We inspected Trinity Court Nursing Home on 3 and 10 April 2018. The first day of the inspection was announced and the provider knew we would be returning for the second day.

At the last inspection, the service was rated Good.

At this inspection, the service was rated Requires Improvement.

Trinity Court Nursing Home 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.

Trinity Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people with nursing needs.

There was a registered manager 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 provider had transitioned to a new electronic care plan system computer system in July 2017 but we found that staff were still adapting to the new system. Some records were still being completed on both the old and the new care plan system and were not always consistent. Some record keeping in relation to risk was not being reviewed in a timely manner. People that were identified at being at high risk did not always have their records reviewed in line with the level of risk.

The provider did not always follow the appropriate procedures with regards to covert medicines for people who lacked the capacity to make decisions about their medicines.

Although people told us they enjoyed the food and they were provided with appropriate amounts food and drink throughout the day, the provider was not following guidelines in relation to food hygiene.

The registered manager was not fulfilling the requirements of her registration and had not submitted notifications in relation to safeguarding concerns and applications for DoLS that had been granted.

The quality assurance audits were not effective in identifying the issues we found during the inspection, however the provider demonstrated they were open to feedback and acted upon the recommendations we made throughout the inspection. This included arranging for staff to undergo training in the new care plan system and signing up to the CQC Provider Portal to enable them to submit future notifications in a timely manner.

People using the service and their relatives told us they had no concerns about safety and that staff were caring and looked after them. They were confident that if they were to raise any concerns, they would be listened to and the provider would take action where necessary. We saw that when concerns were raised, the provider investigated and acted to resolve these to the satisfaction of the complainants.

Staff recruitment procedures were robust and staff received mandatory training which enabled them to support people effectively. Staff told us they felt supported and worked well as a team. Records confirmed they received regular supervision.

People's healthcare needs were managed by staff. Appropriate referrals were made to community professionals if required and a GP visited the home regularly to review people who were not feeling well. The provider had good working relationships with health and social care professionals, which was reflected in the feedback we received from them. The provider worked collaboratively with external organisations to support care provision and service development.

The service enabled people to carry out person-centred activities and encouraged them to access activities by arranging for external agencies to facilitate them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possib

We carried out an unannounced comprehensive inspection of this service on 1 and 3 March 2016. A breach of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to person-centred care.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trinity Court Nursing Home on our website at www.cqc.org.uk.

There was a registered manager 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.

Trinity Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people for respite, palliative and dementia care. At the time of the inspection, there were 50 people using the service, although three of them were in hospital.

At our previous inspection we found that although care plans were reviewed on a regular basis they were not person-centred in all cases. We also found some gaps in the records that we saw.

At this inspection, we found that improvements had been made.

The activities co-ordinator had completed personal histories and social care activities for people using the service so that staff could provide care that met their individual needs.

Risks to people had been identified and were assessed using standard screening tools. Where a risk had been identified, action was taken and associated records were updated accordingly, including the advice of specialist healthcare professionals.

This inspection took place on 1 and 3 March 2016. The first day of the inspection was unannounced; the provider knew we would be returning for a second day. The provider met the Regulations we inspected at their last inspection which took place on 7 July 2014.

Trinity Court Nursing Home provides care for up to 50 people. The home is arranged over three floors and accommodates people for respite, palliative and dementia care. At the time of the inspection, there were 50 people using the service, although one person was in hospital.

There was a registered manager 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.

People using the service told us they felt safe living at the home and that the staff were kind and friendly and caring towards them. Relatives that we spoke with also told us they had no concerns about the safety of their family members.

Care workers demonstrated a caring attitude when we observed them during the inspection. They spoke to people in a gentle manner and took their time when supporting them.

Staff supported people with regards to their medicines and people’s support needs in relation to health were being met by the provider. They were registered with a GP who visited the service on a weekly basis. Annual medicines reviews also took place. Other health professionals, such as physiotherapists, speech and language therapists and community nurses were involved in people’s care and updated care records as appropriate.

People told us they enjoyed the food at the home and told us they were offered a choice in relation to their meals which were prepared using fresh ingredients. The chef had been working at the service for a number of years and was familiar with people’s needs.

The provider was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Consent was sought for everyday decisions and where people did not have the capacity to consent to more complex decisions, decisions were made in their best interests, involving relevant professionals.

