Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Improvement action plan issued following the previous inspection

Where we asked the provider to complete an improvement action plan following the last inspection, include the text below, adapting where necessary:

'Following the last inspection, what they would do and by when to improve the key question(s) to at least good.' Then describe at a high level what you found, adding detail in the detailed findings section for the relevant key question(s).

Focused inspection

'We undertook an announced / unannounced focused inspection of on . This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection had been made. The team inspected the service against of the five questions we ask about services: is the service well led, , (more as needed)? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection'

Comprehensive or focused inspection

Where breach topic has moved to a different key question in Next Phase

When we completed our previous inspection on DD/MM/YYYY we found concerns relating to . At this time this/these topic area(s) was/were included under the key question of . We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this/these topic area(s) are included under the key question of . Therefore, for this inspection, we have inspected this key question and also the previous key question of to make sure all areas are inspected to validate the ratings.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

Service Types and descriptions

Care at Home services

Domiciliary care agency

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to [older adults], [younger disabled adults], [children].

Provider of care to people living in specialist housing

Location proving care to people housed under supported living arrangements

This service provides care and support to people living in [a] [insert number of] 'supported living' setting[s], so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Location proving care to people living in extra care housing

This service provides care [and support] to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is [bought] [or] [rented], and is the occupant’s own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at peop

This inspection took place on 28 and 29 September 2016. The first day was unannounced and the second day was announced. At our last inspection on 12 November 2013, the home needed to make improvements to their quality monitoring processes.

Trevella House is a residential home registered to provide accommodation and support for up to six adults with mental health needs. At the time of our inspection six people were living at the home.

There was a registered manager 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.

At this inspection we found there had been some improvement to the service’s quality monitoring processes. However they still required further improvement to ensure people received a safe and effective service.

The provider had recruitment processes in place however they were not always robustly applied and required some improvement.

People received their medicines as prescribed by healthcare professionals. Medicines were stored and administered safely, although there was some improvement required on the recording of when medicines were administered.

People who lived at the home felt secure and safe in the knowledge that staff were available to support them, when they needed to be supported. The provider had systems in place to keep people safe from the risk of abuse.

People were protected from the risk of harm because staff followed up to date risk assessments to reduce the risk of harm for people who lived at the home.

Staff sought peoples’ consent before providing support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People were encouraged to be as independent as possible and were supported to make choices and to take responsibility for their own daily routines. People prepared their own food and drink at times to suit them and were encouraged to consider healthy food and drink options.

People were supported to access health care professionals to ensure their health care needs were met.

People were supported by staff that were kind, caring and respectful and knew them well. People were treated with dignity and respect and staff understood people's needs well. Staff received the training and support they needed to carry out their role.

People’s health and support needs were assessed and reviewed and they were encouraged to participate in activities and interests if they wished. People knew how to complain about the support they received and felt confident their concerns would be addressed.