Inspection on 11/03/09 for Trinity Court

This inspection was carried out on 11th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trinity Court 03/03/10

Trinity Court 30/11/09

Trinity Court 01/12/06

Trinity Court 25/10/05

Trinity Court 17/11/04

Trinity Court 01/07/04

Trinity Court 27/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Trinity Court Station Road Staplehurst Kent TN12 0PZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary Cochrane     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Trinity Court Station Road Staplehurst Kent TN12 0PZ 01580895288 01580895310 trinity@consensussupport.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Consensus Community Support Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Trinity Court is a detached three storey property on the outskirts of Staplehurst. The lower two floors are available for use by service users. The home provides for 10 single en-suite bedrooms and a range of day spaces. There is a large secure garden to the rear of the property. There is easy access to local shops, medical centre, post office and pubs. Car parking space is available to the front of the property. Buses to local towns stop close by. There is a mainline railway station near the home. Trinity Court caters for 10 adults with a learning disability who may also have behaviour that challenges. Current fees range from GBP1274.29 to GBP1889.90 per week. Clients pay separately for hairdressing, toiletries and horse riding. There is a staff team consisting of support workers, seniors, deputy manager and manager. Care Homes for Adults (18-65 years) Page 4 of 38 Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The last at this service was in December 2006. The visit to Trinity Court was an unannounced Key Inspection which took place over one day. The manager was available throughout the day. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. The service is registered for 10 service users. When we visited there was 9 people living at the home. Care Homes for Adults (18-65 years) Page 6 of 38 The visit included talking with service users and care staff. General observations were made during the day of how people are supported. We had a look around the home and various records were inspected. We observed how staff supported service users during social activities and when offering care. We looked at and discussed service users individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. Since the last inspection there have been 2 safe guarding vulnerable (SVA) adult alerts raised at the home. This means that the local social services adult protection team has been informed about incidences which may affect the service users. The alerts have been dealt with according to procedures and the service have taken the appropriate action to make sure the service users are protected. What the care home does well: What has improved since the last inspection? The service has made improvements to the environment since the last inspection. Carpets have been replaced and some areas have been redecorated. There is still work to do and the company now have a 5 year maintenance plan in place to make sure the work that is identified as needing doing is completed in a timely manner. Care Homes for Adults (18-65 years) Page 8 of 38 The home now have a maintenance man 2 days a week which makes sure jobs do get done. The service now has thorough and robust practices which are followed when employing new staff. The home make sure they check the employment history of all staff when they apply for a jobs. Any gaps in their history are explored at interview. References are sought from previous employers and safety checks are carried out. This means service users are protected by the companys recruitment procedures. What they could do better: Everyone living at the home needs to have a contract on their files so they can see and know what they are paying for. Each service users has a care plan but these need to be developed to give staff all the information they require to support and care for the service users in a way that suits them best. The support plans need to identify and meet all their needs. Plans need to help people to live a fulfilling life. This will promote independence and autonomy for service users while keeping them as safe as possible. Plans need to be used by the staff as a daily working document. The home needs to evidence that service users are involved and have more choices about what they do. The service needs to make sure that all the personal and health care needs of people are identified and met. This means that the health of the service users will be promoted and they will receive all the care that they need. This will improve and maintain their wellbeing. There needs to be robust individual behavioural guidelines in place for each person who needs them. These need to give direction and guidance to staff about what they have to do if there is an incident which may involve them using specialist interventions to manage certain behaviours. This will make sure that all service users and staff are protected and risks kept to a minimum. The way medication is administered needs to be reviewed. This will make sure people receive their tablets as safely as possible and reduce the risks of any errors. Communal areas in the home could be more homely and inviting. People need to be able to freely access all areas of their home. The staff all need to have the necessary mandatory and specialist training to make sure they have the knowledge, competencies and skills to look after the service users. They also need to have regular supervision to support them to do their jobs effectively and in the best interest the service users. The company need to make sure that the shortfalls identified in their audits are acted on and implemented in a timely manner. The home needs to develop and implement quality assurance systems to ensure that it is meeting its aims and objectives and is improving the service for the people who live at the home. The manager needs to register with the commission. She also needs the support of the Care Homes for Adults (18-65 years) Page 9 of 38 company to make sure there are enough resources available to adequately support and meet the needs of the people who live at Trinity Court. