Inspection on 22/06/09 for The Trio House

This inspection was carried out on 22nd June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Trio House 26/06/07

The Trio House 16/05/06

The Trio House 07/11/05

The Trio House 22/06/05

The Trio House 19/02/05

The Trio House 15/09/04

The Trio House 18/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 The Trio House 15 Abbotsmead Road Belmont Hereford Herefordshire HR2 7SH Lead Inspector Ms Jean Littler Key Unannounced Inspection 22nd June 2009 11:30 The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Trio House Address 15 Abbotsmead Road Belmont Hereford Herefordshire HR2 7SH 01432 342416 01432 342416 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) Miss Margaret Clark Stevenson Provider in day to day control Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 3 The maximum number of service users who can be accommodated is: 3 26th June 2007 Date of last inspection Brief Description of the Service: The Trio House is home to three adults who require care due to severe learning disabilities. The home was set up just for them in 2001 when the care home the men were living in closed. The provider and manager of this home (Miss Stevenson) was also manager of their former care home and so they have all known each other for many years. The property is a detached family house, which is situated on a large, modern housing estate on the outskirts of Hereford city. There are local shops and facilities nearby, such as a superstore with a café and a park. The home has a suitable vehicle to provide transport for outings to town or further afield. The current fee for the service is £1103.00 per week for each service user. Additional charges are specified in the homes Terms & Conditions of Residence document, and include holidays, clothing, individual personal needs, renewing personal goods, funeral expenses and transport. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. At the last Key inspection in 2007 the service was rated as providing Good outcomes for people living in the home. Therefore it has not been inspected for two years. We (the Commission) did carry out an Annual Service Review on 25th July 2008. This Key inspection was carried out over six hours. The owner and manager, Miss Stevenson, was there for part of the time to help. We looked around the home and saw some peoples bedrooms. We watched the way people spent their time and how staff supported them. We spoke with two of the staff. We looked at some records such as care plans and medication. Two relatives of the people living in the home and three staff returned surveys to give us their views. Miss Stevenson sent us the Annual Quality Assurance Assessment before the inspection, which contains information about the service. What the service does well: The house is near local shops and nice open spaces. The house is quite homely with a private garden. People have nice bedrooms and some have their own bathrooms. People are being well supported with their personal care needs. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 6 Staff respect their preferences and choices. People are supported to take part in activities they enjoy and go out regularly. People enjoy the good quality meals provided. People are supported with their health needs and their medication is looked after safely. What has improved since the last inspection? What they could do better: People could have more person centred plans that include development goals. They could have more opportunity to try personalised holidays and activities based on their individual interests. Each person should have their own Health Action Plan. The en suite bathroom should be used by the person who has that bedroom not the staff. Proper checks need to be carried out on people who want to work at the Home before they start. More of the staff should become qualified. Records could be clearer and better organised to help protect people. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 7 The management of the home could be improved if there was senior staff, shift leaders and more staff supervision. The way the Miss Stevenson checks on the quality of the service could be improved to make sure standards keep improving. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Trio House DS0000024794.V376293.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 The Trio House DS0000024794.V376293.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5. People using the service experience good quality outcomes in this area. have made this judgement using a range of evidence, including a visit to service. The home was set up for current service users and there have been any changes. People do have a contract agreed between the provider their funding authority and the home provides a statement of terms conditions. EVIDENCE: We this not and and It was previously confirmed that a statement of purpose, service users guide and a terms and conditions of residence documents are in place for the home. There is a contract agreed by the provider with the funding authority for all three men, Herefordshire Council, and they monitor this contract. The service users are all men who have shared accommodation for eighteen years. The home was set up for them in 2001 when the care home they were living in closed. Miss Stevenson was the manager of their former care home. Because of the circumstances Miss Stevenson has not needed to assess the needs of any prospective new service users. Therefore key Standard 2 and other standards relating to the admission of new people to the home cannot be assessed. The Trio House DS0000024794.V376293.