The Trio House is located in Hereford, Herefordshire. The service provides accommodation and personal care for three adults who are living with learning disabilities, autistic spectrum disorders and complex health needs. People receive accommodation and 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.

This inspection took place on 20 July 2018 and was unannounced.

There was not a requirement to have a registered manager at this home. The home was managed by the registered provider. Registered providers and registered managers 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.

At our previous inspection in December 2017, we rated this service as 'Inadequate,' and it was therefore placed in ‘special measures.’ We had identified breaches of regulation in relation to safeguarding people from abuse or improper treatment; the need for consent; receiving and acting on complaints; good governance; staffing; failure to display the ratings; and failure to notify the CQC of incidents involving alleged harm or abuse.

At this inspection, we found the provider had taken action to meet the requirements of Regulations. However, further improvements were still required. We identified a further breach of Regulation 18, which related to the failure of the provider to notify CQC of three Deprivation of Liberty Safeguards application outcomes as required by law.

Services that are in ‘special measures’ are kept under review and inspected within six months. We expect services to make significant improvements within this time frame. During this inspection the provider demonstrated to us that improvements had been made and the service is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is no longer in ‘special measures.’

At this inspection, People and relatives had been provided with contradictory information about the provider’s complaints procedure. Care plans did not always reflect people's end of life needs and preferences. Staff confirmed that they received regular training to give them the skills to meet people’s needs, the process for their formal supervision remained inconsistent.

There were sufficient numbers of suitably qualified, competent and experienced staff deployed to meet people's needs, who supported people in a way that was respectful and compassionate.

The risks associated with people’s individual care and support needs had been assessed, recorded and reviewed. Both the provider and staff understood their individual responsibility to protect people from abuse. Pre-employment checks were completed to ensure prospective staff were suitable to work with people.

People’s relatives and community professionals were able to express their views on the service and to participate in care planning and reviews. People had support to participate in social and recreational activities. The provider had introduced procedures to ensure complaints were recorded, investigated and responded to.

The provider promoted an open culture within the home, and consulted with people, their relatives and staff about the service. Staff felt well supported, valued and were clear what was expected of them at work. The provider had quality assurance systems and procedures in place to enable them to monitor and improve the quality and safety of people’s care and support.

You can see what action we have told the provider to take at the back of the full report.

The Trio House is located in Hereford, Herefordshire, The service provides accommodation and personal care for three adults who are living with learning disabilities, autistic spectrum disorders and complex health needs. On the day of our inspection, there were three people living at the home.

The inspection took place on 13 December 2017 and was unannounced.

There was not a requirement to have a registered manager at this home. The home was managed by the registered provider. Registered providers and registered managers 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.

At our previous inspection in December 2015, we rated this service as 'Good.' At this inspection, breaches of Regulation were identified. These were in relation to safeguarding people from abuse or improper treatment; the need for consent; receiving and acting on complaints; good governance; staffing; failure to display the ratings; and failure to notify the CQC of incidents involving alleged harm or abuse.

Allegations of abuse or harm had not been investigated effectively or appropriately. Allegations of abuse or harm had not been shared by the provider with the local authority, the police, or with the Care Quality Commission. This had placed people at risk of continued abuse or harm. he provider and staff did not understand their roles and responsibilities in protecting people from abuse or harm.

There were no contingency plans in place to cover staff absences. There were no structured induction programmes for staff. Inexperienced and untrained staff were placed on duty to care for people, despite not having the knowledge needed to safely meet their needs.

Whilst staff had received training in some key areas of their practice, they had not been trained in all relevant aspects, such as moving and handling. Staff did not receive ongoing supervision in their roles.

People had been unlawfully deprived of their liberty, The provider was unaware of their responsibilities in regard to the Mental Capacity Act.

People's confidential information was not always kept secure.

There was no system in place for capturing, investigating or responding to complaints. The provider had mechanisms in place to continually monitor and review the quality of care provided. Where the provider had policies and procedures in place, these had not been followed.

