The Care Quality Commission
  • Care Home
  • Care home

Archived: Trent Lodge Residential Care Home

Overall: Inadequate read more about inspection ratings

6-8 Essex Road, Enfield, Middlesex, EN2 6TZ (020) 8367 2159

Provided and run by:
Dr S Seyan and Mr J Kotecha

All Inspections

29 April 2015

During an inspection looking at part of the service

After our inspection of 21 and 22 January 2015 the provider wrote to us to say what they would do to meet legal requirements for the continued breaches we found.

We undertook this unannounced focused inspection on 29 April 2015 to check that the most significant breaches of legal requirements, concerning the management of risk, which had resulted in enforcement action, had been addressed.

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 Trent Lodge Residential Care Home on our website at www.cqc.org.uk.

We will undertake another unannounced inspection to check on all other outstanding legal breaches identified for this service.

Trent Lodge provides accommodation and personal care for up to 16 older people. There are 14 rooms, two of which are shared rooms. At the time of our inspection there were 13 people residing at the home.

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.

We found that the provider had followed their plan in relation to these regulations. This means legal requirements for the management of risk had been met.

We saw that individual risks to people’s safety were being explored, assessed and information recorded about how these risks might be minimised.

When people’s needs changed information was now being accurately recorded and staff were told about any updates in handover meetings.

The registered manager and provider had implemented a monthly health and safety audit. This audit covered a number of areas including checks on medicines, equipment, the environment, care plans and fire safety. These checks were being carried out and where issues or problems had been identified we saw that action was being taken to address these.

21 and 22 January 2015

During a routine inspection

This unannounced inspection took place on 21 and 22 January 2015 and was undertaken by two inspectors.

At our last inspection of this service in March 2014 the provider was not meeting all the regulations we looked at. We found that assessments of risks to people had not always been updated in response to people’s changing needs and following significant events affecting health and safety. Prior to the inspection in March 2014 we issued the provider and registered manager with a warning notice regarding their continued breach of regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2010. At this inspection we found that the registered manager and provider were still in breach of this regulation.

Trent Lodge provides accommodation and personal care for up to 16 older people. There are 14 rooms, two of which are shared rooms.

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.

Although people told us they felt safe at the home, there were a number of checks and procedures that the registered manager and providers were not following that put people at unnecessary risk. The areas that were not being checked properly included people’s individual risk assessments, environmental risk assessments, the management of medicines, accidents at the home as well as staff recruitment.

There were no regular health and safety audits being undertaken which should have picked up the areas of concern that we found during this inspection.

The registered manager and staff at the home had not always identified and highlighted potential risks to people’s safety.

People and their relatives said they had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians. However, some communication difficulties between the service and the local district nurse team left people at unnecessary risk.

Food looked and smelt appetising and the cook was aware of any special diets people required.

People told us they liked the staff who supported them and staff listened to them and respected their choices and decisions.

People and their relatives said they were satisfied with the numbers of staff and that they didn’t have to wait too long for assistance when they needed help.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment. They told us that if the person could not make certain decisions then they would have to think about what was in that person’s “best interests” which would involve asking people close to the person as well as other professionals.

People using the service and their relatives were positive about the registered manager. They confirmed that they were asked about the quality of the service and had made comments about this. However, the registered manager and provider were not always carrying out their legal responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service was run.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These breaches were in relation to people’s care and treatment, the management of medicines, individual risks to people’s safety, managing environmental risks, communication with other visiting healthcare professionals and the safe recruitment of staff. You can see what action we told the provider to take at the back of the full version of the report.

5 March 2014

During an inspection looking at part of the service

We carried out this inspection to check whether improvements had been made since our last inspection of the service in January 2014 after which we served two warning notices on the registered manager and the registered provider. At that inspection we found that significant risks to people who use the service had not been accurately assessed and the planning and delivery of care was not person centred. There was no clear guidance for staff on how they should support people with dementia and impaired memory. In addition, accurate records of people's care and treatment were not being maintained. There was a risk that records of significant events affecting people could not be located promptly. We had asked the provider to take action to address these concerns by 21 February 2014.

At our inspection of the service on 5 March 2014 we found that although improvements had been made in standards of record keeping, risks to people who use the service had not been accurately assessed and the planning and delivery of care was not person centred. The provider had not complied with the warning notice served in respect of the care and welfare of people.

