with their meals, some gave one to one care when a person had difficulties eating.

Two people did not want the pudding so were offered tea and biscuits. A selection of biscuits and tea was quickly brought for people.

People were able to take part in a range of group and individual activities such as card games, listening to music, outings in the local community and craft work.

Best interest meetings had been held to ensure the care and support provided was still meeting the needs of the person.

People who used the service and their representatives were asked for their views about their care and treatment.

Is the service well-led?

During our inspection of Trevaylor Manor we saw evidence to support a judgement that this service was well-led.

We were able to talk with eight members of staff and, apart from one who had only been at the home for eight months the other members of staff had been at the home for some time, one 10 years and one for 23 years. They were all positive in their attitude on how the home was organised and run and we were told by several carers that it was the best run home they had experienced.

We spent time watching what was happening, observing the type of support people got and whether they had positive experiences. We saw people talked with staff during personal care and when being assisted. People we spoke with who lived at Trevaylor Manor told us they were very happy there, and a visiting relative told us “the staff are excellent, they tell me everything I need to know and I can speak to the manager anytime I want”.

During our inspection, we found people’s privacy; dignity and independence were largely respected.

We saw people were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw people assisted by staff and equipment being used properly, for example, wheelchairs with footrests in place.

We saw care plans were in place to direct staff as to the care and support people needed. People's records were personalised and provided clear information about the person’s wishes and abilities.

Trevaylor Manor adhered to robust recruitment practices in order to protect people.

People had confidence they could express any concerns they may have, although records of complaints made were not kept.

Records were in place to demonstrate the safety and management of the service, and these were stored securely.

We used our SOFI (Short Observational Framework for Inspection) tool for approximately 1 hour in the main lounge/dining area. The SOFI tool allowed us to spend time watching what was happening and helped us record how people spent their time, the type of support they got and whether they had positive experiences. We saw people’s privacy and dignity was respected and staff were helpful. We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted.

During our inspection, we found people’s privacy, dignity and independence were respected. People’s views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us that training was provided, and also confirmed that staff supervision took place.

Care plans and associated documentation did not provide sufficient detail, and did not always direct and guide staff of the action they needed to take in order to meet people’s assessed care needs. People's records were personalised and provided clear information about the person’s wishes and abilities.

The majority of people said they were very happy living in the home. People said that staff were supportive and provided them with good care. People said the food was to a good standard, and there was enough to eat and drink. Everyone said they were happy with their accommodation. People said they were happy with the activities that are provided at the home.