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s main needs are included in their care plan. People may benefit if person centred planning was more active and used to help develop their social and life skills. People are being supported to make some day to day choices within their capabilities. EVIDENCE: Each person has a care plan folder. The sample seen showed that they contain a personal profile. These covered people’s background, personality and relationships. They were not dated to show when the information was last checked for accuracy. Their care information is not in a format that is accessible to people with learning disabilities. The information about their needs is not very detailed but does cover relevant areas of personal, health and social needs, preferences, activities and some information about each person’s strengths and wants. There does not seem to be a particular focus on helping people The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 11 develop further social or life skills, although staff said they do encourage people to be independent where possible. Aims for the year ahead were more about possible new activities and planning additional holidays and there does not seem to be a system in place to check that these aims are being acted on in a timely manner. Risk assessments relating to their support needs are in place but are stored centrally. These included managing behaviours, advising staff to offer reassurance and redirect the person. Others relate to environmental hazards such as guarding radiators or general risks such as falling, choking, bathing, swimming and support required when out in the community. None were seen relating to the holidays that take place. This guidance is an important part of care planning and consideration should be given to keeping these in the care plans so they are reviewed at the same time as the care plan. Review meetings are currently being held annually. Planning could be made more proactive by goals having timeframes and meetings being held at least every six months to review these goals and develop the person centred plan for the next six months. Staff said they try to encourage people to make daily choices about food and activities within their limitations. Staff are able to interpret people’s body language and facial expressions and so get to know what they like and want to do. The plans could better explain people’s communication needs and how staff need to support communication and decision making in line with the Mental Capacity Act. The Trio House DS0000024794.V376293.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): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being supported to take part in various leisure activities within the community and at home that they enjoy. More active person centred planning may help them try new experiences and further develop their social and life skills. The home also helps them to maintain links with their families and provides wholesome meals they like. EVIDENCE: There was a relaxed atmosphere in the home. The men had only returned the previous evening from a weekend by the coast so they were having a quiet day. People were clearly choosing which room to spend time in. The back door was open and people could go into the garden freely to enjoy the sun. The communal space allows each person to have their own area, so one man often prefers to listen to music in the conservatory while another likes the television on in the lounge. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 13 People spend one day a week at a local day service. All have regular activities such as horse riding, swimming and music therapy sessions and also go on group outings and holidays. Having lived in the same care home for many years they are used to this and seem to get on well together. There is a suitable vehicle to provide transport for outings to town or further a field. During the day one person went for a walk to the local supermarket to get shopping and have a snack. After lunch all were offered aromatherapy sessions. Additional funding was agreed in 2006 to enable the men to have more individualised activities. This involves designated staff time during weekdays to provide one to one support with activities out in the community. Each person has an activity plan which shows they go out for drives, shopping, swimming, walking etc. Staff confirmed that people go out regularly and have busy lives. A worker explained that one man loves football and she hopes to be able to take him to see a live match. She would also like to take one man on a train. This type of person centred planning should be prioritised. In June people had been on their annual holiday in Spain that Miss Stevenson arranges and takes part in. Regular weekends away at her static caravan on the coast are also arranged. Staff were unable to provide photographs or a written record of the recent holidays to demonstrate how the men had spent their time. Miss Stevenson reported in the AQAA that there are plans for individual short breaks to other locations, however, this was mentioned at the last inspection and has not happened yet. The men are all of a similar age with severe learning disabilities who are physically able. There are no ethnic or cultural differences amongst them. Miss Stevenson reports that the service offers an ordinary home to them with staff that understand their differences, individual needs and support them to feel confident out in the community. The staff team are currently all women. It would be positive if men could be recruited to balance