The inspection visit took place on 20 April 2017 and was unannounced.

Trewartha is a care home providing nursing care for up to 37 people predominately living with dementia. The service is in the Carbis Bay area of St Ives. It is a single storey purpose built service within a housing area. There are a range of aids and adaptations to support people. The service is close to local amenities and a transport network. There is a large garden area which is not overlooked. At the time of the inspection visit there were 34 people living at the service.

At the last inspection in March 2015 the service was rated overall ‘Good’ with ‘Outstanding’ in the domain responsive.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe.

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.

The registered manager had systems in place to record accidents and incidents and take action when required. Where sudden and unexpected incidents occurred staff had the knowledge and skills to deal with them safely and effectively. We observed an example of this during the inspection of the service. Staff worked together to ensure there was minimum disruption or change affecting other people.

Recruitment checks were carried out to ensure suitable staff were employed to work at the service. Our observations and discussions with staff, relatives and people who lived at Trewartha confirmed sufficient staff were on duty both day and night. People said, “Always around when you need them (staff)” and “I visit a lot and there are always staff to be seen. They (staff) take time to see what residents need.”

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation if Liberty Safeguards (DoLS).

Staff were supported by a system of induction training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided. For example, care of people living with dementia and for people with specialist dietary needs.

Staff had the skills, knowledge and experience required to support people with their care and meet their social needs. The registered manager had instilled a culture where staff were open to learning and shared new skills with their colleagues. For example, researching meaningful activities and acting as ‘leads’ in areas of infection control.

There were enough staff available to ensure people received prompt and attentive care. Staff had time to chat with people as well as meeting their care and support needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. For example, staff using one to one support for continuity and by having the time to let the person take the lead and control of what they wanted to do.

The service provided a varied range of meals and drinks for people. There was a sufficient choice and people received appropriate support where required. Where people required specialist support with their dietary intake and fluids, systems were in place to monitor and manage their needs.

Medicine procedures at Trewartha were safe. Staff responsible for administration of medicines had the competency and training required. Medicines were stored securely with access only by designated people.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and as people’s changing nee

Trewartha is a nursing home which provides care and support for up to 37 people. At the time of this inspection there were 35 people living at the service.

There was a registered manager in post who was responsible for the day-to-day running 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection on 30 March 2015. We last inspected the service on 12 May 2014. At that inspection we had no concerns.

We inspected the service over one day. The atmosphere was very welcoming, calm and friendly. People were able to move around freely spending their time in various comfortable areas of the service as they chose. People living at the service were not able to easily express their views and experiences due to their healthcare needs. We observed care being provided and spoke to families, visitors and healthcare professionals to gain their views. Everyone spoke very positively about the staff and the management team. People told us; “Wonderful home, wonderful people, I love them all to bits, they provide wonderful care for my mother, they are the most brilliant carers I have ever met, they really care for people as though they were their own family, I give it 110%” and “They provide really lovely care, excellent,” “They are dedicated to the well-being of the residents, taking a genuine interest in each one, and supporting each other in the work they do.”

People told us care was taken to provide food in an appetising manner. One family member told us; “My mother has to have her food pureed , they don’t just puree up the whole meal into one plate of the same colour, she gets different foods such as vegetables, meat and potatoes pureed separately in different colours upon her plate, much nicer.”

Staff working at the service had a very good understanding of the individual needs of the people they supported. Staff received training and support which enabled them to be effective in providing individualised care for people. Staff and management were aware of the importance of respecting people’s rights according to the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

The service had been adapted to support the needs of people who were living with dementia. For example all bedrooms had a photograph of the person to whom the room belonged on the door, together with a picture of something that was relevant to that individual. There was clear signage around to home to help orientate people.

Staff were aware of people’s preferences and choices and supported them to be as independent as possible. A wide range of relevant and meaningful activities were provided according to what people had requested on their ‘wish list’. People were supported to maintain their connections with the local community by going out regularly and having people visit them from outside. Family were encouraged to stay with their family members at the service if wished.

People were well cared for. Some women wore jewellery, nail polish and make-up. Staff were kind and respectful when supporting people. People told us;“ They are wonderful, so helpful and kind, always smiling and willing to assist with anything,” “There is always something going on here if you want to get involved, they ask us what we enjoy and then they arrange it for us. We go out in the minibus sometimes. They (staff) are very good here, they take an interest in each of us.” Visitors told us, “They make a real fuss of people if it’s a special day for them.”

Staff were all well informed about the past lives of the people they cared for. Staff used this information to have meaningful conversations with people and supported them with relevant activities which they enjoyed. The care plans for people at the service were, very detailed and individualised, and regularly reviewed to take account of any changes that may have taken place. They provided staff with specific guidance and direction on how to meet each person’s needs according to their preferences and choices.

Families spoke very highly of the registered manager and her deputy managers. Comments included; “It is because of them (management) that this home is like it is, lovely atmosphere, relaxing and calm, but efficiently run.” The registered manager told us how they supported the families and friends of people who lived at the service. Family members were encouraged to visit whenever they wished and join people at the service for activities, meals or a drink if they wished. Staff told us unanimously they provided ‘really good care’ to people and their families and friends.

