Trafalgar Care Home

Trafalgar Care Home is a residential care home. The home is registered to accommodate up to 29 older people in one adapted building. Nursing care is not provided by staff in the home. This type of care is provided by the community nursing service. At the time of this inspection there were 23 people living in the home.

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

People lived in a home where the staff team and managers were committed to providing personalised care.

Staff and managers were clear about their roles and robust systems had been implemented to ensure the quality and safety of people’s care were monitored and improvement actions taken.

There were enough safely recruited staff to meet people’s needs. People, and relatives, told us the staff were kind.

People were protected from the risks of cross infection. Staff understood how to use PPE appropriately and the home was kept clean.

People were supported by staff who understood the risks they faced and had received appropriate training. People felt safe and were supported by staff who understood how to report safeguarding concerns.

Where people could not consent to live in the home, Deprivation of Liberty Safeguards had been applied for appropriately to ensure that people’s rights were protected. 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 received their medicines as prescribed. Oversight of medicines administration was robust.

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 April 2022).

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection, that rated those key questions, to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

Trafalgar Care Home is a residential care home. The home is registered to accommodate up to 29 older people in one adapted building. Nursing care is not provided by staff in the home. This type of care is provided by the community nursing service. At the time of this inspection there were 18 people living in the home.

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

People lived in a home that had undergone substantial management and staff change. The manager and staff team were working to ensure continual improvement in the quality of the care people received.

Staff and managers were clear about their roles and systems had been implemented to ensure improvement. These systems needed to be embedded.

People told us the staff were kind and helpful we saw this was the case. Staff were attentive to people’s needs and were both respectful and familiar in their approaches. One person told us, “They (staff) are friendly and helpful.”

The management of risk within the home had improved. The Fire Service had been satisfied by works undertaken to ensure the safety of people and staff. We identified some situations where risk management was not adequate. These were addressed immediately; errors were rectified, care plans were updated to reduce the risk of reoccurrence and staff received guidance to ensure their understanding.

People were protected from the risks of cross infection. Staff understood how to wear PPE appropriately and the home was kept clean. People received visitors safely and their relationships with loved ones were valued.

Staff told us they felt well supported and this meant they were confident they had the skills and knowledge they needed. Training associated with risk management had been provided and further training was scheduled that reflected people’s identified needs and development opportunities for the staff team.

People felt safe and were supported by staff who understood how to report safeguarding concerns.

Where people could not consent to live in the home, Deprivation of Liberty Safeguards had been applied for appropriately to ensure that people’s rights were protected.

People received their medicines as prescribed. Care plans related to time dependent medicines were improved during our inspection.

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 inadequate and there were breaches of regulation (published 27 September 2021).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 28 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection, that rated those key questions, to calculate the overall rating. The overall rating for the service has changed from Inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

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

Trafalgar Care Home is a residential care home. The home is registered to accommodate up to 29 older people in one adapted building. Nursing care is not provided by staff in the home. This type of care is provided by the community nursing service. At the time of this inspection there were 22 people living in the home.

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

People told us the staff were kind and we saw this was the case, however, staff were not deployed in a way that met people’s needs. People waited for support in unsupervised communal areas and people’s care plans related to safe eating and drinking and skin care were not followed.

People were not protected from the risks of cross infection because staff did not wear their PPE in line with guidance.

Environmental risks were not always well managed. A fire alarm system was silenced when damaged and this meant that when a fire started the alarms did not sound and some bedroom doors did not automatically close. Whilst no one was injured in this fire, safe practices were not followed.

Staff told us they did not always feel well supported and that their training and supervision sessions were not up to date. This meant they were not confident they had the skills and knowledge they needed. Training related to health and safety had not been delivered in line with the provider’s policy.

People were supported by staff who understood how to report safeguarding concerns.

Most people received their medicines as prescribed. The provider had identified that some pain relief was not being given as prescribed in the week prior to our visits. This had not been addressed when we visited.

The oversight of the service was not sufficiently robust to ensure improvements. There had been a delay in carrying out some audits. This meant actions such as ensuring flooring did not present a trip hazard and pain relief being given as prescribed had been delayed. Actions identified by the provider had not been acted upon in the home. This meant issues related to the oversight of deprivation of liberty safeguards and safe care and treatment had not been addressed in a timely manner.

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

Rating at last inspection

We did not rate this service at our last inspection (published 27 April 2021).

The last rating inspection for this service was Good (published 25 June 2019).

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

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the oversight of the home, fire safety and staffing. 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.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led key question sections of this full report.

