Care Home: The Trio House

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What the care home does well This was a short focused inspection and not a full review of the service provided. We did however note that the men were well presented and relaxed and the home was clean and comfortable. Staff spoke in a kind and supportive manner to the men and encouraged them to be independent while they were having their evening meal. What the care home could do better: Records kept about the service provided to the people living in the home need to be accurate and clear. Monthly reviews of the men`s care plans should be recorded more formally to demonstrate that the information collated during the month has been considered, and any changes actioned where appropriate, such as unplanned weight loss. Activity planning should be person centred and clearly linked to people`s preferences as described in their care plans. Records about activities need to be in more in depth to enable the level of enjoyment and benefit from each activity to be monitored and reviewed. A record should be kept of the men`s daily wellbeing when they are on holiday and photographs should be taken. These steps would enable the level of enjoyment and benefit from the regular holidays to be monitored and reviewed by those involved in making their future plans. The people involved in planning for these vulnerable men`s lives should ensure decision are always made in their best interest. The medication storage facility should be upgraded to a purpose built cabinet with capacity to store controlled drugs should this ever be prescribed. Recruitment records need to show that robust procedures are followed before any new employee starts work at the home. Random inspection report Care homes for adults (18-65 years) Name: Address: The Trio House 15 Abbotsmead Road Belmont Hereford Herefordshire HR2 7SH one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Littler Date: 0 3 0 8 2 0 1 0 Information about the care home Name of care home: Address: The Trio House 15 Abbotsmead Road Belmont Hereford Herefordshire HR2 7SH 01432342416 01432342416 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Provider in day to day control Type of registration: Number of places registered: Conditions of registration: Category(ies) : Miss Margaret Clark Stevenson care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 3 The maximum number of service users who can be accommodated is: 3 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: Learning disability (LD) 3 Date of last inspection Brief description of the care home The Trio House is home to three adults who require care due to severe learning disabilities. The home was set up just for them in 2001 when the care home the men were living in closed. The provider and manager of this home Miss Stevenson was also Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home manager of their former care home and so they have all known each other for many years. The property is a detached family house, which is situated on a large, modern housing estate on the outskirts of Hereford city. There are local shops and facilities nearby, such as a superstore with a cafe and a park. The home has a suitable vehicle to provide transport for outings to town or further afield. The current fee for the service is £1070.60 per week for each service user. Additional charges are specified in the homes Terms Conditions of Residence document, and include holidays, clothing, individual personal needs, renewing personal goods, funeral expenses and transport. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: We, the commission did an unannounced inspection of The Trio House. This means that no one at the home knew the Inspector would be going there. We did this inspection because there have been some concerns about the care people living there get. These are still being investigated under the local Safeguarding Vulnerable Adult procedures, so we are not able to comment on them specifically in this report. We therefore can only give a general overview of our findings. We met the three people who live there and the two staff on duty. We observed the early evening routine. We were not able to talk with the men about their views about the service. This is because they have special communication needs, which people only become familiar with over time. We spoke only briefly to the owner and manager, Miss Stevenson, as she left after the first 40 minutes of the visit. We looked at some of the records that must be kept including a new workers recruitment file, the staff rota, daily activities, health and medication records. The two staff on duty had both worked regularly in the home for over three years and knew the men well. The staff rota showed that there is always two staff on during the waking day. One carer explained that at night a worker comes in to sleep over, however, one man can be restless at night, so this night shift can become a waking night duty when required. All three men seemed relaxed and at ease with the staff. They were well presented and were appropriately dressed for the warm day. They were in different rooms initially but were not involved in any particular activity. After half an hour a carer gathered them in the lounge and put an American street dance DVD on for them to watch. The staff did not sit with the men. One prepared the evening meal and the other did tasks and spent some time talking to her colleague. Both checked on the men periodically and commented on them enjoying the film. Our direct observations in the lounge indicated that they were not following the film. Two men wandered out of the room soon after the start and the other man was looking around the room. This mans care plan said he likes music but not the, boom boom type. This guidance seemed at odds with the film that had been chosen by staff. After the inspection, Miss Stevenson told us, Both staff understand in week days the bonding time for clients without being disrupted by staff, it has taken five years for the clients to feel happy and content in each others company with no challenging behaviours. Later the staff assisted the men to eat their evening meal in an un-rushed way. The interactions were appropriate and the level of assistance seemed to be in line with the guidance in their care plans. The men were being encouraged to be as independent as possible. Soon after the meal they were assisted with their evening routine of personal care, as the staff felt they were all tired. When we left at 7.30pm all three were either bathing or in their bedrooms with music on. Diary entries for the men confirmed they each attend a day centre once a week. On other days they are usually involved in an outing