Archived: Pentlow Nursing Home

Pentlow Nursing Home is a residential care home providing personal and nursing care up to 60 older people. Accommodation and services are spread over two neighbouring buildings called Pentlow and Summerdown. At the time of the inspection 28 people were in Pentlow and 11 were in Summerdown. People's nursing and support needs varied, some were living with complex care needs and a dementia. Others had been admitted for short term placements from hospital or for emergency support, until they could return home or move to another service.

People’s experience of using this service and what we found

People were not always receiving their medicines safely or as prescribed. People were not always supported to have maximum choice and control of their lives and records did not demonstrate that staff had supported people in the least restrictive way possible and in their best interests. People did not always have their care needs recorded or attended to. Personalised care plans were not in place for everyone. Systems to asses, monitor and improve quality of the service had still not been established effectively in all areas. This meant areas that impacted on people’s safety and care had not been addressed.

The service was clean and hygienic. Staff had a good understanding of how to identify and respond to any suspicion or allegation of abuse or discrimination. Staffing arrangements ensured people’s needs were responded to in a timely way. Staff were recruited safely. There were suitable arrangements in place to assess and respond to risks to people and staff.

Staff training was co-ordinated and planned. All staff completed essential training to ensure they had suitable skills to care for people. Staff had the opportunity to develop new skills and maintain their competencies. People's dietary needs were assessed, and food provided was tailored to their individual needs.

People were supported by staff who were kind and caring. Staff promoted independence and ensured people spent time with and enjoyed time with people who were important to them. People felt comfortable with staff and formed positive relationships. Staff were aware of people’s privacy and dignity and made sure this was respected. People were listened to and had their choices responded to.

People were supported to take part in a variety of activities that they enjoyed and were meaningful. Complaints were responded to effectively. People’s communication needs were assessed and responded to. End of life care was planned and delivered in a compassionate way.

The registered manager had established an open and honest culture where staff and people felt able to share their views, and where incidents, safeguarding concerns and complaints were dealt with proactively.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement. (published 17 December 2018) and there were two repeated breaches of regulations, a warning notice was served in respect of one breach. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, improvement had not been made and the provider was still in breach of regulations.

The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulations 12, 11, 9 and 17. This is because medicines were not always handled safely. Staff were not working within the principles of the MCA. People’s needs were not fully recorded and responded to and the quality monitoring systems had not supported safe, effective and responsive care in all areas. Following the inspection, we received information from the registered manager and nominated individual. This confirmed action being taken and planned. It included the recruitment of a new deputy manager and new quality monitoring and governance systems.

Please see the action we have told the provider to take at the end of this report.

This inspection took place on 18 and 23 October 2018 and was unannounced. At the time of this inspection 34 people were living at the service, 11 in Summerdown and 23 in Pentlow. The first day of the inspection was unannounced, this meant staff did not know we were coming.

We had previously carried out an inspection in December 2014 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in June 2016 where we found improvements had been made and regulations had been met. However, further improvements were needed. We inspected the home again in August 2017 where we found some improvements but we found further and ongoing areas that required improvement, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the management of medicines did not always provide clear records to ensure medicines were given safely and in a consistent way. Agency staff were relied on as part of the regular staff provision. They had not received training on specific care and practice related to the service they were working in. The care documentation and records did not always provide staff with the information and guidelines to provide person centred care. The quality monitoring systems did not always establish best practice or identify all areas for improvement.

The provider sent us an action plan and the registered manager provided monthly updates on the progress being made to ensure the regulations were being met. At this inspection we found a number of improvements had been made. However further improvements were required. This the fourth time this service has been rated Requires Improvement.

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.

The management of medicines still did not always ensure medicines were handled safely and in a consistent way. Medicine records and care documentation were not always completed to ensure GP prescriptions were appropriately recorded and followed. When people were prescribed 'as required' medicines guidelines were not provided to ensure staff gave these in a consistent way.

Infection control measures had not ensured the sluice rooms were hygienically clean. This meant there was a possible risk of cross infection.

The quality monitoring systems did not always establish best practice or identify all areas for improvement. The quality monitoring audits had not addressed ongoing problems with the safe handling of medicines, inconsistent records, and the risk of cross infection in the sluice rooms. Care records were not complete and were not always accurate for each person.

There was a structured management team with identified roles and responsibilities. However, staff gave mixed feedback on how the management team supported them, some were positive and others were negative saying they were unhappy and felt undervalued. This could lead to staff instability which would impact on people’s care.

People told us they were satisfied with their care and treatment and were looked after by staff who knew and understood their individual needs well. Staff were kind and treated people with respect, promoted their individuality and independence whenever possible.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Staff were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people's needs could be met. The registered nurses attended additional training to update and ensure their nursing competency and skills were maintained.

Staff monitored people's nutritional needs and responded to them. Preferences and specific diets were provided to ensure people’s health and safety was maintained. People were supported to take part in a range of activities maintain their own friendships and relationships with whoever they wanted to.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and in ‘resident’s meetings’. Satisfaction surveys had been completed. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Many people needed support with their personal care, eating and drinking and mobility. Some were living with a dementia and memory loss and required support with this, along with their physical care needs. Pentlow Nursing Home is based over two neighbouring buildings called Pentlow and Summerdown.

