Inspection on 30/11/09 for Trinity Court

This inspection was carried out on 30th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 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 17/02/2010.

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 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 full review a ‘key’ inspection. Lead inspector: Sarah Montgomery     Date: 3 0 1 1 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 34 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 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 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. 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 Care Homes for Adults (18-65 years) Page 3 of 34 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 Consensus Support Services Limited care home 10 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 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 caters for 10 adults with a learning disability who may also have behaviour that challenges. 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 34 Over 65 0 10 1 1 0 3 2 0 0 9 Brief description of the care home Please contact the home for up to date information about weekly fees. Care Homes for Adults (18-65 years) Page 5 of 34 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: This key unannounced inspection was undertaken on the 30th November 2009. We were in the home from 10am until 5pm. The manager was present throughout the inspection and assisted with the process. On the day of inspection, five care staff were on shift, and the deputy manager and manager were in the home. The home is registered for 10 service users, and there are eight service users presently living at the home. During the inspection we spoke with the management team, staff and service users. The evidence detailed in this report was supported by findings made from assessing a range of documents. These included pre admission assessments, care plans, risk assessments, daily notes, weekly activity planners and staff rotas. We also referred to the homes annual quality assurance assessment (AQAA). This is a Care Homes for Adults (18-65 years) Page 6 of 34 self monitoring document we ask the service to complete. The home tells us in this document how they are performing in all the outcome areas we inspect. We ask them to identify what they do well and to tell us about what improvements they may make. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 34 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 9 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users cannot be sure their individual support needs will be adequately assessed or met by the home. Evidence: Standards 1, 2, 3 and 5 were assessed. To assess these standards we looked at the statement of purpose, service user guide, written agreements (individual contracts) and the homes admission policy. We also looked at pre admission assessment documentation for two residents, and spoke with staff and residents from the home. We cross referenced this information with care plans and risk assessments. In addition, we looked at the homes annual quality assurance assessment (AQAA). This is a document sent to us by the home in which they tell us what they are doing in terms of meeting national minimum standards. The homes service user guide and statement of purpose were inspected. They were then cross referenced with all evidence gathered throughout the inspection. This is because the statement of purpose and service user guide tells prospective and current Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: service users, and their representatives what services are provided by the home. It is important that these documents are up to date and relevant as they serve as a benchmark for all service provision. We found that the service user guide was a user friendly document, providing information in an easy read format, accompanied by pictures. Equally, the statement of purpose was a detailed document, providing good information about the home, the staff team, and services provided. However, when cross referenced with evidence gathered throughout the inspection process, we found that these documents were aspirational rather than factual. For example, both the statement of purpose and service user guide state Trinity Court aims to support service users to participate in their local community as fully as possible. And, if you come to live at Trinity Court you would be given a contract. None of the service users have a contract. This is an outstanding requirement from the previous inspection. The manager told us they have been unable to locate contracts for individuals, either from Consensus head office or from care management. The contract is an agreement between the service user and the home. We saw that the homes service user guide has a good description of a contract. It is recommended that each service user is given a copy of the service user guide, which has been personalised in a way which reflects their own personal contract including a breakdown of fees. In addition, we found activities to be very basic, with community participation for many service users either sporadic or non existent. This does not match with the statements made in the service user guide or statement of purpose. The home must ensure that the statement of purpose and service user guide is reviewed and updated regularly, and reflect the current services offered at the home. There have been no new admissions to the home since 2005. We looked in detail at two pre admission assessments. One file inspected contained no pre admission assessment information at all. Without any gathering of information in the pre admission assessment stage, the home cannot sufficiently demonstrate it can meet the needs of the individual, or offer an appropriate service. Care plans and risk assessments are developed following assessment of support needs. Without assessment, the development of meaningful care plans is not possible and at best can only be generic and not person centered. When we looked at this individuals care plans and risk assessments we found they had significant shortfalls. These shortfalls Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: will be detailed in Outcome area 2 (individual needs and choices). The second file inspected contained a thorough pre assessment which detailed the individuals assessed needs, and the homes proposed response to meeting these needs. When we cross referenced this pre assessment with the individual service users care plan we found that the home were not