Archived: Trent House

Trent House is registered to provide accommodation for up to 19 older people with personal care needs, including people living with a cognitive impairment. There were 18 people living at the home at the time of the inspection.

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

People were supported by staff who were kind, compassionate and caring and who understood their likes, dislikes and preferences. People were happy living at Trent House and told us they felt safe.

Recruitment practices were effective and there were sufficient numbers of staff available to meet people’s needs. People were protected from avoidable harm, received their medicines as prescribed and infection control risks were managed appropriately.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to access health and social care professionals if needed, received enough to eat and drink and were happy with the food provided. Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

The management team were open and transparent. They understood their regulatory responsibilities. People and their relatives felt the management team were open, approachable and supportive. Everyone was confident the provider would take the necessary actions to address any concerns promptly. The providers had effective governance systems in place to identify concerns in the service and drive improvement. They were responsive to feedback from people, staff and professionals and took action to make improvements in the service.

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 21 June 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

There is no required follow up to this inspection. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

The home was last inspected in July 2017 and we identified improvements were needed as there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have effective systems to assess, monitor and improve the service provided. At this inspection we found the provider had taken action to meet the requirements of the regulations. Further work was needed to ensure all the improvements the provider had identified and planned were implemented in practice and sustained over time.

This inspection took place on 30 April 2018 and was unannounced. We returned on 3 May 2018 to complete the inspection.

There was no 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. The provider has a condition of their registration that they must have a registered manager at Trent House. A manager was in post and they told us they were going to submit an application for registration to us. We will monitor this to ensure the provider meets the conditions of their registration.

The provider regularly assessed and monitored the quality of care provided. Feedback from people and their relatives was encouraged and was used to make improvements to the service. The manager had a good understanding of improvements that were needed in the service and had plans in place to implement them. Staff were confident in the skills of the manager and their ability to continue to make improvements to the service.

Work was needed to complete work to improve the building, including addressing kitchen fittings, providing safe access to the garden and to complete the programme to replace carpets and floor coverings. The provider had detailed plans in place to complete this work, with contractors booked.

The provider had identified improvements were needed to the home’s recruitment practices, to ensure they had a full employment history for staff employed. This information was being collected from existing staff and the recruitment procedures had been changed to ensure it would be collected for new staff.

Although there were still improvements to be made to the service, the directors and manager had a clear understanding of what was needed and a plan to complete the actions.

People who use the service were positive about the care they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for assistance.

People told us they felt safe when receiving care and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them. Medicines were stored safely in the home and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

There were sufficient staff available to provide safe care. Staff understood the needs of the people they were providing care for and had the knowledge and skills to meet their needs. Staff received a thorough induction when they started working at the home, including time shadowing experienced staff members. Staff demonstrated a good understanding of their role and responsibilities. They had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The staff team were responsive to people’s needs and wishes. People had regular meetings to provide feedback about their care and there was an effective complaints procedure. People enjoyed the social activities that were arranged.

The home is based on three floors with an interconnecting passenger lift, plus a basement that houses the manager’s office, store rooms and a laundry.

The inspection was conducted on 27 and 28 July 2017 and was not announced.

A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with CQC and their application was being processed. 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.

A fire safety risk assessment conducted by the provider identified that remedial work was needed, particularly to fire resisting doors, to bring the home up to modern fire safety standards. Following the inspection, the fire and rescue service issued a ‘deficiency notice’ requiring the provider to make these improvements by 30 November 2017.

A quality assurance system was in place, but this had not always been effective in bringing about improvement in a timely way. For example, although some improvements had been made to the environment since our last inspection, further work was needed to refurbish the home. The issues had been identified in audits conducted by the manager, but the provider had not developed plans to complete the work until we raised concerns during the inspection.

Staff sought verbal consent from people before providing support and followed legislation to protect people’s rights. However, applications to deprive people of their liberty had not been submitted to the local authority and staff were not clear of the action to take if people tried to leave the home unsupervised.

Staff were skilled and competent. They felt supported in their role by the manager; however, none had received an appraisal in the past year and some said they did not always feel supported by the provider.

People told us they felt safe and staff knew how to identify, prevent and report incidents of abuse. Individual risks to people were managed effectively in a way that promoted their independence. There were procedures in place to deal with foreseeable emergencies.

Medicines were managed safely and people received their medicines as prescribed. There were enough staff to meet people’s needs and recruitment procedures helped ensure only suitable staff were employed.

People praised the quality of the meals and were supported appropriately to eat and drink enough. They were also supported to access healthcare services when needed.

Staff were kind and caring. They supported people in a quiet, patient and unhurried way. They supported people to build and maintain important relationships. They protected people’s privacy, encouraged them to remain as independent as possible and involved them in planning the care they received.

Care and support were delivered in a personalised way according to people’s individual needs. People were empowered to make choices about all aspects of their lives. They had access to a range of activities based on their interests.

The provider acted on feedback from people. People new how to make a complaint and felt listened to. They also felt the service was run well by the manager.

There was a clear management structure in place. Staff had confidence in the manager, understood their roles and worked well as a team.

There was an open culture; visitors were welcomed at any time and the manager notified CQC of all significant events.

We identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

There had been no registered manager in place since May 2015. 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. A manager had been appointed who was going through the process of registering with the Care Quality Commission (CQC).

Providers are required to notify CQC of significant events, so we can monitor occurrences and prioritise our work. Two occurrences had not been notified to CQC as required, but the manager had introduced a clear process to help ensure this did not happen again.

Some parts of the environment did not support the needs of people living at the home. Signage was limited, bedroom doors were not personalised and the garden was overgrown and inaccessible. The manager told us of plans to improve the environment, which included the installation of a new passenger lift as the current one had become unreliable.

People felt safe at Trent House. Care staff knew how to prevent, identify and report abuse. Risks to people were managed appropriately and there was a system in place to analyse and learn lessons from accidents and incidents that occurred.

Appropriate arrangements were in place for obtaining, storing, administering and disposing of medicines. People received their medicines when needed from staff who were suitably trained.

There were enough staff to meet people’s needs. Effective recruitment processes were in place and staff knew how to keep people safe in an emergency.

People liked the food, had enough to eat and drink and received appropriate support to eat when needed. They were supported to access healthcare services, including doctors, nurses and specialists.

People had confidence in the knowledge and the ability of staff to provide effective care; staff were suitably trained and supported in their work.

Staff followed the principles of legislation designed to protect people’s rights and freedom. They sought consent from people before providing care and support.

People were cared for with kindness and compassion. Staff took particular pride in the way they cared for people at the end of their lives. Interactions between people and staff were positive and staff clearly knew people well.

People’s privacy and dignity were protected at all times. They were involved in planning the care and support they received and staff supported them to follow their faith.

People received personalised care and support that met their needs. Staff demonstrated a good awareness of people’s individual support needs and responded promptly when their needs changed. Care plans provided sufficient information to enable staff to provide care in a consistent way.

People were encouraged to make choices about every aspect of their lives. They were able to take part in a wide range of activities suited to their interests. People knew how to raise concerns and the provider acted on feedback from people.

People were happy living at Trent House and told us it was run well. Staff enjoyed their work, were motivated and felt supported by the manager. The manager was held in high regard by staff and received appropriate support from the provider.

The manager promoted an open and transparent culture. Visitors were welcomed at any time and links had been developed with the community to the benefit of people and their families.

There was an effective quality assurance system in place, together with a development to further improve the quality and safety of the service.