Pendean House Care Home

Pendean House Care Home is a residential care home providing personal and nursing care for up to 40 older people. At the time of our inspection, 30 people were in residence as double rooms were being used for single occupancy. The home offers respite stays and works closely with the local Macmillan team providing palliative care. It consists of one adapted building set in extensive grounds, just outside the town of Midhurst. All bedrooms have en-suite facilities and there are a range of communal areas for people to enjoy.

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

There had been significant improvements in the service since our last inspection. All of the issues we had identified had been addressed and the staff team were engaged and full of ideas on how to further improve the service and support people to live their lives to the full.

People received high quality care and support from a staff team who valued and celebrated individuality and diversity. People spoke of a family feel and it was evident they enjoyed close relationships with staff. People shared examples of how staff had supported them, from help with the little things that made life more comfortable to achieving specific ambitions. People were involved in their care and in decisions relating to the home. The relationships between staff and people receiving support demonstrated dignity and respect at all times.

The home worked closely with Macmillan and staff were skilled in supporting people at the end of their lives. A number of people came to the home specifically for palliative care. Relatives spoke highly of the care. One said, “The home has been exceptional in their care for (my relative) and for the family. They have been very supportive throughout and have offered to let me stay. Everyone is very friendly and considerate”. Another family had written to staff saying, ''You are all amazing and showed (my relative) and all of us so much compassion and support'.

There was a programme of events, often involving people from the local community. The home offered activities seven days a week. Some people, who preferred to spend time in their rooms, shared how they would appreciate more social contact. The registered manager was looking at ways to expand the provision of one to one support for people who preferred not to participate in group activity.

People received good care that improved their wellbeing. Care plans had been improved since our last visit, they described people’s care needs in a thorough and person-centred way. Staff were attentive to changes in people’s needs and took action to involve healthcare professionals whenever necessary.

People had confidence in the staff who supported them. Staff received regular training and were encouraged to further their skills and experience. Staff felt supported and were highly motivated to deliver the best care for people. One staff member said, “I am very happy with the training offered. I like to have more qualifications and learning so I can do more for our residents here”. Another told us, “We're a very good team, everyone helps everybody, everyone gets on”.

People felt safe at the home. One person told us, “I am very happy living here and with the care that they give me”. Risks to people had been assessed and staff followed guidance to keep people safe. Staffing levels were enough to meet people's needs. Medicines were managed safely. Lessons were learned if things went wrong.

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

People enjoyed the food and were able to make suggestions for changes or additions to the menu. Premises were suitable and comfortable and met people's needs. Staff had been trained in infection prevention and control.

People benefited from a well led service. The registered manager had shaped a culture where people were at the heart of the service. There was a clear leadership and management structure in place, which helped to ensure that staff understood their role and responsibilities. The service was well organised and had a range of systems in place to ensure its smooth operation and to support good communication. One staff member said, “(Registered manager) is very approachable. She sorts things out”.

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 23 October 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home provided care for older people, some of whom had dementia. Some of the people were admitted on a short stay basis and were receiving support from the local hospice team. The home had 34 rooms and was registered to care for up to 40 people. The home is set over two floors and had passenger lifts, between the floors.

The last comprehensive inspection was on the 26 and 31 May 2016. At this time the home received a rating of ‘Good’ overall but required improvement in the ‘well-led’ domain. A breach of legal requirement was found, relating to oversight and governance. This was followed by a focused inspection on 12 September 2017. This inspection looked specifically at the ‘Well-led’ domain. At this inspection the overall rating was ‘Good’ and the legal requirements had been met.

We inspected Pendean House Care Home on 26 July 2018. We brought forward this comprehensive inspection due to information of concern we had received. This information related to the management of end of life care. During the inspection we reviewed the care people received at this time. We found some omissions in the paperwork and assessments. However, people were receiving appropriate and compassionate care and staff were delivering symptom management, under the guidance and support of the Macmillan team.

We reviewed personal risk assessments and the documentation that described the care people required. Some of the risk assessments had not been updated to reflect people’s current needs. The care plans were not always person-centred and did not fully identify the care people required. This could impact on the care people received, as there was insufficient information in the documentation to determine what support and care a person needed. You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we reviewed how medicines were managed. Staff had received relevant training and there was a regular audit in place. However, we saw some errors in the prescribing and recording of the delivery of medicines, which had not been identified by the audit process. One person was meant to have two different nutritional supplements prescribed on the medication administration record (MAR). However, one type of supplement had been written up in two separate areas of the chart. Some of the paperwork relating to topical medicines (creams and lotions) and instructions relating to drugs that are given as required (PRN), were missing from the MAR. The impact of this on the people was low, as the nurses had been giving the correct supplements and were aware of when and how to administer the topical and PRN medicines. However, both the management of medicines and audit system, which should have identified the errors, are areas that require improvement.

There was a system for recording accidents or incidents that happened within the home. However, the paperwork was not always fully completed, which would make it hard to determine if there were trends or issues that required addressing. The manager and staff co-operated with the local authority and there was a safe guarding and whistle-blowing policy. There was a complaints procedure and it was seen that any complaints were reviewed and investigated.

There was an audit and quality assurance system. However, this had not identified errors and omissions in the paperwork we reviewed, for example with the management of medicines and the lack of person-centred information, within the care assessment and planning documents. After the concern relating to standards of care, the management team had made an action plan to address the issues identified. However, the oversight and governance of the home is an area that continues to require improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive ways possible; the policies and systems in the home supported this practice. People within the home told us that the staff were caring and respectful. People were helped with their communication needs and staff asked for consent before completing any care.

