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Reports


Inspection carried out on 20 February 2019

During a routine inspection

About the service:

Trianon is a care home that provides personal care for up to six people with learning and physical disabilities. The service is provided in two semi-detached bungalows which have been adapted into one. All bedrooms are for single occupancy. At the time of the inspection, five people were living at the home.

What life is like for people using this service:

We were introduced to people throughout our visit and made to feel welcome. Although people were not fully able to tell us about their experiences, we had brief conversations and everyone looked comfortable and relaxed in the presence of staff.

People were cared for by a consistent and motivated staff team who had received sufficient training to carry out their roles. Staff demonstrated an excellent understanding of safeguarding and whistle-blowing and knew how to report concerns. Medicines were well managed and people received their medicines as prescribed. Robust checks were in place to identify and take actions when shortfalls were identified.

People were helped to exercise support and control over their lives. Staff supported and encouraged people to be as independent as they could be. The service has been developed and designed in line with values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

People were supported to access health care services and regular visits were undertaken by the GP. People’s dietary needs were comprehensively assessed and people received support to eat and drink.

People received care that was kind, compassionate, respectful and responsive to individual needs. Care plans were detailed and reviewed each month. People and relatives were asked for feedback and knew how to complain. No-one was receiving end of life care at the time of our inspection visit.

The registered manager had a clear vision which they expressed with great enthusiasm about the quality of care and service they aimed to provide.

The service worked in partnership with other organisations to make continuous improvements and develop best practice.

Everyone we spoke with told us how much the service had improved since the registered manager had been in post. Comments included, “She’s just marvellous” and, “We started to see significant improvement in short timescales under her management.”.

The service met the characteristics of Good in all of the key questions we inspected. Therefore, our overall rating for the service after this inspection was Good.

More information is in detailed findings below.

Rating at last inspection:

Requires Improvement (report published in February 2017).

Why we inspected:

Services rated "requires improvement" are re-inspected within one year of our prior inspection.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

Inspection carried out on 15 December 2017

During a routine inspection

Trianon 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. Trianon is registered to provide accommodation and personal care for up to six people with learning and physical disabilities. The service is provided in two semi-detached bungalows which have been adapted into one. All bedrooms are for single occupancy. At the time of our inspection there were six people living at Trianon. The provider, Networking Care Partnerships (South West) Limited, is part of Eden Futures. Eden Futures is one of the largest independent supported living businesses in the UK.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This inspection was carried out on 15 and 19 December 2017. The first day of the inspection was unannounced.

At our last inspection on 27 July 2016 and 2 August 2016 the overall rating of the service was requires improvement. We found two breaches of regulation relating to the management of medicines and poor record keeping. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

We found improvements had been made in relation to the storage of medicines and record keeping. However, we identified other areas which required improvements. There was a continuing breach found in relation to safe care and treatment and the governance of the service.

This is the third consecutive time the service has been rated Requires Improvement. We plan to meet with the provider to discuss how the will improve the service.

The service has not had a registered manager since 2016. A new manager was appointed in September 2017 and intended to submit an application to register with the Care Quality Commission (CQC) by the end of January 2018. 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.

Medicines were not always safely managed and we identified the need for improvements. For example the ordering of prescribed supplements; the storage of medicines which required additional security and some aspects of records.

The provider had not followed their robust recruitment process to ensure people were protected from unsuitable staff. There were not always enough staff available to support people although the provider was recruiting for new staff and agency staff were used to cover shortfalls.

People were not provided with regular opportunities to participate in activities outside of the service. We have recommended people have access to meaningful and stimulating activities both inside and outside of the service in order to provide better opportunities for social inclusion.

Parts of the environment would benefit from refurbishment, for example the sensory room. This had been identified in the provider’s ‘service improvement plan’.

The monitoring systems in place had identified some issues and action had been taken to address some shortfalls. However the governance systems had not identified issues found at this inspection.

Risks had been assessed in order to reduce the likelihood of injury or harm to people. Staff had a good awareness of their role in keeping people safe and were able to described how they kept people safe, including who to report any concerns about potent

Inspection carried out on 27 July 2016

During a routine inspection

We undertook an unannounced inspection on 27 July 2016. We returned on 2 August 2016 as arranged with the manager to complete the inspection. This comprehensive inspection was brought forward because of concerns raised with the local authority by a healthcare professional. The concerns related to staff knowledge of people’s complex needs; people spending long periods of time in bed; poor record keeping; missed medical appointments and the sensory room being inaccessible. Our inspection substantiated the concerns around poor record keeping.

At our last inspection in October 2015 we found the service was not meeting one of the regulations of the Health and Social Care Act (2008) we inspected. The service was in breach of regulation 11 – Consent to care and the overall rating for the service was ‘requires improvement.’ This inspection found the service had made the improvements identified in their action plan.

Trianon is registered to provide accommodation and personal care for up to six people with learning and physical disabilities. The service is provided in two semi-detached bungalows which have been adapted into one. All bedrooms are for single occupancy. At the time of our inspection there were six people living at Trianon.

