Care Home: 3 Trinity Close

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What the care home does well Each relative who completed their own survey, or wrote on behalf of an individual, said the home does provide the care and support they expect. People are treated well by staff and supported to take part in a variety of activities. The staff members who wrote to us said they are provided with up to date information about the care needs of the people who live in the home. They are provided with appropriate training and are well supported in their roles. The health professionals who responded by survey said the home seeks their advice and acts upon this to manage and improve individuals` health care and respects each person`s privacy and dignity. Staff are experienced and have a good knowledge of each individual`s needs. This provides a confident and consistent method of support. The people who live in the home appear happy and relaxed in the company of staff. Staff members understand their needs and learn how to communicate effectively with each person. The location of the home provides easy access to all amenities within Bath. The home also has a leased minibus, which provides individuals with the opportunity to access day services as well as other opportunities in the wider community. What has improved since the last inspection? Each staff member is now provided with the training they need to enable them to support people in a safe and effective way. What the care home could do better: The registered person should continue to develop communication strategies for each person who lives in the home. This would support them to make more decisions about their own lives. The registered person should ensure all risk assessments are dated and reviewed regularly. This would ensure each person has current information in their care plan which explains how to support them in a safe and consistent way. The registered person must ensure the improvements to the environment, currently being carried out, are completed. This would ensure individuals are provided with a homely, comfortable and suitably adapted home to live in. The registered person must ensure the home is managed with sufficient care, competence and skill to ensure the welfare and safety of individuals and staff; this relates to fire safety checks. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 3 Trinity Close 3 Trinity Close Bath Bath & N E Somerset BA1 1US     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: David Smith     Date: 1 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.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: 3 Trinity Close 3 Trinity Close Bath Bath & N E Somerset BA1 1US 01225443575 01225443575 paul.flett@dimensions-uk.org 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) : Dimensions (UK) Ltd care home 5 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 5 5 May accommodate up to 5 persons aged 18 - 65 years requiring personal care only Date of last inspection Brief description of the care home 3 Trinity Close is operated by Dimensions (UK) Ltd, an independent voluntary organisation, to provide personal care for up to five people who have a learning and physical disability. The home is just a five-minute walk from the centre of Bath, where individuals can benefit from ease of access to all the amenities offered within the city. The premises are part of a general needs housing scheme developed by Sanctuary Housing Association. Number 3 Trinity Close is a ground floor flat within a row of what looks like terraced houses. Accommodation is on one level and five single bedrooms are equipped with wash hand basins. There is an enclosed rear patio garden, reached through the patio doors of the Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home lounge, dining and kitchen area. Four people currently live in the home; there are no plans to increase this number. 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: 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: The last Key Inspection of this service was completed on 18/04/07. This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent seven and a half hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission. The pre-inspection planning involved reviewing the report of the last Key Inspection completed in April 2007 and the Annual Service Review carried out in May 2008. We Care Homes for Adults (18-65 years) Page 6 of 34 also looked at the service history, which details all other contact we have had with the home. We provided the home with their Annual Quality Assurance Assessment (known as an AQAA). This is a self-assessment, which focuses on how well outcomes are being met for the people who live at Trinity Close. The home sent us their AQAA when we asked for it. It was clear and gave us all the information we asked for. We provided a number of surveys for people who live in the home, their relatives and health professionals to enable us to carry out the last Annual Service Review. We sent new surveys to the individuals who live here, health professionals and staff members as part of this Key Inspection. In total 18 people have written to us and their views have been included in this report. The surveys for the people who live in the home have been completed for them by a relative. The people who live here have communication difficulties; staff communicate with each person by speaking with them and also by interpreting signs, body language and gestures, but this needs to be learned over time. It is not possible for us to ask each person about life in the home and therefore time was spent in communal areas observing how people made their needs known and how staff respond. We spoke with the Manager and staff members who were working in the home on the day we visited. We also viewed all communal areas of the home and some of the bedrooms used by the people who live here. We gathered additional information for this report by looking at a number of records within the home such as individuals care plans, risk assessments, accident and incident reports, medication administration, staffing records and health and safety procedures. The people who live at Trinity Close wish to be described as people who live in the home, or individuals, rather than service users. Dimensions (UK) Ltd uses the term people we support. This terminology has therefore been acknowledged and replaced the term service user in this report. What the care home does well: What has improved since the last inspection? What they could do better: The registered person should continue to develop communication strategies for each person who lives in the home. This would support them to make more decisions about their own lives. The registered person should ensure all risk assessments are dated and reviewed regularly. This would ensure each person has current information in their care plan which explains how to support them in a safe and consistent way. The registered person must ensure the improvements to the environment, currently being carried out, are completed. This would ensure individuals are provided with a homely, comfortable and suitably adapted home to live in. The registered person must ensure the home is managed with sufficient care, competence and skill to ensure the welfare and safety of individuals and staff; this relates to fire safety checks. Care Homes for Adults (18-65 years) Page 8 of 34 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.