out the team and bring different relationships into the men’s lives. All men have regular contact with their families. Relatives are invited to annual placement review meetings. Two relatives returned surveys to us. Both felt the service met people’s needs and allows them to live their chosen lifestyle. They feel they are given enough information to keep up to date and know how to complain if this were ever needed. Staff told us that there is a menu in place based on what people are known to like and it is always clear if they do not want something and an alternative is given. A sample showed a varied and balanced diet with roast dinners, spaghetti bolognaise etc. Staff said the meals are freshly prepared and include fresh vegetables. No one needs a special diet but some need some assistance with cutting food up. People have their meals together at the kitchen table. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 14 Staff said one man will bake cakes with help. The men were not encouraged to get involved with making snacks and drinks or with other tasks during the inspection. When this was questioned a carer did get one man involved with bringing the laundry in from the garden. Staff should be encouraged to engage the men with day to day tasks in the home rather than staff being busy around them. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are having their personal care and health needs met. They do not yet have their own Health Action Plans. Their medication is being safely managed in the home but arrangements for holidays could be improved. EVIDENCE: Service users were observed to be clean and dressed in suitable clothing for the day. Care plans contained charts to show that personal care needs have been attended to daily. Staff confirmed that people need a lot of support with personal care but that they are encouraged to do as much for themselves as they can, such as washing and cleaning their teeth. Care plans have a health section that include details of people’s health related issues and medication. There was no date on these to show how up to date the information was. Records have been written after health appointments such as doctor and dental visits showing what the outcome was. The GP is carrying out annual Wellman checks. One person’s notes showed he had seen his consultant recently and his mother had also attended the appointment. People The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 16 do not yet have a personal Health Action Plan as recommended in the Governments Valuing People Guidance. These plans help make sure that their physical and emotional health are being closely monitored, any problems identified and their good health promoted. They are owned by the person and enable them to take their health records with them if they move to a different service. Regarding the management of medication none of the men are able to self medicate and so staff manage these on their behalf. There is a policy and procedure in place, but these were not viewed. Staff complete training on safe handling of medicines and receive in-house instruction from Miss Stevenson. The medicines are stored in a filing cabinet. This is not ideal as it is not as secure as a specifically designed medication cabinet. Staff confirmed that the keys are being held securely. The administration records were up to date and clear. They did indicate that when the men are taken on holiday the charts are not taken. When the men are taken away in the care of the service the proper records should still be taken and used for their protection. Staff told us that people are occasionally given Lemsip when they have a cold. They did not know if the GP had approved the use of this in conjunction with their prescription medicines. The GP should be asked to provide details of the homely remedies that can be safely given and these instructions should be kept in the care plan. The Trio House DS0000024794.V376293.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the men are unable to express their views directly the home has a system for complaints and they all have relatives to raise concerns for them. Basic arrangements are in place to help protect people in the service, but they are being put at potential risk because proper checks are not always being carried out before new staff start work in the home. Miss Stevenson needs to ensure she is open with other agencies about events in the home to provide the greatest protection for people possible. EVIDENCE: The home has a complaints procedure, although the men’s disabilities mean they are not able to express their concerns or views verbally. It is essential therefore that their families, staff and other people would do so on their behalf. Miss Stevenson told us in the AQAA that no complaints have been received. We have not had any concerns raised with us about the service. The surveys we received and those sent out directly by Miss Stevenson in 2008 showed that relatives feel able to raise issues with her. We contacted the day centre accessed by the men for feedback. They said the men seem well supported. They had not been informed about the recent holiday to Spain therefore they understandably felt that communication could be improved. There is information in the home about protecting people from abuse, which Miss Stevenson said new staff are shown during their induction. She has now arranged for staff to also attend a training session on Safeguarding Vulnerable Adults run by Hereford Council. It would be good practice to provide refreshers The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 18 each year. The