Trinity Manor

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people’s needs. This is the first inspection for this newly registered service. This key question has been rated good. This meant people’s needs were met. Care plans provided staff with enough guidance to provide the individual care people wanted. The provider had processes to support equity in people’s experiences and outcomes and ensure people were able to engage with other healthcare professionals and agencies when they needed to.

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 and their relatives reflected an increase in the number of permanent staff. This meant staff had more opportunities to build their knowledge of individual people and provide more person-centred care. One relative described a personal situation for their family member which was impacting on their wellbeing. They explained how a member of staff had sought guidance about how they should respond when the subject was raised. The relative described the positive impact this person-centred approach had on their family member. Another relative described the person-centred approach demonstrated by the manager and explained, “The manager spoke with [Name] and found he liked films and discussed what type of films he liked and arranged for him to go to the cinema and have a film night with other likeminded residents.”

Staff told us they felt people’s care plans gave them enough guidance to provide the individual care people wanted. Staff gave examples showing how people’s care had been tailored to meet their individual needs and preferences. One staff member told us a person had asked for a key so they could lock their bedroom door, and this had been actioned. Another staff member explained how they had worked with 1 person, so they could have their creams applied in the way they preferred. Staff told us they found out about people’s care preferences by talking to them. One staff member gave an example of how they used their native language to communicate with 1 person living at the home who was distressed. The person expressed a wish to receive spiritual guidance from a priest from their own country. The staff member located a priest who subsequently visited the person to provide spiritual comfort. A senior staff member told us they were proudest of the person-centred care people received. The staff member told us, “The company know each resident is different, they like different times to get up, they have different preferences. This needs to be reflected in the care plan and staff need to know this.” Another member of staff explained, “The residents are happy with our own (permanent) staff and the person-centred care we provide is continuous."

Staff understood and responded to people's anxieties, speaking reassuringly with them. For example, 1 person was unsure of where they should be in the home, a staff member quickly supported the person to prevent their distress. The person responded positively to the staff member’s reassurance.

Care was flexible to people's needs and preferences to support continuity of care. For example, some people chose to maintain their previous healthcare professionals when they moved to Trinity Manor.

The provider’s operations director explained how they looked to the local community to identify gaps in care provision they could potentially fill. This had resulted in the opening of the second floor at Trinity Manor for discharge to assess beds to support the ongoing care of people who no longer required treatment in hospital.

Healthcare professionals were positive about the provider’s understanding of the care needs of the community and the provision of the discharge to assess beds to support people’s transition from the acute sector.

The provider worked with other healthcare professionals to develop systems that were co-ordinated and responsive.

Staff were aware of people who may have issues with their hearing or their sight and communicated with them in a way they could understand. The menu for the day was available but was in noticeably small sized print and not pictorial. People would have benefited from more accessible information to help them remember their menu choices which had been made the day before.

Staff confirmed people currently residing permanently at the home did not require diverse or bespoke communication methods. However, a senior member of staff told us 1 person who came for respite stays brought their own communication cards to use with staff. Some people did enjoy and benefit from sensory objects, which helped them to feel more secure.

Processes were in place to consider if people needed support to meet their communication needs. These also referenced the impact of people’s sensory needs. Where people had fluctuating ability to tell staff what care they wanted, care planning systems guided staff to check for non-verbal signals from people. Communal areas had hearing loops to support people with hearing aids.

Feedback from people and relatives indicated a more robust process had recently been implemented to ensure their views had been sought and incorporated into people’s care plans. Comments included: “Yes, we were involved a bit in the original care plan, and I believe we are going to have someone contact us when they update it” and “We haven’t been part of his care plan and there was no meeting with us to discuss it but in the last few weeks we have had phone calls a few times asking us to come and discuss [Name’s] plan.” People told us they could share their views about the service in regular ‘residents’ meetings’. One person said, “I did ask if we could have the options of jacket potatoes and omelettes and that is now part of the menu.” Another person said, “I have got exactly what I want here. We do have residents’ meetings where you can raise any issues.” Relatives expressed confidence in raising issues and felt the new manager had a proactive approach to seeking their views and opinions. One relative said, “The manager always looks for our views and seeks to know how she could improve matters and always tries to answer any awkward questions we may have.” Another relative commented, “I am confident my voice would be heard. I have never had to write to complain, any issue has always been dealt with promptly.”

Staff gave examples showing how people's wishes and individual preferences were identified and incorporated into their day-to-day care. For example, catering staff explained 1 person had expressed a wish for more salad options. We saw menu options had been diversified in response to this. Catering staff also sought people’s views on the menu options they would like through discussion at the end of meal service and as part of “Resident of the Day”. Care staff told us they involved people in day-to-day decisions about their care. This included where they wanted to spend their time, what they wanted to wear and what activities they may wish to do. One staff member explained how they showed objects such as items of clothing for people to choose from, if people were not able to verbalise their preferences.

