Trinity Lodge is registered to provide accommodation and personal care for up to 40 people. The home provides a service for older people living with dementia. There were 37 people living at the home on the day of our inspection visit. The home was divided into three units, with a lounge, dining area and kitchenette on each unit.

We inspected Trinity Lodge on 1 December 2016. The inspection was unannounced. At our previous inspection in October 2014 the service was meeting the legal requirements.

There was a registered manager in post at the service. 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 registered manager was away from work at the time of this inspection. The home manager was deputising in their absence.

People, their relatives and staff said Trinity Lodge was a safe place to live. Staff understood their role in keeping people safe and for reporting concerns about abuse or poor practice within the home. There were systems and processes to protect people from risk of harm. These included a risk management process, a thorough staff recruitment procedure and an effective procedure for managing people’s medicines.

The managers understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had completed training in the MCA and understood how to support people to make decisions about their daily lives. Where people lacked capacity to make decisions about their care, decisions had been made in the person’s best interests.

People told us staff were friendly and caring. Throughout our visit staff showed people kindness and treated people with respect. People were treated as individuals and were encouraged to make choices about their care. Staff protected people’s privacy and dignity when providing care.

Staff had up to date information about people’s care and a good understanding of people’s needs and preferences. People’s care records contained individualised information about how people liked to receive their care.

There were enough suitably trained staff to keep people safe and to meet people’s needs. Staff received the training and support they needed to meet people’s needs effectively. All staff, whatever their position, had been trained to understand dementia so they could interact effectively with people living in the home.

People’s health needs were monitored and people were referred to healthcare professionals when a need was identified. There were processes to ensure people’s nutritional needs were met and people had enough to eat and drink during the day. Snacks were readily available to encourage people to eat.

Visitors were welcomed and relatives and friends could visit at any time. There were processes in place for people and relatives to express their views and opinions about the home. People and relatives told us they were listened to and were confident they could raise any concerns with staff and the managers.

People told us they were happy with their care and had no complaints about the service they received. People who lived at the home, relatives and staff said the home was well managed. There were systems in place to monitor the quality of the service. This was through feedback from people and their relatives, staff meetings and a programme of checks and audits.

We inspected Trinity Lodge on 8 October 2014 as an unannounced inspection.  At the last inspection on 3 April 2014 we found that there were two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. We found people were not protected against the risks associated with the administration of medicines. We also found the provider was not ensuring that persons employed were supported in receiving appropriate training and professional development. On this inspection we found the provider had made the necessary improvements and was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Trinity Lodge provides accommodation for up to 40 people who have a diagnosis of dementia.

There were 37 people living at Trinity Lodge when we inspected the service.

A requirement of the service’s registration is that they have a registered manager.  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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection, however they were not present during our inspection as they were on leave. We spoke with two care managers who were temporarily covering the registered manager’s responsibilities during their absence. We also spoke with the regional manager during our inspection.

We spent time in communal areas over the course of the day and saw interactions between people and staff were respectful, cheerful and kind. People told us they liked the staff. It was clear staff had a good understanding of people’s communication abilities and adapted their approach accordingly.

People told us they felt safe. There were sufficient staff to meet people’s needs. The managers and staff were knowledgeable about how to meet the needs of people in their care, and how to protect them from abuse.

There was a system in place to identify and manage risks, and staff were acting appropriately in response to identified risks.

Medicine administration was conducted safely. This meant people were protected from the risks associated with the administration of medicine.

Staff received suitable induction and training to meet the needs of people at the home. Staff  also received regular supervision meetings and appraisals which supported them in identifying training needs, and assisted managers to identify any areas of staff development. This meant people were being cared for by suitably supported and trained staff.

There were appropriate policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected.

We saw that some people who were at risk of poor food or fluid intake were not having their food and fluid intake monitored closely. We saw that recording on fluid and food intake charts was not consistent and have asked the provider to improve record maintenance in this area.

