Background to this inspection
Updated
31 January 2023
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 Health and Social Care Act 2008.
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
The inspection was carried out by 2 two inspectors.
Service and service type
Trinity House Care Centre is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Trinity House Care Centre is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. A new manager had been in post for 6 weeks and had submitted an application to register. We are currently assessing this application.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
During the inspection we spoke with 2 people who lived in the home and 6 relatives. We also spoke with 9 members of staff including the manager, the compliance manager, the head of quality and compliance, the nominated individual, team leaders, care staff, the staff trainer and the cook. The nominated individual is responsible for supervising the management of the service on behalf of the provider-.We also spoke with 1 visiting health care professional. We reviewed a range of records including 7 people’s care records and 3 people’s medication records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
Updated
31 January 2023
About the service
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.