Inspection on 03/03/10 for Trinity Court

This inspection was carried out on 3rd March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Trinity Court 30/11/09

Trinity Court 11/03/09

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 16/05/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: Trinity Court Station Road Staplehurst Kent TN12 0PZ one star adequate service 30/11/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Montgomery Date: 0 3 0 3 2 0 1 0 Information about the care home Name of care home: Address: Trinity Court Station Road Staplehurst Kent TN12 0PZ 01580895288 01580895310 trinity@consensussupport.com www.consensussupport.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Consensus Support Services Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 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 registered care home providing care and support for up to 10 adults with learning disabilities who may have additional challenging behaviours. Service users are supported by a team of staff which includes; a manager, deputy manager, senior support staff and support staff, and waking night staff. Care Homes for Adults (18-65 years) Page 2 of 17 3 0 1 1 2 0 0 9 Brief description of the care home Trinity Court is part of a group of homes owned by Consensus Support Services Limited. They have additional structures in place to provide support to the home. This includes an area and a regional manager as well as support from human resources, specialist behavioural staff and a quality assurance manager. Trinity Court is a detached three storey property on the outskirts of Staplehurst. The ground floor is available for use by service users. The home provides for 10 single ensuite bedrooms, a lounge, dining room and kitchen. 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 are not currently accepting referrals for admissions to the home as there are significant ongoing safeguarding concerns and significant breaches in Regulation. Care Homes for Adults (18-65 years) Page 3 of 17 What we found: This focussed inspection was undertaken in response to serious concerns raised about the care of service users at Trinity Court, and concerns about how the home is managed. The concerns raised significant doubt to the Commission about the organisations (Consensus Support Services Limited) ability, competence and fitness to run this home. The concerns strongly indicated there may be serious breaches of Regulation. We looked at three outcome areas: Individual Needs and Choices, Personal and Healthcare Support, and Conduct and Management of the Home. We found significant shortfalls in all outcome areas with evidence demonstrating that service users were not being appropriately cared for, and had suffered neglect. We issued three immediate requirements with regard to our findings. In addition we served Code B notices which told the provider of our evidenced serious concerns around the fitness of the registered person and serious concerns about the management of the home. Our inspection evidenced additional concerns about the care of service users. These were referred to safeguarding immediately. The home sent us their annual quality assurance assessment (AQAA) on March 4th 2010 (the day following the inspection). This is a self assessment document which we require the home to complete. We ask the home what improvements they have made, and ask them to indicate what they do well and what they could do better. We looked at this document to see how the home had assessed their performance, and cross referenced their findings with what we found when we inspected. They told us in the AQAA that: we are writing risk assessments in a more individualised format and are ensuring they meet the clients needs. And, Trinity Court has a good well balanced team, giving the clients a happy and safe environment to live in. The AQAA further states that each client has a health action plan, and service users have files which hold evidence of any medical appointment attended. Evidence gathered at this inspection does not support any of these assertions. Our findings are as follows: Individual Needs and Choices: Standard 9 - Risk Assessment. This home had a key inspection on November 30th 2009. Shortfalls were identified at this inspection. We found the home was not reviewing risk assessments, and they did not have any systems in place to ensure risk assessments were regularly reviewed. We required the registered person to ensure any changes are identified and the appropriate action is taken. During our visit today we spoke with the deputy manager and asked her to indicate if any of the service users needs had changed recently. She told us the needs of a service user had recently changed in terms of exhibiting behaviours, and gave examples of the service user running into the main road (which the home is on) when he returns to the home following visits to his family, and of subsequently displaying aggressive behaviour towards other service users and members of staff. We looked at the file of this service user. We saw a risk assessment dated 29th December 2009. This risk assessment recorded the known hazards and recorded actions Care Homes for Adults (18-65 years) Page 4 of 17 to be taken by the home to minimise the risks and safeguard the service user. We asked the deputy manager for more details about the incident which triggered the risk assessment to be put in place. She described an incident on 29th December 2009 in which the service user was dropped off in the homes car park (adjacent to the main road) by a family member and ran straight into the road. Staff had to follow and stop traffic. Staff were unable to support the service user to enter the home, and the service user left with the family member and returned to his relatives. The following day the service user was picked up by staff from the home and returned to Trinity Court. The risk assessment states under assessment of additional action taken/required: all home visits are to stop until a safer strategy is in place. The home has not put in place any new strategy. The risk assessment has not been reviewed. We were told that