Tripletrees

We found the following examples of good practice.

Plans were in place to isolate people with COVID-19 to minimise transmission. The service had good supplies of personal protective equipment (PPE) that were readily available in stations throughout the service.

Visitors were asked to take a lateral flow COVID-19 test, have their temperature checked, use hand sanitiser and sign in on arrival. Visiting health and social care professionals who were part of a workplace COVID-19 testing assurance programme, such as GPs and district nurses were not required to take lateral flow tests.

The service took action to replace hand sanitiser pump dispensers with wall mounted push style hand sanitiser dispensers when some people had found the pump dispensers difficult to use.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and residents were regularly tested for COVID-19. The building was clean and free from clutter.

People were well supported by staff to have telephone and internet contact with their family and friends. The service facilitated in person visits in a manner which minimised the risk of infection spread.

Staff ensured people’s welfare had been maintained and they had sufficient stimulation, for example through activities.

Tripletrees is situated in Burgess Hill in West Sussex and is the only home owned by the provider. Tripletrees is registered to accommodate 28 people. At the time of the inspection there were 28 people accommodated in one adapted building, over four floors. Each person had their own room and access to communal bathrooms. The home provided accommodation for older people and those living with dementia.

The home had a registered manager. A registered manager is a ‘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 home is run. Since the previous inspection on 27 April 2016, the provider of the home had changed. The registered manager had taken over ownership of the home. The management team consisted of the two providers, one of whom was the registered manager, and another member of staff who was the head of care. At the previous inspection the home was rated as Good. At this inspection we found the home remained Good.

People were at the heart of the registered manager’s and staff’s vision and values. The registered manager and staff held the values of love, respect, compassion and care in high-regard. These values were embedded in staff’s practice. Without exception, comments from people and their relatives were overwhelmingly positive. Comments from people’s relatives included, “The care is so good. I can sleep easily in my bed now. They even help my relative to know who I am. The carers are loving and considerate” and “You cannot beat the care and consideration they receive here. I would give them 10 out of 10. It feels like one happy family”. A healthcare professional told us, “They seem to have people’s best interests at heart”.

Thoughtful, compassionate and creative ways of enabling people to feel valued and well-cared for had been put into practice. People were asked what would make them feel content and if they had any wishes. One person had expressed sadness and anxiety about not knowing where their parent’s graves were. Staff had exceeded expectations and had searched records and cemeteries until these had been found. The person had been supported to visit and lay flowers at the graves. They were reassured and settled once they knew where their parents were.

Innovative approaches with the use of technology demonstrated that staff cared about people and wanted them to have a good-quality and enriched life. ‘Apps’ had been created and each person had their own log-in when using an electronic tablet. Dependent on people’s abilities, they could use these independently or with assistance from staff. Observations showed people enjoyed looking at this personalised facility. This included photographs of their families, or places of interest to them, their favourite television programmes and music that they liked to listen to.

People told us that they remained safe. They were protected from abuse and discrimination. Sufficient numbers of skilled staff ensured people’s physical and emotional needs were met. Risks to people’s safety were identified and mitigated. Infection control was maintained.

People’s needs were assessed and reviewed on an on-going basis. People received personalised care. People were actively involved in their care and in decisions related to it. People were supported to maintain their health. They had access to medicines, which were managed safely, and received support from external healthcare professionals when required. An external healthcare professional told us, “They really work with us to make sure people are getting good care”. People received appropriate end of life care to ensure their comfort.

People told us that they enjoyed the food. People’s access to nutrition and hydration continued to meet their needs. People had access to an environment that met their needs. Communal areas, as well as private spaces, enabled people to spend time on their own or with others.

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 at the home supported this practice. People were treated with respected, their privacy and dignity was maintained.

People and relatives were involved in the running of the home. Their opinions and suggestions were respected and acted upon. People, relatives, staff and an external healthcare professional, were complimentary about the leadership and management of the home. When asked to describe this, a relative told us, “Exceptional”.

Further information is in the detailed findings below.

Tripletrees provides accommodation for twenty-eight older people, some of whom were living with dementia and who may need support with their personal care needs. On the day of our inspection there were twenty-two people living in the home. The home is a large detached property situated in Burgess Hill, it has a communal lounge and dining room and well maintained gardens.

The service had 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 2008 and associated Regulations about how the service is run.

Staff told us that they found their induction training helpful and that it enabled them to develop an awareness of people’s needs and an understanding of their role. Staff were sufficient in number to ensure people’s needs were met and their safety maintained. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns. People felt safe. One person, when asked what made them feel safe told us “Everything, they look after me”.

Risks to people’s safety had been assessed and identified and measures put in place to ensure people’s safety. For example, for people who had been assessed as being at risk of developing pressure sores, appropriate measure had been taken to ensure they had access to relevant professionals and equipment to minimise the risk of skin breakdown.

People received their medicines on time and told us that if they were unwell and needed medicines that staff provided these. Observations confirmed this. Medicines were administered by trained staff who had been provided with relevant guidance to inform their practice. There were safe systems in place for the storage, administration and disposal of medicines.

People were asked their consent before being supported with care. Mental capacity assessments and deprivation of liberty applications had been undertaken to ensure that, for people who lacked capacity, appropriate measures had been taken to ensure that were not deprived of their freedom unlawfully.

People had access to relevant healthcare professionals to maintain good health. Records confirmed that external health professionals had been consulted to ensure that people were being provided with safe and effective care. Healthcare professionals confirmed that people received appropriate support to maintain their health. One healthcare professional told us “There is good communication, they ring us or speak to us when we are here for other people if they are ever worried about anyone”.

