Archived: Care Management Group - Trafalgar House

Care Management Group - Trafalgar House is a residential care home registered to provide personal care for up to 8 people living with a learning disability or autism. At the time of inspection there were 7 people living at the home.

The service has been designed and developed taking into account best practice guidance and the principles and values underpinning Registering the Right Support.

People’s experience of using this service and what we found

Quality assurance systems were in place and used to identify areas for development. Although incidents were analysed there was limited evidence of how learning from incidents took place at a local level. Some records did not always reflect the level of detail needed to show what had happened or what actions had been taken. This lack of detail also meant that the provider may not have full oversight of incidents at the home.

There were systems in place to help maintain people’s safety. Staff understood safeguarding and their own responsibilities about reporting concerns. Following recent training and guidance at the home staff understood the importance of reporting concerns in a timely way and told us they had the confidence to do this. Risks to people were well managed and staff understood how to support people. There were enough staff to support people each shift and appropriate infection control procedures were in place.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 April 2018).

Why we inspected

We undertook this targeted inspection because we had about concerns shared with us in relation to the support people received and allegations of abuse.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspection even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit.

Trafalgar House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Care and support is provided for up to eight people with a learning disability. At the time of our inspection, there were seven people living at the service. The service provides care and support to people living with a range of learning disabilities and mental health diagnosis and a variety of longer term healthcare needs such as epilepsy and diabetes. The service is a large house within a residential area in Bexhill-on-Sea. The accommodation comprises two large lounges and a dining room with access to a rear garden. People have their own spacious bedroom.

At the last comprehensive inspection on 13 and 14 January 2016 the service was rated overall Good. At this inspection we found the service remained overall Good. At the last inspection, we found a breach in the regulations and the safe domain which was rated as Requires Improvement. The provider provided an action plan as to how the issue raised would be addressed. We undertook a focused inspection on 14 March 2017 to review the improvements made, and found the issue highlighted had been addressed.

Systems had been maintained to keep people safe. People and relatives told us how they felt safe with the care provided. They knew who they could talk with if they had any worries. A relative told us, “They make sure he is safe in every aspect.” They felt they could raise concerns and they would be listened to. People remained protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had continued to be developed. Staff told us they had been supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. One member of staff told us, “It’s a lovely company. I love it here.”

People's individual care and support needs continued to be identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. Comprehensive and detailed care plans provided staff with information about how people wished to be cared for in a person-centred way. People met with their keyworkers monthly to discuss the care to be provided. People told us how they felt listened to, supported to be independent and they were involved in decisions about their care. Staff had a good understanding of consent.

People and their relatives told us they were happy with the care provided. A relative told us, “It’s been brilliant. (Person’s name) has improved in the time he has been here.” People continued to be supported by kind and caring staff who knew them well and treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. Staff told us it was a good team. One member of staff told us, “It’s a good team. We all get on. We all know what we are doing.”

The provider continued to have arrangements in place for the safe administration of medicines. People were supported to get their medicine safely when they needed it. People continued to be supported to maintain good health and eat a healthy diet.

Staff and visiting health and social care professionals told us the service continued to be well led. Staff told us the registered manager was always approachable and had an open door policy if they required some advice or needed to discuss something. Senior staff carried out a range of internal audits, and records confirmed this. People and their relatives were regularly consulted about the care provided.

We undertook this focused inspection on 14 March 2017 to check the provider had followed their plan and to confirm they now met legal requirements. We found improvements had been made and the provider was now meeting all legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trafalgar House on our website at www.cqc.org.uk

Trafalgar House provides accommodation and support for up to eight people. Accommodation is provided from a large detached house. The building is located within a residential area in Bexhill-on-Sea. The service provides care and support to people living with a range of learning disabilities and mental health diagnosis. People had a range of needs and all required some assistance. This included, personal care, communication and going out. Several people have been living at the service for over 12 years. There were eight people living at the service on the day of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The provider had taken steps to ensure people’s safety in relation to previous concerns regarding security. The systems and checks which had been established to secure the garden were fully embedded within staff routines. People told us they felt safe living at Trafalgar House and staff were clear on their responsibilities associated with protecting people from harm both within the service and when out in the wider community.

The environment was routinely checked to ensure it was safe for people. Various in house checks were undertaken by staff in areas such as fire safety and water temperatures. Servicing and maintenance of fixed equipment such as boilers and hard wiring electrics were completed by external contractors. We have made a recommendation to the provider as to how they respond in a timely manner to requests from the registered manager in relation to where remedial works have been recommended following an external contractors visit.

People’s care needs had been assessed and risks associated with supporting people living with complex behavioural needs were managed in line with these assessments. Assessments were detailed and up-to-date and had been completed for a wide range of daily living needs.

All aspects of medicine management were managed safely and in accordance with current regulations and guidance. Staff were knowledgeable about people’s medicines and where to access support if they required additional guidance. Medicines were been stored, administered, audited and reviewed appropriately.

There were sufficient numbers of staff with the skills, knowledge and experience to support people. When staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Checks were also undertaken to ensure staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place.

The registered manager was on annual leave on the day of inspection. However, we spoke with two shift leaders and two members of the support staff. Following the inspection we spoke with the secretary who provided all the information we requested. Staff told us that they felt well trained and supported. Staff demonstrated a good understanding of safeguarding processes.

We looked at record keeping and found that, whilst there were some areas that needed to be updated or completed, these had been identified and work was well underway to achieve this.