Trianon

We found the following examples of good practice.

Safe arrangements were in place for people’s relatives and professionals visiting the service. This included reviewing evidence of a confirmed negative lateral flow device test (LFD), a recent negative polymerase chain reaction (PCR) test result, vaccination against COVID-19 and the requirements to show a COVID-19 pass. Visitors were encouraged to wear personal protective equipment (PPE) in line with government guidance and ensure hand sanitisation.

The provider had identified a designated sheltered area away from the main building for visitors to undertake lateral flow tests and await results.

Policies and procedures relating to COVID-19 were up to date which enabled staff to keep people safe.

The provider had a policy in place that ensured their readiness in case of an outbreak. This included how zoning principles would be used to ensure people’s safety as well as safe management of risks of cross infection.

Risks to people’s wellbeing such as, where people found it difficult to communicate effectively with staff wearing face masks had been assessed. Staff used Makaton (Makaton is a language programme that uses signs together with speech and symbols, to enable people to communicate) and pictorial signage to ensure people had the information in a format that was accessible for them. People had access to technology to enable them to communicate with family.

Staff training was up to date and monitored by the registered manager.

The service was clean and fresh, staff carried out regular touch point cleaning. Regular infection control audits took place and actions had been followed up when required

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.

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 potential abuse. Professionals said in their experience the service was safe. One said, “Staff look after people very well; they know people very well and know when something is amiss…”

Staff demonstrated an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s ability to consent to care and treatment had been assessed and best interest decisions had been made where appropriate.

People were supported to maintain their health and well-being. The service had developed good relationships with health and social care professionals and sought their advice appropriately to ensure people’s needs were met. People had choices of a varied and balanced diet at mealtimes and they had adequate fluids to ensure they were hydrated.

Staff spoke positively about the training available and they demonstrated they had the skills and knowledge to support the people in their care. Staff felt supported and appreciated by the manager, although they felt undervalued by the provider.

Visiting professionals described a caring ethos within the staff team. Comments included, “The feeling you get here is that it is very homely…staff are very caring and interested in people. I would be happy to have a loved one here…” We saw consistently kind and friendly interactions between staff and people being supported.

People’s care plans detailed their needs and how they preferred to be supported. People received the care they needed, in the way they preferred and staff were responsive to their needs. There was a core group of stable staff, many had worked at the service for a number of years and had built up a good rapport with each person and demonstrated a good understanding of individual needs and preferences.

Staff were committed and motivated to provide the best possible care for people at the end of life. The service had fully engaged with other health professionals to ensure people received the appropriate care.

Staff were able to communicate with, and understand each person’s requests and changing moods as they were aware of people’s known communication preferences.

At this inspection we identified three breaches of regulations. You can see what action we have asked the provider to take at the back of the full version of the report.

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 improvements.

We found two breaches 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 this report.

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.