Trinity Manor

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first inspection for this newly registered service. This key question has been rated as good. This meant the effectiveness of people’s care, treatment and support achieved good outcomes. Staff shared information between themselves and with other healthcare professionals to ensure people’s needs and preferences were met. Staff worked in accordance with the Mental Capacity Act 2005 and followed legislative requirements when restrictions in people’s care plans were required to keep them safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt their needs and wishes had been considered when their care was planned. People on the discharge to assess unit generally reflected an understanding of the assessment process to establish their future care pathway. One person expressed anxiety about the process; staff provided reassurance and explanation.

Staff told us they used information gathered on people's pre assessment to help them to meet people's preferences and needs when they first moved to the home. Staff told us they were supported to understand people’s changing needs through handover meetings and updated care plans and risk assessments. The deputy manager told us, "I lead on the admissions. I do all the pre-admission assessments. If it is D2A then it is based on the trusted assessor but if I have any concerns or queries, I will contact the wards directly. I do face to face assessments for all other placements."

Systems were in place to undertake an outline assessment of people’s needs prior to them receiving care at the home. The views of people, relatives and other health professionals were obtained when people’s needs were assessed. Assessment systems considered a wide range of areas of potential need. For example, health and mobility presentation, people’s staff gender and ambient temperature preferences, communication and nutritional support needs and risks. A process of ‘Resident of the Day’ had been introduced to ensure people's care plans were reviewed at least monthly and continued to reflect people's needs and preferences for their care delivery.

People did not raise any concerns to suggest they were delivered care against good practice guidance and felt their nutritional and hydration needs were met. We received positive comments about people’s weight gain since moving to Trinity Manor. One relative told us, “[Name] has put on weight, almost a stone, since they moved here from hospital.” Another relative commented, “[Name] was underweight when they went there but their weight has increased, and they give them food all the time.” People confirmed they always had a choice of meal and alternatives were available if they did not like either of the main options. Although some people told us they would prefer more traditional food, we saw people’s views were being sought when menus were developed. People were offered a choice of drinks, and these were placed near to them. However, several people and relatives did note what they considered to be the inappropriate drinking glasses and types of drinking cups being used. Most said there had been improvement recently with better suited drink receptacles being used for some people.

Staff told us they were kept up to date with changes to people’s nutritional support needs through daily meetings. Staff gave examples showing how they put their knowledge into use. This included fortifying people's meals, should they be experiencing weight loss. Staff told us people decided what meals they would like prepared for them. A member of catering staff told us, “We always have a vegetarian option, and have enough extra if people change their choice.” Catering staff explained how they worked flexibly to ensure people had access to meals and snacks when they wanted them. This helped to ensure people had enough to eat to remain well. A senior staff member advised us people were weighed regularly, so any concerns would be identified, and referrals made to GPs and the speech and language therapy team (SALT) for further support.

People’s needs were met through evidence-based treatment. The provider used recognised assessment tools to identify people’s risks in areas such as skin integrity and nutrition. There was evidence of where good practice guidance had been used to develop care plans to mitigate identified risks. Staff were given information on current guidance in supporting people’s individual risks and health needs through the display of information in staff areas within the home. Where people required a modified diet, this was recorded in their care plans and there was accessible information to alert staff to common allergens in food. However, the process to promptly communicate changes in people’s diets needed to be improved to ensure consistency of care and encourage people to drink enough to remain well.

People were referred to other healthcare professionals when needed. Processes ensured information about people was shared within the staff team.

Staff told us they were supported to provide good care to people through relationships built with other health professionals, such as GPs and advance nurse practitioners. A staff member gave an example showing how people and their relatives were supported when they wanted help from other agencies. This included arranging meetings between relatives and professionals, and by providing guidance on how to obtain support from other agencies. Staff told us they were kept informed about people’s needs through staff and handover meetings, and working together. One staff member said, “We have flash meetings every day and we also have a meeting with our manager, the deputy and the other unit manager, almost every day. We discuss the health and safety of the residents.”

Healthcare professionals told us information was available when they needed it and any requests to carry out monitoring checks were complied with. One healthcare professional told us, “I feel this is done when requested with blood pressures, blood sugars and other tests. I have never had any issues at all.” Another said, “They are quite responsible and responsive to those requests.” The provider used a form to share information about people with other healthcare professionals. One healthcare professional told us, "It is a good communication tool so changes to care plans don’t get missed.” However, another healthcare professional told us the tool was not used consistently and gave an example of when instructions had been given to make a change in a person's treatment, but it had not been done in a timely way. They said, "It did not seem to have been communicated or changed."