meeting or recording the assessed needs as stated in pre assessment documentation. This means that although the home can evidence they have followed a thorough pre admission assessment path, they have not demonstrated that the home can meet assessed needs and personal aspirations as these have not been followed through into care planning. We have asked the home to ensure all future assessments of prospective service users are comprehensive and detail all support needs of the individual. Care Homes for Adults (18-65 years) Page 12 of 34 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. Service users cannot be sure they will receive appropriate support in their daily lives. Evidence: Standards 6, 7 and 9 were assessed. To assess these standards we looked at care plans, risk assessments, and documents which told us how service users are supported to make decisions about their lives. This included review documentation, service user meeting minutes, and daily notes. We also looked at the homes annual quality assurance assessment, the statement of purpose, and information supplied to the Commission from other professionals. The homes statement of purpose tells prospective residents that a detailed service user plan will be drawn up within six weeks of admission. It will include all of the facilities and services the home will offer to the individual in order to meet their needs and aspirations. The annual quality assurance assessment tells us our service users have individual plans which explains their needs and aspirations, and what is needed to achieve their goals. This is drawn up, is detailed and reviewed regularly. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: The care plans of two individuals were assessed in detail. We could see that some work had been undertaken, and progress has been made in care planning for assessed needs. However, care plans do not provide sufficient details of support needs. This means that care staff are unable to provide support appropriately or consistently. An example of this is a care plan regarding weekly activities which states: staff are to support (service user) with his weekly activities in the community. There are no further details regarding what support is required. There was no evidence on care plans that the home had sought the views, personal preferences or aspirations of service users. The home has developed activity care plans for service users. When these care plans were cross referenced with individual daily planners, and with daily notes, it was clear that these care plans were not being adhered to. We were told that staffing numbers at the home did not allow for much of the care planning of individuals to happen with an acceptable frequency. This will be discussed in more detail in outcome area 3 (lifestyle) and outcome area 7 (staffing). Risk assessments contained more detail with clear support guidelines for staff, and accompanying behaviour guidelines for service users where necessary. We could not find evidence of review of risk assessments. The home needs to ensure it has systems in place to regularly review risk assessments. The home has not developed systems which record how service users make decisions. We read through the daily care notes of several service users. None of the care notes seen recorded how choices or decisions are made. Coupled with the lack of person centred care planning, this tells us that service users at Trinity Court have limited opportunities to influence their day to day lives. Care Homes for Adults (18-65 years) Page 14 of 34 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 poor 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 confident they will be supported and enabled to participate in activities of their choice. Evidence: Standards 12, 13, 15, 16 and 17 were assessed. To assess these standards we looked at records which told us how service users are supported to lead the lifestyles of their choice. These records included individual weekly planners, records of community participation, and evidence of maintaining and development of independent skills. We also looked at records which told us about whether meals at the home are healthy and nutritious, and looked at information provided in the statement of purpose and annual quality assurance assessment. The statement of purpose tells prospective service users that all service users, as part of compiling their service user plan, will be included in drawing up their programme of Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: daily activities. This could include college courses, employment, sport, shopping, social clubs and activities, hobbies and cultural or religious needs. We also aim to provide opportunities for a range of activities within the house. For example, art, craft, cookery, gardening and skills teaching sessions. Staff will support service users to pursue any hobbies or interests that are identified. It also states we are very aware of the need for structured day activities. The annual quality assurance assessment tells us that Trinity Court enables all service users to fully participate within the local community. Evidence gathered from inspection of records tells us that service users have poor lifestyle opportunities. We looked at individual daily planners for all service users. We saw that activities for each morning (until lunchtime) was virtually the same for all service users, and consisted of making breakfast, tidying bedroom and taking clothes to the laundry. When we questioned the manager about the lack of activity present in the morning programmes, it became clear that the daily planners were based around staffing numbers and availability rather than choices made by service users. We questioned whether each service user participated in the household chores described and was told that sometimes individuals would choose to do the chores, but often they do not want to. This means that service users are spending a large part of each day without stimulation and without fulfilling their aspirations and choices. The daily notes of service users do not indicate they have made choices to carry out these activities. Indeed, many daily notes stated watching tv in lounge. Activities on individuals weekly planners for the afternoon suggested some community participation, for example shopping, horseriding and trampolining. However, the majority of the activities for the afternoon are provided in house. Examples of these are arts and crafts, bingo, garden activities, DVD night. Again, as with the morning activities this weekly programme