Archived: Trinity House Nursing Home

Updated 29 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 8 February and was unannounced. The inspection was completed by two inspectors.

This inspection was prompted in part, by concerns we had received from the local authority ‘adult quality team’, the clinical commissioning group and members of the public who had contacted us. Therefore, due to the timing of this inspection, we did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information we held about the home, including statutory notifications that the provider had sent us. A statutory notification provides information about important events which the provider is required to send us by law. We also contacted health and social care commissioners who place and monitor the care of people living in the home, to identify if they had any information which may support our inspection.

During our inspection we spoke with three people who lived at the home, four visitors/relatives, one chef, three care assistants, two nurses, the deputy manager and the acting manager. We also met with the providers.

We looked at care plan documentation relating to five people, and three staff files. We also looked at other information related to the running of and the quality of the service. This included quality assurance audits, training information for care staff, staff duty rotas, meeting minutes and arrangements for managing complaints.

Updated 29 March 2018

This inspection took place on 8 February and was unannounced. This was the first comprehensive inspection at this home and took place following a number of concerns that had been raised by a variety of sources to the CQC about care planning, the competence of staff and the safety of people within the home.

Trinity House Nursing Home is a nursing care home. People in care homes receive accommodation and nursing 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. Trinity House Nursing Home accommodates up to 23 people in one adapted building and at the time of the inspection had seven people living there.

The home is required to have a registered manager however at the time of the inspection they did not have one. 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.

Inadequate systems were in place to ensure the home provided high quality care for people. Auditing systems were irregular and were ineffective at highlighting all the areas that required improving. When audits had identified that improvements were required, there was a lack of action to make those changes in a timely way.

Feedback from people living at the home was not reviewed or acted on, and feedback from the local authority and clinical commissioning group had not effectively been actioned. The systems in place to improve people’s nutritional intake were ineffective. However this had not had a negative impact on people, and people at risk of malnutrition had sustained or improved their weight gain.

Staff did not receive adequate supervision or feedback about their performance and improvements were required to the training of staff. The provider had not taken effective action to ensure that all staff providing care were competent and skilled to do so. We found that staff had not received expected training before they were able to support people, and as a result we found evidence that people were not supported safely.

People’s care plans and risk assessments were insufficient and did not provide sufficient information to staff about what the risks were for each person, or how staff could reduce those risks.

There was a lack of knowledge about safeguarding procedures and how concerns should be reported and investigated. Accidents and incidents were not analysed or reviewed to identify if any learning could be made to prevent similar incidents from occurring and there had been a lack of action to ensure that the premises were safe and suitable for the people that lived within the home.

Improvements were required to ensure that people that lacked mental capacity to make decisions for themselves had decisions made about their care, in their best interests. Improvements were also required to ensure that all healthcare requirements were met, particularly those of a long term nature such as dental care.

Improvements were required to ensure people preferences were respected and they were able to wake up and get dressed when they wished. The provider also needed to ensure people had access to an independent advocate if they wished and that people’s independence was promoted and encouraged.

People’s care plans contained insufficient guidance for staff and further improvements were required to ensure information was current and reflected people’s current care needs. People were not given sufficient opportunity to communicate their end of life wishes, and people had limited opportunities to pursue their interests and activities.

Staff were recruited in an appropriate manner, and sufficient checks were completed on staff’s previous backgrounds. People were treated with kindness and staff had built positive relationships with people that helped them to feel comfortable within the home.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service therefore in ‘special measures’. Services in special measures 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.