People received their medicines safely. People were protected from the risk of infection.

Staff and the provider knew individuals well and understood their styles and methods of communication. People's changing healthcare needs were responded to.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.

Services in special measures will be kept under review; if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.

Our inspection team was made up of one inspector. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

The people living at The Trio House were unable to express their views about the quality of the service.

Is the service safe?

The people who used the service were being supported and enabled to make informed choices about their care and treatment.

We saw that comprehensive assessments were carried out on admission to The Trio House. This enabled staff to provide care according to the individual needs of each person.

Staff told us some people who lived at the home often went out shopping or travelled into town accompanied by staff. We saw that staff were very supportive. They took time to explain things in a way that promoted people's dignity was maximised.

Staff we spoke with were happy to work for the service and told us that they "Would recommend to others to work here", "I'm happy here" and that "We are a good team".

We saw evidence that the provider operated an effective and robust recruitment process.This helped to ensure that only suitably qualified and skilled were employed at the service.

This meant that people were supported by staff members who were suitable for their required roles. From the staff records we looked at we were able to see that the staff currently working for the home had been appointed correctly.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from what we saw and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well.

Staff had received training to meet the needs of the people living at the home.

We found people were protected from the risks of inadequate nutrition and dehydration. The provider provided people with nutritious food and drinks. We saw that people were provided with the appropriate support and encouragement they needed to eat and drink.

Is the service caring?

People were supported by kind and attentive staff. Care workers showed patience and gave encouragement when supporting people. We observed that people were able to do things at their own pace and were not rushed.

Is the service responsive?

People’s needs were assessed regularly. As people's needs changed, staff were able to review plans of care to meet individual needs appropriately.

Records confirmed people’s preferences, interests, goals and needs had been recorded. Care and support had been provided in accordance with people’s wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of their roles. Quality assurance processes were in place. The provider had an effective system to assess and monitor the quality of service that people received.

The people who lived in this home were unable to communicate verbally.

As we watched we saw the staff were very attentive towards them. We saw that the staff always asked them how they would like things to be done, were always mindful of their privacy and treated them with respect. We saw that staff talked with them as they provided their support.

Staff told us that they felt able to raise any issues with the manager or senior staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

We saw staff were always available when people needed help.

The provider had developed a system whereby they can monitor how well the home is meeting the needs of the people who live there.

We visited this home on 13 September 2012.

We did not use our Short Observational Framework for Inspection (SOFI) tool as the nature and mood of the people using this service made it inappropriate. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

We found that the people who lived in this home had difficulty in communicating. We could not be sure that they understood what we were asking them.

As we were unable to talk with many of the people who lived in this home we gathered evidence in different ways. We looked at records, talked with staff and observed the way that the care was provided.

This inspection took place on 17 December 2015 and was unannounced.

The Trio House is registered to provide accommodation with personal care for up to three people with learning disabilities.

There was a registered manager 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 and associated regulations about how the service is run.

People were kept safe from harm by staff who knew how to recognise and report any concerns about people’s safety. There were enough staff on duty to respond to people’s health needs at the times when they needed support. The provider completed checks to ensure staff were suitable and safe to work at the home.

People were supported to take their medicines when needed. Medicines were administered and stored appropriately.

People were supported to make decisions and choices about their care and support. People’s permission was sought before any care or support was given. Where people did not have the capacity to make specific decisions themselves these were made in their best interests by people who knew them well.

People were able to eat what they wanted when they wanted and had choice of fresh nutritious food.

People were supported to access health and social care services to maintain and promote their health and well-being and were treated with kindness, compassion and respect. Staff supported what people could do and promoted dignity and respect with the support they gave.

People received care and support to meet their diverse needs including people who had complex health needs. Staff supported people to pursue their interests.

Staff were well supported and had access to regular training and supervision. Staff felt that they were able to contact the registered manager at any time if they needed support or guidance.

There were a range of audits and checks to make sure that good standards of care and support were maintained. Where any actions were identified these were actioned quickly.