Archived: Trinity House Care Centre

Trinity House Care Centre is a care home providing personal care and accommodation for up to 35 people. At the time of our inspection there were 12 people living at the home.

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

The provider’s systems and processes had failed to identify concerns that came to light during the inspection.

Closed circuit television (CCTV) had been put in place without people’s knowledge or consent. This meant people were not supported to have maximum choice and control of their lives and the policies and systems in the service did not support this practice.

Systems were not in place to analyse accidents or incidents to identify any trends or lessons to be learned. The provider’s own policies and procedures had not been reviewed to ensure they were fit for purpose for this part of their business. A dependency tool in place to assess staffing levels had failed to identify the need of an additional member of staff required on the morning shift.

Audits had failed to identify information was missing from a member of staffs file and the completion of fluid charts was not robust.

People felt safe in the company of staff who supported them. Where safeguarding concerns had been raised, they were reported and acted on appropriately. Risks to people were assessed and staff were provided with up to date information regarding people’s care needs.

People were supported to receive their medicines as prescribed and were protected from the spread of infection by the use of personal protective equipment [PPE].

Since the last inspection a compliance manager had been appointed and a number of improvements had been made to the service. This included ensuring people’s views were sought about their care and staff worked alongside other agencies in order to meet people’s care needs.

A number of quality audits had been introduced to assist the provider and manager to assess, monitor and improve the service. Staff, people and relatives spoke positively about the improvements that had been introduced since the last inspection. The manager was new in post and was in the process of induction which was aimed to provide them with the knowledge and skills required to drive improvement in the service.

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 (published 08 July 2022) and there were breaches of regulation. We issued a notice of proposal to impose positive conditions on the provider’s registration which meant the provider was required to submit monthly reports to us, outlining the progress made against the areas for improvement that were required. The provider appealed the notice of proposal, but their appeal was not upheld and a notice of decision to impose the conditions on the providers registration was issued on 10 November 2022.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations 12, 13 and 18. However, the provider remained in breach of regulation 17 and 11.

This service has been in Special Measures since 6 July 2022. During this inspection the provider demonstrated that improvements had been made. However, the service remains rated as inadequate overall as the domains of effective and responsive are rated inadequate and therefore the service will continue to be in Special Measures.

Why we inspected

We received a number of anonymous whistleblowing concerns in relation to the care provided by the service including allegations of physical and financial abuse. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same, based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. We found no evidence during this inspection that people were at risk of harm from these concerns.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified a continued breach in relation to regulation 17, good governance and regulation 11, consent.

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

Follow up

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

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Trinity House Care Centre is a care home providing personal and nursing care for up to 35 people. At the time of our inspection there were 21 people living at the home.

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

We were not assured the provider was keeping people safe. The provider had not always fully assessed the risks to people’s health, safety and welfare. We were not assured incidents and accidents involving people were consistently reported, recorded and investigated. People’s medicines were not always managed and administered safely. The provider had not fully protected people from the risk of abuse and improper treatment. The provider had failed to ensure there was a consistent and effective clinical oversight of the service.

People’s needs and choices had not always been appropriately assessed before they moved into the home to ensure effective outcomes of their care. We were not assured people's nutrition and hydration needs were being met. People were not always supported by staff who had the skills and knowledge to meet their needs. We were not assured the provider always liaised effectively with other agencies. The physical environment had not been adapted to take into consideration the needs to people living with dementia.

The provider was not working in line with the principles of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s care records did not always include information about their preferences, personal history or background. People were not always encouraged to be as independent as possible. People’s care records did not demonstrate people and their relatives were involved in decisions about the care provided. We observed staff treating people with kindness and compassion.

People did not have person-centred care plans in place to help staff ensure they received personalised care. Staff did not have clear written guidance on how to meet people’s individual needs and preferences. People were not supported to follow their interests or take part in meaningful activities. People’s information and communication needs had not been explored with them, recorded or communicated to staff to promote effective communication. People's end of life preferences had not been explored. The provider had a robust complaints procedure in place.

The provider had failed to implement effective systems to assess, monitor and improve the service. We were not assured the provider or manager understood their regulatory requirements. Records relating to people’s care were not always accurate, up-to-date or complete and some records were illegible. The provider had not actively sought the views of people, relatives, staff or visiting professionals. We were not assured the provider was acting in line with their responsibilities of the duty of candour. Staff we spoke with felt supported by the manager.

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

Rating at last inspection

This service was registered with us on 02 April 2020 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 18 November 2019.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, need for consent, safe care and treatment, safeguarding service users, meeting people's nutritional and hydration needs, good governance and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

We found the following examples of good practice.

The home had a portable ‘visitor pod’ under construction and had purchased a patio heater. This meant that people could maintain relationships safely by meeting with loved ones through a protective barrier.

A person who was unable to self-isolate was being cared for in a separate zone of the home. Therefore, this person was able to access areas such as a separate lounge and staff were able to control the spread of infection.

The home was using a traffic light system to label people’s doors with a coloured sticker. This meant that people’s COVID-19 status was clear to staff providing care but was displayed discretely.

Two members of the staff team had received intensive training in infection control with a view to sharing this knowledge with the wider staff team. Staff were observed wearing personal protective equipment in line with current guidance.

Further information is in the detailed findings below.