At a previous unannounced comprehensive inspection of this service carried out on the 19 and 21 2017, we found breaches with regulatory requirements relating to Regulation 9 [Person centred care], Regulation 10 [Dignity and respect], Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 14 [Meeting nutritional and hydration needs], Regulation 17 [Good governance] and Regulation 18 [Staffing]. As a result of our concerns the Care Quality Commission took action in response to our findings by rating the service as ‘Inadequate,’ placing the service into ‘Special Measures’ and amending the provider’s conditions of registration.

A further focused inspection was undertaken on the 12 September 2017 and at that inspection we solely looked at the domains of ‘Safe’ and ‘Well-Led’. The quality rating of the service remained ‘Inadequate’.

Trippier House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 36 older people and people living with dementia.

Trippier House is a large detached building situated in a quiet residential area in Colchester and close to all amenities. The premises is set out on two floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor.

The Local Authority had placed a restriction on the service provision following our last inspection to the service in June 2017. This inspection was completed on the 30 April and 1 May 2018 and was unannounced. At the time of this inspection there were 15 people living at the service.

Since our last comprehensive inspection to the service in June 2017 and focused inspection in September 2017, a new manager had been appointed and had been in post at Trippier House since the 6 December 2017. The manager was registered with us on 16 April 2018. 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 overall rating for this service is ‘Requires Improvement.’ However, the service remains in ‘Special Measures.’ We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Improvements were noted since our last inspection. Risks to people’s safety and wellbeing had been assessed and recorded. Moving and handling practices by staff were safe. The deployment of staff within the service was now suitable to meet people’s needs. Staff responded promptly when people used their call alarm to summon staff assistance. People were positive about the care provided and no evidence of poor care practices by staff were witnessed during the inspection. The dining experience for people was much improved and people’s comments about meals provided were positive. Care plans had been reviewed and updated; and these now reflected people’s care and support needs; and the care to be delivered. Training statistics for staff had improved and training was now embedded in staffs’ everyday practice.

However, further improvements were required to the service’s quality assurance arrangements at both provider and service level as these were not as effective as they should be. Visits by the registered provider’s representative had not identified the issues found as part of this inspection. The culture of th

This was an unannounced and focused inspection carried out on 12 September 2017.

Trippier is a care home that provides accommodation and personal care for up to 36 older people who are vulnerable due to their age and frailty, and in some cases have specific and complex needs, including varying levels of dementia related needs and end of life. On the day of our inspection there were 21 people using the service.

We carried out an unannounced comprehensive inspection of Trippier on 19 and 21 June 2017, and we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was given an overall judgement rating of 'inadequate' and is therefore in Special Measures.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trippier on our website at www.cqc.org.uk

Services in Special Measures are 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.

The service had a registered manager in post but they were not present during this inspection. An acting manager was in position whilst the registered manager was on leave. 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.

Following the inspection in June 2017, we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do immediately to address them. An action plan was returned to us the following day. We took immediate enforcement action to restrict admissions, to ensure adequate staffing levels and to ensure that effective leadership and oversight was in place to mitigate the risk to people. This inspection was undertaken within the six months timescale because we received further information of concern from the local authority and whistle blowers which related to poor staffing levels and poor care. Because of this, we wanted to check that the enforcement action were had been taken was resulting in improvement.

This inspection focused on the areas of safe and well-led. At this inspection, we found that sufficient improvements had not been made since our last inspection on 19 and 21 June 2017 and the provider was continuing to fail to meet the requirements of the regulations, commonly referred to as The Fundamental Standards of Quality and Safety. These breaches had led to the continued failure to adequately care and protect people and exposed them to the risk of harm. The Commission is currently considering its enforcement powers.

