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Inspection carried out on 8 November 2017

During a routine inspection

The inspection took place on 8 November 2017 and was unannounced.

Trent House is a home that provides accommodation and personal care for up to five people with a learning disability. 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 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.

At this inspection, we did identify areas in which the provider was not meeting their legal requirements.

Quality assurance audits were carried out and actions identified completed. Staff understood the requirements of the Mental Capacity Act 2005. Where restrictions were in place for people the proper procedures were followed. People were consulted at all stages in relation to their care. We saw evidence that people made their own decisions about what they wished to do.

People were shown respect by staff and encouraged to be independent. Staff were seen to be caring and kind to people. People were happy living in the house and we found the environment was clean, hygienic and homely. The environment was suitable for the people living there.

People’s medicines were managed safely. Important information about people’s healthcare needs and medicines were recorded in their care plans. Staff worked alongside healthcare professionals to meet people’s health needs. Where any accidents or incidents occurred staff took appropriate action in response to them.

People were cared for by sufficient numbers of staff. We did not see people having to wait to receive care or support. Appropriate checks were carried out when recruiting staff to ensure that they were suitable for their roles. Staff were aware of their responsibilities in relation to keeping people safe. Both in respect of keeping people safe from harm because individual risks had been identified and also in respect of signs of abuse. People were comfortable with speaking with staff if they had any concerns.

There was a procedure in place to help ensure that people were kept safe in the event of an emergency. People lived in a safe environment. Regular checks were made on equipment and services within the house to check they were well maintained.

People were provided with food that matched their preferences. People had access to activities that suited their needs and to help ensure they did not feel isolated. People’s individuality and what mattered to them was recognised by staff. Activities were meaningful to people and they had the opportunity to attend events outside of the house and local community.

The registered manager created a positive culture and staff felt supported by here. Staff received training appropriate to their roles and the provider’s values. Staff benefited from regular supervision and appraisals.

Inspection carried out on 26 October 2015

During a routine inspection

Trent House is a care home which provides care and support for up to five people who have a learning disability, such as autism. At the time of our visit 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 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 and associated Regulations about how the service is run. The registered manager was not present during our inspection and we were assisted by the shift leader and other staff.

Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way. Where there were restrictions in place staff had followed legal requirements to make sure this was done in the person’s best interests. We found that mental capacity assessments had been carried out for people for specific decisions.

We saw staff had really good relationships with people. It was evident staff knew people well and were knowledgeable in relation to their individual likes and dislikes. When people wished time on their own staff respected this.

People were safe living at Trent House as staff carried out appropriate checks to make sure that any risks of harm were identified and managed. For example, there was a swimming pool in the back garden and people had risk assessments around that.

Staff knew how to safeguard people from abuse. They were able to tell us what they would do in such an event. We saw information for people around safeguarding displayed in a way they could access. In the event of an emergency and people needed to be evacuated from the home staff had guidance to follow. People would be moved to another of the provider’s homes should the house need to be evacuated.

Staff were provided with training specific to the needs of people. This meant they could work in a confident and independent way. We saw this happen throughout our inspection.

There were enough staff deployed in the home. Where people required one to one care, we saw this happen. We did not see anyone having to wait to be assisted by staff and there was always enough staff on hand to support people when they needed it.

People received their medicines in a safe way and staff had supported someone to be able to self-medicate. People were involved in choosing and cooking the food they ate. We saw people had participated in shopping for the food for the week. People were independent wherever possible and this was encouraged by staff.

Appropriate checks were carried out to help ensure only suitable staff worked in the home. Staff were involved in running the home as they had the opportunity to meet together to discuss all aspects of the home. Staff also met regularly with their line manager to discuss their individual work.

Professional involvement was sought by staff when appropriate in order to maintain good health for people. We saw people were referred in a timely way if people’s needs changed or they were not well.

Activities were planned in an individualised, meaningful way for people. One person told us they had stopped a particular activity and this was respected by staff. Other’s told us they really enjoyed the activities they did because they had chosen them.

Quality assurance procedures were in place and audits were undertaken by both the staff and the provider. People had access to information on how to make a complaint should they wish to.

Inspection carried out on 7 August 2014

During an inspection to make sure that the improvements required had been made

During our inspection in June 2014, we found that some of the records held by the service in relation to individuals were inaccurate or out of date.