lacked the community activity or range of activities as described in the statement of purpose. When we looked for evidence regarding the community activities, there was some evidence in daily notes of individuals accessing community facilities. For example local markets, shops and walks. However, we also found that many did not take place. Again we were told that activities were limited because of staffing numbers, and this is the reason why many activities were in house. However, we saw that most of the in house activities failed to take place. We were told this is because staff are busy with other activities such as cooking, cleaning and laundry duties. All records inspected regarding lifestyle choices tell us that the home is failing to record the wishes and aspirations of service users with regard to their lifestyle Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: choices. It is also failing to provide appropriate choices or opportunities for service users to lead valued and fulfilling lives, and to become part of their community. Discussion with staff and with service users, and information read in service user files told us that the home supports and enables service users to maintain contact with their families and important people in their lives. We also observed good interactions between staff and service users, and could see service users are respected and treated with dignity. We noticed that service users do not have access to the kitchen. The kitchen door is kept locked unless a staff member is in there. We were told it is because the handwashing sink does not have a thermostatic control, and therefore service users are at risk of being burnt. There are no plans in place to fit a thermostatic valve. We were told that service users used to have free access to the kitchen, and valued being able to make drinks and snacks independently. This situation must be addressed without delay to ensure service users are able to use the kitchen in their home. We could find no risk assessment on service users files which explained why there was restricted access to the kitchen. The home must ensure all residents have unrestricted access to the home. We looked at menus and at the food available at the home. As previously stated, staff are responsible for the preparation and cooking of all meals at the home. This includes meals for staff on shift. This means a minimum of of twelve meals per mealtime, and equates to thirty six meals per day, not including snacks and drinks. Discussion with staff and management regarding this evidenced that this duty meant that a member of staff spends a high proportion of the shift cooking, and not fulfilling their duties as a member of care staff. We were also told that staff skills in cooking varied, and staff struggled with cooking meals for a large group, and struggled with cooking meals in terms of catering skills. The manager added that when recruiting staff, emphasis was not placed on competencies in the kitchen. Menus were heavily reliant on frozen ready type meals. We were told this is because of time restraints, and because of lack of staff cooking skills. Although some service users told us they enjoyed the food, it was clear that the meals provided do not promote service users health and well being, and are not nutritious, varied or balanced. The manager told us this (4 week rolling) menu had been in place for years, and the service users had been eating the same food probably since the home opened. She spoke about consulting service users with regard to developing new menus which address choice and nutrition. Care Homes for Adults (18-65 years) Page 17 of 34 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 their personal and healthcare support needs will be met. Evidence: Standards 18, 19 and 20 were assessed. To assess these standards we looked at records which told us how service users are supported with their health and personal care. These included health care plans, health appointment records including evidence of specialist support if required, records which told us how service users receive personal care, records which tell us about medication practices and protocols in the home. We also looked at information in the statement of purpose, and what the service told us they do in their annual quality assurance assessment. The annual quality assurance assessment tells us that service users have individual plans which state their preferences in the way that they are supported. We inspected the health care plans of two service users in detail. We found shortfalls in many areas of the care planning. Most notably, they lacked detail in how support was to be provided, and guidelines for PRN medication were insufficient. For example, a care plan for personal care only detailed support needs for hair washing. It did not Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: state support needs in other areas of personal care. We were told by the manager that this service user requires support in all areas of personal care. A guideline for PRN medication (when required) following a seizure did not provide information regarding the signs or symptoms of a seizure for this individual, or any guidance around when to telephone the on call manager for agreement to use the PRN medication. Guidance for PRN medication for constipation gives no information to staff about the condition, nor is there any advice on how long the symptoms have been present before the medication is given. The only guidance on administering the PRN medication is one word: constipated. The home has begun to develop health action plans for all service users at the home. Inspection of these plans evidence consultation with the service user, and demonstrate a person centred approach. Records seen evidenced the home supports service users with accessing healthcare appointments, ensuring specialist services are accessed when required. The home maintains good links with the community learning disability team, and service users are supported by this team. Staff have received training in medication administration. The home has revised how medicines are audited and monitored in the home, and there are good systems in place to ensure correct protocols are followed. Medication is audited daily, and a qualified pharmacist undertakes detailed medication audits regularly. Medication administration charts inspected evidenced medicines are administered correctly. Care Homes for Adults (18-65 years) Page 19 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident they will be listened to and protected from