the service user would not be going to visit his family for the foreseeable future. We saw evidence that a care manager had written to the family about the incident, and had included suggested strategies. This was dated 19th February 2010. There was however, no record of any meeting held by the home with the service user to consult with him about restrictions imposed in terms of not being currently supported to see his family. Furthermore, the home has failed to ensure the needs of this service user are met, and they are failing to support and enable him to continue seeing his family - an activity which we were told he values, looks forward to and enjoys. We observed that the letter from the care manager stated as you are aware, previously there have been incidents of (service user) refusing to go into the house and running off towards the road and putting himself at risk due to the home being on a main road. This sentence suggested to us that the incident on the 29th December 2009 was not the first (as stated by the deputy manager), but one of a number of times this has happened. We spoke with the responsible individual and asked him for details of previous incidents. We were informed that there had been at least three other incidents where this has happened. This means that the home knowingly and consistently placed this service user at risk of significant harm (possibly death), and failed to put any strategies in place until the service user had ran into traffic on a main road for the fourth time. This is clear evidence of neglect, and evidence of a breach of Regulation. We issued an immediate requirement to the registered person which required the home to ensure the home is appropriately managed and to ensure that support needs are recorded on care plans. The home is required by law to inform the Commission of significant events. This includes being notified of any event in the care home which adversely affects the well-being or safety of any service user. Trinity Court has never sent us a notification on any incidents involving the above service user running into traffic, or incidents involving aggressive behaviour towards other service users and staff. Personal and Healthcare Support: Standard 18 - Healthcare. At the key inspection in November 2009, we found shortfalls in many areas of health care planning. The registered person was required to ensure all health care plans were updated, and required to ensure that health care plans include detailed information on when to administer PRN (when required) medication. Evidence gathered at todays inspection tells us that these requirements have not been met. We assessed a health care plan. We chose this health care plan because we had been Care Homes for Adults (18-65 years) Page 5 of 17 made aware by the home in a Regulation 37 notification that this service user had been very seriously ill, and had had a recent hospital admission. We felt that the home would have ensured the health care plan was reviewed and updated to reflect the changing health need of the individual, and include detailed support plans and in depth risk assessments. At the very least we expected to find a care plan in place to support the service user upon discharge from hospital, and a reassessment prior to discharge of all health, personal care and social needs to ensure the home could meet his needs, and to ensure the home had all necessary support systems in place for his return. The care plan had not been reviewed or updated, either since our key inspection, since the hospital admission, or any date subsequent. Although the health action plan is not dated, we can see from the two dates for doctors appointments in 2008 that it is likely it was completed in that year. We asked the responsible individual why this had not been done. He was unable to answer the question apart from telling us that it should have been. Information contained in the health care plan is poor, and does not adequately address how the home supports the service user with his health care needs, or how the home ensures that the healthcare needs of the service user are assessed and recognised, or that there are procedures in place to address them. Under the my ongoing health section, it states I need my general health monitored, and my eyesight which is poor. Records show that the most recent visit to the optician was in August 2008. There were two GP appointments in 2009 (January and February), and two GP appointments in 2008. There are no records of any medication reviews, and no records of any health screening appointments. Information in this health care plan tells us that the home have never supported this service user to go to the dentist or have his hearing checked. Although one of the contacts on the people who help me page is a psychiatrist, there is no record of this service user accessing this service or being supported with an appointment. The immunisations record is blank. As stated, we know from the Regulation 37 notification that this service user was admitted to hospital in late 2009. There is no record of this. Nor is there any record of a GP appointment prior to admission. We looked at the daily notes of this service user to see if they reflected what measures the home had taken to ensure the service users health needs were met, and to assess if the home had recognised the changing needs of the service user and had responded appropriately. We analysed daily records beginning five weeks prior to admission to hospital, and all daily records since admission to the date of this inspection. The daily records tell us that on nine separate occasions, over a space of five weeks, prior to admission to hospital, this service user was unwell. Some of the comments on the daily notes are: sick twice in lounge and then in bedroom. Spent most of the day lying down. He was sick this morning. Brought up mostly fluid. I mentioned his condition to the manager and deputy manager yesterday, and again today. Went on walk to park but after 200m he sat on sidewalk and refused to go any further. He appears to be unwell. He ate well. No problem. spent most of the day in his room lying on