The provider has been responsive in ensuring additional oversight and support for staff. We have not been able to review the sustainability of these changes.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, the deployment of staffing and the oversight of the home at this inspection.

We have taken enforcement action in relation to risk management and the oversight of the home.

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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Trafalgar Care Home is a residential care home. The home is registered to accommodate up to 29 older people in one adapted building. Nursing care is not provided by staff in the home. This type of care is provided by the community nursing service. At the time of this inspection there were 21 people living in the home.

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

Following the end of the Covid-19 outbreak at the service people were enjoying spending time in communal areas and the layout of the home meant there was a variety of well-ventilated spaces available to them. This helped promote social distancing.

One person told us they were very happy with their care and support, highlighting the cleanliness of the home, the standard of the food and the kindness of the staff. Another person reflected positively on risk management related to the pandemic how they were supported.

People were also enjoying visits with family and friends that had restarted in line with government guidance. People were also supported to keep in touch with loved ones via telephone, mobile phone and via the internet.

Staff had received additional training on how to keep people safe during the Covid-19 pandemic and had plentiful supplies of personal protective equipment. All staff were seen to be wearing PPE (Personal Protective Equipment) appropriately. The registered manager made assurances that the individual risks staff faced would be revisited in light of the most recent change in government guidance related to working safely in care homes.

People’s care plans related to the risks they faced to maintain healthy skin and eat and drink safely had been updated and reflected their individual needs. The records staff kept about people’s care were sufficient.

Cleaning records had been updated and the oversight of cleaning had been enhanced. The home was well ventilated and clean.

Recommendations made by the Clinical Commissioning Group (CCG) during their visit on 19 February 2021 had been actioned or were scheduled. This reduced the risks associated with cross infection.

Staff and people were regularly tested in line with the government’s current testing programme.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Rating at last inspection and update.

We did not rate this service at our last inspection (published 8 April 2021). There were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Trafalgar Care Home is a residential care home. The home is registered to accommodate up to 29 older people in one adapted building. Nursing care is not provided by staff in the home. This type of care is provided by the community nursing service. At the time of this inspection there were 22 people living in the home.

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

There was a Covid-19 outbreak at the service that resulted in the majority of the permanent staff team being unable to work. During this time, we received concerning information about the ability of staff working in the home to manage the risks people faced in relation to eating and drinking enough and keeping their skin healthy. We also received concerns about poor infection prevention and control (IPC) practices at Trafalgar Care Home. This information was initially followed up with an IPC visit on 19 February 2021 by staff from the Dorset NHS Clinical Commissioning Group (CCG) Quality Improvement Team. They made some recommendations to improve IPC within the home.

At the inspection, we noted that some improvements had been made following the CCG visit, such as some new chairs in communal areas. However, other concerns were highlighted, particularly the incorrect use of PPE by some staff members, a lack of robust oversight of cleaning and unsafe management of infectious waste.

The inspection also identified concerns about how the risks some people faced were being managed. For example, the registered manager and a senior member of the team told us that people did not appear to have been well hydrated during a period when the majority of the home’s permanent team were not working due to an outbreak of Covid-19 in the home. Records did not reflect that an immediate improvement had happened since they identified this concern and records were not always accurate.

Staff reported people were in improving spirits despite the current restrictions of being cared for in their rooms. People were supported to keep in touch with loved ones via telephone, mobile phone and via the internet.

Staff had received training on how to keep people safe during the Covid-19 pandemic and had plentiful supplies of personal protective equipment. Due to concerns identified, staff were provided with refresher training following our visit.

Staff and people were regularly tested in line with the government’s current testing programme. The size of the home and variety of spaces meant there were well ventilated spaces people who could not stay isolated in their rooms could spend time. This helped promote social distancing.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns we had received about risk management and infection prevention and control measures at the service. A decision was made for us to visit to look at these risks.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the Safe sections of this full report

Since our inspection visit, the provider reported that they have taken action to improve infection prevention and control measures.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches of regulation in relation to the safe care of people living in the home at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We requested assurances from the provider regarding the changes they had made following our inspection visit. They told us they would send us photographic evidence of these changes by 5 March 2021. We will request an action plan from 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.

Trafalgar Care Home is a detached home on a main road in the seaside town of Weymouth. The care home provides personal care for up to 29 people, many of whom have dementia type illnesses. At the time of the inspection there were 20 people living at the home and one person on a respite stay. Accommodation at the home is provided over two floors which can be accessed by a lift. It is not registered for nursing.