The provider had processes to gather feedback and involve people in planning their care. This was through care reviews, meetings, suggestions and a formal complaints process. We found the management of complaints needed to be improved to ensure a robust audit trail and that the provider’s complaints policy had been followed. Where people’s complaints had been responded to, there was limited information about how and where they could escalate their concerns if they were not happy with the outcome.

Relatives told us staff supported their family members to access other healthcare professionals for guidance and advice. One relative told us, “The GP for the home is very good. We are meeting him here this afternoon. [Staff member] has organised this meeting.” Another relative explained how staff had supported them to prepare for meetings with other agencies to review and consider their family member’s future care pathway. They told us, “[Staff member] was very helpful with his preparation for CHC (continuing health care) and came to the assessment meeting.”

Staff explained how they used a recognised tool to assess people to identify any deterioration in their health. They told us this meant people who could not verbally express their pain or discomfort, could be referred to other healthcare professionals as needed.

Healthcare professionals told us they had regular weekly ward rounds at the home which meant people were able to access care, treatment and support when they needed to. Some healthcare professionals shared that sometimes matters were escalated without some basic clinical checks having been carried out. However, they recognised processes were being introduced to improve this aspect of clinical management. One healthcare professional commented, “I have noticed in recent times they have recruited nursing staff who are putting more processes into place.” Another told us, “I think Trinity Manor has gone through huge changes and currently I feel they escalate concerns sensibly and in a timely manner to myself and our team who are often at Trinity Manor.”

People's health was monitored to identify when they needed referral to other healthcare professionals. Care plans contained information about how those people who may not be able to express their pain verbally, demonstrated an increase in their pain levels. Care plans also informed staff what signs could indicate a deterioration in health associated with specific health conditions.

People and their relatives did not raise any concerns in relation to this quality statement. We were given examples of where people’s wishes for their outcomes had been achieved with the support of staff. For example, one person who had been cared for in bed had expressed a wish to be able to mobilise again. With the correct pain management regime in place, the person was now able to mobilise with a walking frame. A relative told us how their family member was now able to get out of bed for an hour each day after being cared for in bed when they arrived at the home. They explained how this outcome had a positive impact on the person’s day.

The manager told us most people could express their wishes or had families who could support them to explain the outcomes they wished to achieve. They told us where a need was identified, they would refer people to advocates to ensure their wishes were known and what they expected from the care provided. The told us, "We have a person upstairs who has no family. I got in contact with the social worker to say someone needs to look after them. Social services got them an advocate."

The provider had processes to support equity in people’s experiences and outcomes. People had communication care plans, so staff understood how to support people to share the outcomes they wanted to achieve. More robust processes were being introduced to enable those closest to people to engage in developing people’s care plans to ensure they reflected people’s preferences and expectations.

Relatives spoke positively about the standards of care when people were very poorly or in receipt of palliative care. One relative told us how their family member had remained stable at Trinity Manor despite being given a poor prognosis. A visiting healthcare professional told us, “I have seen some really good examples of end-of-life care. People look comfortable and well cared for." We saw the service had received compliments for their end-of-life care, one of which stated, “We will never forget how kind and supportive you were, and your dedication helped us during [Name’s] final days in ensuring both her and our care needs were met."

Staff told us they were encouraged to consider people’s end of life wishes and discussed the best ways for this to be achieved. One staff member said, “Senior staff do talk to us about end-of-life care, such as skin care and repositioning people. There are lots of checks on those on end-of-life care.” Another staff member gave us examples of improvement in people’s health and wellbeing because of the quality of care provided to people in receipt of end-of-life care. The staff member said, “[Name] is still poorly but much better and now sitting out in a chair, getting out of bed. The family are so thankful to us.” Another staff member explained the importance of providing good care in people’s final days, "Because it is the last thing you do for them, it is probably one of the most important things you can do for them and for their families, it is their lasting memory."

People's care plans included the Recommended Summary Plan for Emergency Care and Treatment form (ReSPECT). This plan provides clinicians with information about whether attempts at resuscitation should be undertaken for the person and their preferences for where their care should be delivered should they become unwell. Some information was recorded about people’s wishes for their end-of-life care, but we found further holistic information would ensure people spent their final days as they wished to. Arrangements were in place for training to be delivered by a local hospice to support the provision of end-of-life care. The training was planned to be delivered over 2 days to clinical and senior care staff.