Inspection on 07/10/08 for Trinity House

This inspection was carried out on 7th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trinity House 31/10/07

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Trinity House 105 Station Road Hendon London NW4 4NT     The quality rating for this care home is:   two star good 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: Duncan Paterson     Date: 0 7 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 27 Information about the care home Name of care home: Address: Trinity House 105 Station Road Hendon London NW4 4NT 02082020114 Telephone number: Fax number: Email address: Provider web address: mogiogwa@hotmail.com Name of registered provider(s): Name of registered manager (if applicable) Martin Ogiogwa Type of registration: Number of places registered: Quality Housing & Social Care Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 5 Date of last inspection Brief description of the care home Trinity House is newly registered with the CSCI and provides care and support for up to five people with mental health problems, some of whom may have a forensic history. Although the service is registered for six people due to space restrictions there are only five bedrooms. The registered person is looking into the possibility of building an extension to the home in the future. Trinity House is a detached house in a residential street in Hendon and is well served with local transport, shops, parks etc. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 6 Brief description of the care home There are four bedrooms on the first floor and one on the ground floor. Three rooms have an en-suite facility consisting of a shower, toilet. Washbasins are in the room. The other two rooms are within close proximity of a bathroom and toilet. There is a communal lounge and dining room with an adjacent kitchen. The staffing structure consists of the manager, deputy manager and support workers, providing 24-hour support. The stated aims of the home are, To promote independence, selfdetermination and to contribute to the rehabilitative process. This enables service users to attain their optimum quality of life, and to move on to more independent living, in a home of their own. The range of fees at the time of the inspection is #850 - #1400 per week. Care Homes for Adults (18-65 years) Page 5 of 27 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: two star good 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 inspection took place on 7 October 2008. The inspection involved talking with the manager and staff present that day as well as residents. The homes Annual Quality Assurance Assessment (AQAA) was taken into consideration as well as returned surveys. Two surveys were returned from residents as well as four from staff. Comments were also received from placing authorities on the telephone. The inspection also involved a tour of the premises and an inspection of a sample of the homes records, policies and procedures. Care Homes for Adults (18-65 years) Page 6 of 27 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 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 7 of 27 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 8 of 27 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. People using the service have a detailed plan of care, which is reviewed together with staff and changes made when required. Risks to residents as part of their individual life styles are recorded and reviewed. The management and staff work hard to assist and facilitate residents to make decisions about their life. Evidence: The standard of written documentation, including polices and procedures, is good in this home. It is evident that time and effort has been devoted to writing the policies and trying to get them right. Both the statement of purpose and service users guide had been updated a few weeks before the inspection. Both documents are clearly written and provide detailed as well as easy to read descriptions of the service and the aims and objectives. The central aim, of providing a rehabilitation service and helping residents move on into independent accommodation, is something that is clearly understood and articulated by the manager and staff. It is also clearly set out in the statement of Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: purpose. Each staff member spoken to was working towards this aim and knew that this was the overall aim of the service. There are rules about how the service is run and these are also clearly set out in the statement of purpose or in one of the homes policies. One of the aims is to have a drug free home and random drug testing is carried out. Although there are policies about this there is no information in the statement of purpose. It is recommended that this policy is detailed in the statement of purpose so that potential residents will be clear about the rules of the home. There is detailed assessment information about each resident. There are a number of files which contain assessment and care planning information. Details from placing authorities as well as from the homes own assessments were seen. Some of the residents have complex needs and include residents who may have to comply with Mental Health Act sections. The manager has previous mental health social work experience and was seen during the inspection liaising with placing authorities about the needs of residents. Care Homes for Adults (18-65 years) Page 10 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is well organised with residents benefiting from well written and appropriate care plans and detailed risk assessments. Opportunities are given to residents to make decisions about life at the home. Evidence: The care plans and risk assessments for the two people currently living at the home were looked at. Both people were spoken with as well as a third resident who was visiting briefly that day. The care planning information is comprehensive and is set out carefully within two main folders. These set out the work staff are involved in as well as the goals residents are working towards. There is very clearly an emphasis on helping people recover and build skills to assist them to move on to more independent living. There were goals for this work. Both residents were being encouraged to take up employment and there were goals about this as well. There was also a great deal of background information about each person as well as notes from Care Programme Approach (CPA) meetings and links with healthcare professionals. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: Residents said that they liked living at the home and that staff worked well with them. One person said that staff were good and, they are helping me to move on. Another resident said, the rooms are nice and the staff are nice. Staff were observed working with residents politely and carefully and there was a friendly atmosphere. The risk assessments seen were also detailed. For example, one seen had clear information at the start which was followed by a six point risk management plan. The plan was being regularly reviewed. Feedback received from placing authorities was that the home had prepared care plans well, were providing an appropriate service and linked well with the statutory authorities in times of emergency. Residents were less enthusiastic about the freedom they had in the home. One resident, for example, felt that he was not always able to do what he wished and another felt that the visiting rules were at time tight. However, for some residents there may be limitations placed upon them because of care they are receiving under the Mental Health Act. This sometimes meant that the manager and staff needed to know where people were going and be sure they returned at certain times. Having said that, there are freedoms for residents to take part in activities as well as make decisions about life at the home. There are regular residents meetings and notes of these meetings were seen. Care Homes for Adults (18-65 years) Page 12 of 27 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. Residents are provided with lots of ways to develop themselves as well as with support and encouragement to move to independent living. Staff support residents to develop their cooking skills so that they can become self-sufficient. Evidence: The manager and staff have established a number of ways to work with residents in terms of personal development and with providing activities and leisure opportunities. The care plans, as already mentioned, set out goals for each resident and record keyworking sessions. Staff are clear that they need to work with residents to build their confidence and help them move on. One staff member described assisting residents to cook as part of this work. Residents confirmed that they took part in leisure activities. There was a recent trip to Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: Brighton, for example. The manager said that money was provided for weekly social events such as bowling or going to the cinema. Residents said that they visited family members. The two residents are being assisted to take up employment. One of the staff members said that he ran a Mens group which is offered to residents to discuss arising matters and create a space for the men in the home. Residents take it in turns to cook with the support of staff. The kitchen was stocked with sufficient food including a range of fresh fruit and vegetables. The records of food served provided evidence that a balanced diet was provided. Care Homes for Adults (18-65 years) Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well organised workforce at the home which has good links with healthcare professionals and placing authorities. Staff work well with residents to make sure they look after their health and personal care. Agreeing a returns procedure with the supplying pharmacy will provide increased protection for residents. Evidence: There are clear healthcare records about each resident. These were seen when the residents care plans were inspected. These included detailed records about healthcare professionals involved in the care of residents as well as CPA review papers. The placing authorities confirmed that the home worked well with them and were providing care appropriately. The feedback from residents was positive. Care tended not to be of a personal nature but residents confirmed that staff helped with making sure that residents had equipment they needed as well as assistance with taking up preventative healthcare appointments. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: The medication storage arrangements and records of administration were inspected. Residents are encouraged to self-medicate but staff were still overseeing the arrangements. There is a book entitled Medication Audit Book, in which records of the receipt of medication is kept. These are clear records. The Boots system is used which is a blister pack system where the prescribed amount is contained in day ordered packs. The two residents currently living at the home are taking only small amounts of medication so the current arrangements are relatively straightforward. However, there were stocks of medicines for residents who were no longer at the home and these need to be returned to the pharmacy. In addition, there needs to be an agreed method for the return of medication to the pharmacy. Although there were records that medication had been returned they had not been countersigned by the supplying pharmacy. Care Homes for Adults (18-65 years) Page 16 of 27 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. There are clear complaints and safeguarding policies and procedures which enable staff to provide residents with a clear and supportive service. The service makes it easy for people to complain but records of complaints must be kept. Evidence: The complaints and safeguarding policies and procedures were inspected. In general, the policies and procedures at this home are well written and succeed in reaching a tone which is friendly, clear and supportive to residents. These policies were like that and provide residents and staff with clear information about how to make a complaint or respond to a safeguarding matter. The safeguarding policy needed a minor amendment so that it was clear that the lead role for investigation safeguarding matters resides with the local authority. The manager updated the policy during the inspection. Staff have a good understanding