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Inspection carried out on 8 January 2019

During a routine inspection

This comprehensive inspection took place on 8 January 2019 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 1 December 2017 where one breach of legal requirement was found. The provider failed to have safe medicines protocols in place for medicines that were to be given “as and when needed.”. At this inspection we found the provider had addressed this breach.

Trinity House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Trinity House is registered to provide care and support for up to five people with mental health needs. Trinity House works jointly with a neighbouring care home, Trinity House Annex, run by the same provider. The building is a detached house in a residential street in Hendon and is well served with local transport, shops and parks. There are four bedrooms on the first floor and one on the ground floor. Three rooms have an en-suite facility consisting of a shower, toilet and there are washbasins in each room. The staffing structure consists of the registered manager, deputy manager and support workers, providing 24-hour support. The stated aims of the home are, 'To promote independence, self-determination and to contribute to the rehabilitative process. This enables service users to attain their optimum quality of life, and to move on to more independent living, in a home of their own'.

There were four people using the service at the time of our inspection.

There is a long standing registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were very happy with the care and support they received.

Staff working at the home demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences.

Staff told us they enjoyed working in the home and spoke positively about the culture and management of the service. Staff described management as supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided.

The manager and deputy manager provided good leadership and people using the service and staff told us they promoted high standards of care.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were supported and staff listened to them and knew their needs well. Staff had the training and support they needed. There was evidence that staff and managers at the home had been involved in reviewing and monitoring the quality of the service to drive improvement.

Recruitment practices were safe and relevant checks had been completed before staff worked at the home. People’s medicines were managed appropriately so they received them safely

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home.

Staff were caring and always ensured they treated people with dignity and respect.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s views on the service were regularly sought and acted on.

People participated in a range of different social activities and were supported to attend health appointments. People were supported to maintain a healthy balanced diet.

Person centred care was fundamental to the service and staff made sure people were

Inspection carried out on 1 December 2017

During a routine inspection

This comprehensive inspection took place on the 1 and 6 December 2017 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 23 June 2017. Breaches of legal requirements were found. We served enforcement warning notices on the provider in respect of four breaches that had the greatest impact on people, in the areas of good governance, recruitment, infection control and premises. We also found breaches of regulations in respect of staff support and consent. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to all the breaches.

Trinity House is registered to provide care and support for up to five people with mental health needs, some of whom may have a forensic history. Trinity House works jointly with a neighbouring service, Trinity House Annex. The building is a detached house in a residential street in Hendon and is well served with local transport, shops and parks. There are four bedrooms on the first floor and one on the ground floor. Three rooms have an en-suite facility consisting of a shower, toilet and there are washbasins in each room. The staffing structure consists of the registered manager, deputy manager and support workers, providing 24-hour support. The stated aims of the home are, 'To promote independence, self-determination and to contribute to the rehabilitative process. This enables service users to attain their optimum quality of life, and to move on to more independent living, in a home of their own'.

There is a long standing registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were happy with the care and support they received. Staff working at the home demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences.

Staff told us that a number of improvements had taken place since the last inspection. They enjoyed working in the home and spoke positively about the culture and management of the service. Staff described management as supportive and confirmed they were now receiving regular supervision.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were supported and staff listened to them and knew their needs well. Staff had the training and support they needed. There was evidence that staff and manager at the home had been involved in reviewing and monitoring the quality of the service to drive improvement.

Recruitment practices were now safe and relevant checks had been completed before staff worked at the home. We saw improvements in the way that medicines were managed, however, a protocol for PRN (as and when) medicines had not been completed.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home.

There have been a number of improvements to the premises of the home, the home had been redecorated throughout and a garden maintenance schedule was in place. We found the home to be clean and infection control measures were in place.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest’s decisions had been undertaken by relevant professionals. This ensured that any decisions were made in accordance with the Mental Capacity Act, DoLS and associated Codes of Practice.

Staff were caring and treated people with dignity and respect.

Systems to monitor the quality of the ser

Inspection carried out on 23 June 2017

During a routine inspection

This comprehensive inspection took place on 23 June 2017 and was unannounced.

At our last inspection in September 2015 we found the provider was not meeting the legal requirements in respect of fit and proper persons employed, safe care and treatment and good governance. At this inspection we found, although some improvements had been made, these were insufficient.

Trinity House Annexe is registered to provide care and support for up to five people with mental health needs, some of whom may have a forensic history. Trinity House Annexe works jointly with a neighbouring service, Trinity House. The building is a detached house in a residential street in Hendon and is well served with local transport, shops and parks. There are four bedrooms on the first floor and one on the ground floor. Three rooms have an en-suite facility consisting of a shower, toilet and there are washbasins in each room. The staffing structure consists of the registered manager, deputy manager and support workers, providing 24-hour support. The stated aims of the home are, 'To promote independence, self-determination and to contribute to the rehabilitative process. This enables service users to attain their optimum quality of life, and to move on to more independent living, in a home of their own'.

