This was an unannounced inspection which took place on 20 and 21 March 2018. The inspection was brought forward as we had received concerns about the risk of infection at the service.We last inspected Passmonds House in February 2017 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014) in that medicines were not always managed safely and recruitment procedures did not ensure suitable candidates were selected to work at the home. At this inspection we found improvements had been made in both these areas, and the service was no longer in breach of these regulations. However, we found concerns in other areas. We found that there were insufficient staff to meet the needs of the service, which was a breach of Regulation 18 of the Health and Social Care Act (2008) Regulations 2014.
We also identified concerns in relation to infection control, poor standards of hygiene and, maintenance of the premises. This meant there was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities 2014.
A Warning Notice was sent to the registered provider requiring them to comply with Regulation 15(1)(a)(c) (d) (e) and (2) of the Health and Social Care Act (Regulated Activities) Regulations 2014. They appealed publication of the warning notice, however this was not upheld. The registered provide must make sure the poor standards of hygiene are resolved before 17 August 2018.
We made three further recommendations regarding training, capacity and care plan reviews. We found the training provided to staff did not provide them with sufficient information to carry out their duties; staff were not always aware when a person was lawfully being deprived of their liberty; and care plan did not take all recorded information into account.
Passmonds house 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. Passmonds House provides accommodation and support for up to 35 people in two double and 31 single rooms. Twenty-two of the rooms have en-suite facilities. At the time of our inspection nobody shared a double room. It is comprised of two units over two floors, with lift access to the upper floor and ramps to all entrances. At the time of our inspection there were 30 people living at Passmonds House.
'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.' At the time of our inspection the service had a manager who was in the process of registering with CQC.
People who used the service were safeguarded against potential harm, and they told us that they felt safe at Passmonds House. When we spoke with staff they told us they were confident they would report any issues of malpractice to their manager, and we saw that the service responded to issues of poor practice.
We saw and were told by staff that they were sometimes overstretched, which meant that there was little time during the day for work on an individual basis with people who used the service. However, staff showed a good knowledge of the individuals they supported, their needs and preferences, and respected their religious and cultural beliefs.
We saw records which showed people received supervision, but this needed greater structure and frequency. During our inspection we saw staff and managers communicated well with each other to ensure tasks were completed, and that people took responsibility for their own work. The staff cooperated well with each other to share the workload equally.
Attention was paid to people’s diet and nutritional needs, but not everyone enjoyed the food that was offered. However, we were told that if people did not want food that was on the menu they could request an alternative, which was provided.
We saw attention was paid to people’s health needs, and a visiting health professional told us staff promptly referred any issues of concern, and followed their advice to ensure people remained healthy. The service had worked with a district nurse to monitor for signs of illness and skin integrity, showing a proactive response to any potential health concerns.
Capacity and consent was generally sought, and there was evidence that where people lacked capacity decisions were made in people’s best interest, and appropriate authorisation to support people had been requested. However, when we spoke with staff they were not clear as to who might be subject to any authorisation to deprive them of their liberty, or what this might mean.
Individual preferences were not reflected in the premises or the environment. There was little attention to how bedrooms were decorated and furnished. The layout of communal rooms did not allow for small group work or social interaction, an upstairs room was not used because of the poor light aspect and décor, which meant that there was little room in the downstairs lounges for people to socialise.
When staff were supporting people they were courteous, polite and respectful, and care plans reflected their needs. People told us that the staff knew how they liked to be treated and that they were caring. We saw, and were told that there were some social activities on offer, but there was not always enough stimulation for the people who used the service. When we spoke to staff and the manager they displayed a good understanding of how to support people approaching the end of life.
There were structures in place to review the service, and people had completed questionnaires to check their overall satisfaction with the service. These showed people were generally satisfied but greater analysis would help to improve the quality of service provision, as the questionnaires did not reflect some of the views people fed back to the inspectors.