harm. Evidence: Standards 22 and 23 were assessed. To assess these standards we looked at records which told us how the home ensures service users are kept free from harm and abuse, and records which demonstrated that the home listens and responds to service users concerns or complaints. We also looked at information contained in the statement of purpose, service user guide, and annual quality assurance assessment. Service users have a pictorial complaints procedure. It is pictorial, and is in an easy read format. The procedure in the statement of purpose is detailed and fully explains the processes of making a complaint. Staff at the home were observed to have good communication with service users. The atmosphere was inclusive, and it was clear that service users are listened to. The culture of the home promotes an enviroment where service users are enabled and supported to communicate their feelings. The home has told us in their annual quality assurance assessment that it recognises that some service users may find the complaints procedure difficult to use, and they are looking at ways to make the complaints procedure more accessible. We spoke to some service users about making a complaint. Service users indicated to us that they would talk to staff if they were unhappy about something at the home or in their lives. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: We spoke with staff about their knowledge of policies and protocols for safeguarding vulnerable adults. We saw that all staff have received appropriate training in adult protection. Staff spoken with demonstrated a good understanding and knowledge of adult protection, including what their role is in recognising and reporting suspected abuse. Records inspected demonstrated that the home has clear systems in place for recording, responding and reporting suspicion or evidence of abuse or neglect. Care Homes for Adults (18-65 years) Page 21 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do not live in a homely, comfortable or clean environmnent and would benefit from many areas of the home being redecorated and refurbished. Evidence: Standards 24 and 30 were assessed. To assess these standards we looked at the communal areas in the home, and was invited into two bedrooms. We also looked at records which told us how the home ensures service users are kept safe, for example certificates of equipment testing. In addition we looked at systems in place to ensure the home is clean and hygienic, and looked at information supplied in the statement of purpose and annual quality assurance assessment. The service user guide gives prospective residents an overview of the environment including communal areas, outdoor space and bedrooms. The annual quality assurance assessment tells us the home plan to continue to refurbish the home. The home is spread over three floors, with just the ground floor being used as the residential home for service users. Doors to bedrooms, the kitchen, laundry and bathroom are off a long corridor, with the lounge being at the end of the corridor with (locked) access to the garden. Residents would benefit from some consideration given to providing an additional lounge area which may also be used as a quiet room as the Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: one lounge is considered insufficient for the number of service users. The kitchen has no window and was dark with lingering cooking odours. Consideration needs to be given to provide adequate ventilation by way of a velux window or more robust extractor fan. All service users have their own en-suite bedrooms. The two bedrooms seen were homely and contained personal items. We did note that in one room the bedlinen was dirty and required washing. There needs to be appropriate systems in place to support service users to wash bedlinen. Although service users daily planners have laundry down as an activity five days per week, the annual quality assurance assessment tells us that each service user is assisted at least once a week to clean their room. The communal toilet requires decorating and repair. There was no toilet lid, no bin lid, and no toilet paper. Some areas of the lounge walls were cracked and damaged. This requires repair and redecoration. As stated in outcome area three, the kitchen and garden are locked and not freely accessible to service users. The home must ensure that service users have access to all communal areas in the home and provide appropriate support and risk assessments to enable this to happen. The long corridor requires urgent attention. At present it is poorly decorated and is shabby. The home does not present as comfortable and homely. Consideration should be given to carpetting the long corridors in the home to support a more homely environment, and to provide more comfort to service users. Not all areas of the home were clean. We are aware that staff are also responsible for all cleaning in the home, as well as their duties as carers and cooks. This situation needs reviewing by the Company. At present the staff team are unable to provide sufficent time and care to all their duties. Consideration needs to be given to creating an additional cleaning post to ensure the home is clean and hygeinic. Although the annual quality assurance assessment tells us that the portable electical equipment was serviced and tested in 2009, we found this not to be the case, and this work is out of date. The home must ensure all equipment and certificates are in date to ensure the health and welfare of service users and staff. Care Homes for Adults (18-65 years) Page 23 of 34 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. Service users cannot be sure their needs will be met due to insufficient staffing numbers. Evidence: Standards 32, 33, 34 and 35 were assessed. To assess these standards we looked at records which told us about the skills and competencies of staff. These records included recruitment processes, staff training and the homes rota. We also looked at information provided in the statement of purpose and at what the home has told us about in the annual quality assurance assessment. The statement of purpose tells prospective service users Trinity Court offers service users a high level of support, and Consensus will endeavour to maintain a ratio of staff to clients that ensures a required level of support. Evidence gathered at the inspection tells us that staffing levels at the home are inadequate to meet the needs of service users. There are 8 service users currently living at the home. The rota shows us that five staff