Inspection on 07/09/05 for 3 Trinity Close

This inspection was carried out on 7th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

3 Trinity Close 18/04/07

3 Trinity Close 03/05/06

3 Trinity Close 21/12/05

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 Peter Still Unannounced 7 September 2005 14:45 th 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 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 Stationary 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 D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) New Era Housing Association Ltd Mr Paul Flett PC Care Home 5 Category(ies) of LD Learning disability (5) registration, with number PD Physical disability (5) of places Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 5 persons aged 18 - 65 years requiring personal care only Date of last inspection 15-Feb-2005 Brief Description of the Service: 3 Trinity Close is registered as a care home operated by New Era, an independent voluntary organisation, who are part of the New Dimensions group, 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 service users 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 terrace houses. Accommodation is on one level and five single bedrooms are equiped with wash hand basins. Three bedrooms are equipped with ceiling track hoists and closomat toilet. One bathroom has an Aqua Nova bath with hoist and there is an additional shower room with toilet and wash hand basin. There is an enclosed rear patio garden, reached through the patio doors of the lounge/dining/kitchen area. This patio garden is also accessible to number 9 Trinity Close, which is an interconnecting property also overseen by New Era but currently not in use or registered as a part of 3 Trinity Close. 3 Trinity Close has its own leased mini bus enabling service users to access opportunities ouside the city centre and the costs are supported by a contribution from service users mobility allowance. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place from 14.45 to 17.30 and two staff were present, including the new deputy manager, both were enthusiastic and positive about their work. The inspector communicated with three of the four residents and was able to observe the other resident. The home continues to function with four residents and there have been no changes since the last inspection. The atmosphere at the home was warm and friendly with staff showing a good understanding of resident need. The lounge/dining/kitchen area is the focal point for the home where residents were clearly happy and content. The inspector looked around the home and inspected a number of records. A number of issues concerning the environment need to be addressed and the plans New Era Housing Association have been considering need to come to fruition swiftly. What the service does well: What has improved since the last inspection? A number of issues raised at the last inspection have been resolved. The home has been proactive in gaining the support of the continence advisor, which has led to a change of medication for a resident and ending the need for an invasive procedure. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 6 What they could do better: 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. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Residents benefit from good admission and assessment practice, that ensures that the home is able to meet their needs. EVIDENCE: Care needs are assessed through good documentation and pre admission assessment and three care files demonstrated this. Resident’s needs and individual goals were clearly recorded. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 Care plans, supported by Key Worker reviews provide good information concerning assessed and changing needs and personal goals. Residents are meaningfully involved in decisions about their lives. EVIDENCE: The inspector reviewed 2 comprehensive care plans, with thorough and up to date Key Worker recordings and review. The inspector observed that the direct staff knowledge of resident’s needs is a crucial factor in their ability to provide the high quality of direct care, observed during this inspection. Residents confirmed this to the inspector by their happiness and contentment with the communications they were having with staff. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 13, 17 Staff work hard to provide opportunities for personal development and contact in the local community for residents, although a recent shortage of staff has led to a difficulty in carrying through all individual care plan goals, leading to some lack of stimulation and interest for residents. Residents enjoy a healthy diet. EVIDENCE: The close proximity of the centre of Bath and all that it offers is valuable to the home and staff told the inspector that residents do enjoy going out and that they take residents out frequently; the use of the mini bus is also a valuable asset for residents in this respect. One resident enjoys going to Church and staff said they also read the bible to the resident, which is appreciated. Staff talked with enthusiasm about the ‘quality time’ they give to each resident and the inspector was able to observe their commitment. The inspector was told that residents had enjoyed a holiday to Minehead this year. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 11 Staff were not able to confirm that, during the last month, all individual resident care plan goals had been met. This has been due to a member of staff being sick and another having left. The member of staff who has left had been working on communication symbols for a resident and this work will need to be continued to ensure staff can use the approach to aid the ability of this resident and others to enjoy improved communication and choice. The inspector was told that normally the home functions with three and sometimes four staff on certain mornings, providing valuable time for one to one work with residents. Concern was raised at the last inspection that a reduction in staffing was impacting on the ability of residents to take part in activity and this situation is continuing. A requirement will be made that staffing levels are reviewed and increased where needed and during times of staff shortage to ensure residents assessed needs can be fully met. There was limited evidence of the use of smell in promoting sensory stimulation and it is recommended that this be explored within the home. The garden/patio area could also help with this. The menu was read and was considered to provide a healthy diet. It was noted that a dietician has also provided input to support the home. The meal being prepared on the day included fresh vegetables and lean meat with the fat carefully drained off. Evidence was seen that the sensory element of the food preparation and homely atmosphere of the kitchen/lounge and dining area is a very positive aspect for the home. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Resident’s health and social care needs are mainly well met and promoted by good planning and documentary arrangements. Sound knowledge of specific individuals and their changing needs ensures personal support in the way residents prefer. Medication administration procedures are sound. EVIDENCE: Staff were observed to be very aware of residents needs and preferences. This was also evidenced by the expressions and contentment presented by residents. Three care files showed evidence of thorough recording and input from specialist services including the local CLDT. Evidence was also noted of good key worker recording. Staff were aware of the symbols, which were being established, to use with a resident and showed a set to the inspector but they said that they are not currently using it. Bedrails are used for residents. A risk assessment was not seen for a resident with a specific need and staff on duty were not aware of it. Since the risks Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 13 associated with the use of bedrails can be high, a requirement will be made for a risk assessment to be provided, having been agreed with external agencies, which is reviewed and available to staff at the home. This will also need to take into account that currently, there are no waking night staff and a resident in difficulty may not be able to obtain necessary attention. It is possible that the manager does hold good documentation concerning this and if all the above points have been considered, then it will remain necessary to ensure all staff can find the documentation easily and are aware of its contents. Residents cannot administer their own medication. The drugs cupboard was seen and records correct for the day of inspection. At the last inspection the homely remedy record was required to be updated and kept up to date. Staff said this had been done but they were not able to find the file for inspection. The manager needs to ensure that all records are known and easily available to staff. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Arrangements for protecting residents from the risk of harm or abuse are in place. EVIDENCE: There was no evidence of any complaints since the last inspection. Staff provide good clarity on the steps to take if they were concerned that a resident may be at risk. The home has good policies and procedures in place and staff have had training on the protection of vulnerable adults. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 A homely and mainly comfortable environment is provided, however a number of improvements are needed to maintain safety, comfort and ensure sufficient space. EVIDENCE: The inspector was very impressed with the way the lounge, dining and kitchen area were being used as the focus for the home. The home was also clean and tidy. Currently two residents use wheel chairs and this presents difficulties in the limited clear space within the home. A concern about this was raised at the last inspection and it remains an issue where resolution needs to be found, however it is recognised that the situation is improved by the home functioning at 4 residents rather than the registered number of 5. The last inspection raised concern about the large skylight, which tends to produce condensation and drips. This problem still exists. The blind was seen to be badly water stained and with debris, possibly leaves, resting on it. On the day of inspection, the weather was hot and the need for the blind obvious, it also provides privacy from flats above. Ventilation is also a problem and a Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 16 resident who rarely moves from the lounge may have been uncomfortable; the patio doors were open and curtains were drawn to try to block the heat. Work is needed to resolve this in the near future since it is unacceptable for residents. The dining room table, which gave concern at the last inspection, was seen to be in good condition and very clean. Some kitchen worktops are poor and need replacement. Some carpets are stained including one in a residents’ bedroom and these need to be cleaned or replaced. The corridor carpet is stained outside the home’s shower room: a requirement was made at the last inspection to resolve this but it remains outstanding. The hot water was checked and in the small bathroom near the lounge, the water was found to be very hot, presenting a risk of scalding. The hot water for the Aqua bath was very hot when the inspector set it to the high temperature and this must be reviewed. The small laundry room, which is crucial for the home was found to be too hot for staff to spend time in. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36 Staff are motivated, and working positively to ensure the good care of residents. EVIDENCE: The home benefits from an experienced staff team, where three have worked at the home for a long time, providing consistency and excellent understanding of residents needs. Staff talked of good support from the manager, with six weekly supervision as well as further supervision and support whenever it is requested. A member of staff who has worked at the home for many years was clear and confident within the role and had good knowledge of policy and procedure and was a great help during the inspection in providing the necessary records for inspection. The new deputy manager talked enthusiastically about work at the home and it is positive that the providers have managed to appoint to this post. Visits are undertaken to the home by the providers as required and the records of these were inspected. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The review of changes to the service to resolve concerns needs to lead to positive steps being taken in the near future. These concern the environment and that staffing levels can meet the assessed needs and care plans of residents. In particular, the need for waking night staff must be regularly reviewed to ensure resident safety. EVIDENCE: The last inspection raised concern regarding a need for waking night staff, in that three of four residents would not be able to call for assistance should they need any during the night. Residents are clearly extremely vulnerable both in terms of their physical well being/health needs and their total reliance on staff to respond to their needs. An immediate requirement was issued at the last inspection to ensure a waking member of staff was employed; however following the inspection and further discussion with the Commission it was Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 19 agreed that this could be withdrawn and further monitoring of the concern to be put in place. At this inspection, the inspector concurs with the inspector’s view at the last inspection, concerning the high vulnerability of residents and therefore the possible need for waking night staff. However the inspector did not find any evidence of a concern at not having waking night staff from either the records or from the staff talked to. The staff at the time of this inspection were not able to show the inspector a written review of the risk assessment concerning this matter and it will be required that a review is conducted to establish if waking night staff are required or not and that written records of the review and updated risk assessment are maintained and reviewed at least every three months. Fire checks and those for electrical equipment have been conducted and recorded appropriately. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 2 x 2 x x x 3 Standard No 31 32 33 34 35 36 Score x 3 x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trinity Close Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? 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 20 Regulation 13.2 Requirement Maintain the homely remedy record at the home so that it is easily available to staff and ensure they are aware of it [this was within a requirement at the last inspection with a compliance date of 28/02/05]. a) Clean/replace the stained corridor carpet,outside the homes shower room [this was a requirement at the last inspection with a compliance date of 31/03/05]. b) Clean/replace dirty carpets in residents bedrooms. c) Ensure that condensation from the skylight window in the lounge does not fall onto the blind. d) Replace kitchen work tops that are in poor condition. Ensure suitable staff are working 16/12/05 at the care home in such numbers to meet the needs of service users at all times. (This is to ensure there are suficient extra staff to provide activity and also to review and provide Version 1.30 Page 22 Timescale for action from 7/9/05 2. 24 23.2.b 16/12/05 3. 33 18.1.a Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc 4. 33 18.1.a 5. 42 12.1.a 6. 42 23. 2 7. 42 13.4 waking night staff if it is necessary) Provide and make a review of the risk assessment need for waking night staff easily available within the records of the home and review this at least every three months. Provide CSCI with a copy of this review. Provide risk assessments for the use of bedrails that have been agreed with external agencies and ensure they are reviewed and staff are aware of them. Review the possibilities to improve the facilities at the home to: increase space; improve ventilation; improve the laundry. Provide CSCI with a copy of the outcome of this review. Ensure water from taps cannot cause harm by scalding. 31/10/05 31/10/05 16/12/05 30/9/05 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. 2. Refer to Standard 19 24 Good Practice Recommendations Consider development of sensory possiblitites to aid stimulation for residents, within 3 Trinity Close, when reviewing care plans. Review the possibilities to improve the facilities at the home to: increase space; improve ventilation; improve the laundry. Trinity Close D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG National Enquiry Line: 0845 015 0120 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 D56_D05_S8190_Trinityclose_V234152_070905_Stage4.doc Version 1.30 Page 24 - 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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