Care Home: Trinity House

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What the care home does well Trinity House offers a small group living environment, which crosses over between a care home and supported living. Staff provide support to people using the service in a person centred way, which enables them to live the life they choose, with many opportunities to enjoy a range of activities and experiences and to participate in the local community. The outcomes for people using this service are good, they are supported and encouraged to live a life that is meaningful and to be as independent as they can be. They are supported by a dedicated staff team who work well together for the benefit of people living in the home. Comments made by people using the service, confirmed this, "I have enjoyed Christmas and all the parties, The Chicken Shed Theatre and pantomime at Acorn village" and "I believe I am treated with respect as an adult and my privacy is respected". Each of the people living in the home have two care files, one which provides information for staff and the other, which has been developed to reflect the individual, their life and people and things that are important to them. Both sets of care plans are well written, organised and take into account the experiences, feelings and needs of the person. Written information is supported by photographs and pictures which, reflect the people who are important to the individual and important aspects of the individual`s life. What has improved since the last inspection? Concerns were raised at the last key inspection in 2006 about residents being at risk of burns from hot surface temperatures of radiators, the noise level of an alarm fitted to a bedroom door and the risk of an individual falling on the stairs into their bedroom. A tour of the home confirmed all of these issues have been addressed. A previous requirement was made for the manager to ensure Control of Substances Hazardous to Health (COSHH) data sheets were obtained and held for the relevant cleaning products purchased. These were produced during the inspection and were being held with the appropriate cleaning products, to be used in the event of accidental spillages or other incidents where this information would be required. An Annual Service Review ASR was completed by us in Novemeber 2007. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. Using all the information we had about the service our judgement was that the service continued to provide good outcomes for the people living there. What the care home could do better: CARE HOME ADULTS 18-65 Trinity House 47 High Street Manningtree Essex CO11 1AH Lead Inspector Unannounced Inspection 4th February 2009 10:00 Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trinity House Address 47 High Street Manningtree Essex CO11 1AH 01206 394550 01206 391216 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Acorn Village Limited Mr Jeffrey Allan Peck Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 6 persons) One named person, over the age of 65 years, who requires by care by reason of a learning disability, whose name has been provided to the National Care Standards Commission The total number of service users accommodated in the home must not exceed 6 persons 12th December 2006 3. Date of last inspection Brief Description of the Service: Trinity House is registered under the Care Standards Act 2000 as a care home providing personal care, support and accommodation for 6 adults with learning disabilities, including one service user over the age of 65 years. Acorn Village Limited manages the home, a registered Charitable Trust established in 1972, that also runs a larger home for adults with learning disabilities at Mistley, Essex. The registered manager of Trinity House is Jeffrey Peck. Trinity House is located in the village of Manningtree, approximately 15 miles from Colchester. The accommodation is arranged on three floors. Bedrooms are for single occupancy and are located on the first and second floor. Communal rooms consist of a kitchen/diner and a sitting room. There is a small garden to the rear of the property. The home is ideally situated for access to the local community and facilities that include a supermarket, shops, bank and library. The home is unsuitable for persons with mobility difficulties because of the narrow staircases that lead to the bedrooms. Fees range form £400 and £700 per week. Toiletries, hairdressing, private chiropody and leisure pursuits are charged at extra costs. This was the information provided at the time of this key inspection. People considering using this service may wish to obtain more up to date information from the home. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and took place on a weekday, which lasted six hours. This was a key inspection, which focused on the core standards relating to adults aged 18-65. The report has been written using accumulated evidence gathered prior to and during the inspection, including a relatives ‘Have Your Say’ survey and the Annual Quality Assurance Assessment (AQAA). This document is issued by the Commission for Social Care Inspection (CSCI) and gives providers the opportunity to inform the Commission about their service and how well they are performing. A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. During a tour of the home, time was spent talking with three people living in the home and three staff. Both the registered manager and deputy manager were available and fully contributed to the inspection process. What the service does well: Trinity House offers a small group living environment, which crosses over between a care home and supported living. Staff provide support to people using the service in a person centred