Staff recruitment at the home was robust and staffing levels were sufficient to meet people's needs. Call bells were answered quickly, however we found that staff were stretched at certain times of the day. This was confirmed by care workers we spoke with and through reviewing staff meeting minutes.

We found that although care plans were reviewed on a regular basis, and were well designed with respect to clinical care, they were not person-centred in all cases. We also found some gaps in the records that we saw, some related to person- centred information and others related to care planning.

The service was well-led. People and relatives told us they knew who the management team were. Staff told us they felt supported. The director and area manager were a regular presence at the home.

Robust quality monitoring took place, including medicine, clinical and health and safety audits. These were completed by the registered manager, area manager and external professionals.

The service demonstrated its commitment to continuous learning and improvement by being involved in a number of schemes, including an accreditation award from the Gold Standards Framework (GSF) for end of life care. The service was a member of the registered nursing home association and attended provider forums in the borough. They were also taking part in a research study by the National Institute for Health Research around helping care home staff to deliver person-centred care to people living with dementia.

During this inspection we found breaches of Regulations relating to care planning. You can see what action we told the provider to tak

Trinity Court Nursing Home is based on three floors of a large converted house; the main seating and dining area lead out into a conservatory with tables and chairs. There was an extensive lawned garden area with a sensory herb and flower area and fruit trees. People were able to move around the areas freely and where needed, were supported by care staff to do this.

During our visit we spoke with six people who used the service and three family members. We spoke with the registered manager, a visiting GP and eight members of the nursing and care staff team. Staff told us "it's a happy home" with "a friendly manager." Relatives we spoke with told us staff were friendly and caring.

On the day of our visit there were 49 people living at the home. From conversations with people who used the service the overall impression was that people were happy with the care they received. People told us "I'm happy here" and "staff are nice." Family members told us their relatives were "happy" and "comfortable."

People had care plans in place and risk assessments had been completed. There were activities on offer such as chair based exercises, singing, ball games and nail painting sessions. There were sufficient numbers of staff on duty the day we visited to meet people’s needs, although extra support may have been needed at mealtimes to assist with the high proportion of people who required assistance.

The provider had systems in place to ensure that the quality of the home was monitored and surveys and audits were completed on a regular basis. People we spoke with told us they would make a complaint to the manager if they had any reason to do so. The appropriate staff were trained to deal with emergencies.

The home was based on three floors of a large house; the main lounge, dining room led into a sunny conservatory and enclosed garden. The doors were open and people could move freely about. There was a lift for people to access upper floors when accompanied by staff. All the stairs going up had a stair gate which could be opened and the stairs down had a locked door accessed by a key pad.

During our unannounced visit we spoke with six people who used the service, two family members, 11 members of staff, and a visiting GP. Staff told us, “This is a good place to work” and “Communication between us is good”. A family member told us they were very happy with the care being given to their relative.

Our inspection on the 2nd August 2012 found that some people were not able to express their views and be involved in making decisions about their care and treatment. There was a lack of information in the care plans that we reviewed to show what had been done to assess each person's mental capacity and what would be required to keep them safe. A choice of mealtimes was not made available due to a lack of staff at these busy periods of the day. Assessment of care needs were not consistently recorded and confidential information was not being held securely.

The provider wrote to us about the changes they had made to involving people in decision making; confirmed that individual records had been updated and security for personal information improved and noted that meal times had been extended to meet the needs of the service users.

During this unannounced inspection we saw improvements had been made to people’s choice about their care and treatment, care plans had been updated, were consistent and held securely and meal times were flexible.

We spoke to eight people who use the service, three family members, seven members of staff, a visiting GP and Pharmacist. People told us “I’m well looked after, I’m satisfied”. “They’re (staff) very nice to me”, “staff are polite”, “it feels like a family, staff are kind, patient and compassionate”, “They make special curries, with hot sauce”.

This inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met. The inspection team comprised of a practicing professional, an expert by experience and inspector. People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One person said that their “food was always lovely, presented well with their own napkin" this person said that they preferred to eat all their meals in their own room and this was always allowed.

People said that that they were treated with dignity and respect at all times when they were having personal care or when staff came into their room. One person made a point of saying that staff would "always knock before entering my room".

The people we spoke to were generally positive about the care they received at the home. They said they liked being there, the food was good, and the staff were nice. One person said it could be "a bit boring”.