There were established links with the GP, advanced nurse practitioner and frailty nurse who all had a designated day each week to visit the home. This meant healthcare professionals could build up a knowledge of people and referrals to other healthcare professionals such as SALT or the occupational therapist could be completed without delay. However, systems to ensure advice given by health professionals was promptly and consistently embedded into care planning arrangements needed further development. There were effective systems to share information between the staff team.

People or their relatives could choose to make their own routine appointments with healthcare professionals such as dentists, opticians and chiropodists. Where people needed support from staff to make these appointments, this was provided.

Staff gave examples showing how the care provided had led to increases in people’s mobility and general health. Staff particularly referenced supporting people to undertake gentle exercise. One staff member told us, “We do seated exercise every day. It is very good for their core; you sit and lie in bed an awful lot as you get older, and you need to keep that core strength there. Exercise when you are not as mobile as you used to be is very important."

People were supported to maintain their health to support their physical and mental wellbeing. For example, people’s oral health was risk assessed and reviewed and information pulled through to a personal care plan. People were supported to undertake health assessments and checks where appropriate and necessary with external healthcare professionals to avoid deterioration to their health. Lifestyle co-ordinators supported people’s emotional health and physical well-being.

Conversations with people and their relatives demonstrated improvements in their outcomes and quality of life. One relative told us how their family member’s health had remained stable having been discharged to the home several months previously with a very poor prognosis. This relative explained, “[Name] is pretty stable, had no further illness, no breathlessness, there have been no catheter problems, they sleep well now, and they can talk well. Trinity Manor have kept them stable.” Another relative told us their family member’s health conditions were managed well as previously they had numerous hospital admissions. This relative told us, “Since [Name] has been at Trinity Manor, they have only been to hospital once and even then, they returned after 6 hours.” People in the home on a discharge to assess basis also spoke of positive outcomes. One person told us, “I am having some tests, I feel I am getting better, and my energy levels are improving. Hopefully I will be going home.” Another person said, “This is a much better place here. They are working towards me getting better, the other places were not right for me.”

Staff told us they checked people’s weights and regularly reviewed their medicines so they could be sure people were not experiencing pain. Senior staff told us how they monitored people’s daily records such as food and fluid charts to ensure positive outcomes for people. One staff member told us, "We check everyone is having enough fluids and there will be no dehydration and if everyone has had food. If someone is not drinking enough, we report to the seniors and the nurses." Another member of staff explained how nursing staff supported good practice in areas such as catheter care.

Through their quality assurance processes, the provider had identified monitoring tools in relation to people’s dietary and fluid intake, repositioning, bowel monitoring and catheter care had not always been completed accurately. In response, the provider had introduced twice daily checks by senior staff to ensure monitoring tools were completed accurately and used effectively to promote people’s outcomes. Although this continued to be a work in progress at the time of our visit, positive outcomes were evidenced in people’s records.

People were offered choices about where and how they spent their time. One person told us they chose to eat in a specific dining area because they preferred the atmosphere there. During our inspection, 1 person declined their medicines at the time they were offered. Their refusal was respected, and the nurse returned a short time later and offered them again. Nobody raised any concerns about a lack of choice or feeling compelled to do anything they did not want to do.

Staff gave examples showing how they promoted people’s choice and gained their consent before providing care. Staff understood some people may not be able to provide their consent verbally. Staff explained how they checked people's reactions to the care offered before proceeding. Staff told us if people declined care, they would respect this, but would provide an opportunity for them to reconsider their choice at a later stage. One staff member explained, “If someone refused personal care, we would leave the resident for some time and then go back again. If they continue to refuse, we ask a different person with a different approach. We would report and document it." Staff told us they regularly considered people’s capacity for specific decisions. One staff member said, “I do Mental Capacity Act assessments and apply for deprivation off liberty safeguards (DoLS) because you have to consider some of the restrictions such as locked doors we have here. If people don't have families, we may need to consider best interest decisions.” The staff member told us information on approved DoLS was communicated to care staff during handovers.

Care plans prompted staff to seek consent before delivering care to people and explained when they may need to act in people’s best interests. For example, in relation to supporting people with personal care. Where people had restrictions in their care plans and had been assessed as unable to make a decision for themselves, the provider followed the legislative requirements of the Mental Capacity Act 2005 and applied for a DoLS. Records were maintained of people’s power of attorney and whether for finance and/or health decisions. This ensured people with the legal right were involved in decision making.