Trewan House is a residential family owned 'care home’ located in the Hough Green area of Widnes. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The home specialises in providing accommodation for older adults and adults experiencing different forms of Dementia. The home has 42 ensuite bedrooms and is registered to provide support for up to 44 people. At the time of our inspection, there were 39 people living in the home.

At the last inspection on the 7 September 2015, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There were two registered managers in post at the service, who were also part of the registered provider team, both of whom were on site during our inspection. The registered managers shared responsibilities among themselves for the running of the service, with one being responsible for business and finance matters and the other responsible for overseeing care related duties. 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.

Our observations showed people were supported by sufficient numbers of suitably qualified staff and did not have to wait long for support. People told us staff responded to them in a timely manner and call bells were answered promptly. One person commented, “There are enough staff about. The staff don’t take long when I use my call bell.”

Staff recruitment files contained all the relevant pre-employment recruitment checks to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. Staff had received training in ‘Safeguarding’ to enable them to take action if they felt anyone was at risk of harm or abuse and understood the reporting procedures. The safeguarding policy was available in the staff office for ease of reference.

Care files contained individual risk assessments to assess and monitor people's health and safety in respect of a variety of potential hazards.

Appropriate assessment tools had been used to measure the level of risk and guide staff on what action that should be taken to mitigate this such as the Waterlow assessment tool in respect of pressure area care and the Malnutrition Universal Screening Tool (MUST).

People were happy with how their medicines were managed and staff received training to undertake this practice safely. We saw that medication was stored safely and securely and within their recommended temperature ranges. There was no PRN (as when) protocols in place for people who required as needed medication although staff spoken with had a good knowledge regarding the circumstances in which this was to be administered. The registered manager took immediate action on the inspection day to devise a new protocol template to ensure staff knowledge was reflected in the associated paperwork.

People were supported to live in a safe environment and a series of checks was completed to ensure that equipment did not pose a risk to people living in the home. We identified that the sluice room was not secured by a lock. We brought this to the attention of the registered managers who took immediate action on the day of the inspection to secure a coded lock to the door.

People were supported to have maximum ch

We undertook an inspection of Trewan House on the 11 September 2014. We spoke with 30 people using the service, five visitors, seven staff members including the two home managers, during our visit.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives; the staff supporting them and from looking at records.

Is the service safe?

We saw that risks to people's health and wellbeing had been identified for areas such as falls and nutrition and risk assessments were in place to manage these so the people who lived at the home were safeguarded from unnecessary hazards.

Maintenance certificates were available, these included, portable appliance testing, nurse call system, gas safety and fire equipment. All of the certificates we looked at were up to date.

The home manager was aware of the relevant process to follow if there were any safeguarding concerns.

Policies and procedures had been developed by the provider to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). This is a legal requirement that is set out in an Act of Parliament called The Mental Capacity Act (MCA 2005). This was introduced to help ensure that the rights of people who had difficulty in making their own decisions were protected. The aim is to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. Records showed that DoLS were in place as and when necessary.

Is the service effective?

We observed the support provided to people living at the service and we noted various examples of good practice. We observed staff respectfully speaking with people as they approached them so they were aware who was supporting them. We saw various examples of good communication and patience and understanding by staff who interacted with each person in a friendly and positive manner. Comments received from relatives and visiting professionals included: "The manager makes sure that the services provided are tailored to the needs of each person who lives here. It's a fabulous place" and "The staff are helpful, courteous and knowledgeable. They go out of their way to assist whenever we visit. The care provided appears to be excellent".

Is the service caring?

We spoke with 30 of the people who lived at Trewan House. Their comments included: "a wonderful place to live in, a fabulous place with most caring staff, the care and support is provided just how we want it, we get good care and we can also have a great laugh, staff ask us what we want and then make sure we get it and I would not want to live anywhere else this to me is heaven".

We spoke with five relatives during our visit. They were very positive about the service and the care provided to their relatives. They told us they had been involved in discussions about the care and support provided to their relatives and they told us that the staff were "wonderful, kind and caring" and that the home was an excellent place to live.

The staff members we spoke with could show that they had a good understanding of the people they were supporting and that they were able to meet their various needs. They identified that they worked together with each person who lived in the home to identify and meet all health and social care needs to include daily activities and interests.

Is the service responsive?

We saw that each plan was personalised and reflected the needs of the individual. We also saw that the plans were written in a style that would enable the person reading it to have a good idea of what help and assistance someone needed at a particular time. The plans we looked at were well maintained and held details of risk assessments, nutritional screening and records of visits from other health care professionals, such as GPs and district nurses. This enabled staff members to know when these visits had taken place and why.