of safeguarding matters and, with one exception, have received safeguarding training. No complaints have been made to the home since the home opened and therefore the complaints records were blank. However, a complaint had been made at a residents meeting and this must be recorded. The matter was minor but it is important that Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: records are kept when people complain so that the home can provide evidence that complaints have been properly investigated. Care Homes for Adults (18-65 years) Page 18 of 27 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. Good quality accommodation is provided for residents. Evidence: The home is in a large detached house and provides a pleasant, comfortable home for residents. Each resident has their own bedroom with en suite facilities and each room is a good size. There is a lounge, a dining room and a kitchen as well as a separate laundry area. There is a large garden to the rear. Additional bathrooms are provided. An empty bedroom was viewed as was (by invitation) one of the current residents bedroom. The rooms are comfortably furnished and well equipped and residents had been able to bring in their own possessions. The home is well equipped with computer access for residents as well as Sky TV and fitness equipment. The home is also a generous size with plenty of space for residents. The detached aspect provides a good location for times when there may be some challenging behaviour. Care Homes for Adults (18-65 years) Page 19 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are now much better protected by the staff recruitment arrangements. Staff are now recruited properly and safely. Residents also benefit from staff who have good morale and are supported to do their work by an effective manager. Evidence: The manager and three staff were interviewed and four staff files were inspected. Staff spoke clearly and confidently about their work at the home. Each person spoken with said that they liked working there and derived great satisfaction from helping residents to move on. It was common for staff to say that helping residents in this way was the best thing about working in the home. It was striking that each member of staff was able to describe the aims of the home and confirm that they were working towards these aims. Staff confirmed that they had a good relationship with residents. One member of staff, for example, spoke about his work running a Mens group where he spent time with residents in a relaxed environment. Staff also confirmed that they received support from the manager and benefited from individual supervision as well as the group support of team meetings. Records of individual supervision and team meetings were seen. Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: The recruitment records for 4 staff were inspected. Evidence was provided that staff are recruited properly and safely. The requirement given at the last key inspection about staff recruitment has been complied with. Staff were able to describe the training they had received. Many of the staff have done, or are doing NVQ qualifications, and staff confirmed that they had received mandatory training. Records of staff training received were seen. Care Homes for Adults (18-65 years) Page 21 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run and managed home. Residents can be confident that their views will be asked for and responded to. Health and safety is properly responded to. Evidence: The manager also owns the home and has relevant mental health social work experience. He understands the needs of residents and has been able to provide both residents and staff with a well oragnised, supportive care setting. The evidence of this inspection is that staff feel supported and are motivated to work towards the aim of assisting residents develop their independence skills. The manager has also produce a set of well written, informative and effective policies and procedures. The ideas behind these policies have been translated to staff and the home is performing well in terms of meeting its aims and the needs of residents. An examples of this effective work is the homes quality assurance system. In the Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: relatively short time the service has been running the manager has been able to build up effective links with a range of groups and obtained useful feedback about the service. An evaluative report has been written which has enabled the home to respond to residents views and wishes. The health and safety records are well organised and well presented. All the relevant health and safety records were available for inspection as were records of the servicing of equipment and fire safety. There was evidence that health and safety was properly responded to. However, the fire risk assessment was not dated or signed. To be a useful tool the manager will need to ensure that the risk assessment is reviewed regularly with changes made where appropriate. The manager said that no money for residents is looked after at the home but that work was planned to assist residents with money management skills in the future. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 20 13 Excess medication must be returned to the pharmacy and records of medication returned to the pharmacy must be kept. There were no countersigned records of medication which had been recently returned to the pharmacy. A returns procedure needs to be agreed with the supplying pharmacy. 01/12/2008 2 22 22 All complaints made about the service must be recorded. Complaints need to be recorded so that the home can demonstrate that the issue has been properly investigated. 01/01/2009 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. Care Homes for Adults (18-65 years) Page 25 of 27 No. Refer to Standard Good Practice Recommendations 1 2 1 42 Details about the homes drug policy should be included in the statement of purpose. The homes fire risk assessment should be dated and signed. Care Homes for Adults (18-65 years) Page 26 of 27 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 © (2008) 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. 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