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service Users Guide provide sufficient information for service users and their family/advocates to make informed decisions about the homes ability to meet their needs. Service users know that the home will assess their needs and aspirations. Service users do not know what services they are paying for at the home. Evidence: The home has an up to date statement of purpose and a service users guide. Both are well written and informative. The Service User Guide contains relevant information about the home and how care will be delivered. The guide has been developed into a format which is suitable for the service users. It contains pictures and symbols that are easy to follow and understand. The service users do not have easy access to the guide so do not have the information to tell them what the home has to offer. The manager said that this issue would be addressed. Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: No new service users have moved into the home since the last inspection. We did see 2 assessments of the existing service users. These were comprehensive and contained the necessary information for the service user/representative and the home to decide whether or not they could support and care for the person. We also saw a copy of a joint assessment done by the care manager. The companys assessment procedure is that all new referrals are sent to head office. The manager of the home and a person from head office then go together to assess the prospective service user. This will make sure that the home has the facilities, skills and resources to support the person in the best possible way. We saw that none of the service users have contracts and terms and conditions of residency on file. The manager was unable to locate these and told us they were kept at head office. This means that the people who use the service have no information available to them about what they are paying for. We were told this information would be made available to the service users. This shortfall was identified in the companys audit in July 08 and again at the follow up visit in October08 but at the time of the visit it remained outstanding. The companys time scales had not been adhered to. Care Homes for Adults (18-65 years) Page 13 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are short- falls in the planning, implementing and risk assessing the changing needs of the people who use the service. Service users are able to make some decisions about their lives but this needs to be developed further. Evidence: Each of the people living at the home has a care plan. We looked at 3 care plans to see if information from the initial assessments had been followed on into the care plans for service users and staff to use. The plans contained some of the information needed to meet personal care needs of the service user and some of this was of a good standard. We could see how people liked to be supported with regards getting to getting up, personal care, and some of the things that they liked to do. Part of the plans were individualised and attempts had Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: been made to make them person centred but there was gaps in the information. The plans had not been completed. The ones we saw did not reflect the support and care identified in the initial assessments. In one persons plan it stated that support was needed to make breakfast but there was nothing written to say how this would be done. There was no evidence to say the person had made breakfast. Another person was identified as having problems sleeping at night but there was nothing in place to tell staff how to best manage this situation. We also found that incidents of aggression had not been adequately recorded. Incident forms had not been completed and care plans had not been up- dated. The ways people communicated and how they could be supported to make their needs and wishes heard were not included in the plan also peoples goals and aspirations were not identified and followed through. This was a recommendation in the last inspection report. The staff who knew the service users well were able to tell us how peoples need are met, but there were no systems in place to show this was being done consistently. Service users plans did not cover all aspects of health and social care, medical needs, specialised needs, behaviour management and interventions. Care plans had not been updated to reflect changes in support and care. We could not see how changes made to peoples care are being monitored to make sure they are effective and beneficial. Some plans had not been signed or dated. The support/care plans were kept upstairs and staff came up there to write them. Daily reports are written at the end of each shift, we could see they were not being used as a daily working and service users were not involved in this process. We found that relevant information concerning activities and how people spent their time had not been recorded in the daily records so we could not trail if people had been supported and doing the things that they wanted to. Shortfalls in the care planning system had been identified at the companys audit in July 08 and highlighted again at the follow up visit in October 08. This shortfall remained unmet at the time of our visit. We have taken into account that the home has recently has had management change and a lot of new staff. The manager told us that she was aware of the shortfalls. The service does recognise the rights of the service users to take control of their lives and make their own decisions and choices. We saw that people were able to make some say about what they did during the day. Some of the service users told us how they may decisions and choices. We saw that staff listened to them and acted on their wishes and gave the necessary support. The service does need to be able to demonstrate and evidence that service users are able to make decisions and choices about how they want to live their lives inside and outside the home. Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: There are risk assessments in place. Some of the risk assessments we saw were thorough and robust and gave direction and guidance about how risks could be managed effectively while allowing service users to be independent as possible. However some of the risk assessments around behaviour had gaps which potentially could lead to service users and staff being at risk. We also saw that people where restricted in which areas of the home they could access. They could not freely go into the dining room kitchen or garden. The doors to these areas were locked. We saw no individual risk assessment in place to say way these restrictions are in place and what risk they pose to service users if they are adequately supported. Care Homes for Adults (18-65 years) Page 16 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of the Service Users have opportunities to are supported to do activities that they enjoy and be part of the local community. Family links are encouraged and maintained wherever possible. The home provides a choice of healthy, nutritious meals. Evidence: Everyone at Trinity Court has an activities plan and are doing different things. During our visit we saw that life at the home is busy and active for the majority of the service users. People were relaxed and happy and getting on with normal daily activities. We spoke to service users and staff and saw that the home promotes and supports individuals to live a meaningful life. Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: On the day of the visit some service users were going horse riding. Some people have accessed college courses in the past and the manager is in the process finding courses that would be appropriate for different service users. Some people go swimming and one person was very proud of a certificate he had attained. There are regular trips out for lunch. Everyone we were able to speak with said they were very happy with their life styles and they had plans to do more things. The home does need to make sure that the people who are not so able also have the opportunities to develop a life style that suits their capabilities and preferences. The home is not showing what they do if someone decides they do not want to a do an activity. The staff are not recording how they are encouraging and supporting people to do things. They are not saying what alternatives are offered. The outcome of this is that it seems that some people are spending a lot of time in doors watching television or cleaning their rooms and not going out and about. The manager told us she would address this issue. Some service users access the local facilities and are part of the local community. They go to social clubs and discos. The majority of the service users have contact with their families and visits home are arranged. Personal friendships within and out-side the home are supported. Anyone who wants to can have an annual holiday. Service users are supported and encouraged to be independent and involved in some areas of daily living within the home. They are supported to clean their own rooms do their own washing. This could be extended to using the kitchen more regularly so the all life skills are promoted. Service users are offered a key to their own rooms and agreements are signed to indicate if they wish to have one or not. We saw that care staff had good body language and communication skills. They were seen to talk and interact in a positive way; they involved and included service users in conversations. The staff on duty at the time of the visit were respectful and caring. Service users told that they liked to staff and that they are able to choose who is their key worker. Service users can choose when they want to be in company or when they want to be in the privacy of their own room. The care staff at the home prepare the meals. There is a 4 weekly menu plan and the choices of food offered to the service users is nutritious varied and healthy. Meal times Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: are done in 2 sittings which means that people receive the support they need. People have a choice about what they would like to eat. The staff keep a record of the food that is being offered and what is chosen and eaten by the service users. People told us that they liked the food. Staff did tell that on occasions service users do help prepare meals but we saw no evidence of this on the day of the visit or in the documentation kept by the home. Care Homes for Adults (18-65 years) Page 19 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users cannot be sure that all their personal and healthcare needs will be monitored and met. The homes medication procedures do not fully protect the safety of service users. Evidence: We saw that some people did have support plans in place around their daily routines with regards to getting up and going to bed and personal hygiene. They explained the particular way that people like to have things done. We saw that care staff gave the people the support and assistance that they need while allowing them to do a much as possible for themselves. Each person living at the home has a key worker. The home have started to develop health action plans but these had not been completed. When we looked at the health care records of the service users we found that some people had been to visit specialist services or their doctors but plans had not been up dated or reviewed to reflect the changes in their support and care. There Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: was nothing in place to evidence how the changes were going to be monitored and what action staff should take. One person had their epilepsy medication reviewed and changed, there was nothing documented to say this change was going to monitored and whether it was beneficial or not. We saw that 2 people within the home have behavioural needs. We were told that the company has employs a behavioural specialist. The companys July 08 audit reported that the home would receive input form a behavioural specialist but at the time of the inspection this had not happened. We looked for guidelines that should be