Archived: Trinity House Care Centre

Trinity House Care Centre is a residential care home providing personal and nursing care to nine people aged 65 and over at the time of the inspection. The service can support up to 35 people.

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

Although work had been completed on the quality of monitoring systems, these were still not completed consistently. The provider had not consistently ensured a positive working relationship with external organisations to ensure the safe transfer of people moving to alternative accommodation. People spoke positively about the management in place and staff told us they felt supported.

People felt safe and staff knew how to report concerns of abuse. Risks to people’s safety and well being were being assessed. There were sufficient numbers of staff to meet people’s needs. There were effective infection control practices in place. Medicines were managed in a safe way.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 26 September 2019). At the last inspection, breaches of regulation were found. At this inspection enough improvement had not been sustained and the provider was still in breach of some regulations. The service remains rated as requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns in relation to the provider not working in partnership with external agencies to ensure a safe transition to new services for people who were moving home. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection..

We have found evidence that the provider needs to make improvement. Please see the Well Led key question. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to the management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Trinity House Care Centre is a residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

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

The provider lacked oversight of the service and had not identified serious risks to people’s safety. Where feedback had been provided on how the service could be improved, this had not been acted upon. People and staff did not feel supported by the provider.

Risks to people’s health and safety had not always been assessed. Where risks were assessed, these had not been consistently acted upon. People did not always feel there were enough staff to meet their needs. Records showed that medication may not have always been given as prescribed. Staff knew how to identify, and report concerns of abuse and good infection control practices were followed.

Staff had not always received training relevant to their role. The decoration of the service did not always promote independence for people living with Dementia. 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’s dietary needs were met and they had access to healthcare services where required.

People told us that staff were kind and caring to them and that they were treated with dignity. However, people did not always feel able to express their views in relation to their care.

Care records did not always hold personalised information about people. People were not always satisfied with the availability of activities. Complaints made had been investigated and people’s end of life wishes had been explored.

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 25 December 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the safety of the premises. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe 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.

Enforcement

We have identified breaches in relation to assessing and acting on risk and ensuring that effective quality monitoring takes place at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At our previous inspection on the 21 August 2018, the provider was found to be in breach of Regulations, 13 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 and was rated as requires improvement overall. This was because the provider’s audits and systems did not identify the shortfalls that we did, there was no oversight of staff training and allegations of abuse had not been reported appropriately. At this inspection we found that these regulations had been met. However, further improvement was required and therefore the provider’s overall rating has not changed.

Trinity House is a care home with nursing. People in care homes receive accommodation and nursing or 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. Trinity House is registered to provide accommodation for up to 35 people. At the time of inspection there were 31 people living at the home. Trinity house is arranged over three floors. Some of the people who lived at Trinity House were living with dementia and some had a physical disability.

There was a registered manager in post but she was on maternity leave at the time of this inspection. 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 told us they felt safe. Risks to people were individually assessed and guidance was available to staff on how to reduce these risks to people. Staff had a good understanding of safeguarding and where to report concerns to and referral to the local authority were made appropriately. people told us there was enough staff to meet their needs. People received their medication as required. The home was kept clean and tidy.

The provider had audits in place. However, they had not always identified the shortfalls that we did. There was a system in place to ensure oversight of staff training. Staff told us they felt supported. People’s feedback was sought. However, there was no evidence that this was used to drive improvement within the home. The provider explained they were in the process of implementing a ‘You said, we did’ board which would identify the areas highlighted by people and relatives for improvement and what the service has done as a result.

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 2008 and associated Regulations about how the service is run.’

At our last inspection on the 09 February 2017 we rated the provider as ‘requires improvement’. This was because there were quality assurance systems in place but they were not comprehensive and did not show the action taken where concerns had been identified. We also found that records were not always kept appropriately and some Deprivation of Liberty safeguards (DoLS) applications had not been submitted. At this inspection we found insufficient improvements had been made.

People told us they felt safe. Risks to people were individually assessed and staff knew how to minimise risks to people. However, care plans detailing what the triggers to people were and how to minimise risks were not always in place. We saw that where staff had concerns about people’s safety, they had reported this to the registered manager or provider. However, the local safeguarding policy had not always been followed.

Staff understood the importance of seeking consent and giving people choices. However, staff told us they had not received recent training in MCA and DoLS and required up to date training to further their knowledge.

The provider had audits in place for areas such as care plans and medication but these had not identified shortfalls that we did. We found that accidents and incidents were recorded but this information was not analysed to look for trends to reduce reoccurrence.

There were enough staff to meet people’s needs. However, some people and relatives felt that they were sometimes short staffed. People received their medications as prescribed. The home was kept clean and tidy and staff wore appropriate personal protective equipment (PPE).

We saw that staff had the skills to meet people’s needs and knew people well. People gave mixed responses in relation to the food with some people telling us there needed to be more variety. People had access to health professionals when required.

People were supported by kind and caring staff. We saw staff had the time to engage in meaningful conversation with people and staff knew people well. People’s privacy and dignity was maintained by staff. People were supported to remain as independent as possible.

People and their relatives knew how to raise concerns and we saw where complaints had been raised, these had been dealt with appropriately. We found that within the home, there were different activities throughout the day to engage people in.

Staff spoke positively about the registered manager and felt supported in their role. The registered manager was visible throughout our inspection and we saw people and relatives approach them with any queries or concerns.

We found the provider was not meeting the regulations around safeguarding and the overall governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

Our inspection was unannounced and took place on 09 February 2017. This was the first inspection since the provider had taken over in October 2016.

There was not a registered manager in place and the provider was standing in as acting manager whilst recruitment was being undertaken in order to appoint a new registered manager. 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.

Quality assurance audits were carried out, but they were not comprehensive and did not show the action that had been taken where concerns arose. We were not notified of incidents or accidents as required. Records were not always kept appropriately. People were happy with the service they received. Staff were supported in their roles and felt that their views or opinions were listened to.

There had been a delay in submitting applications related to the Deprivation of Liberty Safeguards (DoLS). Staff gained the consent of people before assisting or supporting them. Staff assisted people to access food and drink and encouraged people to eat healthily.

Risk assessments had been completed to minimise risk to people. People felt that they were cared for safely and staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed. People felt that a sufficient number of staff were available to them. People received medicines when they required them and the administration of medicines was carried out safely.

Staff had the skills and knowledge required to support people effectively. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going training and regular supervision to assist them in their role.

People were involved in making their own decisions about their care and their own specific needs. People felt listened to, had the information they needed and were consulted about their care. People told us that they felt that staff cared for them in a dignified and respectful way. People were encouraged to retain their independence.

Staff understood people’s needs and provided specific care, people’s preferences had been noted and staff were aware of the history of the person. Regular activities were undertaken and people were encouraged to maintain friendships. People knew how to raise complaints or concerns and felt that they would be listened to and the appropriate action would be taken.