Staff were confident in responding to people’s individual needs, quickly and calmly defusing any situations which may be challenging to people or staff. There was a consistent approach between different staff and this meant that people’s needs were met in an agreed way each time according to what was stated in the care plan.

The service sought the views and experiences of people who used the service, their families and friends. There were many compliments on display in the main entrance. All of them were thanking the management and staff for providing very good care and support of both the person who lived at the service, but also the families.

People told us; “I have always found the manageress and her team very helpful and kind and supportive,” “I can ring or visit any time, they make events very special indeed, they are truly wonderful” and “Having observed how the team works together I feel that this quality is achieved through careful support and management, which shows genuine appreciation for each member of the team.” People told us they felt the management were responsible “for the sympathetic, compassionate and nurturing atmosphere of the home.”

Staffing was stable and morale was high and the atmosphere at the service was warm, friendly and supportive. Staff told us; “I am very happy here, I have worked at other places and this is very good” and “I love my job, I feel very lucky to be supported well.”

People spoke very highly of the registered manager; “I don’t think I knew what I was looking for but Trewartha was the eighth home I visited and I knew straight away that I had found ‘the one’. The manager started talking with such warmth about Mum moving in. We haven’t looked back since”

The culture of the service was open, honest and caring and fully focussed on people’s individual needs. Staff told us; “We are proud of what we do here” and “We are a great team.” Trewartha had been given an award for care excellence by a national care trade body in 2014/15.

The inspector gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them, a visiting healthcare professional, comments left on the www.carehome.co.uk website about Trewartha and from looking at records.

Is the service safe?

People told us they felt safe. Complaints and reporting procedures were robust. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives. The registered manager and deputy managers wrote the staff rotas and took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required.

Trewartha alerted the local authority and the Care Quality Commission when notifiable events occurred or when they had any concerns regarding people who used the service.

Trewartha had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them, and it was clear that they were involved in writing their plans of care. We saw people, or their representatives consistently signed care plan reviews to show they had read and agreed to the content of the care plan. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

Is the service caring?

We spoke with one person who lived at Trewartha, a visiting healthcare professional and also received comments from relatives of people at Trewartha. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example “X is treated with love and care, and staff are so kind and thoughtful nothing is too much trouble”, “Excellent and thoughtful care on all counts” and “X has always received the very best treatment from very caring and thoughtful staff”. When speaking with staff it was clear that they genuinely cared for the people they supported.

There was a complaints procedure for people who used the service, their relatives, friends and other professionals involved with the service. Where shortfalls or concerns were raised these were taken on-board and dealt with. People’s preferences, interests, aspirations and diverse needs were recorded and acted upon.

Is the service responsive?

Many people who lived at Trewartha had complex health needs and were either not able, or chose not to join in group activities. The records showed people were routinely offered one-to-one or group activities.

The service worked well with other agencies and services to make sure people received care in a coherent way. Trewartha gave opportunities for people, their relatives and staff to express views and opinions about the service.

Is the service well-led?

Trewartha had regular support from the district nursing team and GPs from the local GP practices. This ensured people received appropriate care in a timely way.

We saw that the registered manager monitored staffing to ensure it was effective and sufficient, such as, evidence to show that planned and/or unplanned events (such as sickness or training absence) had been managed appropriately ensuring a good quality service and safe service.

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and used their views to improve support for people who lived at the service. Staff told the inspector that Trewartha was a happy place to work.

The service had a quality assurance system, and staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. We spoke to three visitors to the service who told us that they were pleased their friends and family lived at Trewartha.

We saw people chatted with each other and with staff and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights. People were protected by the home’s infection control procedures, management of medicines and people were protected by the home’s robust recruitment procedures.

We found staff received appropriate professional development and supervision.

We carried out a visit to Trewartha on 19 October 2012. People and their relatives told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We spoke with three relatives of people who used the service, and they said they were very happy with the care and support their family members received at Trewartha. We saw people who used the service interacting with the staff, and from the verbal and non-verbal communications seen we understood staff to be attentive, helpful and polite. The atmosphere in the home was warm and welcoming.

Care plans and associated documentation were in place. They included detailed information that directed and guided staff of the actions they needed to take in order to meet people’s assessed care needs. People's records were personalised, and showed choices were made by people in respect of their daily lives.

There was a flexible approach to mealtimes with the main meal being in the evening. We also saw people eating hot and cold food at various times of the day when they felt hungry

There were enough skilled and experienced staff to meet people's needs. We saw staff spending time with people providing care and support but also enjoying social activities with them and their relatives.

We saw people who used the service interacting with staff and they looked comfortable with the staff group. Two relatives told us that they felt their family members were safe at Trewartha and they would know who to speak to if they had any concerns.

We saw that accurate and appropriate records were maintained and stored securely to protect peoples personal information.

We spoke with some people who were able to talk to us about the service and about how they make choices in the care they receive. They told us that they have the opportunity to express preferences and make choices. There is a stable team of care workers that work hard to meet the needs of the people that live there. Comments received from people that live at Trewartha confirm their confidence in the care workers and the manager. People said they were satisfied with the care provided and the kindness and politeness of the care workers.

A representative from the Department of Adult Care and Support (DACS) told us that “there are no current concerns about this service”.