This inspection took place on 6 November 2018 and was unannounced. At our last inspection on 24 May 2016 we rated the service as Good. This inspection was to review the ratings.

Trinity Fold is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides nursing and personal care for up to 50 older people, some of whom may be living with dementia. Accommodation is provided on three floors with passenger lift access between floors. There are communal areas on the ground floor, including a lounge and dining room. There were 44 people in the home when we inspected.

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.

People’s care needs were not always being met as care plans were not always accurate or up to date. This meant people were at risk of receiving inappropriate or unsafe care. The issues we raised at the inspection were acted on promptly by the registered manager who notified us of actions they had taken following the inspection.

Activities for people were limited, particularly for those who chose to stay in their rooms. The activity organiser had been off work for a few months which had impacted on activity provision. The provider acknowledged this and told us of the plans they had to recruit new activity staff in the near future.

Medicines were managed safely. Risks to people were assessed and managed to keep them safe. Staff had been trained in how to identify and report abuse. Records we reviewed showed appropriate action had been taken to keep people safe and safeguarding referrals had been made to the local authority safeguarding team.

Staff were recruited safely and received the induction, training and support they required to carry out their roles. There were enough staff to meet people’s needs and keep them safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home was clean and staff followed good infection control practices. Checks were carried out regularly to ensure the safety of the premises and any equipment used. The home was comfortably decorated and furnished. However, some areas required improvement to make them more dementia friendly so people living with dementia could find their way around more easily.

People and relatives spoke highly of the staff who they described as kind and caring. We saw staff had developed good relationships with people and knew them well. Staff treated people with respect and maintained their privacy and dignity.

People told us they enjoyed the food. A choice of food and drinks were available at all times. People knew how to make a complaint and we saw complaints raised had been dealt with appropriately.

People, relatives and staff spoke positively about the registered manager and the way the home was managed. There were systems in place to measure monitor and manage the quality of the service. However, we found these needed to improve as issues we identified had not been resolved by the provider until we brought them to their attention. We made a recommendation about improving governance systems.

We identified one breach of regulation in relation to safe care and treatment. You can see what action we have told the provider to take at the end of the full version of this report.

We inspected Trinity Fold on 24 May 2016 and the visit was unannounced. Our last inspection took place on 16 July 2014. At that time, we found the provider was not meeting the regulations in relation to staffing, records and assessing and monitoring the quality of the service. We told the provider they had to make improvements and found on this inspection the necessary improvements had been made.

Trinity Fold is a 50-bed home and is registered to provide accommodation and personal care for older people. Nursing care is not provided. The accommodation is arranged over three floors linked by a passenger lift. All of the bedrooms have en-suite toilet facilities and there are communal lounges and dining areas for people to use. The home is located a short distance from Halifax Town centre.

On the day of the inspection there were 44 people using the service and one person was in hospital.

There is a registered manager in post who has worked at the service for 10 years. A registered manager is a person who has registered with the Care Quality Commission (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.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their various roles. Staff told us they felt supported by the registered manager and deputy manager and were receiving formal supervision where their could discuss their on-going development needs.

People who used the service and their relatives told us staff were helpful, friendly and caring. We saw people were treated with respect and compassion. They also told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

The chef and kitchen assistant had a good knowledge of people’s dietary needs and preferences. People told us there was a choice of meals and the food was good. We also saw there were plenty of drinks and snacks available for people in between meals.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People who used the service and relatives told us they were happy with the care and support being provided. We saw people looked well groomed and well cared for.

People’s healthcare needs were being met and medicines were being managed safely.

Activities were on offer to keep people occupied both on a group and individual basis. The activities co-ordinator was aware of people’s interests and was providing relevant sessions for them. People also had the opportunity to participate in the local community and enjoyed visits from children from a local nursery and school.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

Visitors said they were made to feel welcome.

There was a complaints procedure in place and we saw where concerns had been raised these had been dealt with appropriately.

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address these shortfalls. People using the service were asked for their views and were able to influence the way the service was managed.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

We inspected Trinity Fold on 16 July 2014 and the visit was unannounced.  Our last inspection took place on 19 August 2013 and, at that time, we found the regulations we looked at were met.

Trinity Fold is a 50-bed home and is registered to provide accommodation and personal care for older people. Nursing care is not provided. The accommodation is arranged over three floors linked by a passenger lift.  All of the bedrooms have en-suite toilet facilities and there are communal lounges and dining areas for people to use.  The home is located a short distance from Halifax Town centre. 

The home has a registered manager who had worked at the home for eight years. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe at the home and we saw there were systems and processes in place to protect people from the risk of harm.  Staff had been trained and understood the safeguarding procedures. They knew about the different types of abuse and how to report any concerns.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

People we spoke with told us they liked the staff and that staff knew what they were doing. One person said: “The staff are always lovely and helpful.”  Another said: “I really like them.  They are all so nice to me.”  We observed that staff were confident, competent and compassionate when they were offering care and support.

Staffing levels were not always sufficient to meet people’s needs because shifts were not always being covered when people were on annual leave or sick leave.  One person said: “Sometimes there aren’t so many of them (staff) and I might have to wait a bit longer for things but I do understand that they are busy.” 

Without exception the people we spoke with commented positively about the meals and dining experience at the home. People were very happy with the quality and variety of the meals provided.  One person said; “The food is nothing like I thought it would be before I came to live here.  It’s more like what you’d get in a hotel.” 

People we spoke with told us various activities took place in the home such as quizzes and reminiscence sessions. They also said entertainers visited and  trips out were arranged.

We saw from the care plans people were supported to access healthcare services such as GPs, community matrons, podiatrists and district nurses.  We spoke with three visiting healthcare professionals who told us they had no concerns about the home and felt the care and support delivered was of a high standard. One person said: “If my relative needed care they would come here.”

We found some records that we asked for in relation to the management of the service were not available or could not be located.  We also found satisfaction surveys had been used to find out people’s views about the service. However, the results of these had not been followed up.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with six people living in the home, one relative, hairdresser, district nurse and five staff. These are some of the things they told us:

“I am very happy here, it has been a very positive move for me.”

“The staff are very good and I get help when I need it.”

“The home is always clean and tidy.”

“I can follow my own routine.”

“There are activities on offer if you want to join in.”

“I can please myself if I spend time in my room or the communal areas.”

“I really enjoy working here.”

We found that people were treated with dignity and respect and were involved in planning their care and support. The system for administering medication was managed safely.

Our conversations with people and staff, together with observations on the day of our inspection evidenced that there were enough staff on duty.

The provider had an appropriate system in place for gathering and evaluating information about the quality of care the service provided.

We spoke with 12 people who live at the home, two relatives and five members of staff. These are some of the things they told us:

“I like living here, the accommodation and the staff are very good.”

“Everything is very nice, if you want something staff will get it for you.”

“The food is very good and there is a choice for every meal.”

“There are activities to join in with if you want to. Tomorrow is an Italian evening with food and an Italian film.”

“The home is kept clean and tidy. I can choose if I spend time in the lounge or in my room.”

“If there was something I was unhappy about I would tell a member of staff and they would sort it out for me.”

“Staff keep me informed about my relatives wellbeing and talk to me about their care and support.”

“I enjoy working here, it’s a good staff team.”

People who use the service all told us staff looked after them very well and overall they were very satisfied with the care they receive and they were comfortable living at the home.