way, which enables them to live the life they choose, with many opportunities to enjoy a range of activities and experiences and to participate in the local community. The outcomes for people using this service are good, they are supported and encouraged to live a life that is meaningful and to be as independent as they can be. They are supported by a dedicated staff team who work well together for the benefit of people living in the home. Comments made by people using the service, confirmed this, “I have enjoyed Christmas and all the parties, The Chicken Shed Theatre and pantomime at Acorn village” and “I believe I am treated with respect as an adult and my privacy is respected”. Each of the people living in the home have two care files, one which provides information for staff and the other, which has been developed to reflect the individual, their life and people and things that are important to them. Both sets of care plans are well written, organised and take into account the experiences, feelings and needs of the person. Written information is supported by photographs and pictures which, reflect the people who are important to the individual and important aspects of the individual’s life. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: As the service has two vacancies at present, the manager must ensure that the service users guide and other information about the home is current and up to date. This information should also be available in a format suitable for the people for whom the home is intended, such as appropriate language, signs and/or pictures. Although the home is comfortable, the environment is in need of modernisation. The layout of the house restricts who can move into the home due to the high and narrow stairs and two of the bedrooms being on the second floor, which is up another narrow flight of stairs. The décor in the home is looking tired and dated. The facilities in the home need modernising, only two rooms, which are located on the second floor have en-suite facilities. The four people currently residing on the first floor share a bathroom and toilet. The manager must ensure they establish a quality assurance monitoring system at appropriate intervals, which seeks the views of people using the service and their representatives, to reflect the quality of care provided at the home. This is an outstanding requirement from the key inspection on 12/12/2006. The staff office and a resident’s bedroom on the first floor were being wedged open, this would prevent the doors from closing in the event of a fire. Although, arrangements have been made for ‘Dorgards’ be fitted to these doors, the manager should consult with their local fire authority to ensure these comply with current fire safety regulations. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5, People using this service experience good quality outcomes in this area. People considering using this service will have an assessment of their needs completed to ensure the home can meet their needs, however information about the service needs to be reviewed to ensure this up to date and provides accurate information. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA reflects the statement of purpose has been revised to ensure information is up to date, however the service users guide and other paperwork relevant to support and advise prospective clients needs to reviewed and updated. This was last reviewed in 2004. As the service has two vacancies at present this information should be current, with clear information and provided in a format suitable for the people for whom the home is intended, in an appropriate language, signs and pictures. Information provided in the AQAA and verified at the inspection confirmed the home has a detailed admissions policy and procedure in place, which reflects prospective clients, would be invited to visit, as often as they wish. Followed by a thirteen-week probationary period and assessment to ensure the individual’s needs are being met and that the service can continue to met their needs. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 10 The home is currently registered to provide support and accommodation to six people. At the time of this inspection four people were living there. The home is looking to introduce a fifth person who is currently living in Acorn Village. The manager confirmed the individual is being introduced over a period of time, so that they can assess their needs and compatibility with the people who currently live in the house. Planned visits have been arranged including mealtimes and evenings. Two service users files and care plans were tracked as part of inspection process. Both had pre admission assessments completed, which covered all aspects of the individual’s health, personal and social care needs. These included a description of the support and interventions required by staff, to maximise the individuals independence and to keep them safe. Both files contained a copy of the contract between the organisation and the individual. The contract reflects the individual’s fees, including method of payment, what services are included and the rights and obligations of both parties. A written statement had been attached reflecting the contract had been explained to each person, using all forms of communication, to ensure that they had fully understood the complications of signing the contract. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, People using this service experience good quality outcomes in this area. People using this service know they will have their needs and personal goals reflected in their individual care plans and will be supported to take risks as part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed person centred care plans and risk assessments have been completed to support people using service, to take make choices and take risks in all aspects of their lives. Each service user has two care files, one which provides information for staff and the other, which has been developed to reflect the individual, their life and people and things that are important to them. Both sets of care plans are well written, organised and take into account the experiences, feelings and needs of the person. To ensure people using the service are fully involved in planning the service they receive, regular reviews are held, which involves themselves and people involved in their care and support. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 12 Most recent reviews seen reflected comments made by the individuals, these included, “I have enjoyed Christmas and all the parties, The Chicken Shed Theatre and pantomime at Acorn village” and “I believe I am treated with respect as an adult and my privacy is respected”. The AQAA reflects staff have received training to support people using the service to complete care plans and that the formats have been improved to make these more person centred and user friendly. The plans contain a lot of photographs and pictures of friends, relatives, current and previous staff and the names and contacts of important people in ‘my life circle of support’. They also contained a short life history and ‘my life story’. Each plan has been developed with the individual, to establish ‘how I spend my life, ‘what I want to do and the support I needed to achieve this, to lead an independent lifestyle and to help me keep safe’. Using photographs and pictures, people have been supported to make choices and decisions about their daily life, including a section, ‘All about me’, which covers, ‘things I like and don’t like, my thoughts and wishes, good things about me, what I find difficult, things that are important to me and who can support me the best to achieve the things I want to do’. Assessment summaries of each individual’s strengths and needs have been completed, these provide detailed information of the support they require to manage daily life skills and include, communication, self care, domestic tasks, close personal relationships and friendships, social skills, leisure and use of community facilities, such as shops, banks, public transport and community participation. These assessments are supported by risk assessment and risk management strategies desigend to support the individuial to take responsible risks when accessing the community, road safety and to manage long-term health related conditions. Risk assessment were seen in each of the resident’s files, which reflect how people are supported to obtain, secure and spend their own personal money. The skills and knowledge of each individual had been assessed to establish their understanding of financial matters. Money management plans had been completed setting out the level of support they required to manage their money and spending and points to consider. Records of two people tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17, People using this service experience good quality outcomes in this area. People using this service are supported to live meaningful lives, both in the home and in the community, enjoying a full and stimulating lifestyle with a variety of options to chose from. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed the staff work more as enablers to ensure people using the service maximise their skills and potential in all areas of daily living. This includes encouraging and enabling residents to participate in the day-to-day running of the home. Each person has a life skills day where they are expected and supported to take part in the cleaning and household chores. An individual was observed gathering the cleaning materials they required to clean their room and the bathroom. People were observed freely moving around their home, helping themselves to breakfast cereals, washing up their dishes and making tea and coffee as and when they required. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 14 Observation and discussion with people living in the home confirmed they are supported to follow their interests and take part in community life. The AQAA reflects residents are well known in the community and a lot of the local shopkeepers know the residents by name. One individual was observed going out with staff support to go to the building society, to withdraw some money for personal shopping. Two people were observed getting ready to go to Acorn Village for the day, where they were scheduled to take part in craft workshops. People using the service are supported to take part in various activities in the home and in the community, such as car boot sales, holiday’s, meals out in pubs and restaurants, aqua aerobics, shopping, horse shows, cinema and to the theatre. Photographs and leaflets also confirmed people had attended various outings, including Colchester Zoo, Spirit of the Horse show at the theatre and a Westlife concert at Leeds castle. Two visits are arranged annually for people from Trinity House and other services run by Acorn Village Ltd to attend Chicken Shed theatre productions in London. People spoke about this being a good sociable event. ‘My day to day life’ and weekly activity plans, reflect people’s choices, including people’s preferred daily routines, such as getting up times, going to bed and when and what they ate. Weekly activities include regular sessions of crafts, art, weavery, cookery and attending college. People using the service are encouraged and supported to access adult education colleges, to learn new skills and further develop their knowledge. The nearest colleges are located in