Trafalgar Street

Trafalgar Street, also known as Priory Lodge, is a care home providing personal care to 3 people at the time of the inspection. The service can support up to 4 people.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

Improvement needed to be made to the environment people lived in to ensure it was clean and well maintained. We have made a recommendation to the provider about this. Staff were aware of people's strengths and what they could do and supported people to make their own choices about their care and support needs. People were being supported by staff to be actively involved and engaged in cooking and completing their own household tasks. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice .Staff learned from incidents and how they might be avoided or reduced. Staff followed safe practices when wearing personal protective equipment (PPE).

Right Care

People and their families told us staff were kind and supported them well. Staff understood how to protect people from poor care and abuse, they had received training on how to recognise and report abuse and were able to tell us when they would report any concerns. We observed staff interacting with people in a kind and compassionate way and in a way that promoted people's independence. People received support from staff who knew them well, understood their needs and considered their preferences.

Right culture

Quality assurance processes had not identified all the concerns in the service. The service had a registered manager who was also registered manager at another 2 care homes. People and staff were very positive about the registered manager. However, we identified shortfalls in systems used by the provider and registered manager to check the quality and safety of the service. These needed strengthening and embedding into practice. Managers understood further work was needed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 02 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 26 March 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

When aggregating ratings with those from a previous inspection add the following wording. Note, ratings cannot be aggregated with ‘inherited ratings’ awarded to a predecessor location.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Trafalgar Street on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Following the inspection, the provider responded by taking actions to improve. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safety and management. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Trafalgar Street is a care home providing personal care and accommodation for four adults with learning disabilities and Autistic Spectrum Disorders. At the time of our inspection there were three people using the service. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

There were systems and processes in place to monitor the safety of the service. These needed strengthening to ensure they were checking best practice was being followed and risks were being suitably addressed. The provider had failed to give the registered manager any supervision and appraisal.

People were safe from the risk of abuse as staff had good knowledge and understanding of safeguarding. People received their medicines as prescribed. Accidents and incidents were reported including actions taken. The environment was clean and odour free.

People were supported by enough staff who had employment checks undertaken prior to starting with the service. Staff received regular supervisions and appraisals and felt very supported by the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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.

Relatives, health care professionals and staff all felt the registered manager was approachable and it was a lovely home. Positive relationships had been developed between the community and the service.

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 5 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

At the last inspection in August 2015, the service was rated ‘Good’. This inspection took place on 1 August 2017 and was unannounced. This meant the registered provider did not know we were going to carry out this inspection. At this inspection we found the service remained ‘Good’.

The home had a registered manager. 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 who lived at the home felt the service was safe. People were protected from abuse and the risks of abuse by staff who had good knowledge of safeguarding. Staff knew how to spot signs of potential abuse and how to report any concerns they may have had. Risk assessments were comprehensive and regularly reviewed to ensure they remained relevant. There were adequate and effective safeguarding procedures in place.

There were enough staff to meet people’s needs. Where additional staff were required due to people’s changing needs, the registered manager ensured staffing levels were increased to meet this.

People were administered their medicines safely and in a way they liked. Medicines were stored, recorded and administered correctly and staff carried out daily checks to ensure any discrepancies were identified quickly and action was taken to address any issues.

Staff were supported well by senior members of staff and the registered manager. They received regular supervisions and annual appraisals. Staff received regular training updates when required.

The home worked in line with the Mental Capacity code of practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People had maximum choice and control over their lives and staff supported them in the least restrictive way possible. Best interest meetings were held where people did not have capacity to make decisions for themselves and policies and systems in place supported this.

People had their privacy and dignity maintained and staff respected the need for private time and space. End of life documentation was clear and comprehensive, containing relevant information that had been sought from people who lived at the home and their loved ones.

The home responded to people’s changing needs and referrals were made to healthcare professionals in a timely manner. People attended regular appointments with professionals including dentists and chiropodists, where needed.

Activities that took place were well received and people enjoyed taking part. People who lived at the home were encouraged and supported to access the wider community and maintain their health with trips to the gym and swimming baths. Staff and people who used the service were regularly asked for their thoughts and opinions of the home and any improvements that could be made.

Quality monitoring systems were in place and audits carried out frequently. When actions were identified, they were addressed and signed off when complete.

Further information is in the detailed findings below.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People were protected from the risks of inadequate nutrition and dehydration. People told us they chose what they wanted to eat.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found that there were appropriate recruitment and selection practices in the home to ensure there were enough qualified, skilled and experienced staff to meet people's needs.

There was an effective complaints system available and people were clear how to make a complaint.