Archived: Trippier

A further focused inspection was undertaken on the 12 September 2017 and at that inspection we solely looked at the domains of ‘Safe’ and ‘Well-Led’. The quality rating of the service remained ‘Inadequate’.

Trippier House 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. The care home accommodates up to 36 older people and people living with dementia.

Trippier House is a large detached building situated in a quiet residential area in Colchester and close to all amenities. The premises is set out on two floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor.

The Local Authority had placed a restriction on the service provision following our last inspection to the service in June 2017. This inspection was completed on the 30 April and 1 May 2018 and was unannounced. At the time of this inspection there were 15 people living at the service.

Since our last comprehensive inspection to the service in June 2017 and focused inspection in September 2017, a new manager had been appointed and had been in post at Trippier House since the 6 December 2017. The manager was registered with us on 16 April 2018. 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 overall rating for this service is ‘Requires Improvement.’ However, the service remains in ‘Special Measures.’ We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Improvements were noted since our last inspection. Risks to people’s safety and wellbeing had been assessed and recorded. Moving and handling practices by staff were safe. The deployment of staff within the service was now suitable to meet people’s needs. Staff responded promptly when people used their call alarm to summon staff assistance. People were positive about the care provided and no evidence of poor care practices by staff were witnessed during the inspection. The dining experience for people was much improved and people’s comments about meals provided were positive. Care plans had been reviewed and updated; and these now reflected people’s care and support needs; and the care to be delivered. Training statistics for staff had improved and training was now embedded in staffs’ everyday practice.

However, further improvements were required to the service’s quality assurance arrangements at both provider and service level as these were not as effective as they should be. Visits by the registered provider’s representative had not identified the issues found as part of this inspection. The culture of the service was not open and transparent. There was evidence to show staff that raise concerns were not always supported and the issues raised taken seriously.

The Care Quality Commission had not been notified of all safeguarding concerns. Improvements were required to ensure investigations were robust as these had either not been undertaken or were incomplete and provided little evidence as to how outcomes had been reached. Reporting of accidents and incidents was inconsistent and not all complaints had been investigated and actions taken.

The registered provider’s arrangements to determine the service’s staffing levels remained contradictory and ineffective. Where staff had been promoted to a more senior role, staff had not received an induction to their new designated role. However, our observation at the time of the inspection showed the deployment of staff at Trippier House was appropriate and people told us there was enough staff around to care for them effectively.

Care plans now covered all aspects of a person’s individual care and support needs and risks to people were clearly identified and managed to prevent people from receiving unsafe care and support. People’s healthcare needs were met and people had access to a range of healthcare services. People received their prescribed medication and staff’s practice was safe. Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Suitable arrangements had been made to ensure that people’s rights and liberties were not restricted and people’s capacity to make day-to-day decisions had been considered and assessed.

Recruitment practices were safe. Staff received appropriate training and this was now embedded in their everyday practice. Newly employed staff received a robust induction and formal supervision arrangements were in place and staff confirmed they felt supported by the registered manager. People were able to participate in a range activities that met their social care needs and preferences. Staff had a good relationship with the people they supported. People were supported to maintain their independence where appropriate and had their privacy respected. The dining experience for people was positive and people had their nutritional and hydration needs met.

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

Trippier is a care home that provides accommodation and personal care for up to 36 older people who are vulnerable due to their age and frailty, and in some cases have specific and complex needs, including varying levels of dementia related needs and end of life. On the day of our inspection there were 21 people using the service.

We carried out an unannounced comprehensive inspection of Trippier on 19 and 21 June 2017, and we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was given an overall judgement rating of 'inadequate' and is therefore in Special Measures.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trippier on our website at www.cqc.org.uk

Services in Special Measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service had a registered manager in post but they were not present during this inspection. An acting manager was in position whilst the registered manager was on leave. 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.

Following the inspection in June 2017, we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do immediately to address them. An action plan was returned to us the following day. We took immediate enforcement action to restrict admissions, to ensure adequate staffing levels and to ensure that effective leadership and oversight was in place to mitigate the risk to people. This inspection was undertaken within the six months timescale because we received further information of concern from the local authority and whistle blowers which related to poor staffing levels and poor care. Because of this, we wanted to check that the enforcement action were had been taken was resulting in improvement.

This inspection focused on the areas of safe and well-led. At this inspection, we found that sufficient improvements had not been made since our last inspection on 19 and 21 June 2017 and the provider was continuing to fail to meet the requirements of the regulations, commonly referred to as The Fundamental Standards of Quality and Safety. These breaches had led to the continued failure to adequately care and protect people and exposed them to the risk of harm. The Commission is currently considering its enforcement powers.

This service will continue to be kept under review and, if needed, could be escalated to further urgent enforcement action. Another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Trippier is a care home that provides accommodation and personal care for up to 36 older people who are vulnerable due to their age and frailty, and in some cases have specific and complex needs, including varying levels of dementia related needs and end of life. On the day of our inspection there were 29 people using the service. This was an unannounced inspection.

There was a registered manager in post. 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 culture within the home did not promote a holistic approach to people's care to ensure that their physical, mental and emotional needs were being met. Robust and sustainable audit and monitoring systems were not in place to ensure that the quality of care was consistently assessed, monitored and improved. Quality assurance systems had failed to identify the issues we found during our inspection.