such as walking in the park or going for a Care Homes for Adults (18-65 years) Page 4 of 11 drink or snack at the local supermarket cafe. In some cases the information was very brief, for example, away or enjoyed visiting friends. The staff on duty were unable to say where this person had gone away to or who the friends were he had visited, as they had not been on duty. One worker said the visit was likely to have been to friends of whichever member of staff had been supporting him that day. This indicated that this was normal practice for staff to visit their personal friends when on duty. For these two days no daily personal care and wellbeing records could be found to clarify what both activities involved. The men are unable to suggest what they would like to do so it is essential that activities are well planned and solely for the benefit of the resident. The medication storage is still below the recommended standard as a filing cabinet is used rather than a robust purpose built cabinet. The medication records were seen. These were up to date and showed doses had been given as prescribed. Miss Stevenson said homely medication, such as paracetamol, is rarely used but if it is administered this is recorded on the charts. The charts seen showed none had been given over that period. Miss Stevenson said she has acted on our previous recommendation and medication records are now being taken on holiday. These were seen for the Spanish holiday in May 2010 and she had signed for all the doses administered during the trip. Miss Stevenson had not implemented our recommendation to write daily care and wellbeing records on the Spanish holiday or the regular weekend breaks taken to Miss Stevensons static caravan in Wales. She was unable to show us any holiday photographs from 2010 with the men in them. She said three staff were due to go on the Spanish holiday with her, but one had to drop out at short notice. She felt two staff accompanying her was sufficient but she has used three staff in recent years because there is so much driving to share. She explained that they travel overnight by boat and so have a long drive on both sides of the crossing. Miss Stevenson reports that the men get a lot out of the holiday and going each year to the same villa has meant they are used to the location. There is currently little evidence to support this verbal feedback and if the journey is very tiring for staff it must also be very tiring for the men. In the care plans holiday information it stated that the men will be tired when they return. The people involved in planning the mens lives, in conjunction with the home, need to ensure decisions made on their behalf are in their best interest, in line with the requirements of the Mental Capacity Act. When asked about recent health issues Miss Stevenson said there had only been one. This related to one man losing weight and his ongoing skin problems becoming much worse. Health professionals had been involved and a cause had been identified. Several medications had been prescribed that Miss Stevenson said were proving beneficial. We looked at the records of the two other men. Both had lost weight over 2010. One indicated that he was now half a stone under his ideal body weight. No action had been taken about this. We wrote to Miss Stevenson after the inspection to ask her to urgently investigate both mens situations. She reported back that one man had lost a stone but he was still over his ideal Body Mass Index weight. She was unaware that the other man had dropped half a stone under his ideal weight since a Wellman check up with the GP in April. She agreed to promptly explore this. On September 14th she reported back that he had now seen his GP who said he was not under weight and looked very well. The urgent action requirement we made has therefore been removed from this report. However, Miss Stevenson needs to ensure that in future any changes to people condition or wellbeing are picked up in a timely manner and acted upon without the prompting of a third party. Care Homes for Adults (18-65 years) Page 5 of 11 The recruitment file of a worker who has started since the last inspection was sampled. This showed that a CRB and one written reference had been obtained before the worker started. Miss Stevenson knows that two written references are needed before a worker is employed, however, this person is a member of her family and a note indicated that she had obtained a verbal reference from the last employer. Recruitment records could be improved so a recommendation has been made about this. This workers file showed that appropriate basic training had been provided such as Food safety, Basic First Aid and the Learning Disability Qualification. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 6 of 11 following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 As the men are very vulnerable and are unable to contribute to planning their care, their care should be reviewed every month and a clear record kept of any changes and action points identified. Clearer records of activities provided in the home and in the community should be maintained to demonstrate that these are planned for the benefit of the individual and that their enjoyment and involvement level is being kept under close review. Those involved in planning for the mens lives should review the current holiday arrangements and ensure any future decision about holidays are in the mens best interest, in line with the requirements of the Mental Capacity Act. Upgrade the medication storage facility to a purpose built medication cabinet with controlled drug storage so this is available should a controlled drug ever be prescribed for one of the men. The medication storage facility should be upgraded to a 2 12 3 14 4 19 Care Homes for Adults (18-65 years) Page 9 of 11 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 purpose built cabinet with capacity to store controlled drugs should this ever be required. 5 34 Recruitment records should show a robust recruitment procedure is always followed to ensure the people living in the home are being safeguarded. Improvements should include:The job application form should have a section for the applicant to provide the details of the two referees they are putting forward. In all cases as least two references should be obtained. Where any information received back about an applicant has had to be weighed, for example, a conviction from several years ago, the recruitment file should contain an audit trail to demonstrate that risks have been considered and further reassurances sought from the applicant or others, where appropriate. Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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