are on each shift. We were told that one service user is allocated a 1-1 at all times. We know that a member of staff is off shift to undertake all cooking tasks. Out of the three staff then left, all domestic cleaning and laundry tasks must be done. This leaves approximately 2.5 members of Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: staff supporting 7 service users with complex needs and challenging behaviour. We can see from the annual quality assurance assessment that all service users require a high level of support with personal care. Evidence gathered throughout this inspection, particularly with regard to opportunities for lifestyle choices and care planning, demonstrates this home is failing to meet the assessed needs and lifestyle choices of service users. It is clear that the home is significantly under staffed, and the present staffing levels do not support the level of support required by service users. Although we observed staff to be caring, competent and relating well to service users, we also noted a high level of inactivity in the home, with many service users spending their days sitting in the lounge. This was supported by reading of daily notes and by conversations with management and staff. At present the home does not have 50 of staff NVQ trained. The annual quality assurance assessment tells us that out of 15 permanent workers, just 3 have NVQ qualifications. Staff have received appropriate mandatory training and have received additional specialist training in challenging behaviour. Two recruitment files were assessed. These were found to have the correct documentation in place to ensure the protection of service users. Care Homes for Adults (18-65 years) Page 25 of 34 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. Service users can be confident that the manager has the skills and competencies to run the home, but cannot be sure that the home is currently well run. Evidence: Standards 37, 38 and 39 were assessed. To assess these standards we looked at records which told us how the home is run, and records which tell us how the home self-monitors their performance. These records include the annual quality assurance assessment, and all records relating to support needs of service users, for example care plans. The annual quality assurance assessment tells us service users benefit from a safe and well run home which reflects individual choices and preferences. This statement does not reflect our evidenced findings. As you have read, there are shortfalls in pre admission assessments, care planning, health care planning, enabling service users to lead valued and fulfilling lives, nutrition, staffing and the environment. This tells us that there are concerns around the way the home is run overall by the Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Company. A theme running through all identified shortfalls is insufficent staffing. The Company must ensure the home is sufficiently staffed to ensure all needs of service users are met, and the home is able to provide the high level of care and support they talk about in the statement of purpose. The manager presented as competent and skilled. She recognises the problems in the home, and is striving to ensure good outcomes for service users. This was evident with the health action plans. However, as stated above, the home needs to be appropriately resourced to enable outcomes to improve and service users lives to be fulfilling. The manager told us morale was low at the home. There has been difficulties in recruiting and retaining staff. Many staff work long hours, and told us they feel they are always juggling and never managing to do one thing well. The home has completed an annual quality assurance assessment, and although it does identify some shortfalls which were evidenced at our inspection, much of the text is aspirational. Quality assurance at the home needs to be more robust, and responsibility must be taken by the Company to ensure standards are raised and service users receive appropriate support. The manager is not registered with the Commission. She is in the process of completing the registered managers application. Care Homes for Adults (18-65 years) Page 27 of 34 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, Care Homes Regulations 2001 and the National Minimum Standards. 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. 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 Care Homes for Adults (18-65 years) Page 28 of 34 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 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. Care Homes for Adults (18-65 years) Page 29 of 34 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 1 4 The registered person must 31/03/2010 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. 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 6 15 The registered person must 31/03/2010 ensure the assessed support Page 30 of 34 Care Homes for Adults (18-65 years) 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 needs of individuals, and personal wishes and preferences of individuals are recorded on care plans. To ensure that service users receive appropriate and consistent support. 4 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. 5 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. 31/03/2010 Care Homes for Adults (18-65 years) Page 31 of 34 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 6 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. 31/03/2010 7 18 13 The registered person must 31/03/2010 ensure that all health care plans include details of the personal preferences of service users with regard to 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. 8 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. Care Homes for Adults (18-65 years) Page 32 of 34 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 To ensure that service users live in an environment which is clean, safe and homely. 9 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. 10 33 18 The registered person must ensure that sufficient numbers of staff are on duty. To ensure the needs of service users are met. 11 39 24 The registered person must ensure that quality assurance at the home is robust. This will enable the home to identify and respond to shortfalls. 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 01/03/2010 31/03/2010 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 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. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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