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 9 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are given the information they need about the home to enable them to make an informed choice about where to live. People are confident the home can support them as their needs are thoroughly assessed before they are given the opportunity to move in. Evidence: There is a comprehensive Statement of Purpose and individuals Guide to the service; these include picture symbols which may make them easier for some people to understand. Each person who lives in the home has their own copy of the guide, which is kept in their room. There have been no new admissions to the home for a number of years and there are no vacancies. However, if a vacancy were to arise, the home has a thorough assessment process which would show whether the home would be suitable for any person interested in living here. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: The relatives who wrote to us said they were involved in the decision for their son or daughter to move to the home and that they did receive enough information to decide if this was the right home for them to live in. One family member said on our relatives behalf, we looked over the home before they moved in. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals needs and goals are met and each person has a plan that they, and people close to them, have been involved in making. Each person is supported to make decisions about their lives and to take risks to enable them to live as independently as possible. Evidence: We looked at two peoples care records during our visit. Each person has a detailed plan which describes the care and support they require and how staff should provide it; information is also included about their life history, who the important people in their life are, how they communicate, what daily routines they may have and what goals they may be working towards. Each individual is involved in planning their care as much as possible, but this can be difficult due to the nature of their disabilities and therefore members of their family Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: and health professionals have also helped to develop these plans and are involved in reviewing them. Staff write daily records which gives an overview of each persons day. Keyworkers ensure care plans are kept up to date by using these daily records; the care and support provided to each person can be changed if the records show this is necessary. Formal reviews are held each year. The records we looked at show that each person attends their review, together with their relatives, staff from the home and a representative from their Funding Authority. All aspects of their care and support are discussed and reviewed; care plans are then updated. Each member of staff we spoke with or who wrote to us said they are always given up to date information about the people they support. One staff member said care plans are regularly updated and another said I believe our care plans and health care notes are very accurate. The surveys completed on behalf of people who live in the home said each person is supported to make decisions about their lives as much as their abilities allow. Where people have difficulties, staff provide appropriate support. One family member said their relatives daily programme needs to be arranged for them but every effort is made to make it as varied as possible. Staff explained that the people who live in the home do have difficulty in communicating; some people have limited speech, some use is made of pictures and picture symbols and a range of other methods has been tried in the home including objects of reference and picture exchange. Some of the other ways individuals communicate, such as through facial expression, body language or gestures, are understood by staff but these do need to be learned over time. It is therefore very important that each person is supported by a consistent group of staff, who know them well. It is clear from speaking with staff that they are very keen to develop communication with the people they support; they continue to try different methods, use new technology and seek professional support. They also wish to provide written information in a format each person can understand. These efforts are commended are should be continued, as if they prove successful, would support each person to make more decisions about their lives. Interactions between staff and people who live in the home were observed informally Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: during our visit. These show that staff have a good knowledge of each persons support needs and how to communicate with them effectively. Both the people who live here and staff appear relaxed in each others company and at no time did staff appear rushed or unable to give people their attention. Care and support is provided within a risk assessment framework, to enable each person to be as independent as possible and to identify areas where the support of the staff is essential in keeping people safe. Each of the person centred risk assessments we looked at are detailed and written in a new format. Some of the assessments we looked at have not been dated when they were put in place; others which should be reviewed each year had not been reviewed in 2008, although the 2009 review has been carried out. Care Homes for Adults (18-65 years) Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as a individual and has opportunities and appropriate support to access leisure and educational facilities. Each persons rights are respected and they are able to keep in touch with families and friends. People have healthy, well presented meals which they are involved in choosing. Evidence: Each person who lives in the home has their own weekly timetable of activities. People continue to attend day services as well as making use of facilities locally or in the wider community. The home has a mini-bus which is suitable for people who use wheelchairs to ensure people are given opportunities to go out if they wish. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: The records we looked at show that people choose a variety of sessions at day services; one person has recently had their day service re-started after a number of years due to staff advocating for them. This is a positive development for this person and the staff we spoke with said they are enjoying their sessions and they are trying to increase the number and variety of sessions they attend. On the day we visited two people were attending their regular day service. The two people who were at home spent some time packing their belongings due to the building work which has started and also went into Bath, supported by staff. During their leisure time people are supported to have meals out of the home, use local facilities and to go shopping. If an individual has specific cultural needs or has a particular interest, this is known to staff who provide appropriate support. One persons family do practice a religion and have asked for certain food choices to be respected for their relative. Another individual enjoys religious music, which they are able to choose, and they celebrate religious festivals such as Christmas and Easter. Individuals are supported to choose holidays or trips out of the home. The records we looked at show that people go away twice a year if they wish to. A further holiday has now been planned whilst some of the building work is carried out; this is described in detail later in this report. Each person is supported to maintain close links with their family and friends. Visitors to the home are welcome and people can meet with relatives in private if they wish. The people who live in the home often visit their families and stay with them for weekends or for longer periods, such as Christmas. Relatives continue to have a high regard for the care and support provided at Trinity Close. One family member said the care my relative receives is second to none. We are very grateful. Other comments include we are pleased with the level of care our relative gets, they always seems to be happy. Other comments from parents at review meetings show they have similar feelings. They said at these reviews the home provides good care and support and they are happy for their relative to continue living here. The health professionals who wrote to us said the home supports people to live the life they choose, responds well to their different needs and respects each persons privacy and dignity. One professional said individuals participate in a range of activities within and outside of the home. The only limits in this are risk. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: The home continues to provide a variety of meals and snacks, which are healthy and nutritious. Each person is given a choice but the staff we spoke with said they do need to help people choose. They feel confident doing this as each persons likes and dislikes are recorded and they know each person well. During our visit two people were supported at lunchtime. Staff offered each person a choice and made sure they understood the choices available to them. One person has recently had their diet changed as they are at an increased risk of choking when they eat. Staff have worked hard to ensure they are still offered a variety of food and they are clear on how to prepare it safely. One member of staff said they are continuing to work closely with the health professionals who support them with this programme. People generally eat their meals in the dining area, which forms part of the lounge. This area is in need of refurbishment and this is described in detail later in this report. If people choose to eat meals in their own rooms this is respected and supported by staff. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support in they way they prefer and their healthcare needs are well met. The home supports each person with their medicines in a safe way. Evidence: Care plans provide clear guidance for staff on how they should support those living at the home with their personal and healthcare. Each person registered with a local G.P., dentist and optician. Other specialist services are accessed when an identified need arises. The records we looked at show the home is supported by Speech and Language Therapists, Occupational Therapists, Consultant Psychiatrists and other relevant professionals. Recording has improved since our last visit; all contact or visits from these professionals is now clearly recorded in each persons health records. The staff we spoke with or those who wrote to us said each persons care plan contains Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: very detailed information on the care and support they need. Staff said they use each persons records and also their observations when supporting individuals each day to alert them to any changes which may cause them concern. The health professionals who wrote to us said each persons health care needs are well met and the home seeks their advice and acts upon this to manage and improve individuals health care. One professional said the care given is excellent. Other comments include staff are very aware of individuals needs, this is a very caring environment and the staff team always listen to clients and professionals. The home uses a monitored dosage system of medication administration, which is well managed. Each person has their own medicine profile as part of their care records; these give staff clear instructions to follow, such as how and when people prefer to take their medicines and also explain what the medicines are for. Staff support each person to take their medicines; no one self medicates. Staff always make sure people take their medicines and only sign the records when they have done so. Each members of staff who supports individuals with medication is trained to do this in a safe and effective way. Medicines are stored securely in the home. Since our last visit the stock of epilepsy rescue medication has been returned to the pharmacy as staff no longer administer this; should this be required an ambulance would be called and this is clearly described in care plans. Care Homes for Adults (18-65 years) Page 20 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. If individuals who live in the home, or people close to them, have concerns about their care they know how to complain; their views would be listened to and acted on. People are safeguarded from abuse, neglect and self harm and the home would take action to follow up any allegations. Evidence: The home has a formal Complaints Policy, a Safeguarding and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. Each person who lives here has their own copy of the complaints procedure which contains pictures and picture symbols to help them understand it. The family members who wrote to us on their relatives behalf said they do know the home has a complaints procedure and who they would speak to if they have any concerns regarding the care and support provided at Trinity Close. One person said as parents we obviously know who to contact. There have been no complaints made to the home since our last visit. We have not had any complaints or concerns direct regarding the home. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The staff we spoke with and those who wrote to us are clear about the important role they have to ensure people are happy with their service and remain safe; they know what to do if an individual, family member or a friend is concerned about any aspect of the care and support provided at Trinity Close. One staff member said the complaints procedure is discussed at team meetings and at our supervision sessions. Staff said they also use observation to help determine how people are feeling; they can often recognise when people are unhappy, in pain or feeling unwell as they learn to recognise these signs. The home maintains clear records of each accident or incident which occurs and we are always notified if anything significant happens. Staff are provided with training in relation to Safeguarding Vulnerable Adults and are subject to Criminal Record Bureau enhanced disclosures, before they start work in the home. Care Homes for Adults (18-65 years) Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trinity Close does not currently provide a homely, comfortable or suitably adapted environment for people to live in. Evidence: 3 Trinity Close is a ground floor flat within a row of what looks like terraced houses. The premises as part of a general needs housing scheme developed by a housing association. The home blends in with other properties which form part of this scheme and is just a five minute walk from the centre of Bath, where each person can benefit from all of the amenities offered within the city. The accommodation is on one level; there are five single bedrooms, each having a hand wash basin. Communal areas consist of one shared bathroom, one shower room, a laundry room, a separate toilet and a reasonably small lounge, dining and kitchen area. There is a small enclosed patio garden which can be reached through patio doors. There is a ceiling track hoist in the bathroom; a mobile hoist is also used in the home. The shower room can be used by people who use a wheelchair and the bath is height adjustable. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: The home continues to show signs of considerable wear and tear. Some carpets are very badly stained and staff told us they cannot be improved by cleaning them as they have tried this. Lots of the paintwork is worn, there are many areas of wall plaster which are damaged, doorways are too narrow to enable wheelchairs or adapted seating to be moved easily around the home and the laundry has no exterior walls, becomes extremely hot and still has its door, which is fire door, left open as it was during our visit. One relative said the decoration is well worn, we have often criticised the lack of space within the home. One health professional said the home need improvements to the building and the staff team would welcome this. We have said in previous inspection reports that the environment is not suitable for the people who live in the home and some areas of the home are difficult for staff to work safely or comfortably in. The organisation has wanted to improve the environment for some time, although this has been delayed as permission needed to be granted by the local authority. This has now been given and work started in the home on the same day as our visit. If this work is completed as planned it will significantly improve the home and provide the following: one person will have their own en-suite facilities, the separate bathroom and shower room will be changed into one large accessible wet room, the doorways will be widened, a new fitted kitchen will be installed and the kitchen area extended, a new sensory room will be created, the laundry will be relocated, the lounge widened and a new staff sleep-in room with en-suite facilities will be created. All areas of the home will have either new vinyl flooring or carpets and will be redecorated. These improvements are likely to take three or four months to complete; a holiday has been planned for each person who lives in the home whilst some of the work is carried out. There is no clear plan of how people will be accommodated on their return, as this will be dependent on how much work has been completed whilst they have been away. These improvements, and the effect they have had on people who live in or work in the home, will be focused upon during the next key inspection. Care Homes for Adults (18-65 years) Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each persons needs are met and they are provided with safe and appropriate support by a competent and well trained staff team. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. Evidence: 3 Trinity Close has a small staff team of seven people to support individuals who live in the home. Most members of staff have worked in the home for a number of years and provide consistent levels of care and support as they have an excellent understanding of each persons needs.There are usually two staff on duty, although on certain days there may be more, depending on the plans of the people who live in the home. The relatives who wrote to us said they feel the staff have the right skills and experience to look after people properly. One relative said all members of staff are friendly and extremely professional and another told us staff like working in the home. Discussions with staff members and observation of their work practice show that they Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: are comfortable with individuals living at Trinity Close who were seen to be at ease with them. It is evident staff have a clear understanding of the needs of each individual and have built a good rapport with them. Staff who wrote to us said they are always given up to date information about the needs of the people they support and there are enough staff working in the home to meet each persons needs. Newer staff said their induction covered the things they needed to know when they started working in the home. They confirmed they are well supported in their role and receive appropriate training. Comments from staff include we put the people we support first, the team works really well together and we try to give the people we support the life they wish to live. The health professionals who wrote to us said they feel the staff team meet each persons needs. One said staff