the bed. appeared to be very tired this afternoon. He spent a lot of time in his room sleeping in bed. Not once during this five week period was the service user supported to see a GP. Care Homes for Adults (18-65 years) Page 6 of 17 The daily notes evidence a complete failure to respond appropriately to the growing health concerns of this service user. There has been a complete disregard of this service users health. The continuing deterioration of his physical health resulted in hospital admission and intense medical treatment. We can see from notes written by care staff during this time that the hospital stay caused this service user to be significantly distressed. Furthermore, analysis of the daily notes, care plans and risk assessments following discharge from hospital, evidence a continued failure of the home to assess or meet the support needs of this individual. To date, his care plan, health care plan and risk assessment has not been reviewed or updated. Conduct and Management of the Home: Standard 37 - Day to Day Operations and Standard 41 - Record Keeping. The key inspection in November 2009 evidenced the home was not well run. We further noted in the report that we had concerns around the way the home is run overall by the Company (Consensus). We stated there were evidenced shortfalls in pre admission assessments, care planning, health care planning, activities, nutrition, staffing numbers, and the environment. This amount of shortfalls tells us that management of the home was poor, and service users were not experiencing good outcomes. We required the registered person to address these shortfalls to ensure the home was well run. Evidence gathered at todays inspection tells us these requirements have not been met. We looked at evidence which told us what systems had been put in place to ensure effective management of the home since the key inspection in November 2009. We were assured by the Companys Operations Director in an email sent to CQC on December 17th 2009 that: staffing numbers would rise, a cook would be recruited, and a thorough review of support plans and risk assessments would be undertaken. In addition, the manager of the home assured us she would complete her application to become the registered manager of the home. Our findings today evidence that none of the assurances given have been followed through. The manager did not progress her application. None of the care plans or risk assessments have been reviewed or updated. Staffing numbers remain the same, and a cook has not been recruited. Consensus care has been aware of significant shortfalls at this care home since at least the inspection in November 2009. Records assessed today demonstrate that these shortfalls remain, the home is not well run, the management team is not skilled or competent, and the organisation has failed to address these shortfalls and have allowed this home to continue to fail the service users living here. These findings were echoed by the responsible individual who was present throughout our inspection. Discussion with the responsible individual and with members of the staff team heightened our concerns about the skills and competencies of the management team. When speaking with a senior member of the management team it was clear she had little understanding of learning disability or challenging behaviour. When asked about a service user we were told he cant communicate. We had met this service user who appeared to have excellent communication skills. We informed her that we found the service user had good communication, and gave an example, she replied I suppose. When we asked her to give examples of service users who are challenging, she told us none of the service Care Homes for Adults (18-65 years) Page 7 of 17 users had challenging behaviour, but then went on to describe behaviours which included self harm and aggression towards others. We discussed our concerns with the responsible individual. He told us that it was a disparate staff team, and that there were competency issues with the management team. Following a safeguarding meeting in February 2010, Consensus took the decision to recruit a project manager. We were informed she would be taking up post within a week of this inspection. Her initial brief was to support the home manager to develop robust systems to ensure the home is well run. Following the resignation of the home manager (after the safeguarding meeting), her brief changed to one of managing the home until a replacement manager is recruited. While it is encouraging that Consensus are looking at ways to support the home, it must be noted that this support is coming three months after the inspection, and prior to this, Consensus have failed to effectively manage this home. We can see from a Regulation 26 report in October 2009(prior to the key inspection) that several shortfalls were noted: An example of this is: health action plans are currently being completed by key workers. Progress is slow. Another is: Number of supervision meetings -none. A Regulation 26 visit was not conducted in November. At the Regulation 26 visit in December 2009 it was noted that support plans and risk assessments were not in place to meet the needs of service users. In January 2010 the Regulation 26 report states: a number of support plans have not been updated, activities were sedentary in nature which did not meet the needs of several of the service users. And, supervision structure poorly maintained. The Regulation 26 report in February 2010 gives the same comment as January regarding updating risk assessments, care plans and supervision structure. A comment was made regarding service users: all service users happy but not particularly challenged. These Regulation 26 visits were conducted over a five month period. They consistently identified themes: poor care planning and risk assessment, staff were not being supported through supervision, and service users were not being support to lead valued and fulfilling lives. This demonstrates that Consensus have not only failed to ensure the health, welfare and safety of service users, but have knowingly allowed this situation to