The Troc Care Home

The Troc is a residential care home providing personal care to younger and older adults with physical disabilities and those living with dementia. The home is spread across 2 floors with a purpose-built extension that can accommodate up to 64 people. At the time of our inspection there were 36 people using the service.

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

People told us they received personalised care that met their needs and reflected their choices and wishes. People used words like ‘excellent’, ‘kind’ and ‘understanding’ to describe their care and staff within the home.

People were protected from the risk of avoidable harm by comprehensive policies and procedures and by staff who were trained and knowledgeable about safeguarding risks and were confident to report their concerns.

There was a dedicated housekeeping team that ensured risks from infection prevention and control were minimised and controlled and kept standards of hygiene in the home to a high level. The provider was working on plans to modernise the original building following a recent extension to ensure these standards continued.

Staff were recruited safely and received comprehensive training to support them in their role. Staff told us they received regular supervisions and support from the management team and confirmed their feedback and ideas for improvements were acted upon.

Care plans were reviewed regularly and involved people and families. There was a robust system of audits that supported staff and the provider to identify changes in people needs and the service. We saw evidence these were acted upon appropriately and timely.

People and relatives told us the management team were approachable with an ‘open door’ policy and that they knew how to raise concerns and were confidently these would be dealt with by the registered manager.

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

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 good (Published 4 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since the last inspection.

We undertook an unannounced focused inspection. This report covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Troc 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.

There was a registered manager in post who was available throughout the 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 at the service were protected from the risk of abuse as the staff were aware of their responsibilities in relation to keeping people safe. There were established procedures and protocols in place to guide staff should they suspect abuse, and the registered manager dealt with any safeguarding incidences thoroughly. The registered manager had processes in place to ensure learning from safeguarding incidents took place to reduce the risk of reoccurrence.

The risks to people’s safety were assessed, and measures to reduce risks were in place to protect people from harm. There were enough staff to meet the needs of the people at the service and the registered manager regularly reviewed staffing levels to ensure sufficient staff were available to support people. Safe recruitment practices were in place.

The management of people’s medicines was not always safe. However, following our inspection, the registered manager sent us information to show how they had addressed this. People were protected from the risks of cross infection as staff undertook safe practices in relation to infection prevention.

People’s needs were assessed using nationally recognised assessment tools and staff supporting people received adequate training to guide them in their roles.

People’s nutritional needs were well managed and people received diets appropriate to their needs. People’s health needs were supported by staff who worked with the relevant health professionals to manage this. People lived in an environment that met their needs.

Staff sought consent from people before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). 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 supported by a caring group of staff who listened to their views and ensured their choices and preferences were met. People received person centred individualised care. They were treated with dignity and respect, and staff supported their independence.

People were supported to join in with several social activities provided by the service. Their concerns and complaints were dealt with in line with the providers complaints policy.

People were supported at the end of their life by staff who were aware of their preferences and their needs and wishes were respected.

The service was well led, the registered manager was visible and supportive towards people, their relatives and the staff who worked at the service. The quality assurance systems in place were used effectively to monitor performance and quality of care. The registered manager responded positively to changes and used information to improve the service and care people received.

The service had a registered manager in place at the time of our inspection, however they were due to leave this role shortly. A new manager had been appointed who informed us they would be applying to become the 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.

People were supported by staff who might not follow the correct procedures to protect them. Risks to people’s health and safety were identified and action was taken when needed to reduce these. There were not always sufficient staff on duty to meet people’s needs. People received their medicines as prescribed and these were managed safely.

People were supported by staff who received appropriate training and supervision and had an understanding of people’s care needs. People were supported to make choices and decisions for themselves. People who might lack capacity to make certain decisions were assessed following the Metal Capacity Act (2005) and if needed decisions were made in their best interests.

People were provided with a nutritious diet which met their needs and were provided with any support they needed to ensure they had enough to eat and drink. Staff understood people’s healthcare needs and their role in supporting them with these.

People were cared for and supported by staff who respected them as individuals. Staff had caring relationships with people and respected their privacy and dignity. People were involved in planning and reviewing their own care and some people were supported by relatives in doing so.

People received individualised care and they were able to participate in meaningful interaction and activities. People knew how to raise any complaints or concerns they had and felt confident that these would be dealt with.

There was not enough time allowed for the service to be effectively audited and monitored. Staff worked well as a team and were supported with their work by the registered manager.

The service had a 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.