There is a long standing registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were aware of the signs to look for should they suspect abuse, including reporting any concerns to the senior support worker and registered manager. Staff knew the external authorities to report their concerns to should they not be happy with the action taken by the service.

Infection control practices were not always followed. We found out of date food in the fridge and the general cleanliness of the kitchen area unclean. We found various issues with the maintenance of the building, including uneven floor boards on first floor landing, causing a trip hazard, this put people at risk of falling over. There were a number of outstanding repairs and the general appearance of some parts of the home required improvements. This had an impact on the wellbeing of people living at the home.

We found gaps in recruitment records for staff employed by the service and staff training in areas such as the Mental Capacity Act 2005 (MCA). Staff did not receive regular supervision. Staff recruitment practices were insufficient and the provider failed to follow their own recruitment policy and procedures.

Risk assessments were detailed and provided staff with information on how to mitigate these risks.

Systems to monitor the quality of the service were not effective in ensuring that the quality of the service was maintained. The registered manager failed to have oversight of the service and did not conduct regular audits to ensure the service operated effectively. We found care records for people living at the home had a number of gaps.

Staff working alone did not have appropriate risk suitably assessed, despite an incident involving staff being attacked and threats towards staff by people using the service.

People's nutritional needs were met and people participated in activities. Most people felt staff treated them with dignity and respect; however, people were not always given a choice.

We have made a recommendation about the management of complaints.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

Inspection carried out on 1 September 2015

During a routine inspection

This inspection took place on 1 September 2015 and was unannounced. Trinity House is registered to provide 24 hour care and support for up to five people with mental health conditions, some of whom may have a forensic history. The aim of the service is to promote independence and to contribute to the rehabilitation process to enable people to move on to their own homes. The registered provider is Quality Housing and Social Care Limited. At the time of our inspection there were five people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People had opportunities to take part in a range of activities within and outside of the home. People were happy with the support provided in the home and we observed that most had developed good relationships with staff members who knew them well, and understood their needs. However two people said that they did not like the way one staff member spoke with them. Health care professionals spoke positively about the care provision, but had concerns about the home environment which was not always clean, and in need of redecoration.

People had individual plans detailing the support they needed but had not always been included in planning the care provided. All of them felt that their privacy was respected, and most people felt that staff supported them in a sensitive and dignified way.

People were supported to attend routine health checks and their health needs were monitored within the home. The home was well stocked with fresh foods, and people’s nutritional needs were met effectively. There were suitable systems in place for managing people’s medicines safely.

Staff in the service knew how to recognise and report abuse, and what action to take if they were concerned about somebody’s safety or welfare. Staff spoke highly of the support, supervision and training provided to ensure that they worked in line with best practice.

Surveys were conducted to gain the views of people living at the home and other stakeholders, and identify areas for improvement, and regular residents meetings were held to consult with people using the service. A suitable complaints procedure was in place for the home, and people told us that their concerns were taken seriously by the home’s management.

At this inspection there were four breaches of regulation in relation to safe staff recruitment, the cleanliness of the home, records to monitor risks to people’s health and welfare, and quality assurance systems at the home. We have made two recommendations regarding obtaining people’s consent, and involving people in their care planning. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 9 August 2013

During a routine inspection

On the day of our inspection, most people were out either visiting family or friends. We spoke with two people using the service. We received mixed views about the service. One person said they felt unhappy living at the home, whilst another spoke highly about the support they received from staff. Comments ranged from, “rather not spend my time here,” and “I get help if I need help.” We spoke with two relatives who told us that their relatives were well cared for. One told us, “staff are always helpful.” Another relative said, “on the whole, they (staff) seem caring, it’s the best place he has been in.” A stakeholder described the quality of care as, ”above average.”

There were appropriate arrangements in place to manage medicines safely. Medication audits took place and staff with responsibility for administering medication had received training. One person living at the home told us that staff explained the medication, including any risks and side effects. One person told us, “if I don’t take my medication I become unwell.”

People were supported to access other health and social care services they needed, including a psychologist referral for someone who had suffered a relapse. Systems were in place to gather information about the quality of the service and people had a say in how the service was run. Staff told us that most people living at the home were independent and therefore do not require constant supervision.

Inspection carried out on 23 October 2012

During a routine inspection

We spoke with two of the five people using the service who told us that they were treated with respect and dignity. They said staff were approachable and easy to talk to. One person told us “I feel comfortable approaching staff,” and a relative told us that the manager was “very approachable.” People told us that they felt safe and could speak to the manager if they had a worry or concern and this would be acted on.

People were given choices and the option to participate in various activities provided by the service and we saw evidence of this in minutes of residents meetings and people’s records.

There were systems in place to ensure that people were protected from abuse and that they received the care they needed. Systems were in place to gather information about the quality of the service and people had a say in how the service was run.

Reports under our old system of regulation (including those from before CQC was created)