Harwich and Clacton. Care plans contained a section, ‘What I do at College’, which included, photographs and certificates providing evidence of courses previously completed, including floristry, cooking for independence and for life and improving communication, using makaton. Additionally, letters were seen confirming courses that people had enrolled on for the coming term, which included music and Tia Chi. The AQAA reflects all of the residents are supported to retain family contact and that families have a good rapport with the staff. This was confirmed in photographs, held in personal plans showing people spending time with their families at Christmas. Additionally, there is good information in peoples care plans of the support provided to enable them to develop and maintain intimate personal relationships with people of their choice. Records show where referrals have been made to appropriate professionals for advice and support and where assessments have been completed around consensual relationships. Staff on duty have developed a very good relationship with people living in the home, interaction between the people living there and the staff was seen to be friendly and appropriate at all times and acknowledged peoples’ rights to choose when to be alone or in company. Discussion with the staff confirmed they have a good understanding of person centred care and were clear Trinity House is the residents home and what their role is to support and enable them to be as independent as can be. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 15 The AQAA reflects all people living in the home are supported and encouraged to prepare their own lunch and breakfast. This was observed during the inspection. Each resident has a day when they are able to choose the main meal of the day, however people are able to select an alternative if they do not want what is on offer. People using the service are involved in the food shopping for the home. Staff were observed to offer help and guidance to residents when choosing the menu and making the shopping list. Residents were observed to help themselves and to make their own lunch and hot drinks. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, People using this service experience good quality outcomes in this area. The health and personal care people receive is based on their individual needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home are supported to have access to health care services. Care plans contained individual health plans, which provided clear information about the individual’s health needs and how these were to be met. Plans were written in a person centred way describing, ‘my life now’ with information on how to support the individual with their personal care, eating, drinking, oral hygiene and specific diets. These are being monitored and where potential complications or problems are identified these are dealt with. Dates of appointments with health professionals are clearly recorded and contain good detail of the reason for the visit, what happened and the outcomes. Specialist services are sought and provided, where required to support people to maintain their health and a good quality of life. Plans show that people have regular access to dentists, General Practitioners (GP) physiotherapists, heart specialists, optician, chiropodist, regular health checks and hydrotherapy. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 17 Information provided in the AQAA and verified at the inspection confirmed staff respond to the changing care needs of people using the service. Discussion with staff confirmed they are currently monitoring the health and well being of an individual living in the home, whose mental health needs are changing. At present staff advised the aim is to keep the individual safe, happy and comfortable in their home. If their condition deteriorates further, there is a possibility of them moving into one of units in Acorn Village, where their needs to could be better met. Observation and discussion with staff confirmed the principles of respect, dignity and privacy are put into practice. Staff confirmed that they are fully aware of the individual needs of people using the service and were able to provide a verbal account of each persons health and well-being. People using the service are supported to look after their own medication. Their medication is kept in their rooms in a locked cupboard, however the staff hold the keys. Residents are assisted and monitored closely to manage their medication and participate with the ordering and stock control. They also co sign to say they have received and taken their medication. Risk assessments have been discussed and completed with the individual to assess the level of support they require to mange their medication. One of the risk assessments sampled showed, the individual needs support, as they are unaware of the potential side effects of their medication, but does state the individual can inform staff if they feel unwell following taking a medication. The assessment also reflects the individual has been offered the choice to hold overall responsibility for their medication, but has declined. They are fully aware of the importance of taking medications and that they need support to ensure they take the correct dose and at the correct times. The Medication Administration Record (MAR) charts for one of the people living in the home was examined. A photograph of the person had been attached to the records to avoid mistakes with their identity. The MAR charts had been completed correctly with no gaps. A check of the person’s medication held against the MAR chart was found to be correct. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23, People using this service experience good quality outcomes in this area. People who use this service have access to robust and effective procedures, which enable them to express their concerns and which protect them from abuse or being placed at risk of harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Acorn Viallge Ltd has a managing complaints and adult protection and prevention of abuse policies and procedures in place. These also apply to Trinity House. These provide clear information about how to make a complaint and include guidance of the procedures staff must take to report allegations of abuse. People using the service also have access to an independent advocacy services, providing a forum for people to raise any concerns independently of the staff in the home. The complaints log reflected there had been one complaint made about the service since the previous inspection. A person living in the home had made a complaint about another reisdent, infringing their rights. This had been fully investigated and resulted in a multi disciplinary meeting with advocacy support to discuss and agree outcomes to avoid incidents reoccurring. The manager also provided a full letter of response to the individual raising the concerns. Information provided in the AQAA states staff have received training around abuse and whistle blowing and that all staff are aware of the procedures with Safeguarding of Vulnerable Adults (SOVA). This was confirmed in discussion with staff who were clear about their role in the reporting of incidents of poor Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 19 practice and suspected situations of abuse. They were also familiar with the whistle blowing policy and procedures and their duty of care to raise any concerns they may have about other members of staff conduct. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30, People using this service experience adequate quality outcomes in this area. Improvements need to made to the decor and internal layout to improve the facilities in the home, which are looking tired and outdated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Trinity House provides the people who live there with homely, welcoming, safe and comfortable accommodation. The building is fully in keeping with neighbouring proprieties and has a small garden, to the rear of the house, which is accessible to all people who live there. Accommodation is arranged on three floors. Bedrooms are for single occupancy and are located on the first and second floor. There are four rooms on the first floor and two on the second floor, which have en-suite toilet facilities. All rooms are provided with hand washbasins. Communal rooms consist of a kitchen/diner and a sitting room. These are spacious and well furnished with domestic style furniture, carpets and curtains. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 21 The service provides a small group living environment, which crosses over between a care home and supported living. However, the layout of the house restricts who can move into the home due to the high and narrow stairs and two bedrooms being on the second floor. The décor in the home is looking tired and dated, and the layout of the home is not really fit for purpose, only two rooms on the second floor have en-suite toilet and washing facilities. The four people residing on the first floor currently share a bathroom and toilet. Staff from Acorn Village maintenance team carry out maintenance and decoration of home. The utility room was in the process of being decorated on the day of the inspection. The house has also recently had a new gas boiler fitted. One of the bedrooms has recently been decorated and carpeted for an individual who has chosen to move into larger room. They showed the inspector pictures of a new bed and furniture they have purchased for their room. Other people’s rooms seen had been decorated to their tastes, which reflect their individual personalities, hobbies and interests. Art and craftwork and other personal items belonging to the residents were seen around the home making the place personalised and homely. Concerns were raised at the last key inspection in 2006 about residents being at risk of burns from hot surface temperatures of radiators, the noise level of an alarm fitted to a bedroom door and the risk of an individual falling on the stairs into their bedroom. A tour of the home confirmed all of these issues have been addressed. Radiator covers are now in situ. Additionally, where concerns had been raised about the noise level of an alarm to alert staff of the individual’s movement during the night. The alarm has been removed, this is no longer an issue, as the individual no longer resides in the home. A banister has been fitted by the steps in the bedroom adjacent to the bathroom on the first floor to provide support for the individual occupying the room. Maintenance records confirmed hot water temperatures are being maintained with the safe recorded temperatures of 41 degrees centigrade for showers and 44 degrees for baths, which minimises the risk of people living in the home being scolded when taking a bath or shower. The premises were clean, and tidy on the day of the inspection and free from any offensive odours. Appropriate domestic laundering facilities are sited in the utility room behind the kitchen. These are accessible to the people living in the home who are encouraged to use the facilities to launder their clothing. A new washing machine has been purchased. Only normal house hold laundry, is dealt with in the home, in the rare event of any heavily soiled linen, this is bagged and taken to Acorn village laundry where they have appropriate facilities to launder these items. Hand washing and of liquid soap and paper towels are provided in bathing and toilet facilities where staff may be required to provide assistance with personal care. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36, People using this service experience good quality outcomes in this area. People currently using this service are protected by the homes recruitment procedures and are supported by a staff team that are trained, skilled and in sufficient numbers to meet their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed the home has a consistent staff team, with few changes, ensuring continuing support for people living in the home. The staff work a flexible rota to support the needs of the people using the service, to achieve their planned activities. The registered manager is predominately based at Acorn Village, however a deputy manager is based at Trinity House. The duty roster reflected there are two support staff (one in a senior position) between 8am to 8pm, with one night staff, sleeping or awake, as required. Staff are supported by care managers through an on call rota system day and night. Staff confirmed there is sufficient staff available to meet the needs of the people living in the home. Observation of the interactions between the manager, deputy, staff and the people living in the home reflects a domestic, non-working environment with a homely atmosphere. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 23 Three staff files were examined both had a recent photograph of the individual to confirm their identity, terms and conditions of employment and all the relevant documents and recruitment checks, required by regulations to determine the fitness of the worker. Records and discussion with staff confirmed these had been obtained prior to them commencing employment. The AQAA identified that Criminal Records Bureau (CRB) checks are kept at Acorn Village, however these were not seen on the staff files. An addendum to show that disclosures had been obtained and when these had been received was seen for each member of staff. Acorn Village Ltd has their own induction training programme, which meets the requirements of the Skills for Care, Induction Standards and includes the City and Guilds award ‘Induction Award in Supporting People with a Learning Disability’. Staff are issued with their own workbook, which is used to monitor their progress through the probationary period. Information in staff files confirmed that new employees had completed their induction training within the first six to twelve weeks of their employment. Staff confirmed their induction covered what they needed to know, to do their job and to meet the needs of the residents. They also told us, “Acorn Village are a good company to work for, and that the training is second to none”. They are able to access National Vocational Qualifications (NVQ) through the company who have assessors on site and that they receive regular supervision and have an annual appraisal to discuss their future training and development. Acorn Village Ltd has its own training department, which provides a wide range of training and development opportunities for staff, including those who work in Trinity House. Examination of staff files and training information provided during the inspection confirmed this. Most recent training has included Non Abusive Physcological and Physical Intervention (NAPPI). This training provides staff with the knowledge to assess, prevent and manage violence and aggression. Other training has included, heath and safety, manual handling, food hygiene, first aid, fire safety, safeguarding vulnerable adults and medication. Additional training has been provided to meet the specific needs of people living in the home have included, makaton and dementia. Staff are to attend a learning disabilities training day, which is being provided by a lecturer from Bradford University. Acorn Village Ltd is registered as an accredited National Vocational Qualification (NVQ) training centre with City and Guilds, offering NVQ 2 and 3 with onsite assessors and verifiers. The home employs a total of nine staff, seven have completed NVQ level 2 or above, with one person currently undertaking the award. These figures reflect the service has met the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Staff files showed that seven of the staff had supervision during October through to December. Supervision records showed discussions were held about ‘you, your work, and your development’ and the outcomes from the employees last appraisal. The manager stated that supervisions had fallen behind, but Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 24 these are now ongoing and all staff are currently having an appraisal. Staff confirmed they had had a recent supervision and appraisal or had a date scheduled. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42, People using this service experience good quality outcomes in this area. To ensure people who use the service have a say in the way the home is run and managed, more needs to be done to obtain their views and their representatives, to ensure the home is meeting their individual needs and the aims and objectives set out in the homes statement of purpose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is suitably trained and experienced to manage Trinity House, having obtained National Vocational Qualification (NVQ) level 4 and the Registered Managers Award. They are supported by a deputy home coordinator who is responsible for the day-to-day running of the home. The deputy works along side staff following a normal shift pattern with additional responsibilities of supervising staff and co-ordinating training. They have received training to support them in their role and has completed NVQ levels 2 and 3. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 26 A previous requirement dating back to the key inspection in 2006 was made for the manager to ensure the quality assurance system was undertaken. The manager confirmed this has not been implemented. We (The Commission) were provided with feedback in one relatives ‘Have Your Say’ prior to this inspection, which provided positive outcomes about the service. Five relatives and three service users ‘Have Your Say’ surveys, issued by us at the time of completing the ASR, provided positive feedback about life in the home and reflected that people were happy with the service they were receiving. Based on this information our judgement was that the quality of the service had been sustained, since the previous inspection, although the ASR reflected an improved quality monitoring, by the service would provide a wider view of quality outcomes. Examination of the incident and accident report book showed a record of twenty six incidents between 29/07/07 – 03/12/08 of episodes of challenging behaviour involving one individual and in some cases other residents. A number of these issues were raised as safeguarding concerns. These had all been logged and reflected various professionals input, including the individual’s social worker, clinical psychologist and mental health team. As a result of multi disciplinary meetings the individual was given notice to leave. Discussion with the manager and records show this situation was managed well. The manager praised the staff for their role in supporting the individual and the other people living in the home and felt that they had developed as a staff team, during this period. The manager stated at no point was restraint used to manage the individuals behaviour and that all staff had received NAPPI training. The manager and staff confirmed the atmosphere in the home is now much better and more relaxed and the existing resident group get on very well with each other. This was evidenced throughout the inspection. Information provided in the AQAA and verified at the inspection confirmed the home conform to health and safety and environmental health policy and regulations. Regular health and safety audits are completed monthly and records examined confirmed the home takes steps to safeguard the health safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety certificates including Portable Appliance Testing PAT were seen. The homes maintenance folder contained appropriate procedures and provided evidence that routine monitoring of systems, such as monitoring hot water temperatures are completed to ensure compliance with health and safety requirements. The fire logbook showed that the fire alarm is serviced regularly and tested weekly. Regular fire training and drills take place. The homes fire risk assessment was seen which is currently being revised. Each service user has an individual fire safety assessment completed. Conversation with one of the individuals confirmed they were clear what to do in the event of a fire. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 27 The lounge door has been fitted with a ‘Dorgard’ to hold this open during the day for ease of access and so that staff can monitor activity in the lounge. However, it was noted that the staff office and a resident’s bedroom on the first floor were being wedged open, this would prevent the doors from closing in the event of a fire. Arrangements have been made for ‘Dorgards’ be fitted to these doors. The manager should consult with their local fire authority to ensure these comply with current fire safety regulations. A previous requirement was made for the manager to ensure Control of Substances Hazardous to Health (COSHH) data sheets were obtained and held for the relevant cleaning products purchased. These were produced during the inspection. The inspector was informed there are plans to move the cupboard containing these items in to the utility room. A safer lock, other than the padlock type currently in use, needs to be fitted to ensure these items are locked securely. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement The manager must ensure that the service users guide and other information about the home is current and up to date. This information should also be available in a format suitable for the people for whom the home is intended, such as appropriate language, signs and/or pictures. This will ensure prospective users of the service will have access to information about the service to decide if it is suitable for them. 2. YA24 23 (2) A review of the physical design, layout and décor of the premises needs to be undertaken to ensure the facilities meet the needs of the people living in the home and that all parts of the home are reasonably decorated. The findings of this review need to forwarded to us (The Commission) 27/03/09 Timescale for action 27/03/09 Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 30 3. YA39 24 The manager must ensure they establish a quality assurance monitoring system at appropriate intervals, which seeks the views of people using the service and their representatives, to reflect the quality of care provided at the home. A copy of the outcome of the quality assurance must be forwarded to us (The Commission). This is repeat requirement from the key inspection on 12/12/2006 01/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA42 Good Practice Recommendations Where arrangements have been made for ‘Dorgards’ be fitted to the office and one service users bedroom door, the manager should consult with their local fire authority to ensure these comply with current fire safety regulations. Trinity House DS0000017986.V374272.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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