There was not an effective system in place to ensure there were sufficient numbers of staff on duty to support people and meet their needs. There were not enough staff to provide adequate supervision, nutritional support, stimulation and meaningful activity. This had a direct impact on people’s safety and welfare.

People’s care had not been co-ordinated or managed to ensure their specific needs were being met. Risks to people injuring themselves or others were not appropriately managed. People's medicines were not being managed effectively to protect them from the risks of not receiving prescribed medicines.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, they were not supporting people in a consistent and planned way. They did not always respond appropriately and in a timely manner to all of people's needs.

Care plans were incomplete, inconsistent and task led. They had not been updated to reflect people’s current care needs. Opportunities to participate in activities were limited and activities provided were not personalised or tailored to meet people’s level of ability, choice or preference.

Training for staff was not managed effectively. There were shortfalls in mandatory training and not all staff had received training in subject areas relevant to their role. Staff demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) However, this wasn’t always seen in practice. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

Staff were aware of their responsibilities with regard to safeguarding people from abuse. However some staff did not know the procedures for reporting concerns outside of the organisation to the professionals responsible for investigating abuse. Staff did not recognise or understand the wider aspects of safeguarding people from risk as identified in this report.

Following this inspection we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us how they would address the concerns and an action plan was returned to us the following day. We also shared our concerns with the local authority and their safeguarding team. We took immediate enforcement action to restrict admissions and force improvement.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Commission is considering its enforcement powers.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Trippier can provide accommodation and personal care for up to 36 older people, some living with dementia. At the time of our inspection there were 35 people living at the service.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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.

There were not enough staff to support people safely. People told us that they felt rushed by the staff, we saw that they were on the go all day and did not have time to spend with people who told us that they spent a lot of time waiting for help. The manager was expected to spend a proportion of their work day supporting people with personal care, which had a detrimental effect on their management duties. There was no deputy manager to support the manager with their workload.

Medicines were managed and stored properly and safely so that people received them as the prescriber intended. However, the medicine records were not always audited properly making them vulnerable to going missing.

People told us that the food was well cooked and had enough to eat and drink to meet their needs. Staff assisted or prompted people with meals and fluids if they needed support. But mealtimes were not always a positive experience.

Care plans were not person centred, but staff showed an understanding to each person’s preferences and needs so that they could engage meaningfully with people on an individual basis. However, the service did not have dedicated activity staff and care staff were too stretched to be able give people the opportunity to take part in activities and pastimes that were tailored to their preferences and wishes. People told us they were bored and spent days when no activities were on offer. People living with dementia, who were not being supported or engaged by staff, and spent time walking around the service, sometimes appearing concerned, trying to initiate interactions with staff and visitors.

Individual staff treated people with warmth and compassion. However, the organisation did not reflect a caring attitude by not making sure that there was enough staff on duty to ensure that they were well looked after and that staff had time to interact with people properly to keep people engaged and fulfilled. Nor did the provider offer people an environment that was clean, attractively furnished and free from unpleasant smells.

The manager displayed good leadership; we found they displayed an open and positive culture. The staff told us that the manager was supportive and easy to talk to. The manager was responsible for monitoring the quality and safety of the service and was supported by the operations manager. There were management meetings with the provider and the providers visited the service regularly the check the quality of the service. They acknowledged the shortfalls of the service, but they had had not taken action to make the necessary improvements. For example taking action to increase staffing numbers, to improve the environment or ensuring there were appropriate staff employed to offer people meaningful activities to keep people engaged with their environment.

Staff knew what to do if they suspected someone may be being abused or harmed and because they had received training to help them recognises and understand the signs of abuse. They were respectful of people’s privacy and dignity.

Staff had received the training they needed to understand how to meet people’s needs, including dementia training. They understood the importance of gaining consent from people before delivering their care or treatment. Where people were not able to give informed consent, staff and the manager ensured their rights were protected. Staff were clear about their roles and recruitment practices were robust in contributing to protecting people from staff who were unsuitable to work within the care profession.

Staff also made sure that people who became unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff understood the importance of responding to and resolving concerns if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that their complaints were addressed by the manager.

We did not speak with anyone who used the service on this occasion but noted that all the identified improvements had been made.

The service was understaffed on the day of inspection by one member of staff. We saw that staff worked hard to ensure people's needs were met and additional staff were available to help people with their lunch. We saw staff treat people with respect and were attentive to people's needs.The care plans we inspected gave an in-depth analysis of care needs and daily records showed what care had been provided to ensure people's needs were met.

Improvements had been made to the recording and administration of medication. In the month prior to our inspection this had been identified as a concern by staff who worked at the service and other health care professionals. We observed medicines being given safely and according to people's needs and wishes.

There were systems in place to measure the quality of the service provided and what actions were being taken to improve the service as necessary. People were consulted about their care and how they wished it to be provided which meant the service met people's individual needs.

People told us that they were able to choose what to eat from a menu each day and choose how to spend their day, which included the times they got up and went to bed.

Staff we spoke with told us about the training they had received to enable them to carry out their roles in supporting people. We saw records that evidenced a training plan for staff.

People who lived at the home and their relatives told us they were able to discuss any concerns with the manager, and that these were addressed in a reasonable time. The manager told us they held meetings with people who lived at the home to discuss future events and developments at the home.