Trinity Care Services Limited

Trinity Care Services Limited is a domiciliary care agency providing personal care. The service provides support to people living in their own homes in the community. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection the service was providing personal care to 40 people.

People’s experience of using this service and what we found

People were safe using the service. Staff had received training to safeguard people from abuse and knew when and how to report safeguarding concerns to the relevant agencies. Staff understood how to manage risks to people to keep them safe. The provider carried out recruitment and criminal records checks on staff to make sure they were suitable to support people.

There were enough staff to support people. Staff attended care calls on time and people were supported by regular staff so that the care they received was consistent.

Staff followed current infection control and hygiene practice to reduce the risk of infection when providing care and support to people. Staff made sure peoples’ homes were kept clean and hygienic.

Where the service was responsible for this, people were helped to eat and drink enough to meet their needs and to take their prescribed medicines. People were supported to manage their health and medical conditions. Staff were observant to changes in people’s health and wellbeing and sought appropriate support for people when this was required.

People were supported in planning and making decisions about their care and support and could state their preferences for how this was provided. Staff knew how to meet people’s needs in line with their preferences.

Staff were provided with training to help them meet people’s needs. The provider supported staff to continually learn and improve in their role through regular supervision and staff meetings.

Staff were kind and caring. They treated people well and supported people in a dignified way which helped maintain their privacy and independence. People’s feedback confirmed they were satisfied with the care and support provided by staff.

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 service was managed well. The provider monitored the safety and quality of care and support provided to people at regular intervals. They checked with people that care and support was delivered to a high standard and continuing to meet their needs. The provider sought people’s views through these checks about how the service could improve further.

The provider had systems to investigate accidents, incidents and complaints and used the learning from these to make improvements to the quality of care and support provided.

The provider was continually improving the service and had implemented new technology to help them do this. They worked proactively with partners to provide care and support that met people’s needs.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was requires improvement (published 13 January 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Trinity Care Services Ltd is a domiciliary care agency. There were 73 people using the service at the time of our inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

The provider had made improvements to the way risks to people were identified and monitored. People and their families told us staff knew how to keep them safe. Staff were confident in identifying any additional support needs to help reduce risk and records were updated to help staff manage people’s needs safely.

The provider had improved their record keeping and the systems used to record and support people with their medicines. This meant the provider could make sure people received their medicines in a safe way at the right time.

Staff understood infection control requirements and worked in a safe way to limit the spread of infections such as COVID-19. Personal Protective Equipment (PPE) was appropriately used and staff followed infection

control procedures.

People told us they were happy with the care and support provided by Trinity Care Services Limited. People told us they were involved in their care and support plans. Staff respected their views and wishes and they had the same staff member or staff team to provide care and support to them.

The provider had introduced a new computerised system that allowed them to monitor the time and length of calls to people. This meant office staff could tell people when care staff were running late and make sure staff had the most up to date information about people’s care and healthcare needs.

Staff told us they felt well supported by the registered manager and had received enough training to help them do their jobs. The registered manager spoke about the improvements they had made since the last inspection and their plans to further improve systems and processes so they could make sure people continued to receive good quality care and support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (16 October 2019).

Why we inspected

This was a focused inspection to follow up breaches of regulation.

We carried out an announced comprehensive inspection of this service on 5 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and to meet the requirement to display performance assessments.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection and the ratings awarded at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Trinity Care Services Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Trinity Care Services Ltd is a domiciliary care agency. It provides personal care to people living in their own homes, flats and specialist housing. There were 87 people using the service at the time of our inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Since our last inspection the provider had started to record people’s risk so staff had a basic outline of the risk people may face. However, we were concerned there was a lack of detail in people’s care records so staff may not know how to reduce risk or know what to do if people became unwell.

Staff checked people’s medicine to make sure they received this safely. However, some of the records were incorrect and the provider was not always sure if they should keep incorrect records or not. We were concerned because some people’s records may be destroyed when it was important to keep them. We have made a recommendation for the provider to read more guidance in this area.

The service was rated requires improvement at their last inspection, However, when we looked at the website for Trinity Care Services we could not see our rating. It is a legal requirement for providers to display their rating so people know what we found during our inspection.

At our last inspection we found the provider was not recording when people could not make decisions about their care. Some people lacked capacity to make certain choices and when this happens there is a legal process to be followed. At this inspection we found the service had started to identify people who may need extra support to make certain decisions but we found more work was needed. We have recommended the provider reads more guidance in this area. However, we did find staff supported people to have choice and control of their lives and support was offered in the least restrictive way possible and in people’s best interests.

People told us staff were caring and they trusted them. People said they normally had the same staff member or a team of staff to care and support them, people said they were happy with the care and support they received and staff respected their views and wishes.

