Trinity House is a residential care home for 6 people with learning disabilities. It is set over three floors and located in on the high street of Manningtree, with good access to local services and amenities. It is near Acorn Village, where the head office is based along with a much larger service owned by the same provider. People and staff at Trinity House benefit from the resources and facilities available at Acorn Village. At the time of our inspection there were five people living at the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Trinity House had a well-established staff team and management support structure. There was effective communication between the registered manager and staff. Staff were well supported and motivated. Regular checks were carried out on the quality of the service which improved the service people received.

There were enough safely recruited staff to meet people’s needs. Where people’s needs changed the registered manager reviewed the staffing and the skills of the staff team and made the necessary adjustments to maintain a good quality of support.

Staff knew what steps to take if they were concerned about a person. Senior staff carried out detailed assessment of peoples’ needs and risks to their safety and effective plans put in place to keep them safe and promote their wellbeing. People chose what they ate and drank, and received support to remain healthy. Staff worked well with outside professionals to meet people’s health and social care needs.

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. The provider had a dedicated maintenance team and staff helped people reduce the risk of infection. The age and the layout of the building provided some challenges which the registered manager addressed effectively on an ongoing basis.

Staff knew people well and treated them with kindness. There was a relaxed friendly environment at Trinity House, which felt like a home rather than an institution. People were encouraged to remain independent, taking part in household tasks. Support was person centred and flexible, ensuring people had fulfilling lives. Care plans were cumbersome, but provided staff with the necessary guidance to meet people’s needs.

The provider promoted an open culture where people, families and staff felt able to speak out. Complaints and concerns were investigated in detail and used to improve the service.

Further information is in the detailed findings below

Trinity House provides accommodation and personal care for up to six people with learning disabilities.

There were five people living in the service when we inspected on 30 October 2015. This was an announced inspection, we telephoned the service prior to arriving to check that there was someone home.

There were two registered managers 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.

There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

There were enough staff to meet people’s needs. Staff were trained and supported to meet the needs of the people who used the service. Staff were available when people needed assistance. Checks were made on staff before they started to work in the service to ensure that they were suitable to support the people using the service.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS).

There were procedures in place which guided staff in safeguarding the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People’s nutritional needs were being assessed and met.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service’s quality assurance system identified shortfalls and these were addressed. As a result the quality of the service continued to improve.

Our inspection team was made up of one inspector. During our inspection visit we spoke with one of the people who used the service, two relatives, the manager, and two staff. We also looked at records, including assessments, care plans, training records, audits and staff records. Where it was not possible to communicate with some people we used our observations to gather information. Below is a summary of what we found. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the home. Any training needed for staff to support people safely was identified and provided prior to the person moving to the service and if their needs changed. This ensured that the staff had the relevant skills and knowledge required to meet the individual’s identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

Where people were able they told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew the people well. A relative we spoke with said “The staff are very knowledgeable about how to support my relative; they encourage him to be as independent as possible.”

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified in care plans where required. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. One person who used the service said, “I choose what I want to eat, when to get up and go to bed.”

The training that staff had received equipped them to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. One person said, “Staff help me to look after myself.” People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. A relative we spoke with told us, “We are very happy with the care that my relative receives from the staff. They always ensure that he is involved in making decisions about his life and the way he wants to live it.”

Is the service responsive?

There was information on how to make a complaint if people were unhappy. This was in a variety of formats that met people’s individual communication needs. Monthly meetings took place for people who used the service where people had an opportunity to provide feedback on the service. Where shortfalls or concerns were raised these were addressed.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result, the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities and that they received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the service.

During our inspection of Trinity House we observed how people were supported by staff. As a result of people’s complex needs some people were unable to communicate verbally but were observed to be calm and interacted in a positive way with staff and other people. It was evident that staff had a good understanding of people’s care needs and preferences.

We saw that there were appropriate support plans and risk assessments in place which detailed people’s support needs and how these were to be met. We saw that people were supported to address their health care needs and referrals were made to other health care professionals where required.

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service. We saw that staff were trained to meet people’s needs. Staff told us they were supported by the manager so that they could carry out their caring responsibilities effectively.

The manager told us: “I like to keep everyone happy, that way staff will want to stay here. I don’t want anyone being unhappy at work as it will affect the people who live here and that’s not fair, it’s not good.”

We used a number of different methods to help us understand the experiences of

people who used the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. Where people were unable to provide a verbal response or tell us about their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Trinity House to be positive.

We observed that staff members were polite and attentive towards people who used the service, in particular those people with no or limited verbal communication. We saw that staff made good eye contact with people that were unable to communicate and used touch, such as holding people's hands or stroking their upper arm to reassure them when they reached out to staff.

During our visit on 20 September 2012 to Trinity House and our previous visits people told us that they felt respected and involved.

People told us they were satisfied with the level of care and support they received at Trinity House and that they felt well looked after by the staff. We were told that the staff were caring and helpful to them. One person told us "It's good here”.

People told us they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.

People told us that they would feel confident in raising any issues that they were not happy about. They told us that the manager and staff always encourage them to raise any concerns. One person with whom we spoke told us that "I can talk to my keyworker if I ever need to".

People told us that the staff were very good and seemed well trained and that there were staff available to them whenever they needed them. People told us that staff were kind and caring. One person with whom we spoke said that "Nothing was ever too much trouble".

We spoke with a number of other people who told us that the staff were caring and helpful to them. People have suitable equipment available to them to assist with their care needs.

People told us when we visited that they liked the service and that it provided a nice environment for them. People told us that they liked their rooms and found them comfortable.

One person with whom we spoke told us that "I like my flat and I choose the colour and pictures". One person with whom we spoke told us that they self-medicated. The person was knowledgeable about their medication and felt their needs were being met.