Care Home: Trinity Court Nursing Home

What the care home does well The manager and staff continue to provide very good care to people living in the home. The home is safe, clean and is well maintained for the residents who live there. Comments from surveys were as follows "Trinity Court service is excellent in all areas, staff are kind and work very hard", "choice of lunch is very good" and "regular meetings between management, friends and relatives is very good". Residents spoke positively about the care received with comments such as " I am very pleased with the care service` and ` I visit my relative very regularly and always find a friendly and homely atmosphere. Comments in surveys as to what the home did well included `always kind and tolerant to the residents, and `whenever we have had to make arrangements for our fathers care in the past we have had to work hard to ensure he is well looked after. In Trinity court we feel he naturally gets the care he needs so we ourselves feel less pressured` and The home is always clean and tidy and my relative is well cared for clean and enjoys his food.` A wide range of activities are offered which takes into account peoples interests and individual needs. What has improved since the last inspection? There is better communication at all levels in the home with people seeing themselves more as a team whatever position they are. Care plans are reviewed monthly with staff taking more responsibility for their key clients and meeting their needs. Better monitoring of staff training and co-ordination of the homes induction program. Files and filing `systems` are better organised making it easier to access current records. What the care home could do better: No requirements or recommendations were made following this inspection Inspecting for better lives Key inspection report Care homes for older people Name: Address: Trinity Court Nursing Home 165-167 Trinity Road Tooting London SW17 7HL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Davina McLaverty     Date: 0 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Trinity Court Nursing Home 165-167 Trinity Road Tooting London SW17 7HL 02087678767 02086823280 azimjivraj@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Newslease Limited care home 50 Number of places (if applicable): Under 65 Over 65 11 1 50 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 5 0 The Home can admit one named service user under the age of 65 years. The category of MD(E) is for one named service user for the duration of their residence in the home. The service user category Mental Disorder (MD) is for 5 service users between the ages 55 - 65 years. Date of last inspection Brief description of the care home Trinity Court is situated on the main A214 Trinity Road, between Wandsworth and Tooting. Nursing care is provided for fifty residents, eleven of whom may have dementia. Accommodation is provided over three floors. There are forty-eight single rooms and one double room. The home has one passenger lift and recently completed building works provide a fifty Care Homes for Older People Page 4 of 26 Brief description of the care home bed home with improved and enlarged communal space. The home has a large level garden, which can be accessed from the lounge area. There is also a wooden patio at the rear of the building with garden tables and chairs. This area is used for barbeques etc. The gardens are well maintained with flowers and lawn area. Parking facilities are available at the front and rear of the building. The home is easily accessible for everyone including wheelchair users. Fees range form #610 -#800 per week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: One inspector and one regulation manager carried out this unannounced inspection. A number of records relating to staff training and recruitment, care documentation, health and safety and medication records were examined. Discussion during the site visit which lasted five hours, took place with the Acting Manager, proprietor , secretary and various staff,residents and relatives. All were helpful, knowledgeable which helped the inspection take place smoothly. Surveys were left with the homes manager to distribute to staff, residents, and health care professionals involved with the service. Thirteen surveys were received at the time of writing this report. No concerns were raised and some of the comments received are included in the report. Care Homes for Older People Page 6 of 26 Prior to the inspection being carried out the home as required, had submitted their annual quality assurance assessment (AQAA) questionnaire, which has been used to help formulate some of the judgements, detailed in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information and opportunities to visit to help them make a decision about moving to the home. They have their needs assessed to make sure the home is the right place for them. Evidence: A current Statement of Purpose and Service User Guide is in place to ensure that people have all the information they need to help them make their choice. Prospective residents and their relatives are also encouraged to visit to assess the quality, facilities and suitability of the home. Admissions are not made to the home until a full needs assessment has been undertaken. Four assessment reports were looked at which confirmed that the assessments are Care Homes for Older People Page 10 of 26 Evidence: conducted professionally and sensitively and has involved the family or representative of the person. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have an individualize plan of care, which is subject to regular review in order, to ensure that their assessed health and social care needs remain met. The home works to an efficient medication policy supported by policies and procedures and practice guidance. Evidence: The AQAA states that there has been heavy investment in the home over the last two years and the quality and integrity of additional facilities and services is monitored, maintained and is in continuous development. We have continued to improve the care plan design, implication and recording and invested heavily in staff training, particularly the areas of Dementia and challenging behavior. We have employed a training sister and we employed a qualified psychiatric nurse. A sample of six care plans were examined. Care plans were noted to lead from identified care needs in the assessments. Care plans were seen to contain appropriate information including photograph, date of admission, next of kin and some life story information including Care Homes for Older People Page 12 of 26 Evidence: hobbies and interests. Each resident on admission is allocated a named nurse and key worker who is identified in the plan. Key workers will build up a special relationship with residents and work on a one to one basis with the person. Specific care plans were in place, where necessary in areas identified at assessment such as skin integrity, continence and risk of falls. Residents/next of kin were involved in their care plans and risk assessments. We saw that the Care plans/risk assessments are updated monthly. A range of pressure relieving equipment in in use throughout the home and care plans contained evidence of regular monitoring of skin integrity and body weight particularly where this is in issue for the person. Wound care is well managed with both documentary and photographic evidence available. The home receives regular visits from other health care professionals eg GP and chiropodist. A GP visits the home twice a week and we were told that the surgery responds well to requests for further home visits. Care staff were observed to be treating residents with respect, and maintained their dignity. All residents spoken to said that the staff were kind and caring. Residents medication are administered, handled and stored in a safe manner, which protects residents from risk of receiving incorrect medication. Staff have worked hard to ensure that there is a clear audit trail of medication into and out of the home. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to to participate in an extensive range of activities , which suit their individual needs. They are encouraged to maintain contact with their families and friends,who are made to feel welcome in the home. Food is considered to be highly important and meal times considered a social occasion. The chef is an important member of the care team and is well aware of the recorded dietary and cultural needs of each resident. Evidence: There is a comprehensive and extensive activity program in the home which residents have contributed to. On the day of the inspection a violinist played for an hour, which residents throughly enjoyed. Also approximately fifteen residents participated in an arts and craft session. An activities person is employed 10-5 daily. The home also employs an aromatherapist who visit weekly as well as a pianist who also comes weekly. Inspectors saw various photographs displayed on the walls of visiting entertainers/ events and outings that had been arranged. The local library supplies books and religious representatives visit regularly. Care Homes for Older People Page 14 of 26 Evidence: Two surveys received, which had been completed by relatives said that they would like to see more activities for their relatives eg provide more physical activity for my mother to take part in and more activities or something different to having a TV on all day. In discussion with the proprietor and staff members we felt that the home exceeds in activities. The proprietor also stated that residents wishes always have to be considered and whilst people are encouraged, activities are never compulsory. Residents spoken with confirmed that they are supported to make choices within their daily lives and their friend and relatives are always made welcome when they visit. A visiting relative confirmed this and said that they could not fault the home. Lunch was observed. The atmosphere was calm and relaxed, a significant feature throughout the site visit. Tables were attractively laid and condiments available. Refreshments were available throughout the day. Staff reported that the chef continues to work hard with his team to make sure that residents dietary and cultural needs are met and residents are consulted on choice of menu. Residents had a choice as to where they sat and could have lunch if their rooms if they wished. For some residents due to their needs, staff supported them in their rooms. Surveys confirmed that people enjoyed the meals at the home. One person stated tat the meals are always well prepare and punctual. The AQAA states we are further developing our activities and menus to reflect the composition of the residents at our home.We are developing Polish dishes to reflect the composition of our residents, our staff and our residents are drawn from approximately the same catchment area and we are aware of the need, as far as possible, to match our staffing mix to the mix of our residents. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to ensure the protection and safety of residents and the staff have had training in these. Evidence: There is a complaints procedure which is displayed in the home. Residents are also given a copy when they move into the home. From discussion with staff they are aware of the procedure and steps to be taken however they state that they would endeavor to resolve any issue before it becomes e a formal complaint. There has been no complaints made since the last inspection. Surveys confirm that people know how to make a complaint . One person in their survey said if we have any small concerns the staff react immediately and remedy any issues. The organisation has procedures for protection of Vulnerable adults and whistle blowing. There is also a copy of the local authority safeguarding procedure and poster relating to safeguarding are on display in the home. Since the last inspection there has been no safeguarding investigations. Staff spoken to were knowledgeable about the actions that should be taken if abuse was observed or suspected. The AQAA states that the home plans over the next 12 months to implement wider distribution of adult protection procedures and complaint handling documentation. To improve in house display and developing the suggestions box in public areas. Also Care Homes for Older People Page 16 of 26 Evidence: targeting training for staff. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and staff encourage residents to see the home as their own. The home is well maintained, safe and very comfortable. Various specialist equipment and adaptations are available to meet individual residents needs. Evidence: Residents live in an environment , which is well maintained and attention is given to making sure that it meets their needs. A passenger lift is available. A tour of the premises was undertaken . Residents are able to personalize their rooms and staff have made excellent efforts to provide a homely environment. The main lounge/dining room features a large fish tank which is the focus of the room and provides a relaxing view. A varied mix of pictures on the wall add to a relaxing environment. Bedrooms seen were attractively colour co-ordinated and residents have been encouraged to personalise them with items of their own, to make them feel more comfortable and homely. Bathrooms seen had suitable adaptations and aids for residents use. Comments in the Care Homes for Older People Page 18 of 26 Evidence: surveys confirmed that residents live in an environment that is clean and free from offensive odours, for example, it is always very clean.and excellent cleaning staff. The kitchen also seen was very clean and well organised. The home had received a rating of 5 stars from technical services when they last carried out their food hygiene inspection. An attractive garden is available with a large patio area which has appropriate tables and chairs. Support rails are also available to provide access into the garden. A gardener is employed which ensures that the garden is always well maintained and attractive for anyone using it. Responses from surveys were positive regarding the premises with comments such as the home provides a good, clean and safe environment for all its service users and is a pleasant place to visit.Another said the home is always clean and tidy. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected from harm by the homes recruitment process and are supported by staff that are trained and competent to do their job. The management team of the home makes every effort to ensure that staff are suitably trained for the work that they thereby ensuring the wellbeing of all residents. Evidence: A copy of the rota was seen which ensures that residents are supported by sufficient numbers of staff who are trained to perform the work they are to perform. The home employs a very experienced clinical nurse/ teacher one day a week who is responsible for ensuring that all staff mandatory training is up to date, as well as assesses their NVQ training. A comprehensive twelve -week induction program is in place for all new staff and there is regular supervision and appraisals in place. The same staff member also works alongside the care staff/nurses in supporting residents in the home. The AQAA states that 24 of the 26 permanent staff have a NVQ qualification or above. This exceeds the standards recommended by the national minimum standards. Staff also access Wandsworth Local Authorities training and training include Dementia care, activities, Safeguarding of Vulnerable adults. Residents can feel confident that staff are well trained for the work that they do and that they have the skills and Care Homes for Older People Page 20 of 26 Evidence: knowledge to meet their needs. The home has good recruitment practices in place, with appropriate checks being made prior to the employee commencing work. A sample of six staff files were looked at and all were found to contain the required information of the Regulations and Schedules and detailed all the appropriate checks having being made. Comments stated in surveys and from a vising relative were positive regarding staff at Trinity Court and included staff are kind and caring. we are happy with the home and with the patience of the staff Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a very strong management team in the home who are proactive in ensuring that Trinity Court is the residents home. Residents and relatives views are listened to and acted upon. The home has policies and procedures in place to ensure the health and safety of residents and staff. Evidence: Since the last inspection of the service the manager resigned. The deputies have been acting up until an appointment was made. The proprietor also visits daily and we were informed that an application has been submitted to Care Quality Commission for approval of the new manager. The senior staff at the home has a positive and proactive approach to running the care home. The proprietor visits every day and is supportive to his staff team. Staff at all Care Homes for Older People Page 22 of 26 Evidence: levels spoken to confirmed this. Staff meetings take place regularly which provides a forum to inform staff of any new developments as well as providing a venue for staff to air their views. Relatives/residents meetings are held quarterly and minutes were seen. There is also a quarterly newsletter which informs people of any changes in the home and future plans as well as acknowledges forthcoming birthdays and events. Regulatory 26 visits are carried out by an independent person and copies of his reports are available in the home. The proprietor stated that a quality Assurance system is in place and a copies of returned questionnaires to the home were available at the time of the inspection and all responses were described as positive. The AQAA states that they home plans to further develop our internal controls to ensure our high standards are maintained and to further develop improved record keeping and communications with all stakeholders. Staff reported that since the last inspection there has been no changes in how the home manages residents personal allowances and strict management controls are in place. All staff have undertaken training to ensure that their working practices are in accordance with current legislation and equipment has been maintained and appropriately checked. Policies and procedures are also in place to maintain the health and safety of both staff and residents. Records checked included fire drills alarm testing, hot water, fire risk assessment, and COSHH assessments. All were found to be in order with the exception of wheelchair checks which failed to record the action taken. This was discussed with the proprietor who agreed to the necessary action to be taken to rectify this issue. A record of accidents and incidents affecting residents is maintained and contains information required within the standard. The proprietor in his AQAA has said that over the next twelve months we plan to further develop our internal controls to ensure our high standards are maintained. Also further develop record keeping and communications with all stakeholders. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!