We found that assessments of risks to people had not always been updated in response to people's changing needs and following significant events affecting health and safety. Care plans in relation to people's dementia care needs provided little detail for staff on how people should be cared for. As a result the planning and delivery of care did not always ensure the welfare and safety of service users.

In view of our concerns in this area and failure to comply with the warning notice within the timescale specified we are considering further enforcement action.

8 January 2014

During an inspection looking at part of the service

We carried out this inspection to check whether improvements had been made since our last inspection of the service in July 2013. At that inspection we found that significant risks to people who use the service had not been accurately assessed and the planning and delivery of care was not person centred. There was no clear guidance for staff on how they should support people with dementia and impaired memory. In addition, accurate records of people's care and treatment were not being maintained. There was a risk that records of significant events affecting people could not be located promptly. We asked the provider to take action to address these concerns.

At our inspection of the service on 9 January 2014 we found that the required improvements to the service had not been made.

People who use the service we spoke with told us they were happy with the care they received in the home. We also observed that people were comfortable in their interactions with staff and staff tried to engage with, and were caring towards, people with memory impairment and dementia.

However, we found that although the needs of people had been assessed, assessments had not always been updated in response to people's changing needs and care was not always being delivered in line with a person's assessed needs. Care plans in relation to people's dementia care needs provided little detail for staff on how people should be cared for. As a result the planning and delivery of care did not always ensure the welfare and safety of people who use the service.

We also found that although significant information about people was recorded, this was not always done consistently or accurately and in a way that protected people against the risks of unsafe or inappropriate care. Information about people's care and treatment was not recorded in a way that meant it could be located promptly and personal and confidential information about people was not always kept securely.

In view of our concerns in these areas we served warning notices on the registered manager and registered provider on 16 January 2014.

25 July 2013

During a routine inspection

At our last inspection of the service in March 2013 we had concerns about the way medicines were being managed in the home, the systems in place to assess and monitor the quality of the service and that the service had not notified the Care Quality Commission of significant events.

At the current inspection we found that improvements had been made. People's medicines were being managed in a way that ensured they were stored and administered safely. The service understood the requirements in respect of reporting serious incident to the Care Quality Commission. There was a system in place to assess and monitor the quality of care provided to people and ensure care and support was provided in a safe environment.

Most people we spoke with were satisfied with the care and support they received from the service. We saw many instances of staff interacting with people in a caring and sensitive way and responding appropriately to their needs. However, not all the risks that affected people had been accurately assessed and the planning and delivery of care was not always person centred. Records of people's care and treatment were not always accurate and information recorded about them was sometimes contradictory and not easy to locate promptly.

14 March 2013

During a routine inspection

We spoke with people who use the service and their relatives. They all told us they were satisfied with the care and support provided to them. For example, a relative told us, 'the staff are very kind and gentle, nothing seems to be too much trouble for them.' A comment we read on a recent satisfaction questionnaire completed by a relative was, 'my father is well looked after at Trent Lodge, the staff are terrific and hard-working.'

People were asked about their wishes and preferences and staff acted in accordance with these. Staff underwent relevant checks before starting work in the service to ensure they were suitably qualified for their role.

However, the service did not have an effective system in place to protect people from the unsafe use of medicines. Staff did not always record when medicines had been given to people and the temperature of the drugs fridge was not monitored. This meant medicines kept in the fridge may not have been effective.

Although there were systems in place to monitor and assess the quality of service provided these were not always effective at identifying and managing the risks to people. For example, several service policies were out of date and missing important information that would reduce the risk to people of receiving unsafe or inappropriate care. In addition the provider had failed to notify the Care Quality Commission of potentially serious injuries to people.

19 December 2011

During a routine inspection

People were being treated with respect. One person said, "Staff do listen to me and do things the way I want." We observed that staff responded to people's needs. Staff were approachable and listened to what people had to say. People spoken to confirmed that they trusted staff and felt safe. A person said, 'I feel safe here.' People told us that staff knew how to support them. A person told us when asked about how staff treated them, "The staff were helpful." People told us that there had been a survey of their views of the home. They knew that this could be used to suggest ways to improve the home.