The provider had improved the way they managed care staff in the areas they worked. This meant staff were more able to make calls to people on time and were able to stay the right amount of time to make sure people received the support they needed.

People and their family members told us when they made a complaint they were listened to and changes were made to make things better.

Staff told us they felt well supported by managers and felt they had received enough training to help them do their jobs. People spoke highly of the experienced regular staff that supported them and felt these staff were trained well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 11 September 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in some areas but not enough to meet some of the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 20 July 2018. We gave two days’ notice to the provider to ensure someone was available to assist us with the inspection.

We last inspected the service in December 2016 and found the provider was meeting the fundamental standards. We rated the service ‘Good’ overall. At this inspection we found standards had deteriorated and we rated the service ‘Requires improvement’ in each key question and overall.

A registered manager was 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.

Although staff numbers were sufficient, people did not always receive care at the agreed times and people raised concerns about lateness and staff rushing and finishing too early. The provider had an electronic system to monitor staff timekeeping but the provider told us this was unreliable at the time of our inspection.

The provider communicated poorly with people when staff were going to be late and also when people would receive a different care worker than usual.

People felt the provider did not always respond well to concerns they raised and did not always resolve issues they raised, such as those relating to timekeeping. People were unhappy with the replacement care workers when their usual care workers were on leave. They found the replacement care workers did not understand their needs and often experienced issues with timekeeping with them.

The provider did not always assess risks to people’s care in line with best practice as part of doing all they could to reduce the risks. This meant written guidance for staff in reducing risks, such as those relating to medicines management, self-harm and aggression towards staff were lacking for some people.

Care plans did not always contain details of how people wanted to receive their care and what was important in relation to their care. However, care plans contained other information about people’s needs and preferences to guide staff.

The provider had not always followed the Mental Capacity Act (2005) in caring for people. They had not always ensured they carried out assessments in a decision-specific way to ensure proper and fair assessments of capacity.

The registered manager required more robust oversight of the service. The provider’s governance systems were lacking as they had not identified and resolved the issues we found during our inspection. This was a breach of regulation. You can see the action we asked the provider to take at the back of our full-length report.

Besides the lack of medicines risk assessments and management plans staff administered medicines safely to people.

The provider had systems to safeguarding people from abuse and improper treatment. The provider checked staff were suitable to work with people through recruitment checks.

Staff received the support to understand their role. The provider trained new staff with a suitable induction and an annual training programme and staff received regular supervision.

The provider consulted people as part of assessing their needs and reviewed any professional reports.

Staff were caring and understood the people they cared for. People liked their usual care workers but were less positive about replacement staff who covered when their usual care workers were on leave. Staff treated people with respect and maintained their privacy and dignity and supported people to maintain their independence.

This inspection took place on 6 and 13 December 2016. Both visits were announced. We gave 24 hour’s notice of the first visit to make sure the registered manager and other senior staff were available at their office to talk with us. The purpose of the inspection was to carry out a full comprehensive review of the service and to follow-up on the two requirement actions and one enforcement action made at the previous inspection in August 2015.

The service had 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 2008 and associated Regulations about how the service is run.

People using the service told us they were treated in a respectful and caring manner by regular staff members who knew them well and supported them safely and effectively.

Staff members had been safely recruited and had received an induction to the service. Staff we spoke with were confident that they provided a good service to people. They had access to training and supervision and said they felt supported by the service.

Staff understood how to help protect people from the risk of abuse. The agency had procedures in place to report any safeguarding concerns to the local authority.

At this inspection improvements had been made to help ensure people and staff were protected from potential risk of harm as the service had identified and assessed any risks to them and reviewed these on a regular basis. We saw people had assessments which were individual to the person and their environment.

We also found the service had made improvements to make sure people were receiving their medicines as prescribed.

Staff had received training in the MCA (Mental Capacity Act) and understood the importance of gaining people’s consent before assisting them.

The service completed assessments of people’s needs and these were used to inform the care plan for each person. New care plan summaries had been introduced and work was on-going to make these more individualised reflecting the person and what was important to them.

People and their relatives felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues.

The registered manager was aware of how many people were using the service and that their care and support needs were being met. The agency monitored the quality of the service and made changes to improve the service provided when required.

We found that people's needs were assessed before care was delivered and people were involved in their care planning. People's care was planned and delivered to meet their individual needs and to ensure their welfare and safety. People knew the details of their care plan and were satisfied with the way care was delivered.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with told us they felt safe. We found that staff received regular training in safeguarding vulnerable adults and had good knowledge about safeguarding people who use the service from abuse.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People who use the service were given appropriate information and support regarding their care and support. Their care records showed that their needs had been assessed by the agency's staff and care plans drawn up accordingly. The manager confirmed that people's needs were re-assessed when there were changes. We saw records that people needs were being reviewed on a regular basis in conjunction with the placing authority.