Care homes near Helston and Truro have been told to make "urgent improvements" after unannounced inspections.

The Care Quality Commission (CQC) visited Trelawney House in Polladras, not far from Carleen near Helston, and St Erme Campus in St Erme, near Truro, in October to check on the action the provider had taken following previous inspections.

Both are run by Spectrum (Devon and Cornwall Autistic Community Trust), which operates 15 care homes across Cornwall.

Trelawney House is a residential care home providing personal care to six people with a learning disability or autistic people.

The overall rating for Trelawney House has now dropped from 'requires improvement' to 'inadequate'. The inspection areas of 'safe', 'effective' and 'well-led' have also dropped from requires improvement to inadequate, while 'caring' has dropped from good to requires improvement. 'Responsive' was not rated on the last inspection, but it is now rated requires improvement.

St Erme Campus provides personal care for up to 20 autistic people. At the time of the inspection, 13 people were living there.

It was previously inspected in May when CQC judged the service to have insufficient staff to keep people safe.

After that inspection, it was rated inadequate overall and conditions were imposed on the provider’s registration requiring it to send monthly reports to CQC explaining how it was increasing and maintaining staffing levels to meet the needs of people using the service.

However, following this latest inspection, the overall rating for St Erme Campus remains as inadequate. 'Well-led' also remains inadequate, while 'responsive' and 'effective' have dropped from requires improvement to inadequate. 'Caring' remains as requires improvement.

Both St Erme Campus and Trelawney House are now in special measures, meaning they must improve or they could be subject to enforcement action.

The CQC said it was currently reviewing what further action to take at both sites, adding that any action taken may be subject to challenge by the provider so it was unable to comment further until the process was complete.

Debbie Ivanova, CQC’s deputy chief inspector for people with a learning disability and autistic people said: “When we inspected St Erme Campus and Trelawney House, we found widespread and significant shortfalls in leadership and care which compromised the safety and wellbeing of people using the service. It is particularly concerning that, other than taking on agency staff, Spectrum had taken little action to make the improvements we told it to make following our last inspection of these services.

“At both homes, there had not been enough permanent staff for some time. The provider was struggling to recruit additional permanent staff and relied on high levels of agency staff to support the home. The agency staff did not have the required training, or enough knowledge about the people using the service in order to keep them safe or to support them to have a reasonable valued lifestyle.

"As a result, people were not having their care needs met and, even with agency support, there were not enough staff to allow people to enjoy their hobbies and interests, which meant they were leading routine, uneventful lives and were often bored and frustrated, which raised their anxiety levels, and sometimes resulted in incidents.

Trelawney House at Polladras was rated by the CQC as requires improvement

Trelawney House at Polladras was rated by the CQC as 'requires improvement'

“At Trelawney House, inspectors were told about three incidents of alleged abuse of people using the service by agency staff, including one when the staff member was mocking a person while providing personal care. That is completely unacceptable, and the staff member has now been removed from the service.

“In addition, incidents weren’t being appropriately reported by Spectrum to the local authority safeguarding team. One person with mobility issues was reported to have fallen multiple times, yet there were no falls risk assessments in place for this person to prevent this from happening again.

"Although Spectrum recognised that this person should be moved to a downstairs bedroom to give them a better quality of life, nothing had been done about it. We also heard that another person was locked in their room when they shouldn’t have been, and that there were times when staff shouted at each other in front of people which caused anxiety and impacted on people’s wellbeing.

“The way in which people are expected to live in both these homes is neither acceptable, nor sustainable. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, and independence that most people take for granted. We have told the provider that it must make urgent improvements to both these services. If it does not, we will not hesitate to use our legal powers and take further enforcement action to keep people safe.”

Responding to the inspection findings, a spokesperson for Spectrum said: “We are extremely disappointed by the Care Quality Commission’s inspection reports, which do not fairly capture the care and support being provided at our services. Following the inspections, we submitted substantial evidence to challenge what we consider to be inaccurate findings. We are saddened that the CQC has chosen not to take this into account and our legal team is appealing the report’s findings.

“Helping the people we support to live fulfilling, independent and healthy lives is our absolute priority. In 2021, we are proud of the work our charity has done. Even though we have been restricted by Government guidelines, the individuals at both St Erme and Trelawney have still been able to enjoy many activities, including sea swimming, surfing, horse riding, volunteering at local businesses, planning and building a sensory garden and enjoying activity groups out in the community.