Reviews of care were undertaken on a monthly basis or sooner if any changing needs were identified. This enabled staff to be responsive to all immediate care and support needs.

Is the service well-led?

The provider told us that information about the safety and quality of the service provided was gathered on a continuous and on-going basis via feedback from the people who used the service and their representatives, including their relatives and friends, where appropriate.

Trewan House had a quality assurance system available to assess the quality of the service it was providing. The 2014 survey had recently commenced and survey questionnaires had been sent out to all of the people living in the home or their advocates. Outcomes from the last survey were very positive and identified that people were satisfied with the staff and services provided.

A copy of the complaints policy was on display within the home and processes were in place to record any complaints received and to ensure that these would be addressed within the timescales given in the policy. The people we spoke with had no complaints about the service. They said that they felt able to express their views about the service they received and would know how to complain if it was ever necessary to do so.

We spoke with 18 people who lived in the home and a number of their relatives. The people using the service who were able to tell us said that they were happy living in the home. Their comments included; “This is a nice place to live”, “it is wonderful here” and “I am very happy, comfortable and well looked after.”

We received wholly positive comments about the home from the visitors we spoke with. One person told us; “we love coming here as all the people appear happy and contented.”

The menu provided a degree of flexibility for people and in practice it meant that at any mealtime it was likely that everyone was able to eat something they had chosen.

The home had an adult protection procedure designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

Staff members completed an induction when they started work at the home. We also looked at staff training and saw that mandatory and other training in areas such as safeguarding, moving and handling and dementia care was being provided. Staff told us they worked well together as a team and felt well supported.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis.

We spoke with eighteen people who lived in Trewan House. Those who were able told us that they were being treated well by the staff members supporting them and that they were involved in all aspects of their care. They said they had been provided with information about the services provided and how staff would carry out those services. People said they were given choices in all aspects of their daily life. People relative’s comments included “Absolutely brilliant, I looked at other homes but thought that this was the best. I come at various times and am always made to feel welcome.

The people using the service told us the staff were kind and helpful and were able to provide a good level of care and support. Comments included "staff are very kind and caring”, "we love being here as we are well looked after”,"staff cannot do enough for us they are lovely people."

People living in the home and their relatives said staff spoke with them on a regular basis to ask their perceptions of how the home was run.

People said that they were aware of their care plan and they had been asked to sign it as being in agreement with it.

People said that they have ‘resident’s meetings’ where they can comment on the service provide. However people said that many of the people living in the home are unable to clearly express their views and opinions and said staff were able to ascertain the wishes of these people through direct discussion, non verbal communication or with their relative or their representative.

We asked the people living in the home about the choice and control they have over their daily lives. People said that they choose their own daily routine as to when to get up, choice of meals throughout the day, support with personal care, and wherever possible are supported to manage their own affairs when possible, for example manage their own money or medication.

People said that the home employed staff to carry out daily activity of their choice and people said this was a most enjoyable part of each day. They said that individual activities were arranged to meet the needs of everyone who lived in the home.

People living in the home said staff are respectful of their privacy and dignity and one person described staff as ‘very diplomatic’ when it comes to personal issues.

The inspection of Trewan House took place on 16 and 18 June 2015 and was unannounced.

Trewan House is a two/three-storey family owned care home for older people. Access between floors is via a passenger lift or a staircase. The premises stands in its own grounds and is located in the Hough Green area of Widnes.

There were 39 people using the service at the time of our inspection.

The service has two registered managers. Whilst they both hold responsibility for the overall management of the home they have a system in which one person manages the care component and the other person takes responsibility for the other management aspects of the home. 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 found that care was provided in an environment which was as homely as possible. Staff went to considerable lengths to make sure that people who lived there were safe, comfortable and content.

Staff knew about the need to safeguard people and were provided with the right information they needed to do this. They knew what to do if they had a concern. They were well-trained. There were sufficient staff to meet the needs of the people who lived in the home

The home was well-decorated and maintained and adapted where required. People had their own bedrooms which they could personalise as they wished.

People living in the home and their relatives said staff were attentive and caring. They said that if they had any concerns they were addressed promptly. People told us that they felt safe, the food was good and the management of the home was second to none.

Appropriate risk assessments were completed and action taken to minimise avoidable harm. This included people’s individual health and wellbeing as well as the management of the home and premises.