local multi-agency procedure was seen in the office and the staff spoken to confirmed they would report any suspicion or incidence of abuse or neglect. There have not been adult safeguarding concerns raised in the last year. The staff supervision file showed that concerns had been raised about the conduct of one worker. There was some evidence of Miss Stevenson’s investigation into the allegation of misconduct. However, there was no clear record of the conclusion. The incident should have been reported to us under Regulation 37. We could have then discussed it with Miss Stevenson to decide if there was any adult protection aspect that the local authority needed to be informed about. Recruitment practices were found to not comply with the regulations and guidance in place to help safeguard vulnerable people. The details are under the staffing section. The Trio House DS0000024794.V376293.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a comfortable, clean, safe and well maintained home that meets their needs. EVIDENCE: The Trio House is at the end of a cul-de-sac on a large, modern, residential housing estate. There is a park next to it and a superstore with a café within walking distance. It is an ordinary detached house and so fits in well with the local community. The home has a fairly small secure garden with a summer house, which is accessed through the conservatory or the kitchen. The house is decorated, furnished and equipped to a good standard and is well maintained. There is a good sized lounge and a brick built conservatory with seating, a television and music centre so providing an extra sitting area. The house has a kitchen dining area, a utility room, office and a staff sleeping in room. Service users all have The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 20 single upstairs bedrooms. Those seen were very nicely personalised and comfortable. One bedroom has an en suite toilet and bath. Another has an en suite toilet and shower but this facility is used by staff who sleep in and not by the resident. There is a communal bathroom outside his bedroom that he uses. This is rather an unusual arrangement that is not ideal. Staff said they do not go into his bedroom to use the facility once he is in bed and they then use the communal toilets. However, it is not ideal if staff are showering while still responsible for residents who are up and about. No mobility aids are required at the moment, however a rail opposite the banister may enable one person to use the stairs more safely. A risk assessment shows he has an unsteady gait and needs staff supervision on the stairs. Miss Stevenson said in the AQAA that routine safety checks have been carried out, such as on gas appliance tests and that staff are receiving relevant training. Electrical items had been checked in the last year. Records in the home confirmed that the domestic fire alarms are being checked and that the fire extinguishers have been serviced. Consideration should be given to fitting a fire alarm in the laundry. All areas were seen to be clean and tidy. There is a policy and procedures are in place relating to infection control. Disposable gloves and aprons are provided for staff. Clinical waste is bagged properly and stored outside until collected. A side door is used so it is not taken through the kitchen. The arrangements in place for soiled laundry are not ideal as there is no sluice facility on the washing machine. Staff said they hand sluice items under the garden tap before washing them, or if they are heavily soiled they are thrown away. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a fairly stable staff team who know their needs and preferences. Relevant training is provided for staff. Staff management systems such as supervision are not well developed but staff say they do feel supported. Staff recruitment procedures are not being followed consistently and proper background checks have not always been carried out before new staff have started. EVIDENCE: The staff team comprises of three full time and six part time care staff. Two workers have left in the last year. Two staff are always deployed during the day, with a third most weekdays between 9am and 3pm to facilitate activities. One sleeps in at night. Staff spoken with said the team works well together and there is good morale. The three staff surveys returned were positive on the whole. They indicated that they have up to date information about the men’s needs; that recruitment checks had been taken up and their induction covered everything they needed The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 22 to know; that the owner regularly meets them and gives them support and they know what to do about any concerns; they feel they have enough support, experience and knowledge to meet people’s different needs and that there is usually enough staff. One commented that team building exercises would be helpful. Some of the staff are keyworkers for the men. One spoken with explained the responsibilities this involves, such as taking people to buy their clothes and toiletries. It does not appear that keyworkers are currently actively involved in care planning. If their role was expanded in this way it would increase their skills and could develop the plans into a more modern and person centred format. Recruitment records were not well organised and some gaps in records were noted, for example two staff only had one written reference. Miss Stevenson said she had got a second one over the telephone for one worker but did not record this. For the other worker she thought it must be lost. One person