People’s experience of using this service:

People felt safe living at Trafalgar Care Home. Their relatives were confident their family members were well cared for. Staff understood how to keep people safe from harm or abuse and understood their responsibility to raise concerns if they were to witness poor or abusive practice. Actions were taken with people’s involvement to reduce their individual risks to a minimum.

People received their medicines on time from staff with the relevant training and competency checks. The home was visibly clean and free from malodours. Staff understood their responsibility to help protect people from infection.

Staff received mandatory and ongoing training that enabled them to meet people’s current and emerging needs with confidence. Care plans were person centred and regularly reviewed. They reflected people’s needs, abilities and desired outcomes.

People’s dietary requirements and support needs at meal times were known and met. People were given assistance in a way that upheld their dignity and respected their wishes. Staff supported people to access health care services in a timely way and followed up on any advice given. This helped people to maintain their health and wellbeing.

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.

People were encouraged to enjoy the company of other people at the home and visitors. Relatives told us they were made to feel welcome and involved. Staff interacted with people in a consistently kind, caring and respectful way. Staff knew people well which helped them provide reassurance at times they were feeling anxious or upset.

People had the opportunity to participate in a range of activities both in the home and community. People could also choose to occupy themselves if they preferred including time spent alone. People at risk of social isolation were offered 1:1 sessions.

Staff felt supported by the management and enjoyed working at the home. The staff got on well as a team and were dedicated to providing people with good quality care. The registered manager was proud of the staff and shared positive feedback with them to ensure they knew they had done a good job. People and relatives were encouraged to share their views and feedback about the care they received via an annual survey. This was used to help improve the service that people received. A relative had fedback, ‘Trafalgar, luckily for us, is a lovely home that no doubt stems from good management.’

Rating at last inspection:

At our last inspection we rated the home Good (published 14/12/2016).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

Follow up:

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

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

Trafalgar Care Home is a detached home on a main road in the seaside town of Weymouth. The care home provides personal care for up to 29 people, many of whom have dementia type illnesses. Accommodation is provided over two floors which can be accessed by a lift. It is not registered for nursing.

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.

People had detailed personalised support plans which enabled staff to provide the right care and support to ensure people’s needs were met. People had opportunities to be involved in activities on both a group and individual level. Staff understood the importance of supporting people to maintain their preferred routines. They were respectful of their diverse needs. Staff knew the best way of communicating with individuals which varied according to the person.

Relatives and staff told us the care was person centred and people’s needs were reviewed regularly. There was an annual review of people’s needs, which relatives and healthcare professionals were invited to. This was an opportunity to ensure that support plans were working for people. There were additional reviews throughout the year if people’s needs changed.

People were cared for by staff who were kind and considerate. The staff were flexible to the needs of people and were able to safely support them. Staff had a flexible approach to their work to ensure they had enough time to sit and talk with people.

Relatives, staff and healthcare professionals told us the registered manager had an open approach where they could speak with them at any time. They told us the registered manager had created a positive culture which encouraged continual improvement. There were systems in place to monitor the quality of the service and to ensure any actions were followed up.

The provider was meeting the requirements of the Mental Capacity Act 2005 and assessments of people’s capacity had consistently been made. The staff at the home understood some of the concepts of the Act, such as allowing people to make decisions for themselves.

The provider had developed a culture of learning and staff told us there were opportunities to attend various in training opportunities and work towards qualifications in health and social care. Staff told us they felt supported. Staff received regular supervision and an annual appraisal.

The registered manager and provider were supportive of new staff and told us they introduced them gently into the work. They were respectful of staffs’ individual needs and were flexible in their approach to accommodate them.

People's care needs and risks were assessed and care was delivered to meet their needs. One person we spoke with said, 'I'm happy here'. One person's relative told us, 'It's a fantastic home. They (the staff) bend over backwards for people.'

The home was clean and there were procedures to prevent and control the risk of healthcare associated infections.

The provider had effective systems to monitor pre-employment checks and recruitment procedures for staff.

The home had suitable systems to monitor the quality of service provided.

During our visit we observed staff offering people choice and independence. An activities co-ordinator was talking to people and offering a range of books and magazines then discussing them with them.

We saw people were kept clean and comfortable. One staff member was observed asking 'do you want a blanket for your legs' to one person and caring for her needs in a gentle manner.

Staff had good knowledge of safeguarding polices and knew the local and national guidance about reporting. There was numerous opportunities to train and develop in the caring role. Some of the staff we talked were doing an aspects of mental illness course, one noted 'I really didn't appreciate the amount of mental illness in the people I care for, I feel more able to help and understand their needs now'.

Records pertaining to people and staff were kept safe in the managers office which ensured confidentiality.