Trinity Court Nursing Home

Trinity Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people with nursing care needs. At the time of the inspection, there were 27 people using the service.

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

Relatives of people using the service told us their family members were safe and they had no concerns about their safety or wellbeing. Risk assessments were reviewed and updated on a regular basis which helped to ensure people’s safety and wellbeing. Recruitment procedures were robust and there were enough staff employed to keep people safe. People received their medicines as prescribed. The premises were kept clean and staff followed relevant current best practice guidelines regarding infection control and prevention.

Staff cared for people in a respectful manner which promoted their independence and maintained their dignity. Person centred care plans were in place which helped staff to care for people in an individual way. People were supported to maintain relationships that were important to them. Staff communicated with people in a way that they could understand. The provider listed when concerns were raised and responded in a timely manner after carrying out appropriate investigations. People were supported according to their wishes in relation to end of life care.

Audits were in place to monitor the quality of service and there was evidence the provider was proactive in making improvements where necessary. Feedback from relatives, staff and healthcare professionals was positive, they told us there was an open culture within the home. There was good evidence of collaborative working with healthcare professionals.

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 June 2019) and there were multiple breaches 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 and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 April, 02 May & 03 May 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 fit and proper persons employed, person-centred care and governance.

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, Caring and Well-led which contain those requirements and Key Question Responsive.

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 coronavirus and other infection outbreaks effectively.

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 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 Trinity Court Nursing Home 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 Court Nursing Home is a 'care home'. 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 Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people with nursing needs.

People’s experience of using this service:

People were happy with the care they received and felt that staff were caring. They told us they felt safe living in the home.

We found there was still some inconsistency in the care records, including risk assessments and support plans that were in place. These were highlighted to the registered manager during the inspection.

Recruitment procedures were not always robust. We found conflicting information in people’s application forms, references and gaps in employment history were not always verified and interview notes for new staff were not always completed.

Quality assurance systems were not always conducted effectively in order to identify and drive improvements.

Care plans contained very little in the way of person-centred information and care plans for emotional support for people showing signs of depression were not always completed.

The provider had identified that the environment and activities needed improvement so that it was better suited to the needs of the people living at the home.

Staff received regular training and supervision. Although new staff received training based on the Care Certificate, it was difficult to see how this amount of training was covered in one day. We have made a recommendation about this.

People received appropriate medicines and health care support. Referrals were made to GP’s and healthcare teams as required.

The provider had achieved platinum status in the Gold Standards Framework for end of life care.

Where people did not have capacity to consent to aspects of their care, the provider acted in accordance to the Mental Capacity Act 2005 (MCA) and consulted with relevant professionals and family members to make decisions in people’s best interests.

The provider followed good infection control practices.

Rating at last inspection:

At our last inspection we rated the service ‘requires improvement’ with a breach in relation to safe care and treatment. Our last report was published on 10 May 2018.

Why we inspected:

All services rated "requires improvement" are re-inspected within one year of our prior inspection.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

At this inspection we identified breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around fit and proper persons employed, person-centred care and good governance. Details of action we have asked the provider to take can be found at the end of this report.

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.

At the last inspection, the service was rated Good.

At this inspection, the service was rated Requires Improvement.

Trinity Court Nursing Home is a 'care home'. 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 Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people with nursing needs.

There was a registered manager at the service. 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.

The provider had transitioned to a new electronic care plan system computer system in July 2017 but we found that staff were still adapting to the new system. Some records were still being completed on both the old and the new care plan system and were not always consistent. Some record keeping in relation to risk was not being reviewed in a timely manner. People that were identified at being at high risk did not always have their records reviewed in line with the level of risk.

The provider did not always follow the appropriate procedures with regards to covert medicines for people who lacked the capacity to make decisions about their medicines.

Although people told us they enjoyed the food and they were provided with appropriate amounts food and drink throughout the day, the provider was not following guidelines in relation to food hygiene.

The registered manager was not fulfilling the requirements of her registration and had not submitted notifications in relation to safeguarding concerns and applications for DoLS that had been granted.

The quality assurance audits were not effective in identifying the issues we found during the inspection, however the provider demonstrated they were open to feedback and acted upon the recommendations we made throughout the inspection. This included arranging for staff to undergo training in the new care plan system and signing up to the CQC Provider Portal to enable them to submit future notifications in a timely manner.

People using the service and their relatives told us they had no concerns about safety and that staff were caring and looked after them. They were confident that if they were to raise any concerns, they would be listened to and the provider would take action where necessary. We saw that when concerns were raised, the provider investigated and acted to resolve these to the satisfaction of the complainants.

Staff recruitment procedures were robust and staff received mandatory training which enabled them to support people effectively. Staff told us they felt supported and worked well as a team. Records confirmed they received regular supervision.

People's healthcare needs were managed by staff. Appropriate referrals were made to community professionals if required and a GP visited the home regularly to review people who were not feeling well. The provider had good working relationships with health and social care professionals, which was reflected in the feedback we received from them. The provider worked collaboratively with external organisations to support care provision and service development.