Spectrums St Erme Campus was among two receiving unannounced visits

Spectrum's St Erme Campus was among two receiving unannounced visits

“Nevertheless, the past two years have been extremely challenging for the social care sector, and we have been particularly impacted by the carer shortages in the UK, which we have felt acutely in Cornwall. We are so grateful to our staff who have gone above and beyond during this difficult time. Every carer at Spectrum is fully trained and capable of delivering the right care and support for the people in our services.

“The inspection reports do not reflect the feedback that we typically receive from the people we care for and their family members, and we would like to thank our community for their support and understanding at this time.

“We continue to be committed to providing the high-quality care we pride ourselves on.”

Spectrum also shared a joint letter it said was written by parents of people being looked after at St Erme, and sent to the CQC, saying they did "not believe our views as parents have been fairly represented or considered, as only four lines of the report covers our views."

This, they said was despite taking "considerable time" talking to the inspector about the good care at St Erme.

They add in the letter: "We as parents spend time at St Erme and have not witnessed, as you [the CQC] state, their lives being restricted."

It is also noted that "we have stated to your inspectors that we are extremely happy with the service being provided and we all believe St Erme is the right place for our sons and daughters."

The following findings were made in the inspection reports, published by the CQC:

St Erme Campus

• The provider had not done enough to ensure that staff were supported to give the people living there the care they needed, and the quality of life they deserved.

• At the last inspection there were not enough staff to keep people safe. Since then, the provider had taken on agency staff to work at the service alongside permanent staff. Despite this, there were still occasions when the service was only staffed to minimum levels and sometimes, when staff were sick, it was below safe levels. Spectrum’s own policies state that minimum, or ‘contingency’ levels should only be in place in extreme emergencies.

• Severe staff shortages had impacted on people’s sense of security and caused anxiety and stress.

• Agency staff did not have all the necessary skills and training to deliver safe care and administer medicines. This meant one person could not go out with agency staff, as they sometimes required immediate access to medicines. In addition, there were some night shifts when agency staff had worked without the support of permanent staff. This meant no-one was available to administer medicines quickly if needed.

• In between inspection visits, three agency staff tested positive for Covid-19. Instead of ensuring that these staff members self-isolated in line with legal requirements, Spectrum asked them to continue to travel to the service from home and work with people using the service who had tested positive.

• Incident reports did not always contain enough detailed information to enable managers and staff to learn from the event and make improvements.

• People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). Despite frequent reminders from Cornwall Council, the provider had failed to supply reports for three people showing that that they were complying with these legal agreements to limit the restrictions imposed on people.

Trelawney House

• Spectrum had not adequately supported the staff at Trelawney House. There was no rota available detailing when staff were due to be on duty for the next week, so they did not know what shifts needed covering or which days they would be working that week. The provider had done nothing to resolve this issue.

• The service had a high turnover of staff and some staff said they felt anxious coming into work. The issue of unsafe staffing was raised as an issue during the previous inspection. Since then, four agency staff had been brought in to support the service, but they did not have the necessary skills, and there were not enough of them, to allow people to have a reasonable quality of life involving, for example, access to their local community and freedom in the home. One person was frequently locked in their room as there weren’t enough staff to support them. Both during the day and at night, the service regularly operated at emergency minimum staffing levels, and sometimes the levels were below this, which was unsafe.

• People’s dignity was not always respected, they were not supported to have choice and control of their lives, and staff did not support them in the least restrictive way possible and in their best interests.

• Adequate training was not given to ensure staff had a good understanding of current best practice in the care sector.

• Incidents where unauthorised techniques were used to support people when anxious or upset had not been appropriately investigated. Poor record keeping meant it was not possible for lessons to be learned following incidents.

• Accurate records of incidents and the support people had received had not been maintained. One person had sustained a head injury that required hospital treatment after a fall, yet the provider had not notified CQC, which is a breach of regulations.

• The provider had failed to appropriately report and investigate incidents of alleged abuse, despite the fact this had been identified as an issue during the last inspection.

• People did not receive the support they needed to eat and drink. One person needed to sit at a table and be accompanied by staff to prompt them to eat so that they had adequate nutrition. Staff were aware of this, yet during the inspection, this person was left alone and was not provided with the staff support they needed to ensure that they ate enough food.

• Action had not been taken to make necessary alterations to the service to enable a person with declining mobility to maintain their independence.

• Noise levels at night prevented people from getting adequate sleep and added to their distress. Noise levels were also high during the day because one person screamed when a person who they didn’t like entered the communal living area. This upset other people living at the service who were sensitive to noise, leading to some people becoming increasingly isolated in their rooms.