are very enthusiastic to improve their skills, they are very willing to support each person and another said the staff are very attentive and helpful. The staff team continues to meet regularly. The staff members we spoke with said that attendance is good and a variety of topics are discussed which relate to the people who live in the home as well as more general issues. They like having these meetings and feel they can bring up any issues they wish to discuss. The home has an effective recruitment process. New staff need to complete an application form, attend a formal interview, provide documents proving their identity and eligibility to work in the UK, at least two satisfactory references and an Enhanced Criminal Record Bureau Disclosure, before they start work in the home. The staff we spoke with and those who wrote to us said all of these checks were carried out before they began working at Trinity Close. Staff are provided with a variety of training opportunities; recently on-line courses have also been developed which staff said they like. The records we looked at show that staff have attended the following sessions: first aid, fire safety, food hygiene, how to move and handle people safely, medication administration, risk assessment and safeguarding of vulnerable adults. Staff are able to choose courses of interest to them; one staff member told us they are attending one course on supporting people who have epilepsy and another on relating to sight loss. Staff are also supported to gain a National Vocational Qualification, known as an NVQ. The home has been successful in supporting staff with their awards and 80 of staff now hold this qualification. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Each member of staff is provided with regular supervision; this is a 1:1 meeting with either the Manager or their Deputy. Staff spoken with said they are supervised every 6 weeks; they welcome these sessions and find them supportive. One member of staff said they give you more time to discuss your work and any other important issues and another said you are able to talk about any issue. Care Homes for Adults (18-65 years) Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and each individual benefits from how it is managed. The views of the people who live in the home, or those close them, are sought to help the home review their practice. Each person is safeguarded as the home keeps clear records, staff understand the ways things should be done and health and safety practices are generally carried out. Evidence: The Registered Manager, Mr.Paul Flett, was present during our visit. He is suitably qualified to manage this home, has a number of years experience supporting people who have complex needs and attends training to ensure his knowledge and skills are updated. He is supported by a Deputy Manager. The staff who wrote to us said they are well supported by the management team. Comments from staff include: the manager and the deputy are very easy to approach Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: and it is very open here, your opinion is valued. One family who wrote to us said we feel the home is very well managed. The views of the people who live in the home are sought as far as possible; some people are able to express if they are happy or not or wish for anything to be changed or improved, but for others this is more difficult. Families are also asked their opinion on the quality of care and support provided by the home. Feedback is sought at reviews and through more informal contact, such as when they visit or at the recent social event held in the home. One family told us our relative is unable to make specific choices, our experience shows that as far as possible consideration is given to their views. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is good, with all records required during our visit easy to access and stored securely when not in use. Dimensions have comprehensive policies and procedures to support the home, which are designed to ensure it complies with the law and remains aware of good practice or new ways of working. Full details of each policy were provided by the Manager on the AQAA he completed as part of this Key Inspection process. The registered providers representative visits the home each month to conduct an audit. They complete a report following their visit, which describes which records they have looked at and who they have spoken with. A copy of each report is kept in the home. There are recording systems in place to support health and safety in the home. We examined the fire log, which shows that there is a Fire Risk Assessment (although there is no evidence it has been reviewed since 2007) and that regular fire drills are carried out so the staff know what to do if there were a fire. The fire alarm system should be tested each week, but the records we looked at show that tests are not consistent and these must be improved. This was discussed with the Manager, who agreed with us. The homes AQAA confirmed that portable electrical appliance safety checks and fire detection and fighting equipment checks were carried out in May 2008, hoisting equipment safety checks were carried out in March 2008 and that the safety of the gas appliances have been checked. They have appropriate insurance cover; the current certificate is displayed in the home. Care Homes for Adults (18-65 years) Page 29 of 34 Care Homes for Adults (18-65 years) Page 30 of 34 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 31 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 37 10 The registered person must ensure the home is managed with sufficient care, competence and skill to ensure the welfare and safety of individuals and staff. This relates to fire safety checks. This would ensure all equipment used to detect a fire is working properly to ensure people are safe. 14/05/2009 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. No. Refer to Standard Good Practice Recommendations 1 7 The registered person should continue to develop communication strategies for each person who lives in the home. This would support them to make more decisions about their own lives. The registered person should ensure all risk assessments are dated and reviewed regularly. This would ensure each person has current information in their care plan which explains how to support them in a safe and consistent way. Page 32 of 34 2 9 Care Homes for Adults (18-65 years) 3 22 The registered person should ensure all risk assessments are dated and reviewed regularly. This would ensure each person has current information in their care plan which explains how to support them in a safe and consistent way. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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