This unannounced inspection took place on the 7 and 8 August 2018. 4 Trinity Court 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. 4 Trinity Court accommodates up to six people with learning disabilities, older people or those living with dementia in one building. There were six people living there at the time of our visit.

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.

The service 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’s safety had been considered by the service, risk assessments both for care and the environment had been completed. These minimised the risk of harm to people. Staff had received training in how to protect people from abuse and guidance for reporting concerns was available.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where required appropriate Deprivation of Liberty Safeguards (DoLS) had been submitted for authorisation. This protected people’s human rights.

Support was offered to staff through training, supervision, appraisals and daily or monthly meetings. Staff told us they felt supported and appeared to be happy with their work. We found the provider needed to increase the availability of training so staff could complete this in a timely way. We have made a recommendation about this in the report.

Trained staff administered medicines. We observed there were sufficient numbers of trained and experienced staff to enable people to receive care when they needed it.

People told us the staff were caring, we observed positive and meaningful interactions between staff and people in the home. Systems were in place to ensure the risk of employing unsuitable staff was minimised.

People’s healthcare needs were supported by the staff. We read documentation related to health appointments with external professionals to assist people with their mental and physical health needs.

Care plans documented people’s preferred method of communication. People had access to the information they needed in a way they could understand it. People’s relatives were encouraged, where appropriate, to be involved in the planning and monitoring of the care provided.

Activities were provided for people to participate in. Families and friends were encouraged and supported to maintain contact with people. This protected people from the risk of social isolation.

People were treated equally, regardless of their disability, gender, sexuality, religion, race or age in line with the requirements of the Equality Act 2010. People’s chosen lifestyles were respected and where staff could offer support to people they did.

People’s nutritional needs were reflected in care plans and we observed staff supporting people to ensure their health and wellbeing was maintained.

Care was provided to people in a way that protected their privacy and dignity. They were respected by staff and treated in a dignified manner. Staff were described as caring by people’s relatives, the registered manager and staff were held in high regard and we received positive comments about the service they provide

The people who lived at the home had complex support needs and were not always able to tell us their views using the spoken word. However, they were able to show us their experiences using different communication styles and with support from members of staff on duty. We saw the relationship and interactions between staff and people who used the service were positive and respectful.

We spoke with two care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieve personal leisure activities or social goals. We looked at four care files that demonstrated the personalised approach in place to support the staff’s comments. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training and support that enabled them to provide a high quality of care.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who used the service. We observed staff assessing people’s needs and ensuring that care was provided in line with individual care plans. We were able to see that people were comfortable and that there was adequate numbers of staff available to provide the individualised support needed.

The people using this service had learning and physical disabilities and problems in communicating verbally. We saw that staff and people using the service appeared at ease together. Staff were attentive and responsive to people’s needs. We spoke to a relative of one person using the service. The relative expressed a high level of satisfaction with it. They said all the staff were very good. The staff kept them informed of developments and they were always invited to reviews. They felt involved in their relative's care. They said their relative had really improved since moving to 4 Trinity Court. They seemed to benefit from the space in the building and now showed a keen interest in activities.

We found staff treated people using the service with respect and had a good relationship with them. We found people’s needs were assessed and their care was provided in line with their care plan. People were protected against the risk of abuse. Staff were supported in providing care and support to people. The organisation had arrangements for monitoring the quality of the service.

We spoke to family members of people using the service. All expressed a high level of satisfaction with it.

We were told that the level of care was very good. That there were good activities and lots of outings were organised.

The families we spoke to told us that staff showed a good understanding of people’s needs. They said that people were treated as individuals and that staff showed a sensitivity to changes which might have an effect on people.

One person described the service as “Excellent”. Another person told us that their relative (the person using the service) received “Lovely care”.

People said that visitors could drop in at almost any time.

People said the staff were always friendly and kept families informed of any changes.

Families were invited to reviews and were given a questionnaire beforehand to help them prepare for the review.

This inspection took place on the 19 and 20 November 2015 and was unannounced. The last inspection of this service took place in 2013. The service was found to be meeting the requirements of the regulations at that time.

The home provides residential care to six adults with a learning disability. It is a requirement of the registration of 4 Trinity Court that there is a registered manager in place. At the time of the inspection a registered manager had been in place since February 2015. 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’s needs were assessed and care plans reflected how staff would meet their needs. Risk assessments were in place to ensure the risk of injury to staff and to people was minimised.

Records were frequently updated in relation to the care provided, and information about people was shared in the handover meetings which took place each day.

The systems used for recruiting staff included making checks on candidate’s backgrounds and previous employment histories. This was to ensure they were safe to work with people.

Medicines were stored safely and securely. We saw that people’s medicines were given safely by trained staff who recorded the administration on the medicine administration sheet (MAR). However, we did find some records related to people’s needs and their medicines were not completed, and the date of opening creams and lotions was not always recorded. We have made a recommendation about how the service could improve on its administration and recording of medicines.

There were sufficient numbers of trained staff available each day to meet the needs of the people living at 4 Trinity Court. Additional staff were used to enable people to attend appointments and participate in activities.

We found records related to staff training and supervision showed staff were receiving support from the registered manager and provider to enable them to carry out their roles effectively. Where there were gaps in training records, plans were in place to provide up to date training.

Staff knew about the Mental Capacity Act 2005 (MCA). This meant where people were unable to make decisions for themselves, staff acted in a way that was agreed was in the person’s best interest. Staff were less knowledgeable about the Deprivation of Liberty Safeguards (DoLS). However, training had been provided and the registered manager knew how to apply for authorisation for DoLS. Further development for staff in this area was needed and agreed.

People’s health was maintained and where professional advice was required to assist people to remain healthy this was sought by staff. For example, speech and language therapy and GP.

People’s relatives told us and we observed staff caring for people in a sensitive and appropriate way. They demonstrated a kind and caring nature and they were knowledgeable about people’s needs and how to meet them. Care plans recorded people’s choices and preferences and these were respected by staff.

People’s relatives and staff told us the service was well managed and they had noticed improvements since the new registered manager came into post. Staff commented on how supportive and approachable the management were. Quality assurance checks had been completed and were on going, these were used to improve the quality of the service to people.