Archived: Trefoil House

Updated 2 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Trefoil House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with fourteen people who lived at the service about their experience of the care provided. We spoke with thirteen members of staff including the registered manager, regional manager, deputy manager, senior care workers, care workers and members of the housekeeping team.

We reviewed a range of records. This included recruitment documentation for staff and multiple medication records. We asked the registered manager to send us a range of records so that we could review these away from the care home. Records included care plans, risk assessments, accident and incident analysis, medication records and staff training and supervision documentation. Additionally, we requested some policies, the provider's statement of purpose and other records relating to the management and oversight of the service.

After the inspection

Following the visit, the inspection continued, and we reviewed the records which were sent to us. We received feedback from twelve relatives and five staff. We held a virtual call with the registered manager and regional manager. We also spoke with three healthcare professionals. Further clarification was sought from the registered manager so we could confirm the accuracy of the records provided.

Updated 2 October 2021

About the service

Trefoil House is a residential care home providing accommodation for older people, who may be living with dementia or a physical disability, who require nursing or personal care. At the time of inspection 48 people were living at the care home.

Trefoil House is split in to four different 'units' across two floors and can support up to 70 people. The building has been designed and adapted to support people living with dementia. Facilities, such as a hair dressing room and social communal areas are available.

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

Robust procedures to safeguard people from potential harm and abuse were not in place. The providers response to unexplained skin tears and bruises did not always identify their review, nor communication, with the local authority safeguarding team. This is the third inspection which has identified this shortfall.

Care plans and risk assessments were not always reflective of people’s needs. Records provided conflictive guidance to staff; and relatives told us they had not always been involved in the care planning process. People were not always involved in their care and robust care plan auditing did not take place.

Medication processes and administration records did not always follow the providers procedures nor best practice requirements. Medication access was not securely restricted, and security measures relating to the storage of controlled drugs was reduced.

Staff deployment was not always effective to meet the needs of people and mitigate risk. We identified concerns relating to staff moving and handling practices due to reduced staff availability.

Training provided to staff did not include regular dementia training updates. Staff had not completed training in key areas such as positive response to behaviour which may challenge, or end of life care.

The providers quality assurance and governance systems had not identified our findings and did not always drive continuous improvements. Actions from a local authority visit in April 2021 had not been completed, and we did not see evidence of clear provider-led timescales in place.

Despite this, people said they felt safe and relatives told us staff were caring. Staff spoke to people in a dignified and personalised manner, and they told us they took pride in their roles. The home was clean, fresh and inviting. The housekeeping staff were diligent in their duties and reported having ample provisions to ensure the cleanliness of the home.

We had mixed feedback relating to communication. Relatives and staff told us communication could be variable, and concerns were not always followed up. However, we saw several different communication methods during the inspection, and were told by some relatives that the registered manager had acted where shortfalls had been experienced.

Healthcare professionals told us staff were responsive to their advice, and followed their referral processes to ensure people had access to services. Several initiatives were planned at the care home to further increase support available, where a person may experience deteriorating health.

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 requires improvement (inspection undertaken 09 April 2019; inspection report published 07 May 2019). We had identified a continued breach of regulation 13 (Safeguarding service users from abuse or improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated as requires improvement and has been rated requires improvement for the last two consecutive inspections. We have identified further breaches of regulation which relate to safe care and treatment, staffing and good governance.

Why we inspected

We received anonymous concerns which related to safe staffing levels and the needs of people not being met. During our remote review of the service, we received further information which led us to enquire further about staffing levels and the needs of people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Having reviewed the information, we held about the care home, no areas of concern were identified in other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service remains as requires improvement. This is based on the findings at 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.

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 inspections, by selecting the ‘all reports’ link for Trefoil House on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in safeguarding people from harm and abuse, and further breaches relating to safe care and treatment, staffing, and good governance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.