Inspection on 18/04/07 for 3 Trinity Close

This inspection was carried out on 18th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Trinity Close 03/05/06

3 Trinity Close 21/12/05

3 Trinity Close 07/09/05

3 Trinity Close 15/02/05

3 Trinity Close 12/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Trinity Close 3 Trinity Close Bath Bath & N E Somerset BA1 1US Lead Inspector David Smith Unannounced Inspection 18th April 2007 10:00 Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trinity Close Address 3 Trinity Close Bath Bath & N E Somerset BA1 1US 01225 443575 01225 443575 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.dimensions-uk.org Dimensions (UK) Ltd Mr Paul Flett Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged 18 - 65 years requiring personal care only 3rd May 2006 Date of last inspection Brief Description of the Service: 3 Trinity Close is operated by Dimensions (UK) Ltd, an independent voluntary organisation, to provide personal care for up to five people who have a learning and physical disability. The home is just a five-minute walk from the centre of Bath, where individuals can benefit from ease of access to all the amenities offered within the city. The premises are part of a general needs housing scheme developed by Sanctuary Housing Association. Number 3 Trinity Close is a ground floor flat within a row of what looks like terraced houses. Accommodation is on one level and five single bedrooms are equipped with wash hand basins. There is an enclosed rear patio garden, reached through the patio doors of the lounge/dining/kitchen area. The current range of fees range from £969.00 to £1035.00 per week depending on the support needs of each individual. Each individual also pays a contribution towards the costs of running the home’s minibus. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of a Key Inspection of this service. I gathered information through discussions with Support Workers and I also spoke with the Registered Manager on the 20th April 2007, as he was not present on the day of my visit. Interaction and communication between staff and people who live in the home was also observed during the course of my visit. Care plans and associated records were examined together with medication administration, Risk Assessments, accident/incident reports, complaints log, staff training and health and safety records. I was also provided with a tour of the home. Other sources of evidence have been used as part of this Key Inspection process. These include the Random Inspection of the service I conducted on 08/11/06, which was focused on environmental issues. Following this visit two enforcement notices were served by the Commission. The home’s action plan in response to both the last Key and Random CSCI inspections and ensuing enforcement notices have also been considered together with the providers own monthly auditing of the service and notifications of significant events which have occurred within the home. I examined staff personnel records on 31/08/06 at the organisation’s Bath offices, where all personnel records are now stored. The Commission also provided the home with a Pre-inspection Questionnaire and a range of Survey Forms for stakeholders prior to this visit. The Preinspection Questionnaire was completed and returned together with six Surveys. In accordance with the person centred approaches within the home, the people who live at Trinity Close are to be described as “people who live in the home”, or “individuals”, rather than service users. Dimensions (UK) Ltd uses the term “people we support”. This terminology has therefore been acknowledged and replaced the term “service user” in this report. What the service does well: Each relative who responded by Survey said their relative received the care and support they expect. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 6 Each health care professional who responded by survey said each individual’s needs are met by the home. Staff are experienced and have a good knowledge of each individual’s needs. This provides a confident and consistent method of support. The people who live in the home appeared happy and relaxed and used both the communal areas of the home as well as their own rooms freely during the my visit. The location of the home provides easy access to all amenities within Bath. The home also has a leased minibus, which provides individuals with the opportunity to access day services as well as other opportunities in the wider community. What has improved since the last inspection? What they could do better: The service has been subject to a review. A plan for the development and future of the service has now been developed. However this still needs to be agreed by the Housing Association and then clearly communicated to all stakeholders. The promotion of greater sensory stimulation still needs to be explored within the home. These developments would provide both an improved living and working environment. Each Risk Assessment must be regularly reviewed. This would promote the welfare and safety of the people who live in the home and the staff team. Each staff member must be provided with mandatory and specialist training, including appropriate refreshers. This will ensure all staff members have sufficient skills to meet the support needs of each individual who lives in the home. Fire safety in the home must be improved. This would promote the welfare and safety of each person who lives in the home and the staff team. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are given the information they need about the home to enable them to make an informed choice about where to live. EVIDENCE: There is a comprehensive Statement of Purpose and individuals’ Guide to the service, which have been adapted to include picture symbols. These detail the facilities, services and ethos of the home as well as the local structure of the organisation. Each person who lives in the home has their own copy of the guide, which is usually kept in their own room. There have been no new admissions to the home for a number of years. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each individual takes into account their personal preferences, supported by both written information in care plans which are subject to ongoing review and a long standing and experienced staff team. The risk assessment process supports each person to take risks as part of their lifestyle. However, these must be regularly reviewed. EVIDENCE: The care documentation for two individuals were viewed. Each person has three separate files, a ‘Care Plan’, ‘Health Notes’ and ‘Daily Living Notes’. Each care plan clearly explained individual’s likes, strengths, dislikes and needs. Aspects of support include daily living, social, emotional and personal Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 11 care, which were all well recorded. Clear guidelines are in place regarding individuals preferred routines and choices. Whilst each care plan was up to date, they did include lots of historical information, which can make them a little difficult to navigate. Staff also told me this can make the review process more difficult. The home should consider reviewing each care plan and archiving information which is no longer current. Annual placement reviews are being held with the relevant Funding Authority. These review meetings are attended by the individual, a representative from the Funding Authority, family members, Keyworkers and the home manager. These meetings are clearly recorded and the outcomes used to update individual care plans. Each individual has a named Keyworker, who ensures that each care plan is kept up to date between the annual reviews. Each section of the care plan contains a review sheet, which Keyworkers sign and date when the relevant section of the plan has been reviewed. Any changes are noted and communicated throughout the team. The care plans I viewed had been reviewed every three months or when individual’s needs had changed. This is good practice. Interactions between people who live in the home and staff were observed during the course of my visit. These were conducted in a sensitive and respectful manner. Individual support needs and methods of communication are clearly known and acknowledged by staff. Due to the nature of the disabilities of the people who live in the home it can be difficult for them to clearly communicate choices/wishes. Staff explained that they use a number of methods to ensure people are supported to make choices and decisions, for example two individuals use Picture Exchange Communication (known as ‘PECS’) to support them to communicate. During my visit I observed clear speech being used, which appeared to be very effective for the two people who were at home. There are several person centred Risk Assessments for each individual who lives in the home, which supports them to take risks as part of their lifestyle. Some of the assessments I examined were last noted as being reviewed in June 2005. There was no evidence they had been reviewed since then. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual who lives in the home has sufficient opportunities and appropriate support to access leisure and educational facilities both locally and in the wider community including holidays, day trips and visits to family and friends. A healthy and balanced diet for each individual is promoted. EVIDENCE: Each individual continues to have their own weekly timetable of activities. These include attendance at specialist day services, hydrotherapy sessions, horse riding, swimming, lunches out, walks, shopping trips as well as activities provided within the home. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 13 On the day of my visit, two individuals were attending their day service. The two other people who live in the home were supported by staff with activities within the home. One person went out to local shops, then was involved in a cookery session. The other individual chose to listen to some music both in the lounge and their own room. They made a clear choice regarding the type of music they preferred and communicated this to staff. Individuals are supported to choose and attend holidays, as well as day trips. Records examined show that individuals have been on holiday to Cornwall and spent a week in Dorset last month. Day trips to coastal resorts and other locations such as Chew Valley Lake take place on weekends. The home currenttly has a full compliment of staff, with two members of staff commencing employment towards the end of last year. The home usually has two members of staff on duty, although on the day of my visit there were three. Staff I spoke with felt this was generally an adequate level of staffing to enable people to choose a variety of activities. Each person is supported to maintain close contact with their family and friends. The home’s policy welcomes visitors at any time. There is a clear record kept within each care plan of family contact, including visits and telephone calls made/received. These records showed that each individual receives regular visits from family members. Some also stay with their relatives at weekends or during holiday periods. Each relative who responded by Survey said the home helps their relative to keep in touch with them. They added they are kept informed of all important matters regarding their relative, although one family thought this could be improved further. One family said their relative is “really well cared for” and another that their relative is “looked after in a homely and friendly way”. I examined the menu records for two people who live in the home. These showed that the home is providing a variety of meals and snacks, which are healthy and nutritious. Individuals are given a choice, but staff spoken with confirmed they need to advocate at times. They feel this is appropriate as they have good knowledge of individuals and their likes/dislikes. The home uses a comprehensive food hygiene system approved by the Food Standards Agency, entitled ‘Safer Food Better Business’. This contains training for all staff on cross contamination, cleaning, chilling, cooking and general management. Daily records are maintained include cleaning, food stock, and dating of food purchased for use in the home. This is good practice. There is a lounge/dining area in the home where each person eats their meals. The recently purchased new dining table and chairs has improved this area of the home. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are supported in their preferred manner, their personal and healthcare support needs are met and that the administration of medication ensures their welfare and safety. Experienced staff have a good knowledge of each person who lives in the home and how to provide appropriate levels of support, however staffing levels remain an issue where individuals require the use of a hoist. EVIDENCE: The health needs of individuals are well met with evidence of good multi agency working taking place on a regular basis. All of those living at the home are registered with a general practitioner; they are also supported with other healthcare needs such as dentistry and chiropody. Other specialist services are accessed when an identified need arises. These are provided by Bridges Community Learning Disability Team. Care records Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 15 show the home is regularly supported by the Consultant Psychiatrist, Speech and Language Therapist, Physiotherapist and other relevant health care professionals. Contact with each professional is recorded and forms part of each person’s care plan. Health care appointments are well recorded by staff in each ‘Care Plan’. However, this information is not always transferred to the individual’s ‘Health Notes’ file, where a detailed record of each appointment, and the outcome, should be maintained. Staff spoken with agreed that this needed to be improved as this was often left for Keyworkers to complete although they did not always accompany the individual to the appointment. This will be raised at the next team meeting later this month. Staff spoken with confirmed that care plans contained extremely detailed information on the care and support needs of each person. Most members of staff have worked in the home for a number of years and felt they had good knowledge of individual’s health care needs and what would alert them to any changes in their health. The continuing needs of two individuals dictate that support is required with intimate personal care and hoists are used as part of this process. The care plans are detailed in this respect and Risk Assessments in relation to manual handling tasks are in place. Two staff members assist with the hoisting process. This effectively leaves three individuals without direct staff support for short periods of time, when only two staff are on duty. The health care professionals who responded by survey said the home does seek advice from them and acts upon this to meet each individual’s health care needs. One professional said the home “seeks to improve its services for residents” and another said the home provides “good appropriate care” to the people who live there. These professionals also felt that the home would benefit from improved hoists and slings to ensure individuals and staff are not put at any unnecessary risk. Training and support is also required in relation to the support some individuals require in relation to eating and drinking. However, they did say that these issues are being addressed and that staff are always “open to advice, training and support”. The home uses the Boots monitored dosage system of medication administration. The records I examined show that two staff sign when medication is dispensed, there is a list of staff names and specimen signatures available, all medication has manufactures profiles in place, stock levels are clearly monitored and recorded and staff have attended training in using the Monitored Dosage system. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 16 Staff spoken with are still unclear on the current policy in relation to rectal valium. Not all staff have been trained to administer this and the home still maintains a stock of this medication, although the current policy within the Dimensions organisation is not to administer this medication. This must be clarified to ensure a safe and efficient system is in place for individuals. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: Each individual has their own complaints procedure, the Dimensions ‘Making a complaint or speaking out’ document, which contains pictures/picture symbols to help each person understand its content. Each person keeps a copy in their room and has this explained to them regularly by staff. There have been no complaints recorded since the last inspection. There have been no complaints received by the CSCI directly regarding Trinity Close. Staff spoken with remain clear about the advocacy role they have. Due to the vulnerability of some individuals, they would rely on staff raising concerns on their behalf. Staff spoken with demonstrated a good knowledge of the action they would take if they suspected or witnessed abuse or felt that any individual’s rights were being infringed. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 18 They also use their daily interactions and observations when supporting people who live in the home to help alert them to any physical signs or changes in behaviour, which may cause them concern. Two relatives who responded by survey said they knew how to make a complaint if they needed to, but one said they were not aware of the formal procedure. Each relative did say however that any concerns they had raised had been responded to appropriately. Staff have been provided with training in the Protection of Vulnerable Adults, although all staff now require refresher training, which is currently being organised. Staff are also subject to Enhanced Criminal Record Bureau Disclosures, prior to commencing employment. Clear records of all accidents and incidents are maintained. The CSCI is also informed of any significant event which occurs within the home. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Several improvements have now been made to the environment. However, further improvements are still required to improve safety, comfort and provide a more homely environment for the people who live in the home. EVIDENCE: Trinity Close is a ground floor flat, which is part of a general needs housing scheme developed by Sanctuary Housing Association. Accommodation is on one level and each of the five single bedrooms are equipped with wash hand basins. There is an enclosed rear patio garden, reached through the patio doors of the lounge/dining/kitchen area. There is a ceiling track hoist in the bathroom and a mobile hoist is also available. There is a shower that is accessible to wheelchair users. The home also has other specialist equipment, such as an adjustable height bath, to Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 20 ensure that dignity and comfort is maintained for each person who lives in the home. There have been several long-standing issues regarding the environment, which have been described during both the last Key inspection process and in greater detail following the Random Inspection I conducted on 08/11/06. Two enforcement notices were subsequently served by the Commission following this Random Inspection. Since my last visit there have been a number of improvements, which have led to a better living and working environment. New carpets have now been fitted in all communal areas of the home and in each individual’s bedroom. A new cooker and hood have been purchased and fitted and the kitchen worktops have been replaced. The small partition wall recently erected