When we visited Trinity Lodge in October 2013 we found improvements were needed in five areas. These were, 'respecting and involving people in their care', 'care and welfare of people who use services', 'staffing arrangements', 'supporting workers', and 'safeguarding'. During this inspection we found some improvements had been made but additional improvement was needed. The inspection team who carried out this inspection was made up of two inspectors and an expert by experience. During the inspection the team worked together to answer five key questions; Is the service safe, effective, caring, responsive and well led?
We spoke with the registered manager, two care managers and a number of care staff. We also spoke with eight people who used the service or their relatives to find out what their experiences were like.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, the staff who supported them and from looking at records. If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We saw people were treated with respect and dignity by staff. People told us the staff were kind and friendly towards them and provided the care and support they needed. One person we spoke with told us, 'I feel safe, no-one has ever hurt me. The staff speak nicely to me; they never shout at me, they are very kind. If I was worried about anything, I would speak to my Carer."
The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.
We saw that since our last inspection staff numbers in the home had increased. We looked at the staff rotas which showed there were sufficient staff on duty to meet people's needs throughout the day. People received a consistent and safe level of support. Recruitment procedures were rigorous and thorough.
Safeguarding procedures were robust. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one.
Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to improve.
We checked whether people's medicines were being managed safely. This included checking if arrangements were in place to protect people against the risks associated with the unsafe management of medication. We found that areas of medicine management required further improvement. People did not always receive their prescribed medication. This posed a risk to people who used the service.
Is the service effective?
People's health and care needs were assessed with them or their relatives before they came to Trinity Lodge to determine their needs and make sure the service could meet them effectively. Specialist dietary, mobility and equipment needs had been identified in care plans where required.
We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate.
People had access to a range of health care professionals some of which visited the home.
It was clear from our observations and from speaking with staff they had a good understanding of people's care and support needs and that they knew them well.
Is the service caring?
We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived at Trinity Lodge.
People and relatives we spoke with were positive about the care provided by staff.
Is the service responsive?
People had access to a GP who regularly visited the home to treat people and respond to health concerns. We saw people were also able to access help and support from other health professionals such as dentists, occupational therapists and dieticians.
One person confirmed they were happy with the choice of food available to them. They said, 'The food is great, and it's lovely, we get a choice, it's hot every time'. People told us they could have a drink or snack when they wanted one. One person said, 'They give me lots of drinks, they come round a lot. I'm happy here, I'm quite happy. The food is nice; I eat it in my room'.
There was an advocacy service available if people needed it.
People told us, that they were able to participate in a range of activities both in the home and in the local community. The activities provided included ones people could enjoy as a group and others that meet their individual interests.
People who used the service, their relatives and other professionals involved with the service completed satisfaction surveys. Where shortfalls or concerns were raised these were analysed and addressed.
We looked at how complaints had been dealt with at the service and found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and dealt with in a timely way.
Is the service well-led?
The service had a quality assurance system in place to identify areas of improvement. Records seen by us showed that identified improvements were addressed promptly. As a result the quality of the service was continuously improving.
Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.
People's personal care records, and other records kept in the home, were accurate and complete.
The provider could not demonstrate that the staff employed to work at the home had the skills and experience needed to support the people who lived at Trinity Lodge. This was because the staff training matrix still showed some staff had not received mandatory training updates. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service. They said the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.