The inspection took place on the 19 February 2018.

Trafalgar House 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. Care and support is provided for up to eight people with a learning disability. At the time of our inspection, there were seven people living at the service. The service provides care and support to people living with a range of learning disabilities and mental health diagnosis and a variety of longer term healthcare needs such as epilepsy and diabetes. The service is a large house within a residential area in Bexhill-on-Sea. The accommodation comprises two large lounges and a dining room with access to a rear garden. People have their own spacious bedroom.

At the last comprehensive inspection on 13 and 14 January 2016 the service was rated overall Good. At this inspection we found the service remained overall Good. At the last inspection, we found a breach in the regulations and the safe domain which was rated as Requires Improvement. The provider provided an action plan as to how the issue raised would be addressed. We undertook a focused inspection on 14 March 2017 to review the improvements made, and found the issue highlighted had been addressed.

Systems had been maintained to keep people safe. People and relatives told us how they felt safe with the care provided. They knew who they could talk with if they had any worries. A relative told us, “They make sure he is safe in every aspect.” They felt they could raise concerns and they would be listened to. People remained protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had continued to be developed. Staff told us they had been supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. One member of staff told us, “It’s a lovely company. I love it here.”

People's individual care and support needs continued to be identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. Comprehensive and detailed care plans provided staff with information about how people wished to be cared for in a person-centred way. People met with their keyworkers monthly to discuss the care to be provided. People told us how they felt listened to, supported to be independent and they were involved in decisions about their care. Staff had a good understanding of consent.

People and their relatives told us they were happy with the care provided. A relative told us, “It’s been brilliant. (Person’s name) has improved in the time he has been here.” People continued to be supported by kind and caring staff who knew them well and treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner. Staff told us it was a good team. One member of staff told us, “It’s a good team. We all get on. We all know what we are doing.”

The provider continued to have arrangements in place for the safe administration of medicines. People were supported to get their medicine safely when they needed it. People continued to be supported to maintain good health and eat a healthy diet.

Staff and visiting health and social care professionals told us the service continued to be well led. Staff told us the registered manager was always approachable and had an open door policy if they required some advice or needed to discuss something. Senior staff carried out a range of internal audits, and records confirmed this. People and their relatives were regularly consulted about the care provided.

We carried out a comprehensive inspection of Trafalgar House on 13 and 14 January 2016. A breach of legal requirement was found in relation to safety and security. After the inspection the provider wrote to us with an action plan stating what they would do to meet legal requirement in relation to the breach of regulation.

We undertook this focused inspection on 14 March 2017 to check the provider had followed their plan and to confirm they now met legal requirements. We found improvements had been made and the provider was now meeting all legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trafalgar House on our website at www.cqc.org.uk

Trafalgar House provides accommodation and support for up to eight people. Accommodation is provided from a large detached house. The building is located within a residential area in Bexhill-on-Sea. The service provides care and support to people living with a range of learning disabilities and mental health diagnosis. People had a range of needs and all required some assistance. This included, personal care, communication and going out. Several people have been living at the service for over 12 years. There were eight people living at the service on the day of our inspection.

A registered manager was in post. 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 and associated Regulations about how the service is run.

The provider had taken steps to ensure people’s safety in relation to previous concerns regarding security. The systems and checks which had been established to secure the garden were fully embedded within staff routines. People told us they felt safe living at Trafalgar House and staff were clear on their responsibilities associated with protecting people from harm both within the service and when out in the wider community.

The environment was routinely checked to ensure it was safe for people. Various in house checks were undertaken by staff in areas such as fire safety and water temperatures. Servicing and maintenance of fixed equipment such as boilers and hard wiring electrics were completed by external contractors. We have made a recommendation to the provider as to how they respond in a timely manner to requests from the registered manager in relation to where remedial works have been recommended following an external contractors visit.

People’s care needs had been assessed and risks associated with supporting people living with complex behavioural needs were managed in line with these assessments. Assessments were detailed and up-to-date and had been completed for a wide range of daily living needs.

All aspects of medicine management were managed safely and in accordance with current regulations and guidance. Staff were knowledgeable about people’s medicines and where to access support if they required additional guidance. Medicines were been stored, administered, audited and reviewed appropriately.

There were sufficient numbers of staff with the skills, knowledge and experience to support people. When staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Checks were also undertaken to ensure staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place.

We spoke with four of the seven people who used the service. We were told that they liked living in the home and one person said he was, “Going on the bus.” We found that staff communicated well with people and offered them choices and opportunities to go out.

The registered manager was on annual leave on the day of inspection. However, we spoke with two shift leaders and two members of the support staff. Following the inspection we spoke with the secretary who provided all the information we requested. Staff told us that they felt well trained and supported. Staff demonstrated a good understanding of safeguarding processes.

We looked at record keeping and found that, whilst there were some areas that needed to be updated or completed, these had been identified and work was well underway to achieve this.

We spoke with people who used the service and they told us, “I like it here, they look after us”, “we can choose what we do” and “food is great”. People also told us that they liked their rooms and the garden. Some people said they had their own televisions, laptops and music in their room.

One visitor said that they had no worries about the support given to their relative.

People were clear about who their key worker was and what their role was. Some people wanted new furniture and fittings in their bedrooms. One person said that his key worker was supporting him to become more independent.

We inspected Trafalgar House on 13 and 14 January 2016. Trafalgar House provides accommodation and support for up to eight people. Accommodation is provided from a large detached house for people with learning disabilities. The building is located within a residential area.

The age range of people living at Trafalgar House was 20 – 64. The service provides care and support to people living with a range of learning disabilities and mental health diagnosis such bipolar and a variety of longer term healthcare needs such as epilepsy and diabetes. Several people have been living at the service for over 12 years. There were eight people living at the service on the day of our inspection.

We last inspected Trafalgar House on 5 August 2013 where we found it to be compliant with all areas we inspected.

A registered manager was in post. 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 and associated Regulations about how the service is run.

People told us they felt safe however we found there were areas that required improvement in this area. We found medicines were not consistently managed safely and in accordance with current regulations and guidance. For example we found examples where people’s Medicine Administration Record (MAR) had not been signed in line with the services own policy.

Some people who lived at the service were under the authorisation of a DoLS. We found an occasion when a side gate had been left open after people had gone out with staff. This meant other people could have left the service out without staff’s knowledge.

People appeared happy and relaxed with staff. There were sufficient staff to support them. When staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. A range of specialist training was provided to ensure staff were able to meet people’s needs.

It was clear staff and the registered manager had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, trips outs, seizures and choking. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People were provided with opportunities to take part in activities ‘in-house’ and to regularly access the local and wider area. People were supported to take an active role in decision making regarding their own routines and the routines and flow of their home. One family said, “The home are excellent at getting the residents out and about.”

Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working at Trafalgar House and positively about senior staff. The registered manager and operations manager undertook regular quality assurance reviews which worked to drive improvement in many areas.

We found a 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 this report.