to ‘close off’ the kitchen has had the loose tiles removed and has been repainted. This is now more in keeping with the colour scheme in the lounge/dining area. The ceiling tiles damaged by ingress of water in December 2005 have now been replaced. New flooring has been laid in both the bathroom and shower room and remedial action completed to the shower room floor to ensure that the water drains away effectively. All of the existing tiles within the shower room have been removed and replaced with new ones, the rusted handrail removed and a new window fitted, as the previous one could not be opened. This has helped reduce condensation. The skylight lounge window still does not open. This window magnifies the sun and has made this area very hot in the past. An air conditioning unit has now been installed and staff spoken with told me this has been very effective in controlling the temperature in the loung/didning area. The weather was very warm last weekend, yet the lounge was pleasant to spend time in. New mattresses have been purchased for both staff sleep-in beds. Whilst several improvements have be made, further improvements are still required to ensure a comfortable and homely environment is provided to each individual and that their support needs can be met. One staff member had suffered an injury whilst performing a manual handling task in one individual’s bedroom. The subsequent Dimensions’ Health and Safety Investigation Report, dated 27/04/06, highlighted a number of areas of concern regarding the environment and in particular the effect of limited space for staff to effectively/safely carry out manual handling tasks within the home. The issue of limited space was seen as a direct cause of the staff member’s injury. The bathroom/shower room also has very limited space for staff to carry out manual handling tasks. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 21 Staff spoken with told me that they still agree that the lack of space in certain areas of the home causes practical problems, especially when hoisting individuals. Also, the doorways are too narrow to enable wheelchairs or adapted seating to be moved easily around the home. I noted several areas of damage to paintwork or plaster, which continue to support these views. The home’s laundry has no exterior walls and this room therefore becomes extremely hot. The laundry door, which is a fire door, needs to be left open. This presents a fire risk and the heat from the laundry passes into the lounge and other communal areas within the home. Dimensions have produced a plan to develop the service, which includes building works to increase the size of one individual’s bedroom, create one ‘wet room’ to replace the separate bathroom/shower room, relocate the laundry facility to another part of the home and increase communal space. These works would also provide new office space, staff sleep-in room and quiet/sensory room. This will be achieved by removing some existing partition walls and using some of the space of the vacant property immediately next door to 3, Trinity Close. The Manager told me that these plans have now been approved by the Housing Association and hopes the works may commence in the near future. This work remains essential to ensure each individual’s needs continue to be met and that a safe working environment is provided for all staff. The Manager explained that the individuals who live at Trinity Close will need to be relocated during any building works and it is essential to have notice of any intended works to allow sufficient time to organise a suitable relocation for individuals, to ensure their welfare and safety. Each person has been supported to decorate and furnish their bedroom to make it personal to them. There are also photos, pictures and many other personal items, which help with this process. The home was very clean and tidy on the day of my visit. The staff team carry out cleaning tasks as part of their day-to-day duties. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy promotes both individual’s rights and their safety. Each person that lives in the home is supported by a cohesive staff team that is committed to providing a good service. Staff are provided with regular supervision and most have completed training courses to ensure they can meet the support needs of each person who lives in the home. EVIDENCE: There is a core of well-established staff with varying abilities who are skilled and experienced to meet the needs of those living in the home. Several members of the team have worked at the home for a number of years and provide consistency and an excellent understanding of each person’s support needs. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 23 Discussions with staff members and observation of their work practice demonstrated that they were approachable, good communicators and were comfortable with individuals living at Trinity Close who were at ease with them. The three staff on duty were confident in their role and helped the inspection process by explaining their knowledge of care plans, reviews and policies and providing records necessary for the inspection. The home now has a full compliment of staff, as two new staff commenced employment in July and September last year. Staff members told me that the staff team remains open and supportive. They felt supported by the manager and were able to discuss issues in an open and honest way. The home still does not employ waking night staff. There has been a Risk Assessment completed in this respect. It, however, remains unclear how one individual would summon support from staff during the night if they were in difficulty, although staff told me if this person were unwell one of the sleepingin staff would provide waking night cover. Regular staff meetings are held, recorded and appropriate subjects are discussed. The last meeting was held on 06/03/07, with the next one planned for 20/04/07. Relatives and health care professionals who responded by Survey said the staff team had the right skills and experience to support each person who lives in the home and were able to respond to their different needs. One relative said “the staff are doing a wonderful job” and another “the staff are always welcoming and we enjoy our visits”. The home operates a robust recruitment process. The staff personnel files examined showed that these contained copies of application forms, interview questions and answers, contracts of employment and medical histories. Staff have to sign the organisation’s policy relating to confidentiality, provide at least two satisfactory references and obtain an Enhanced Criminal Records Bureau Disclosure prior to commencing employment. Each staff member must satisfactorily complete an initial six-month probation period, before being offered a permanent post. I examined the training records of each member of staff. These showed that most have been provided with all mandatory training together with other appropriate training to enable them to support individuals. This includes health and safety, fire safety, food hygiene, protection of vulnerable adults, medication, first aid, epilepsy, mental health and autism. Some staff have also attended intensive interaction, administration of rectal valium, person centred planning and risk assessment training. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 24 Some staff need to complete mandatory training and staff spoken with told me that refresher training in relation to the protection of vulnerable adults is being arranged as some staff attended this training in 2002 or 2003. The home uses a staff-training matrix to track/record staff training however, discussions with the Manager show that this is not up to date as it does not provide any evidence that the two newest staff members have completed their Learning Disability Award Framework (known as ‘LDAF’) and will commence their National Vocational Qualifications (NVQs) shortly. The Manager also told me that the home has made good progress in supporting staff to gain an NVQ qualification, with four staff having already completed their awards (or equivalent) and one staff member working towards theirs. The home’s Deputy Manager is a qualified NVQ Assessor and supports staff in this area. Staff are provided with regular, formal supervision. Although I did not examine the records, staff spoken with told me they are supervised approximately every four to six weeks. They said they find supervision helpful and supportive. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and competent to run Trinity Close, and meet its statement of purpose, aims & objectives. The manager promotes a person centred approach and this is clearly communicated throughout the service. There are systems in place designed to promote and protect the health & safety of both individuals and staff. The home remains the subject of a comprehensive review and improvement programme. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager, Mr.Flett, has a degree in housing management and has completed an NVQ Level 4 in Care and the Registered Managers Award. He also undertakes periodic training to maintain his knowledge and update his skills and level of competence. The management approach remains open and positive, with a clear sense of direction and leadership. Staff spoken with said their views are listened to, and that they remain well supported by the manager. The home has been the subject of a review by the organisation and plans appear to have now been finalised and submitted to Sanctuary Housing Association for approval. The CSCI have also been provided with a copy of this document. These plans, focused on environmental improvements, are described earlier within this report. The staff team were joined at their last team meeting by the Dimensions Regional Director, who explained the proposed changes to them. The members of staff I spoke with explained that the staff team had recently been involved in helping to plan the future development of the home. This had been completed using a person centred planning method known as a ‘path’. This involves having dreams/goals and then planning steps towards these, which build upon each other and should ultimately enable the goals to be realised. It was clear that each goal was focused upon improving the service and facilities available for the people who live in the home. However, to enable some goals to be achieved and to ensure that each individual’s care needs are met, it is essential that the planned improvements in the home are carried out. There are clear recording systems in place to support the Health and Safety within the home. Records examined included water temperature checks, servicing of gas appliances, portable electrical appliance testing, servicing of the ‘Aqua’ bath and hoisting equipment. These checks had been conducted and recorded appropriately. I also examined the home’s fire log. This showed that during the last thirteen weeks the alarm system had not been tested on three separate weeks. The emergency lighting was noted as tested in April 2007, although no other tests were recorded. Although the home has conducted three recent fire drills, none of the people who took part in these drills have been named in the records. One member of staff present during my visit is responsible for leading the health and safety within the home. It was evident they were clear on their role Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 27 and the responsibilities of this post and that they are currently making several improvements to the recording systems used in the home. The home has several generic Risk Assessments in place. These documents should be reviewed at least every six months in accordance with the home’s policy. Several of these were dated as last reviewed in September 2005 and were therefore considered to be out of date. These should be subject to regular review to ensure the welfare and safety of the individuals who live in the home and the staff team. Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 X X 3 2 2 Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 23(2) Requirement Ensure the development plan to improve the facilities at the home to: increase communal space; increase bedroom sizes; improve ventilation and improve the laundry, is carried out. All staff must be provided with all mandatory and specialist training including refreshers. Fire safety must be improved within the home in accordance with the Regulations. All Risk Assessments must be subject to regular review. Timescale for action 18/10/07 2. YA35 18(1) 18/07/07 3. YA42 23(4) 18/04/07 4. YA42 13(4) 18/04/07 Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations Consider development of sensory possibilities to aid stimulation for individuals who live in the home when reviewing care plans. Clarify staff administering rectal valium and review the need to maintain a stock of this medication. The home should consider removing historical information from each care plan to make them easier to navigate. 2. 3. YA20 YA6 Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trinity Close DS0000008190.V334863.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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