Everyone we spoke with told us staff were kind and caring. We found that people’s privacy and dignity was respected.

People and their relatives were involved in planning and agreeing their care. The care we observed matched the information on people’s care plans, which meant people were offered support that met their individual needs.

The manager took appropriate action to minimise the risks to people’s health and wellbeing, because appropriate risk assessments were in place and risks were being managed.

Where investigations had been required, for example in response to accidents, incidents or safeguarding alerts, the home had completed an investigation to learn from incidents and to improve the service. This demonstrated learning was taking place to minimise the risk of them happening again.

The manager had sent notifications to us appropriately about important events and incidents that occurred at the home. They were aware of their responsibilities in notifying regulatory bodies and authorities about important events at the home, and were acting accordingly.

Staff told us they were well supported by the wider organisation, and that support was available from the provider when required.

The provider completed a number of audits to monitor the service, and to drive forward improvements.

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.

We visited the service following information we had received about the standard of care provided. All of the people at the home had dementia but had differing care needs. We spent time in the lounge and dining areas observing people's experience. Most people stayed in their rooms during our visit.

There were not enough staff available at all times to meet the needs of people. There were only two care workers for up to fourteen people. Some people required more than one person to help them mobilise. This meant there was nobody to assist people in communal areas whilst staff were attending to people in their rooms.

We looked at the care records of five people in detail. Although risk assessments were in place we saw that in some cases they were not adequate enough to manage identified risks to people who used the service.

We saw that one member of staff was not always respectful towards people. We observed a member of staff use inappropriate language, “Good girl" to one person.

The staff training matrix showed not all care staff had completed safeguarding training. The matrix also showed a number of care staff had not completed yearly updates on manual handling, falls awareness, medication administration, and pressure ulcer care.

We observed one member of staff administering medication to a person. Whilst doing this the staff member left the open medication trolley unattended where they could not see it. This posed a risk to people who used the service.

We spoke with 11 of the 36 people using the service at the time of our inspection. We also spoke with the manager and five care staff.

All the people we spoke with said staff were polite and treated them with respect. People told us they got the care they needed. Their comments included,

“The people are nice...the food is ok. I get the help I need.”

“The lady that washes my clothes does a great job and she is my friend. She always comes to chat to me.”

We observed staff supporting people with their routines of daily living. People were treated respectfully. We saw staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We observed that staff were kind, caring and attentive towards people using the service.

People told us they felt safe living at Trinity Lodge. Records showed that staff received training and supervision to make sure people using the service were safeguarded from abuse.

We saw evidence that satisfactory pre-employment checks were made before staff started working with people who used the service.

We found that records relating to people’s care and running the service were accurately and securely maintained.

People using the service at Trinity Lodge have dementia care needs, which meant they might have difficulty engaging in complex conversations with us.

We spent time in one lounge closely observing people’s experience. We looked at their mood, how they spent their time and how staff interacted with them.

We saw that people were not left unattended for extended lengths of times. There was a staff presence in corridors and communal areas. We saw staff sitting and chatting with people when they were not involved in a task to meet a particular care need. People appeared to be comfortable in approaching staff with their requests and staff responded quickly.

One person told us, “The staff are very hard workers.” Another person said, “The staff are friendly. The best thing about living here is the companionship.”

We observed that staff treated people respectfully. The addressed people by their preferred names and they were discreet when asking about care needs. Staff gave sensitive explanations when they were helping people, speaking to them at a pace and level appropriate to their individual needs.

People told us they had some choice in how they spent their day. One person said, “I’m happy here. They help me choose what to wear in the mornings and they take me where I want to go."

We observed that staff treated people respectfully. The addressed people by their preferred names and they were discreet when asking about care needs. Staff gave sensitive explanations when they were helping people, speaking to them at a pace and level appropriate to their individual needs.

When we asked, “Do you feel safe here?” people using the service responded positively. No one expressed any concerns about their safety.