People could choose what they had to eat and drink and felt that the food was good. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received drink supplements and foods were fortified to increase their calorie intake.

People were involved in their care and decisions that related to this. Regular reviews and meetings provided an opportunity for people to share their concerns and make comments about the care they received. Relatives confirmed that they were involved in people’s care, felt welcomed when they visited the home and knew who to go to if they had any concerns.

People were treated with dignity, their rights and choices respected. Observations showed people being treated in a respectful and kind manner. People’s privacy was maintained, when staff offered assistance to people they did this in a discreet and sensitive way. People confirmed that they were treated with dignity and their privacy maintained.

Staff knew people’s preferences and support was provided to meet people’s needs, preferences and interests. There was a variety of activities that people appeared to enjoy. People were able to make suggestions as to how they wanted to spend their time and these were listened to and acted upon.

There was a homely, friendly and relaxed atmosphere within the home. People were complimentary about the leadership and management. Staff felt supported by the registered manager and were able to develop in their roles. Healthcare professionals were positive about the leadership and management of the home. One healthcare professional told us “There have been clear improvements in the service provided to residents in the last few years. The registered manager has made a huge difference to the managerial side of the home”.

There were quality assurance processes in place that were carried out by the registered manager and the provider to ensure that the quality of care provided, as well as the environment itself, was meeting the needs of people.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

- Is the service safe?

- Is the service effective?

- Is the service caring?

- Is the service responsive?

- Is the service well led?

This is a summary of what we found-

Is the service safe?

We found people experience care and support that was planned and delivered in a way that was intended to ensure their safety and welfare. There were enough staff on duty to meet the needs of the people living at the home. People were protected from unsafe or unsuitable equipment because the provider had systems in place that ensured all equipment was properly used, maintained, tested, serviced and replaced. Staff personnel records contained all the information required by the Health and Social Care Act. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People we spoke with told us staff knew what they were doing when they supported them every day. Observations we made on the day of our inspection showed staff were experienced and clearly had the skills they needed when working with the people living at the home. Staff demonstrated an understanding and showed consideration when providing care to people with dementia.

Is the service caring?

During our visit all interactions we saw between the staff and the people who lived at the home were respectful. People who lived at the home received care and support in a calm and relaxed manner. We observed that staff were able to spend time and interact with people in a positive way. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence. People's care plans were clearly written, individual and person centred. The care plans contained information regarding people's likes and dislikes in relation to food and daily routines. People told us they liked the staff.

Is the service responsive?

We saw that people were asked their opinion during the day where a choice was available. There was a system in place to monitor how many accidents or incidents had taken place over a given period. We saw that they had been analysed to make sure that the staff learned from such events. We saw that the quality of service that people received had been assessed and monitored against the requirements of the essential standards. We saw evidence that the information from these audits was used to improve the quality of the service. The service was reviewing the shift times to see if they could better accommodate people's bedtime preferences.

Is the service well-led?

We met with the home's owner / manager and the new deputy manager. The manager told us that she was planning to 'Step down as the registered manager' and that 'The deputy manager is responsible for the day to day running of the home. She will apply to be the manager within the next month'. The deputy manager told us that she was 'Committed to improving the standards at the home'. Staff we spoke with were clear about their roles and responsibilities. All said they received the advice and support they needed from the management and colleagues.

All interactions we saw between the staff and the people who lived at the home were respectful. People were spoken with in a sensitive, respectful and professional manner. All feedback that we received from the people who used the service was positive. People told us that they were happy living at the home and that they liked it. Comments regarding the staff included "They are lovely", "Kind" and "They know what they are doing".

We found that the provider did not have effective recruitment procedures to ensure that staff were of good character and had the qualifications, skills and experience necessary for the work to be performed.

Staff we spoke with felt they were provided with training that enabled them to do their job safely and efficiently. Comments from staff included, 'There is a lot more training than before' and 'The training is a lot better'.

During our visit we looked at staff records and other records relevant to the management of the home. The records were held securely and could be located promptly when needed.

Our observations showed that people were treated in a kind and respectful way by staff. They were given choices about their meals and what activities they would like to participate in. We saw many positive interactions between staff and people who lived at the service, which resulted in people showing signs of being relaxed in the company of staff and enjoying the interaction. Staff responded to people's needs promptly and were knowledgeable about peoples individual needs.

There were 23 people who lived at the service at the time of our inspection who had a wide range of needs, including some people who had complex physical and dementia care needs. People consistently told us that they liked living at Tripletrees and said that this was because it had a relaxed, friendly atmosphere and it was a comfortable place to live. One person told us 'Love it here, I can do what I want when I want'. They also told us that they felt safe and that they liked the food.

Relatives spoke positively about their experiences at the service and how the service cared for their relative. They told us how attentive staff were and how well staff knew and understood the needs of their relative. A relative told us 'Although the environment could do with a lick of paint the care here is excellent'.

People who lived the service told us they felt staff knew what they were doing, and that they had the skills to meet their support needs. However, not all staff had undertaken the necessary training in order to help ensure that they are able to work safely with people.

There was not a process in place to ensure that people consented to their care or had their capacity assessed to be able to consent. Not all records were being maintained to protected people from the risks of unsafe or inappropriate care and treatment.

All interactions we saw between the staff and the people who lived at the home were respectful. Support was offered and provided in a way that ensured that people's rights to privacy and dignity were respected. People were spoken with in a sensitive, respectful and professional manner.

We found that the homes policies and procedures were not up to date and contained reference to old legislation.

All the feedback that we received from the people who lived at the home was positive. People told us that they liked the home. One of the people who used the service commented that they were lucky to be there.