We carried out this follow up visit to check that the provider had taken the necessary action to ensure that care plans reflected the most recent needs of a person. We also checked that information was accurate and up to date.

We found on this visit that the registered manager had reviewed the care plans and amended and updated the records where appropriate. This meant that we found the provider compliant.

Inspection carried out on 25 June 2014

During a routine inspection

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At the time of our inspection, the service provided care and support to five people, although one person was on holiday at the time. Some were not able to tell us about their experiences of living at Trent Road because of their communication difficulties; however, we did receive feedback from three people who used the service and three relatives. We also spoke with three members of staff as part of this inspection.

We reviewed records that related to the management of the service which included support plans, policies and daily records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that risk assessments were in place to provide information to staff to help minimise the risk of any harm to people. For example, in relation to being out in the community or being in the kitchen.

The provider had ensured that staff were provided with information that related to safeguarding vulnerable adults. Staff were able to tell us what they would do if they had any concerns. One member of staff told us, “I have a small card with telephone numbers that I can use if I had any concerns.”

Is the service effective?

Our observations told us that staff had a good understanding of people's needs. The relatives we spoke with confirmed this. One relative told us they had seen a difference in their family member since they moved in to Trent House. They told us, “They have come out of themselves since they have been there. A lot more sociable and outgoing.”

Discussion with staff confirmed that staff knew and understood people’s individual care and social support needs. However, we found that some of the care plans were not accurate and had not been recently reviewed.

Is the service caring?

People were encouraged to be independent but were helped when they needed any support. Staff told us they felt there was enough staff on duty each day to support people in the way they needed. One relative told us, “They are very dedicated, affectionate and sympathetic staff.”

The activity plans for the people who used the service showed us that activities were tailored to the individual. One person who used the service told us, “I can do what I like here.” A relative told us, “My relative’s welfare is always put first.”

Is the service responsive?

We saw in a care plan, and also heard from staff, how they had responded to a change in one person’s health.

Is the service well-led?

There were meetings for the people who lived at the home as well as staff. Staff told us the manager encouraged them to make suggestions on how to improve the service. One relative told us, “There is a very good relationship between me and the staff. The owner of the company is great and has an open door policy.”

During a check to make sure that the improvements required had been made

We followed up on our inspection of 07 July 2013 to check that action had been taken to meet the following standard(s). We have not revisited Trent House as part of this review because Ashcroft Care Services Limited were able to demonstrate that the service was meeting the standards without the need for a visit.

This is what we found: The provider had confirmed that People’s rights were now upheld as people's capacity to make decisions had been assessed under the Mental Capacity Act, and that a review of possible restrictions of liberty had been reassessed and new measures had been implemented.

People were now protected against the risks of unsafe or inappropriate care and treatment arising from the lack of proper information about them. The provider told us that everyone had now a mental capacity assessment and could be located when needed, and people’s confidential records were now all kept securely and confidentially. 20.—(1) (a)(2)(1)(a).

Inspection carried out on 9 July 2013

During a routine inspection

We saw that the home had areas of good practice and that outcomes assessed compliant in previous reports remain the same. However there were areas for improvement needed that we identified.

People who use the service told us they liked the home, their rooms and the food was good.

Two people told us they would tell a staff member if something worried them and would ask staff if they wanted a drink.

One person talked about the activities they liked doing and showed us their room and how they had individualised it to their taste.

When telephoning the home for additional information we were pleased to hear a person who uses the service casually answer the phone instead of staff.

We saw that people’s rights were not always upheld. People's capacity to make decisions had not been assessed under the Mental Capacity Act and yet they were being subjected to two restrictions of liberty, which had only been assessed as needed for one person.

We noted that staff received appropriate professional development and support.

We saw comments and complaints that people made were responded to appropriately and that people had their comments or complaints listened to and acted on.

We found that although work was occurring to improve records, people’s records were not all fit for purpose, some could not be promptly located when needed, specifically mental capacity assessments and risk assessments, and some records were all not kept securely and confidentially.

Inspection carried out on 30 November 2012

During a routine inspection

People who use the service are supported to make choices about their lives and are treated as individuals.

People told us that they were involved in choosing meals, and could choose where to be and what to do.

People spoke about community activities they were involved in, such as going to the gym, meals out, pubs, discos and meeting friends.

One person showed us their room and how they had individualised it, and showed us pictures of their recent holidays.

People also told us the staff were nice and they felt happy living at their home, and would go to the manager if anyone upset them.