Archived: Pennsylvania House

Updated 24 December 2016

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 is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This inspection was unannounced and took place on 11, 12 and 14 October 2016 and was carried out by an adult social care manager and an adult social care inspector with an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We looked at the information we held about the service. We looked at the notifications that we had received from the provider about events that had happened at the service. A notification is information about important events which the provider is required to send us by law. We reviewed the information we received from other agencies that had an interest in the service, such as the local authority and commissioners.

We spoke with two people who used the service who were able to communicate their experiences. As 13 people were unable to directly tell us about their experiences due to living with dementia we spent time observing their care in communal areas throughout the three days. We spoke with two relatives, eight members of care staff, an agency care worker, two cooks, the deputy managers and the registered manager and provider. We looked at care records relating to the care of six people who used the service. We spoke with the local authority safeguarding team, three visiting health professionals involved in safeguarding protection plan visits, a chiropodist and a district nurse. We also examined records relating to the running of the home such as audits, medicines administration records (MARS), training records, staff recruitment records and staff rotas. We informed environmental health about the continuing bed bug infestation. We contacted the fire safety officer who joined us at the service on the third day to follow up on their review from January 2016 where recommendations were made. Following their visit on 14 October 2016 the fire authority will be issuing an enforcement notice.

Updated 24 December 2016

This inspection took place on 11, 12 and 14 October 2016 and was unannounced. We carried out this inspection to follow up on concerns raised within a safeguarding process relating to risks to people, the management and control of the risk of the spread of infection and staffing levels at night. We carried out a focussed inspection in February 2016 and found people were not protected from the risks associated with the control and spread of infection, the standard of cleanliness in the home’s kitchen was unacceptable and there were not sufficient staff available to meet people’s needs at night. Personal emergency evacuation plans (PEEPS) had not been completed for each person who lived at the home. This information would assist staff and emergency services if people needed to be evacuated from the premises. We discussed this with the provider and registered manager at the time who informed us they were in the process of completing a PEEP for each person following recommendations from a fire safety officer. Regulatory breaches around safe care and treatment were identified and the service was judged to be requiring improvement.

We carried out this comprehensive inspection in October 2016 to check whether the above issues had been addressed and whether people using the service were safe and receiving effective, caring and responsive care in a well led service. There were 16 people living at Pennsylvania House at the time of this inspection with one person in hospital and one person receiving short term respite care. The home has remained under whole home safeguarding since February 2016 which means it is being monitored by the local authority safeguarding team. An admissions suspension was placed on the home to prevent the service admitting any new admissions and remains in place. As a protective measure community matrons and safeguarding nurses continued to regularly visit the home to ensure people’s needs were being met. We continued to receive concerns arising from these visits, where although the home reacted well to the concerns when told, they did not identify them or put sustainable or safe systems in place to manage the home safely. Concerns included the lack of management of the service, safe medication administration, safe moving and handling, safe staffing levels and supervision of people living at the home and training.

At this inspection we found no improvements had been made other than we received an action plan following the inspection in February 2016 and environmental health visited the home on 18 March 2016 giving a Food Rating of 5, so the cleanliness of the kitchen had improved. There were continuing breaches in relation to the safe care and treatment of people and further breaches in relation to safe staffing levels, application of the Mental Capacity Act 2005, cleanliness and infection control, management of risk, maintenance and meeting people’s individual needs.

We continued this inspection for three days due to our concerns and contacted environmental health and the fire safety officer to share our concerns as well as the safeguarding team. For example, a known bed bug infestation had not been well managed by staff who had no clear instructions about what to do. We asked the provider to deal with this issue immediately. As the fire alarm testing records showed no tests for one month and the general maintenance and cleanliness of the building was shabby we asked the fire safety officer to visit with us on the third day. They also found continued evidence of poor fire safety management despite making recommendations in January 2016. They will be issuing an enforcement notice using their own processes. We spoke to three health professionals visiting the home daily as part of the protection plan arising from the safeguarding meeting discussions. They continued to pick up issues with the correct use of pressure relieving equipment, management of bed bugs and general management. They all said the home and staff appeared unprofessional and shabby, although staff were friendly and helpful, they did not look smart and no staff wore name badges. Staff said they had asked the provider for uniforms and name badges many times.

We found nine breaches relating to seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The overall rating for this service following this inspection in October 2016 is Inadequate which means it will be placed into special measures. Services in special measures will be 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, 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 adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. We asked the provider to voluntarily agree not to admit further admissions until further notice. The provider agreed to this.CQC is now considering the appropriate regulatory response to resolve the problems we found.

Pennsylvania House is registered to provide accommodation with personal care for up to 25 adults. It offers a service for people who may have dementia, mental health needs or learning disabilities. 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. However, the registered manager had moved to the provider’s second service and was based there. The provider assured us the two deputy managers at Pennsylvania House supported by the registered manager would be able to safely manage the home. We found this not to be the case, they were not listened to or empowered to make decisions to ensure consistent management.

Risks to people were not always minimised through the effective use of risk assessments. Staff did not follow care plans but relied on verbal information from each other and poor, basic handovers between shifts. There were insufficient suitably trained staff deployed to keep people safe and meet people's care needs in a timely manner. Staff did not always have the knowledge and skills required to meet people's individual care and support. Although they had training in a range of topics, this was not used to deliver care, staff competency was not managed and staff were not regularly supervised to ensure they were able to meet people’s needs. The provider had good recruitment and vetting procedures but staff did not always have the induction, training and supervision they needed.

People did not receive care that was personalised and reflected their individual needs and preferences. Staff did not have the time to deliver personalised care or use information in the care plans to ensure they knew how to meet individual needs. Although activities were organised by the activity co-ordinator their knowledge of people’s needs was random, they did not use the care plans or relate people’s preferences to activities. They told us they did not feel equipped to manage people with dementia and were restricted by a lack of staff. Staff had little input in managing engagement and stimulation. Although the activity co-ordinator delivered some meaningful activities and one to one sessions with some people they recorded events by activity. This meant some people with more complex needs spent long periods unstimulated and inactive.

People’s rights were not protected. Although applications had been made following legislation to prevent people leaving the home for their own safety, the principles of the Mental Capacity Act 2005 were not followed to ensure that people were consenting or being supported to consent to their care and support.

People's medicines were administered and recorded and staff knew what to do but lack of time did not ensure people were taking their medicines safely.

People's right to privacy and dignity was compromised due to lack of staff time and response. Most people were unkempt, wearing soiled clothes and staff were unable to effectively manage people’s continence.

Systems in place to monitor the quality of the service were ineffective. The management systems were insufficient to provide leadership and guidance to the care staff. People were at risk of receiving poor, undignified, inconsistent and unsafe care. Little improvements had been made since the last inspection, despite the concerns being known to the provider for some time.