Risks to people’s health and safety were not always properly assessed and steps to mitigate risks had not always been taken. People and staff were left exposed to avoidable risks because measures were not always taken to ensure the building was safe. There were sufficient numbers of suitable staff, however they had not always been deployed effectively at busier times of day.

People felt safe living at the home and staff were aware of how to protect people from the risk of abuse. People received their medicines as prescribed.

Staff received training that was relevant to their role and felt well supported. However, staff did not always receive regular one to one supervision of their work. People did not always receive timely support to eat their meals but were provided with sufficient quantities of food and drink.

People received support from healthcare professionals, such as their GP, when needed. However, referrals to more specialist services had not always been made. People were asked for their consent and the Mental Capacity Act (2005) (MCA) was utilised in order to protect people who were not able to make their own decisions about the care they received.

There were positive relationships between staff and people who lived at the home. Staff responded in a caring way to alleviate distress. People were able to be involved in the planning and reviewing of their care and also made day to day decisions about what they wanted to do. People were treated with dignity and respect by staff and their right to privacy was upheld.

People were not always provided with person-centred care and their care plans were not always up to date. There was a range of activities available which people appeared to enjoy. Some people commented that they would like to go out of the home more. People knew how to complain and told us they felt comfortable approaching the registered manager.

The quality monitoring systems used did not always result in improvements to the service people received. Staff did not always maintain accurate records about the care they had provided.

There was an open and relaxed culture in the home and the registered manager led by example. People were asked for their opinion about the service they received and their suggestions were acted upon.

You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Equipment at the home had been well maintained and serviced regularly. A person who used the hoist told us, 'There are always two staff to hoist me, one cannot manage it. I am made as comfortable as I can be with straps under my legs. I have no complaints, I feel safe when they use it.' A staff member told us one person, 'Likes me to hold onto the (wheel)chair as she gets out, it makes her feel safe.'

Staff personnel records contained all the information required by the Health and Social Care Act, although we have pointed out to the provider that there was not a full previous work history for all staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us. "I am looked after very well, I couldn't be happier.' A relative told us, 'The care plans have improved a lot.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We spoke with one person who used the service who we had spoken with on a previous visit. The person told us, 'I am glad you have remembered to come and speak with me, the staff are a lot better now, it is nice to be looked after by someone who cares.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. A relative told us they had mentioned something had not been right for their relation and staff had responded promptly. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw the care planning process recorded what people felt they were able to do for themselves and what they felt they needed support to manage. A relative told us, 'The care plans have improved a lot.'

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities. A staff member said the home was run well. They said they thought communication had improved under the new manager. A staff member said they were encouraged to speak out and felt there was communication to and from management. One staff member said, 'The manager has always got time to listen to what we (staff) have got to say.'

Prior to our visit we reviewed all the information we had received from the provider including their action plan detailing how they would become compliant. During the visit we spoke with two people who used the service and three relatives and asked them for their views. We also spoke with two care workers, a senior care worker and the administrator. We looked at some of the records held in the service including the care files for three people. The manager was on leave so was unavailable to speak with on the day of the inspection, but we spoke with them on the telephone when they returned from leave.

We found the provider had made some of the improvements we required to become complaint and they were now complaint with outcomes two and 16. However we found they were still not compliant with outcome four and we set a further compliance action.

We found people did not give consent to their care and did not always receive care and support that met their needs. One person we asked if they had been involved in planning their care told us, 'I can't remember being asked.' A relative told us their relation had been, 'A bit bored today,' They went on to say, 'Some days are not too bad when there is something for them to do.'

We found people who used the service were protected from abuse. One person told us, 'I get nervous, but I feel I am safe here.' We found improvements were being made to ensure staff received the support and training they needed to carry out their duties.

We found the provider did not have effective systems in place to monitor the quality of the service and make any improvements needed.

One person told us they went out to various activities in the local community. They said, 'I get out a fair bit. It is fine as long as they (staff) know what time I am coming back.' Another person said, 'I lay the tables most days. I like doing it, I like to help.'

We saw a member of staff helping one person walk to the lounge from the breakfast table. They both sang together and the person clearly enjoyed the time the member of staff spent with them. Another person said they felt staff, 'Treat me with the upmost respect.'

People told us they were happy with the care and support they received. One person told us, 'They have been good to me, very good to me.'

A person who used a wheelchair told us they could move freely round the home. Another person said, 'Everywhere is kept looking lovely. It is very homely.'