There was no registered manager at the service. 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 2008 and associated Regulations about how the service is run. The current manager had started the process of registering with the CQC. In addition, we asked the provider representative to contact the previous manager to submit their application to de-register with the CQC.

Medicines management was not always robust. Medicine cupboards did not conform to the Medicines Act 1968; medicines to be returned to the pharmacy were not kept securely and one person was not receiving nutritional supplements as prescribed.

Record keeping was not robust enough to ensure people’s safety because staff were recording key information in different places. This posed a risk that key information would not be clear enough for appropriate follow-ups to take place with other professionals. Efforts were being made to address record keeping, but these measures were in their infancy and needed to be embedded in practice to show sustainability.

People were safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate. For example, staff demonstrated how they were observant to people’s changing moods and responded appropriately.

There were effective staff recruitment and selection processes in place. Staffing arrangements met people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately.

Staff spoke positively about communication and how the manager and deputy manager worked well with them and encouraged an open culture.

A number of methods were used to assess the quality and safety of the service people received and make continuous improv

Inspection carried out on 28 October and 10 November 2015

During a routine inspection

The inspection took place on 28 October and 10 November 2015 and was unannounced. The service was previously inspected on 9 December 2013 when it was found to be compliant.

Trianon provides accommodation with personal care for up to six people over the age of 18 who have a diagnosis of learning disabilities and physical disabilities. The home is made up of two semi-detached bungalows which have been combined into one. All bedrooms are en-suite and for single occupancy. The home is staffed 24 hours a day.

At the time of the inspection, six people had lived at the home for a number of years. People had very complex needs and communication difficulties associated with their learning and physical disabilities. Because of this, we were only able to have very limited conversations with one person about their experiences. We therefore used our observations of care and our discussions with staff to help inform our judgements.

The home had a manager who had been registered with the Care Quality Commission since September 2015. The registered manager was also the registered manager of another nearby home in Exmouth owned by Networking Care Partnerships (Southwest) Limited. He said he divided his time equally between the two homes. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers and nominated individuals, 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. The registered manager had a clear vision for the home and the people who lived there. He described how he and the staff were committed to ensuring people had a positive experience living at Trianon.

People’s needs and risks were assessed and care plans were developed to support them to be as independent as possible. There were some gaps in some risk assessments, however the staff knew people very well and were able to describe the care they required fully. Daily notes reflected the care described in the care plan.

The service provided to people living at Trianon was delivered by a team of staff, who had been trained to support people with learning disabilities and who had in-depth knowledge of people’s needs and aspirations. Staff were supported to undertake training to help them in their role and received regular supervision.

Staff were recruited safely with checks carried out before a new member of staff started working at the home. Staff undertook an induction, including training and shadowing experienced staff until they were assessed as able and confident enough to work with people on their own.

People appeared relaxed and happy with staff who were kind and friendly. People were offered a choice of activities both in the home and in the community and chose what they wanted to do each day. These activities included hydrotherapy sessions, visits to friends, pampering and massage sessions. Staff were able to describe how people communicated with them and recognised simple movements and facial expressions when people wanted or did not want something.

Staff were aware of the importance of people’s rights to remain as independent as possible and supported them to with as few restrictions as possible. Staff had received training on the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards (DoLS). However, there was no evidence that they had followed the guidance. On the first day of our inspection we found there were no applications for DoLS authorisations for any of the people living at the home. By the second day of inspection, the registered manager had contacted the DoLS team and, on their advice, had submitted applications for all the people living at Trianon.

Medicines were stored in people’s bedrooms in secure cabinets. All medicines were administered and recorded safely by staff who had received training in medicine administration. Audits of medicines were undertaken internally and a new medicines audit was being introduced.

People were supported to have their health needs met by health and social care professionals, including their GP and dentist. However there was evidence in care records of missed appointments for some people. The registered manager said that as part of the review of people’s care records, they would be undertaking a review of health professional involvement and following up any appointments which had been missed. People were supported to have a healthy balanced diet.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 December 2013

During a routine inspection

This was the first visit by the Care Quality Commission (CQC) since the new providers Networking Care Partnerships (SW) Limited took over the service in October 2012. The registered manager for the home has recently moved to another home within the group. We spoke with the acting manager during our inspection.

At the time of inspection five people lived at the home. We were told that none of the people could communicate verbally. When we observed the interaction between care workers and the people who lived at the home, we saw that staff knew people�s methods of communication and understood them. Care workers told us they always ensured curtains and doors were closed when people received personal care in their bedrooms as all bedrooms were on the ground floor.

We saw that information about people's care needs was contained within their care plans. For example we saw information about people�s daily routines and how they were to be supported though the day.

Care workers were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring. We saw that people were protected from the risk of financial abuse because the home followed clear procedures.

The provider had evidence of a robust recruitment system. This meant people were protected from the risks of unsuitable staff being employed at the home.

We saw evidence of an effective quality assurance system.