in place for when service users presented with behaviours that might cause a risk to themselves or others. We found that there were guidelines in place and up to a point these were good. But they stopped short of telling staff what to do if a situation arose were they had implement any type of intervention or recognised restraint practices to protect service users. The care staff at the home have not received training in interventions but had been dealing with challenging behaviours. This means that staff might not know the best way to respond if a person does have a behaviour which is challenging. Approaches could be inconsistent and leave people at risk. Each service user is registered with a local doctor and any area of concern related to health is referred to them. There is contact with specialist services when needed. The home has 2 drugs cabinets. Medication is stored safely. The home uses a predispensed system for administering some medicines. This means that the medication is administered to service users more safely as it has been pre-packed by the pharmacist in blister packs. Some of the medications are dispensed directly from bottles. No one administers medication unless they have received the necessary training. None of the service user self administer. We looked at a sample of prescription sheets. The majority of prescriptions sheets had been signed to indicate that service users had received there medication on time. We were concerned to find that the staff were potting up everyones medication into individuals containers, then putting them into a locked box. They were then taking this to the kitchen and administering medication. There was no logical reason as to why medication was being administered like this. It does mean that secondary dispensing is happening. This is unsafe practices as it increases the chances for errors and it is also more difficult to identify errors. When we asked about this we were told that this is the way it has always been done. The manager is now going to review this practice. After the inspection the manager reviewed this procedure and it has now been changed. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a when required basis. There is some Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: guidance in place to tell staff what the medication is for and how much to give but it does given the staff written instructions and guidance to tell them under what circumstances they administer the when required medication. There is a section for this on the protocols but it has not been completed. This means that the medication may not be administered consistently and effects monitored. Care Homes for Adults (18-65 years) Page 22 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system and service users There is inconsistency around how to support individuals with behaviour and restraint issues. Evidence: The home have received no complaints since the last inspection. There is a full complaints procedure in place and it is written in a format that might make it more understandable to people who use the service. Staff spoke about how they support people with communication difficulties to express themselves if they might have a problem. Staff said they have got to know individuals really well and can recognise what behaviours and facial expressions mean. The Manager said that service users are encouraged to voice their feelings throughout the day. She told us their views are listened to. The manager does need to look at other ways some service users can communicate effectively without being totally reliant on the interpretation of the staff. There is now information available to tell people how they can get in touch with advocacy services. There are clear guidelines in place for safeguarding adults. Staff have had training in safeguarding and abuse awareness. They felt confident that they would report any concerns to the person in charge of the shift or the manager. They said they have good communication in the team. We spoke to some of the staff and they were clear Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: about their responsibilities with regards to protecting the people in their care. We were told that there has been 2 safe guarding vulnerable adults alert since the last inspection. These were appropriately investigated and the necessary action was taken by the service to make sure people are safe. As previously identified in Personal and health care section of this report there are shortfalls in how challenging behaviours are managed. This means we cannot be sure that individuals are protected and supported the way that suits them best and keeps risks to a minimum. We saw there are safe procedures in place for looking after service users finances. The home has developed systems of managing service users personal monies, which protects them from abuse. The home provides a safe place for the storage of monies and valuables. The registered manager was able to audit trail and account for the service users finances. Care Homes for Adults (18-65 years) Page 24 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is comfortable and safe. The service users benefit from living in an airy and clean environment. Improvement need to continue. Evidence: We looked around most of the home during the visit. We could see that some environmental improvements have been made since the last visit. There are new carpets in the lounge areas and some areas of the home have been redecorated. The manager told us that they now have a maintenance person who comes to the home 2 days a week so jobs are getting done in a more timely manner. The company have produced a five year maintenance plan which identifies the areas that will need attention and work during this period. We did noticed that on the forecourt of the home there was a big pile of rubbish. The bins were all over the place and this really gave the impression that the house was a residential home, it did stand out from the others on the road. The manager said she would address this. Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: We did notice that the large lounge area was dark. This is because the windows in the door leading to the garden had been boarded up. The manager told us that requests had been made to replace the glass but at the time of the visit this had not been done. Some of the areas of the home especially the hallways did seem clinical and bare. More could be done to make the premises more homely and interesting. A garden house has been built in the corner of the garden. We were told that service users like to spend quiet times in there in the better weather. The manager has plans to make more use of this, perhaps developing it into a sensory area. The service users are encouraged and supported to personalise their rooms. The bedrooms that we saw are individual and reflected the personalities of the people who live at the home. All the bedrooms have an en-suite facilities. Service users have the aids and adaptations they needed to maximise their independence and to assist in their care. The home was clean and fresh on the day of the visit. Service users are supported to clean their own rooms. The laundry area has all the necessary equipment and facilities in place. Staff were aware of infection control procedures. Staff have not received infection control training but this has been planned. Care Homes for Adults (18-65 years) Page 26 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is enough staff on duty at all times but they may not have not got the necessary skills, competencies and knowledge to meet the needs of the service users. Service users are protected by the homes recruitment practices. Evidence: The home have had a lot of staff changes in recent months. There are 12 care staff employed and seven of these are new. Some are working through their induction and others are in the process of doing the necessary training. There is a key worker system and service have a choice about which staff member they would like to support them. Staff were observed interacting with service users throughout the site visit. There was a relaxed atmosphere with service users being able to express themselves and enjoy what they were doing. We saw that the staff are approachable and responded to service users in a positive and supportive way. Some service users indicated or told us that they liked the staff and got on well with them. One person told us that the staff are helping him to do what he wants. The home has an NVQ programme. They have yet to reach the 50 target of staff with NVQ level 2 or above but they are working towards it. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: We looked at the duty rota. There are enough staff on duty on each shift to make sure the service users can do what they want when they want. The manager told us that they have had to use agency staff but they make sure that agency staff are consistent. This has now been reduced as they have own staff team. The home has a training matrix. Shortfalls were seen in areas of staff training. From looking at the evidence it was seen that some staff have not received the required up dated mandatory training even though they have been at the home for a considerable period of time. There are also gaps in specialist training. Staff who had worked at the home for 6 months had not received training in how to safely manage challenging behaviours and restrain people safely. This means that incidences will not be dealt with in a way that is best for individual service users and people might be at risk. The manager did take immediate action and changed the duty rota to make sure there was a staff member on at all times who had received the necessary training. Staff we spoke to at the time of the visit did not have the knowledge and skills they require to undertake their role effectively, efficiently and safely. The home are required to make sure this shortfall is addressed and that training is planned and ongoing. Shortfalls in training were identified at the services audit in July 08 but these shortfalls remained outstanding at the time of the visit. We were told that a lot of training has been planned for over the next few months but there has been a long period of time when staff have been working with vulnerable people with out the necessary knowledge and skills. The management of the home needs to make sure that staff competencies are checked at regular intervals. The service told they have monthly staff meetings. Evidence of this was seen at the site visit. We looked at 3 staff files during the site visit. Since the last inspection the home has improved the way it recruits people. All safety checks are done. People work under constant supervision until their CRB checks are seen. The files we looked at contained the majority of information to make sure that the service users are protected. We did find that a person who was recruited through an agency had not completed the companys application form and they had not sourced their own references. The manager told us she would do this before the new staff member began to work unsupervised. They also no up to date photo of staff on the files. There was no evidence available to say that staff were receiving regular supervision or that annual appraisals had taken place. The manager said that she planned to start Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: these. Care Homes for Adults (18-65 years) Page 29 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are shortfalls in the management and quality assurance systems of the service. Required health and safety checks are undertaken. Evidence: The manager of the service has only been in post since October 08. She was deputy manager at Trinity Court before her promotion and has worked in care for 12 years. She has completed her NVQ level 3 and is waiting to start NVQ level 4 and managers award. She has not yet applied to the commission to become registered. The manager does have has an understanding of the key principles and focus of the service but we did identify shortfalls throughout the inspection process with regards the care and support for the service users and staff training . This means that some care needs are not being managed in a way that would best suit the people who live at the home. Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: We looked at very good, thorough audit that had been done by the regional manager of the company in July 08 and most of the shortfalls identified in this report had already been identified in the audit. They were again identified at a follow up visit in October 08. Timescales had not been met and only a few improvements had been achieved. The company have not taken pro-active steps in addressing these shortfalls in timely manner and they remain outstanding. To address these shortfalls further support and action is required from the organisation. Since taking over the post there have been a lot of staff shortages within the home and this has affected the amount of managerial work that has been completed. The manager told us that now they have enough care staff and have recently appointed deputy. She said with support she will be able to tackle the requirements made in this report and improve the home for the people who live there. The AQAA that was sent to us by Trinity Court had not been fully completed by the previous registered manager. The information that was included was brief and did not give a good overall picture of the service. Quality assurance questionnaires have not been sent to relatives,, staff or other people who have an interest in the service. The manager told us she plans to do this in the coming months. This information will then be collated and the outcomes passed on to those who have an interest in the service. Monthly checks are carried out at the home. And as previously mentioned robust audits have taken place. But these systems have not made sure that the areas of weakness within the home have been pro-actively managed and improved to benefit of the people who live at Trinity Court. The home provides a safe environment for service users to live in and staff to work in. Good working practices ensure the home is free of hazards. The company has an induction programme which is in line with Skills for Care. Policies are in place to strengthen safe practices. All the relevant checks and inspection of equipment and systems have been undertaken and some were evidenced on the day we visited. Dates of all other recent services and checks were included in the AQAA. An accident book is maintained. Fire checks are being done. There home has also has completed a fire assessment. Water temperatures are being logged and are within the required limits. Care Homes for Adults (18-65 years) Page 31 of 38 Care Homes for Adults (18-65 years) Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 All people living at the home 31/05/2009 need to have a contract/terms and conditions, which is available to them. It needs to tell them what services they are paying for at the home and what is extra. The contract needs to be signed by the service user/representative and the registered manager. To make sure people know what they are paying for. 2 6 15 The care plans need to 31/05/2009 contain the relevant information to meet the individual needs of the service users. They need to be used as a daily working document by the service users and staff. Goals and aspirations should be written clearly and simply with steps detailed to reach these goals, with care plans kept up to date. Care Homes for Adults (18-65 years) Page 34 of 38 To make sure that all the needs of the service users have been identified and that there is an accessible plan in place to show how these needs are going to be met by the service. This will a. tell staff what they have to do to look after the person in the way they wish and have chosen. b. to make sure that any changes in service users care is identified and the appropriate action is taken. 3 19 13 The service need to make sure that there are up to date plans and guidance in place to support all peoples health care needs. 31/05/2009 To promote and maintain the health of the service users and ensure there is access to health care services to meet assessed needs. To monitor for improvement or deterioration in health conditions so that the necessary action can be taken. 4 20 13 To have arrangements in place to make sure that medication is administered as safely as possible. 30/04/2009 Care Homes for Adults (18-65 years) Page 35 of 38 To make sure that service users receive their medication safely and in a way that reduces the risk of mistakes. 5 35 18 Staff need to receive 31/05/2009 specialist training so they have the knowledge and skills to meet all the needs of the people they are caring for. To make sure the service users receive the support, care and intervention they need in a way that best supports them while keeping them as safe as possible. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 To make sure that people are allowed and supported to make choices and decisions about their lives. The service needs to evidence why they have restrictions in place about which areas of the home individuals are able to access. Individual risk assessments need to be developed and implement to ensure that all risks are kept to a minimum. Risk assessments need to assist and enable service users not restrict them. Guidelines need to be included in each individual support plan where staff are expected to intervene with potentially aggressive behaviour. 50 of care staff need to be trained to NVQ level 2 or above. All staff need to receive regular supervision and have an annual appraisal. The registered person/company service needs to make sure that the home is effectively managed on a day- to- day Page 36 of 38 2 9 3 23 4 5 6 32 36 37 Care Homes for Adults (18-65 years) basis. They need to ensure that the service users receive all the care and support that they need. The manager needs to register with the commission. 7 39 The quality assurance and audit systems in place should make sure that any shortfalls within the service are addressed and actioned in a timely manner. This will make sure that the service improves and will measure success in meeting the support needs of the people who live at the home. The AQAA sent to the home by the commission should be fully completed to a good standard. Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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