The service enabled people to carry out person-centred activities and encouraged them to access activities by arranging for external agencies to facilitate them. 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.

At this inspection, We found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made a recommendation about good governance. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. 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 Trinity Court Nursing Home on our website at www.cqc.org.uk.

There was a registered manager at the service. 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.

Trinity Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people for respite, palliative and dementia care. At the time of the inspection, there were 50 people using the service, although three of them were in hospital.

At our previous inspection we found that although care plans were reviewed on a regular basis they were not person-centred in all cases. We also found some gaps in the records that we saw.

At this inspection, we found that improvements had been made.

The activities co-ordinator had completed personal histories and social care activities for people using the service so that staff could provide care that met their individual needs.

Risks to people had been identified and were assessed using standard screening tools. Where a risk had been identified, action was taken and associated records were updated accordingly, including the advice of specialist healthcare professionals.

Trinity Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people for respite, palliative and dementia care. At the time of the inspection, there were 50 people using the service, although one person was in hospital.

There was a registered manager at the service. 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 felt safe living at the home and that the staff were kind and friendly and caring towards them. Relatives that we spoke with also told us they had no concerns about the safety of their family members.

Care workers demonstrated a caring attitude when we observed them during the inspection. They spoke to people in a gentle manner and took their time when supporting them.

Staff supported people with regards to their medicines and people’s support needs in relation to health were being met by the provider. They were registered with a GP who visited the service on a weekly basis. Annual medicines reviews also took place. Other health professionals, such as physiotherapists, speech and language therapists and community nurses were involved in people’s care and updated care records as appropriate.

People told us they enjoyed the food at the home and told us they were offered a choice in relation to their meals which were prepared using fresh ingredients. The chef had been working at the service for a number of years and was familiar with people’s needs.

The provider was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Consent was sought for everyday decisions and where people did not have the capacity to consent to more complex decisions, decisions were made in their best interests, involving relevant professionals.

Staff recruitment at the home was robust and staffing levels were sufficient to meet people's needs. Call bells were answered quickly, however we found that staff were stretched at certain times of the day. This was confirmed by care workers we spoke with and through reviewing staff meeting minutes.

We found that although care plans were reviewed on a regular basis, and were well designed with respect to clinical care, they were not person-centred in all cases. We also found some gaps in the records that we saw, some related to person- centred information and others related to care planning.

The service was well-led. People and relatives told us they knew who the management team were. Staff told us they felt supported. The director and area manager were a regular presence at the home.

Robust quality monitoring took place, including medicine, clinical and health and safety audits. These were completed by the registered manager, area manager and external professionals.

The service demonstrated its commitment to continuous learning and improvement by being involved in a number of schemes, including an accreditation award from the Gold Standards Framework (GSF) for end of life care. The service was a member of the registered nursing home association and attended provider forums in the borough. They were also taking part in a research study by the National Institute for Health Research around helping care home staff to deliver person-centred care to people living with dementia.

During this inspection we found breaches of Regulations relating to care planning. You can see what action we told the provider to take at the back of the full version of the report.

During our visit we spoke with six people who used the service and three family members. We spoke with the registered manager, a visiting GP and eight members of the nursing and care staff team. Staff told us "it's a happy home" with "a friendly manager." Relatives we spoke with told us staff were friendly and caring.

On the day of our visit there were 49 people living at the home. From conversations with people who used the service the overall impression was that people were happy with the care they received. People told us "I'm happy here" and "staff are nice." Family members told us their relatives were "happy" and "comfortable."

People had care plans in place and risk assessments had been completed. There were activities on offer such as chair based exercises, singing, ball games and nail painting sessions. There were sufficient numbers of staff on duty the day we visited to meet people's needs, although extra support may have been needed at mealtimes to assist with the high proportion of people who required assistance.

The provider had systems in place to ensure that the quality of the home was monitored and surveys and audits were completed on a regular basis. People we spoke with told us they would make a complaint to the manager if they had any reason to do so. The appropriate staff were trained to deal with emergencies.

During our unannounced visit we spoke with six people who used the service, two family members, 11 members of staff, and a visiting GP. Staff told us, 'This is a good place to work' and 'Communication between us is good'. A family member told us they were very happy with the care being given to their relative.

The provider wrote to us about the changes they had made to involving people in decision making; confirmed that individual records had been updated and security for personal information improved and noted that meal times had been extended to meet the needs of the service users.

During this unannounced inspection we saw improvements had been made to people's choice about their care and treatment, care plans had been updated, were consistent and held securely and meal times were flexible.

We spoke to eight people who use the service, three family members, seven members of staff, a visiting GP and Pharmacist. People told us 'I'm well looked after, I'm satisfied'. 'They're (staff) very nice to me', 'staff are polite', 'it feels like a family, staff are kind, patient and compassionate', 'They make special curries, with hot sauce'.