This service will continue to be kept under review and, if needed, could be escalated to further urgent enforcement action. 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

The inspection took place on 19 and 21 June 2017. The inspection was prompted in part following information of serious concern received from the local authority and to check that the required improvements from our previous inspection on 11 and 16 November 2016 had been made. We found there had been a lack of oversight by the provider to ensure that the service delivered was of a good quality, safe and continued to improve. People’s safety and welfare were compromised because the provider did not have robust and effective quality monitoring processes to identify issues that presented a potential risk to people. Thorough risk assessments had not been carried out to identify risks in relation to people’s healthcare needs. People were not protected from the risks associated with environmental factors such as heat or ineffective cleaning systems.

Trippier is a care home that provides accommodation and personal care for up to 36 older people who are vulnerable due to their age and frailty, and in some cases have specific and complex needs, including varying levels of dementia related needs and end of life. On the day of our inspection there were 29 people using the service. This was an unannounced inspection.

There was a registered manager in post. 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 culture within the home did not promote a holistic approach to people's care to ensure that their physical, mental and emotional needs were being met. Robust and sustainable audit and monitoring systems were not in place to ensure that the quality of care was consistently assessed, monitored and improved. Quality assurance systems had failed to identify the issues we found during our inspection.

There was not an effective system in place to ensure there were sufficient numbers of staff on duty to support people and meet their needs. There were not enough staff to provide adequate supervision, nutritional support, stimulation and meaningful activity. This had a direct impact on people’s safety and welfare.

People’s care had not been co-ordinated or managed to ensure their specific needs were being met. Risks to people injuring themselves or others were not appropriately managed. People's medicines were not being managed effectively to protect them from the risks of not receiving prescribed medicines.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, they were not supporting people in a consistent and planned way. They did not always respond appropriately and in a timely manner to all of people's needs.

Care plans were incomplete, inconsistent and task led. They had not been updated to reflect people’s current care needs. Opportunities to participate in activities were limited and activities provided were not personalised or tailored to meet people’s level of ability, choice or preference.

Training for staff was not managed effectively. There were shortfalls in mandatory training and not all staff had received training in subject areas relevant to their role. Staff demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) However, this wasn’t always seen in practice. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

Staff were aware of their responsibilities with regard to safeguarding people from abuse. However some staff did not know the procedures for reporting concerns outside of the organisation to the professionals responsible for investig

We inspected this service on 10 November 2016 and the inspection was unannounced. We visited again on 16 November 2016 and this inspection day was announced. During our last inspection of this service on 10 January 2014 we found that the service was compliant.

Trippier can provide accommodation and personal care for up to 36 older people, some living with dementia. At the time of our inspection there were 35 people living at the service.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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.

There were not enough staff to support people safely. People told us that they felt rushed by the staff, we saw that they were on the go all day and did not have time to spend with people who told us that they spent a lot of time waiting for help. The manager was expected to spend a proportion of their work day supporting people with personal care, which had a detrimental effect on their management duties. There was no deputy manager to support the manager with their workload.

Medicines were managed and stored properly and safely so that people received them as the prescriber intended. However, the medicine records were not always audited properly making them vulnerable to going missing.

People told us that the food was well cooked and had enough to eat and drink to meet their needs. Staff assisted or prompted people with meals and fluids if they needed support. But mealtimes were not always a positive experience.

Care plans were not person centred, but staff showed an understanding to each person’s preferences and needs so that they could engage meaningfully with people on an individual basis. However, the service did not have dedicated activity staff and care staff were too stretched to be able give people the opportunity to take part in activities and pastimes that were tailored to their preferences and wishes. People told us they were bored and spent days when no activities were on offer. People living with dementia, who were not being supported or engaged by staff, and spent time walking around the service, sometimes appearing concerned, trying to initiate interactions with staff and visitors.

Individual staff treated people with warmth and compassion. However, the organisation did not reflect a caring attitude by not making sure that there was enough staff on duty to ensure that they were well looked after and that staff had time to interact with people properly to keep people engaged and fulfilled. Nor did the provider offer people an environment that was clean, attractively furnished and free from unpleasant smells.