had started six weeks before their CRB arrived and no POVA First (Protection of Vulnerable Adults) check had been obtained beforehand, as is required by law. Applicants are asked to complete an application form and ID is obtained. An urgent action letter was sent to Miss Stevenson about the recruitment shortfalls after the inspection. She replied saying she had now found the missing references and understood that staff should not be allowed to start before the CRB has arrived. Miss Stevenson said new staff are being supported to gain the Learning Disability Qualification after their induction programme. One worker confirmed she had the previous award of LDAF. There is also an induction checklist for new staff and they work shadow shifts to familiarise themselves with care practices, people’s needs and all the home’s policies & procedures. There is a training plan to make sure that staff complete mandatory health & safety training and some courses specific for the men’s needs. The staff spoken with felt adequately trained for their role and said that staff meetings are used for short training sessions such as watching a DVD on infection control. Miss Stevenson said these are held bi monthly in the summer and monthly in the winter. One workers training record showed she had completed the LDQ in March 09, had attended medication, food hygiene, first aid, fire safety and valuing people training. Three staff have an NVQ qualification in social care and another said she was in the process of completing the course. Support for this award should continue as at least half the staff team should be qualified to meet the Standard. Miss Stevenson reported that staff receive individual supervision every three months. The records seen were brief and did not indicate that meetings are held this often. Notes seemed to be mainly agreements about overtime rather The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 23 than about people’s skills, professional development, keyworking duties, training needs etc. One worker said she thought she had supervision about every six months and an annual appraisal. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42. Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. People are settled in their home and they are having their day to day needs met. They could be better protected if recording, management and quality assurance systems were further developed. EVIDENCE: Miss Stevenson owns the service but as there is no appointed manager she is also responsible for the day to day management. She holds the NVQ 4 in Care. We are not aware that she has completed the Registered Managers Qualification which all managers should hold. The rota did not show the hours Miss Stevenson works in the home. Staff spoken with could not describe any pattern to her presence in the home. One said she goes on the holidays and did used to work some weekends. The rota The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 25 available into August did not include Miss Stevenson. Staff did confirm that she holds staff meetings and that she is aware of any issues with the men. There is no senior structure within the team and no practice of identifying a shift leader. Staff said they work as a team and make joint decisions. Although this may feel comfortable for the workers, it means there are no clear lines of accountability on a daily basis when Miss Stevenson is not on duty. Miss Stevenson’s explanation about shortfalls in staff recruitment procedure is an example of how the lack of management structure put residents at risk. She said staff had taken the decision to start a new worker before references and a CRB had been received while she was away on compassionate leave. As mentioned under staffing, records showed that one new carer had worked for six weeks before the CRB arrived. If Miss Stevenson was on leave for more than 28 days a notification should have been sent to us with an explanation of the temporary management arrangements. Miss Stevenson said she was unaware of the requirement to obtain a POVA first check if starting a worker before the CRB was returned. Requirements have been made at previous inspections in relation to poor recruitment practices and a statutory requirement notice had to be issued before standards were improved. It is a concern that after enforcement action had been needed to make improvement Miss Stevenson has allowed the standards in this area to fall again in the two years between inspections. Other records required are being maintained but some of these, such as training records, were not well organised and there did not seem to be any record relating to the holidays even on essential areas such as medication administration. A sample of records were seen relating to resident’s monies. These showed that the men had savings and receipts are kept to evidence expenditure. Those seen showed they had purchased appropriate things such as toiletries and refreshments while on trips out in the community. The information in the AQAA was again very brief. It did not provide much evidence of how the service is providing good outcomes for people living at the home in each area of the service. There were also few improvements described since the last inspection or plans to improve the service in the next year. It is positive that Miss Stevenson has continued with the quality assurance practice of sending out feedback surveys to relatives. Those seen from 2008 contained positive comments. She plans to circulate these again in September 09. The quality assurance check list seen had ticks on a few comments noted, however, it did not