continue month after month. Their inaction constitutes neglect, and service users have been and continue to be at risk of significant harm at this care home. What the care home does well: What they could do better: Evidence gathered at this inspection tells us that service users living at Trinity Court experience poor quality outcomes and are at risk of harm and neglect. The Commission has significant concerns about this home and is taking enforcement action. The responsible individual must ensure that the outstanding requirements made at the November inspection are addressed and met without delay. Care Homes for Adults (18-65 years) Page 8 of 17 Our evidenced findings at this inspection led us to conclude that service users at Trinity Court were not safe, and were at risk of significant harm. The responsible individual agreed with our findings, and assured us he would not leave the premises until the following immediate requirements (issued at this inspection) were completed: ensure the care home is appropriately managed; ensure that service users support needs are known and recorded on care plans, health care plans and risk assessments; and, ensure that appropriate recording systems are in place to record health care concerns, visits with health care professionals, and a record of any outcome of the visit, including actions for the staff team. 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 2. Care Homes for Adults (18-65 years) Page 9 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered person must produce a statement of purpose and service user guide which tells service users and their representatives about the home. The registered person must ensure that prospective residents and their representatives have correct information about all services and facilities at the home. 31/03/2010 2 2 14 In order to meet individuals 31/03/2010 particular support needs, the registered person must ensure that prospective service users are competently and thoroughly assessed prior to admission to the home. . 3 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 Page 10 of 17 Care Homes for Adults (18-65 years) 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action and the registered manager. To make sure people know what they are paying for. 4 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. 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. 5 6 15 The registered person must 31/03/2010 ensure the assessed support needs of individuals, and personal wishes and preferences of individuals are recorded on care plans. To ensure that service users receive appropriate and Care Homes for Adults (18-65 years) Page 11 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action consistent support. 6 7 12 The registered person must ensure service users are supported and enabled to make decisions about their lives. The registered person needs to develop systems which evidence service users are offered choices and are making decisions about their lives. 7 13 16 The registered person must 31/03/2010 consult service users about a programme of activities taking into account hobbies, interests and aspirations. The home must then make suitable arrangements and provide sufficient support for service users to participate regularly in activities of their choice. To ensure service users social and lifestyle choices are met. 8 17 16 The registered person must ensure that service users receive a diet which is balanced and nutritious. To ensure service users nutritional needs are met. 9 18 13 The registered person must ensure that all health care plans include details of the personal preferences of service users with regard to 31/03/2010 31/03/2010 31/03/2010 Care Homes for Adults (18-65 years) Page 12 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action how personal care support is to be provided. This must include detailed information on when to administer PRN medication. To ensure all healthcare needs of service users are met. 10 24 23 The registered person must 23/04/2010 ensure that service users have unrestricted access to commual areas in the home and are provided with appropriate support and risk assessments to allow this to happen. Furthermore, the registered person must ensure that all areas of the home are kept in good repair and decorated to an acceptable standard. This includes providing adequate ventilation in the kitchen. To ensure that service users live in an environment which is clean, safe and homely. 11 30 23 The registered person must 16/04/2010 ensure the home has sufficient time and resources to keep the home clean. To ensure the health and safety of service users. 12 33 18 The registered person must 01/03/2010 ensure that sufficient numbers of staff are on duty. To ensure the needs of service users are met. Care Homes for Adults (18-65 years) Page 13 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 13 39 24 The registered person must 31/03/2010 ensure that quality assurance at the home is robust. This will enable the home to identify and respond to shortfalls. Care Homes for Adults (18-65 years) Page 14 of 17 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 1 9 4 The responsible individual must ensure that service users support needs are known and recorded on care plans, health care plans and risk assessments. To ensure the health, welfare and safety of service users is met. 03/03/2010 2 18 13 The responsible individual 03/03/2010 must ensure that appropriate recording systems are in place to record health care concerns, visits with healthcare professionals, and a record of any outcome of the visit, including actions for the staff team. To ensure the health, welfare and safety of service users is met. 3 37 10 The responsible individual must ensure the home is appropriately managed. To ensure the health, safety and welfare of service users is met. 03/03/2010 Care Homes for Adults (18-65 years) Page 15 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 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 Care Homes for Adults (18-65 years) Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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