The manager displayed good leadership; we found they displayed an open and positive culture. The staff told us that the manager was supportive and easy to talk to. The manager was responsible for monitoring the quality and safety of the service and was supported by the operations manager. There were management meetings with the provider and the providers visited the service regularly the check the quality of the service. They acknowledged the shortfalls of the service, but they had had not taken action to make the necessary improvements. For example taking action to increase staffing numbers, to improve the environment or ensuring there were appropriate staff employed to offer people meaningful activities to keep people engaged with their environment.

Staff knew what to do if they suspected someone may be being abused or harmed and because they had received training to help them recognises and understand the signs of abuse. They were respectful of people’s privacy and dignity.

Staff had received the training they needed to understand how to meet people’s needs, including dementia training. They understood the impo

We carried out this inspection to check that the provider hade made improvements to the environment following issues that we had identified during our inspection of 16 July 2013.

We did not speak with anyone who used the service on this occasion but noted that all the identified improvements had been made.

We visited the service on the 16 July 2013 to follow up concerns identified during an inspection on the 22 February 2013. The concerns were related to respecting and involving people who used the service. The manager sent us an action plan telling us how they were going to address the issues raised. During our inspection on the 16 July 2013 we did not identify any concerns related to people’s dignity. Staff provided care in a respectful and consultative way. Staff engaged with people appropriately and consulted with them about the service provided. We spoke with the senior team leader who was in charge on the day. We spoke with four staff, two visitors and twelve people using the service. We looked at three people’s care plans and observed lunch being provided.

The service was understaffed on the day of inspection by one member of staff. We saw that staff worked hard to ensure people’s needs were met and additional staff were available to help people with their lunch. We saw staff treat people with respect and were attentive to people’s needs.The care plans we inspected gave an in-depth analysis of care needs and daily records showed what care had been provided to ensure people’s needs were met.

Improvements had been made to the recording and administration of medication. In the month prior to our inspection this had been identified as a concern by staff who worked at the service and other health care professionals. We observed medicines being given safely and according to people’s needs and wishes.

There were systems in place to measure the quality of the service provided and what actions were being taken to improve the service as necessary. People were consulted about their care and how they wished it to be provided which meant the service met people’s individual needs.

We were unable to inspect all areas of the home due to infection control measures that were in place during our visit. However we gathered evidence of people’s experiences of the service during our inspection on 22 February 2013, by talking with ten people who lived at the home, relatives who were visiting, the manager and three staff and a visiting health care provider. People we spoke with told us they were happy living at Trippier.

People told us that they were able to choose what to eat from a menu each day and choose how to spend their day, which included the times they got up and went to bed.

Staff we spoke with told us about the training they had received to enable them to carry out their roles in supporting people. We saw records that evidenced a training plan for staff.

People who lived at the home and their relatives told us they were able to discuss any concerns with the manager, and that these were addressed in a reasonable time. The manager told us they held meetings with people who lived at the home to discuss future events and developments at the home.

Some of the information about people's experiences was gathered through talking with them as well as our observations. People who used the service told us that they were happy with their care at Trippier and the care workers were very kind. We saw that people enjoyed the food at lunchtime and the choices that were offered. The staff assisted people with eating their lunch in a relaxed, gentle and encouraging way.

One person with whom we spoke told us that they had a nice bedroom and it was always warm enough. Another said, "The rooms are quite nice really, I have all my bits and bobs around me especially pictures of my family."

Staff were not seen spending social time with individuals. Their interactions were task based, for example explaining what they doing or completing a manual handling task.

One person said, “They do as much as they can but there don’t seem to be enough of them, they are helpful and try to do a good job.”

One person with whom we spoke told us about the need for a piece of manual handling equipment to be fixed in order to increase their mobility.

We were told by various people who use the service that the home was clean, tidy and well presented.

People with whom we spoke told us that they enjoyed the food. One person said, "The food's good and we get a choice." Another person told us, "There is a good choice, enough of it and it is well cooked, I don’t have any complaints.”

One person with whom we spoke said, “The staff do care well for us here.” Another person with whom we spoke said, “The staff are friendly towards us.”

People told us that they were able choose their breakfast, when they get up and what to wear.