contain details of what was being checked in each area before it was being considered as satisfactory. If an effective quality assurance system was in place the gaps in recruitment records would have been identified. Monitoring systems need to be further The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 26 developed before people who have an interest in the service can be confident that standards are being checked and maintained. Comments included in the two surveys returned from relatives included, The service provides excellent care and is a home from home environment. Residents are cared for to a very high standard; Trio House is a very happy environment and I am very confident that my son is getting all the care and attention he requires. Regarding health and safety, staff are being given basic relevant training and the information obtained indicates that risk assessments and necessary servicing and checks are being undertaken. Fire records showed that equipment is serviced and alarms tested. A worker confirmed that fire drills are held. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 27 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 x 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 2 2 X 2 3 x Version 5.2 Page 28 The Trio House DS0000024794.V376293.R01.S.doc NA 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 YA34 Regulation 19 Requirement Two written references from appropriate people and a satisfactory CRB must be held and available for inspection for all staff currently employed in the home. All future staff must only start in post when background checks are in place. This is to help safeguard the people using the service. Timescale for action 31/07/09 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 YA6 Good Practice Recommendations Assess potential goals and support people to develop social and life skills. Keep all care related information, including risk assessments, in the care plan to demonstrate that they are kept under review at least six monthly. The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 29 Hold care review meeting at least every six months, in line with the National Minimum Standards, to ensure person centred planning is active. Ensure information is dated to show how current it is. 2. YA7 Complete Mental Capacity assessments for each person in the home and include in the care plan how decisions are made in their best interest. The risk assessment relating to a person’s epilepsy should cover night time safety, swimming, and bathing. Regular holiday activities and these environments should be risk assessed to show due consideration is being given to people’s wellbeing whilst away from home. Staff should sign risk assessments and care plan files to show they have read them. 4. 5. YA11 YA14 Ensure people are encouraged to be involved in household tasks when staff are completing these. Keep evidence of how the men spend their time on holiday and photographs for their memories. Further develop person centred planning on favourite activities and individual short breaks. 6. 7. 8. YA15 YA19 YA20 Recruit male staff to give the men a balanced input and the chance for different relationships. Each service user should have their own Health Action Plan. A record of the medication administered to people whilst on holiday in the care of the service needs to be maintained to help protect people and ensure they get the correct medication prescribed for them. Obtain guidance from the GP about the homely remedies that can be safely given in conjunction with people’s prescribed medicines. Provide a medication cabinet that is specifically designed for the purpose to increase medicine security. 9. YA24 Fit stair rail opposite the banister. DS0000024794.V376293.R01.S.doc Version 5.2 Page 30 3. YA9 The Trio House Fit a smoke or heat alarm in the laundry. 10. YA27 Review the practice of staff using one person’s en suite shower room when there is a communal bathroom available. Continue to plan to provide relevant and varied training to develop the teams skill level, including Total Communication, LDQ, person centred planning and epilepsy The programme of NVQ training should continue to ensure that at least half the staff team achieve this qualification. The owner should complete the Managers Qualification. The owner should ensure significant events in the home are reported to the Commission in line with the Regulations covering Notifications. 14. YA36 Provide staff with supervision at least every two months and use sessions to help staff develop their skills and fulfil their potential in their role. Develop a senior structures in the home so it is always clear who is in charge and where accountability for people’s wellbeing and for following the home’s procedures lies. Senior staff should share some of the staff supervision responsibility with the owner to help enable sessions to be held more frequently. 16. YA39 Further develop the quality assurance system so it is more effective at showing up problem areas and it is clearer what has been checked and how. Use the information to develop a clear annual improvement plan and share this with people asked to give feedback so they can see how they have contributed to the ongoing development of the service. 17. YA41 Review the way records are maintained and stored so they are well organised and can be easily accessed and useful in the quality assurance process. 11. YA35 12. 13. YA32 YA37 15. YA38 The Trio House DS0000024794.V376293.R01.S.doc Version 5.2 Page 31 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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