This inspection took place on 30 August and 7 September 2017 and was unannounced. At the time of this inspection 40 people were living at the service, 12 in Summerdown and 32 in Pentlow.

The service did not have a registered manager. However, the appointed manager was working in the service and their application for registration was being processed by the Care Quality Commission. 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.

At the last inspection undertaken on the 8 and 9 June 2016 the home was rated ‘Requires Improvement’ overall. This was because we found some areas of practice that needed to improve. At this inspection some areas had improved, including the safety of the premises, however we found further and ongoing areas that require improvement.

The management of medicines did not always provide clear records to ensure medicines were given safely and in a consistent way. There were no records to identify when and how prescribed topical creams were administered and medicines given ‘as required’ did not always have clear guidelines for staff to follow. When ‘as required’ medicines were administered the amount and time was not always recorded.

Agency staff were relied on as part of the regular staff provision. Although there was a basic induction sheet completed, staff had not received training on specific care and practice related to the service they were working in. The operations manager and appointed manager advised that further induction training was to be provided, which would be tailored to the agency staff’s needs.

The care documentation and records did not always provide staff with the information and guidelines to provide person centred care. Care plans did not cover specific health care needs and therefore did not ensure these needs were responded to in a consistent and appropriate way. Other records were not completed consistently to ensure responsive care. For example, the handover sheets used to share key information between staff were not accurate.

The quality monitoring systems did not always establish best practice or identify all areas for improvement. The provider had not established systems that identified and responded to poor record keeping, the management of reported incidents, the submission of required notifications, and a lack of person centred care planning.

People were happy with the care they received and they appreciated and told us they liked the regular staff that cared for them. Staff were kind and attentive and demonstrated a caring approach to people.

Staff employed by the service had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Staff employed by the service were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, that people’s needs were responded to in a timely fashion. The registered nurses attended additional training to update and ensure their nursing competency.

Staff monitored people's nutritional needs and responded to them. Preferences and specific diets were provided. People were supported to take part in a range of activities maintain their own friendships and relationships with whoever they wanted to.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys were used to improve the service. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009 (Part 4). You can see what action we told the provider to take at the back of the full version of this report.

Pentlow Nursing Home provides nursing and personal care for up 60 people both long term and for short periods to cover family holidays or times of ill health. People’s nursing and support needs varied, some were living with complex nursing needs, including end of life care, diabetes, stroke, heart conditions and Parkinson’s disease. Many people needed support with their personal care, eating and drinking and mobility. Some were living with a dementia and memory loss and required support with this along with their physical care needs. Pentlow Nursing Home is based over two neighbouring buildings called Pentlow and Summerdown. There were 45 people living at the service at the time of the inspection including both privately and local authority funded.

This inspection took place on 8 and 9 June 2016 and was unannounced.

At the last inspection undertaken on the 22 and 23 December 2014 we asked the provider to make improvements in relation the safe management of medicines, appropriate provision and support for people to eat and drink. The provider was asked to ensure the care and support provided was person centred and records were complete accurate and informed the care needed and provided. The provider sent us an action plan stating they would have addressed all of these concerns by September 2015. At this inspection we found the provider was meeting these regulations although further work was needed to embed and ensure safe and good practice in all areas.

The service did not have a registered manager in post however there was an acting manager and we were told a new manager had been appointed and was taking up post in August 2016. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The quality monitoring systems needed further development to ensure they were used to ensure best practice and to identify shortfalls and demonstrate effective responses. This included the provision of suitable guidelines and records for medicine administration and management of accidents. Guidelines to assist staff in the administration of medicines were not always complete and records of when topical creams were administered were not always accurate. In addition systems for safety in all areas of the home and garden had not been fully established. These areas were raised with the acting manager for improvement. Feedback received from people their relatives and visiting health professionals through the inspection process was positive about the care, the approach of staff and atmosphere in the home. People said they would recommend the service and one said “I can’t think of a better place to end my days.” People were looked after by staff attentive staff who treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

There was a variety of activity and opportunity for interaction taking place in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with senior staff and the acting manager. People were complementary about the food and the choices available. Staff monitored people’s nutritional needs and responded to them. Preferences and specific diets were provided.

People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be. Feedback was sought from people on a daily basis and satisfaction surveys had been completed. The management style fostered in the home was open and responded to people and staff’s views. This provided a friendly and homely environment that people enjoyed.

During our inspection we found that people were involved in decisions about their care and treatment. Care plans were personalised and documented the needs of people.

Safeguarding measures were in place to protect people living in the home. Staffing levels had been assessed and reviewed to ensure adequate staffing levels in accordance with the organisations requirements. Complaints procedures were displayed around the home and a complaints policy was in place. Evidence was seen that comments and complaints were listened and responded to in a timely and appropriate manner.