There was a system for determining how many staff were required. We received mixed comments from people about the availability of staff. Some people told us that care was provided in a timely fashion, but others mentioned occasions when they had to wait. At the time of the inspection two new members of staff were being orientated in the role. We were advised, by the registered manager, that after their orientation the home would have a full complement of staff. We were also advised that the home routinely had more people on each day than the dependency score indicated.

We similarly received mixed comments about the quality of the food, even though people were given choice and felt able to ask for alternatives to the menu. We observed a meal-time experience. This was a quiet affair and some people would have benefitted from more encouragement and support from the staff.

People’s privacy and dignity was maintained when receiving personal care. Staff aimed to promote and maintain people’s independence. There was a comprehensive activity programme in place. This included activities within the home and a range of excursions and events. The activity team also saw people on an individual basis. The activities contributed to people’s well-being.

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.’

The registered manager was approachable and actively sought ways of gaining feedback from people and their relatives. Staff felt supported and enjoyed working together as a team. The registered manager had also established links with the local community.

There was a clear system in place for ensuring new staff were suitable for the role. There was a process for orientating new staff. There was also a programme of training for all staff, to ensure they had the necessary skills to care for people. There was a system in place for providing staff supervision.

The home was clean and tidy and there were infection control protocols and policies in place. The environmental risks were managed appropriately. The home was adapted to suit the needs of the people. There was a large garden and a vintage reminiscence room.

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

The service has 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.

At the last inspection on the 26 and 31 May 2016, the service was rated Good overall and Requires Improvement in the 'well-led' domain. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found the provider had followed their plan and they were now meeting the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pendean House Care Home on our website at www.cqc.org.uk

Steps had been taken to drive improvement and the provider was now meeting the legal requirements. Wound care plans were now in place and diabetes care plans now included detailed information. However, further work was required to strengthen the provider’s internal quality assurance framework. We have identified this as an area of practice that needs improvement.

There was a friendly, warm and homely atmosphere and a positive culture. People, staff, relatives and visiting healthcare professionals spoke highly of the registered manager. One healthcare professional told us, “I have the highest regard for the manager. She is always very professional, incredibly kind to families and patients. She will always offer the best service she can.”

The values and ethos of Pendean House Care Home were embedded into everyday practice. People were at the forefront of the running of the home and people’s views mattered. Staff understood the importance of delivering personalised care and people received care that met their needs and was personalised to them. One visiting healthcare professional told us, “The care here is good, the nurses are all committed.”

People received care that promoted their wellbeing and was personalised to them.

Pendean House Care Home provides accommodation and nursing care for up to 40 older people. The home has 34 bedrooms, some of which could be used as double occupancy. The home offers long stay, palliative, respite and day services. At the time of our visit there were 30 people living at the home.

The service has 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 took prompt action to respond to changes in people’s care needs but records for each person were not always accurate or complete. We did not identify a direct risk to people but the lack of accurate records meant staff were unable to demonstrate that effective care had been planned and delivered at all times. Records relating to staff training were not fit for purpose.

The system in place to monitor and mitigate risks had not always been effective. We found action had not always been taken in response to the findings of audits. Audits of pressure relieving equipment had failed to identify that some equipment was not providing full support.

People, relatives and professionals spoke highly of the service. People were encouraged to participate in activities that interested them and to forge links with the local community. There was an innovative activity programme and activity staff responded to people’s suggestions.

People were asked for their views on how the service was run and were invited to participate in regular residents’ meetings. They told us that they were listened to and that changes had been made to the menu and activities as a result of their feedback.

People and staff had developed good relationships and many staff had worked at the service for a number of years. People told us that staff were “magnificent” and that they were available to assist them when needed or simply to enjoy a chat.

People told us that staff treated them with respect. Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People felt safe at the home. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. The premises had been adapted to help people maintain their independence. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely.

There were enough staff to meet people’s needs. Staff had received training and were supported by the management through regular supervision and appraisal. Staff were able to pursue additional training which helped them to improve the care they provided to people. Staff had received training in providing support at the end of people’s lives. Relatives spoke highly of the care provided and the support staff had provided to them during a difficult time.

People enjoyed the food and were offered a choice of meals. Staff were attentive to people’s needs and supported those who required assistance to eat or drink. People’s weight was monitored and prompt action taken if any concerns were identified. Some people had been successfully supported to lose weight.

People were involved in planning their care and were supported to be as independent as they were able. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support. This often included the involvement of healthcare professionals, such as the GP, dietician or optician.

The registered manager had a system to monitor and review the quality of care delivered and was supported by the provider. Whilst some issues were identified during this inspection, the quality assurance process had proved effective and delivered improvements in many areas. People, their relatives and staff felt confident to raise issues or concerns with the registered manager.

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

One person said that there were 'maybe a couple' of staff who were not 'natural carers' but overall the staff were 'very good'. One relative we spoke to talked about the 'esprit de corps' and a member of staff confirmed that we 'work as a team' and it is a 'very happy home'

The people we spoke with said the food was 'perfectly okay' and that there was 'always choice'. One person said that it was a bit like 'being on holiday in a hotel when the menus begin to get a bit tiresome in the second week'.

The manager told us that the number of people living in the nursing home was slightly reduced because the home was being refurbished. The manager said that they needed the additional capacity to provide short-term temporary accommodation for people when their rooms were being redecorated and refitted. The number of staff on duty was slightly higher as there were additional staff helping with the refurbishments.

We spent time observing how staff interacted and supported people, some of whom where in their bedroom due to their condition. We saw staff treating people with respect and involving them in activities throughout the time we spent at the service. People appeared relaxed and happy, talking with each other and staff, or involved in activities.

A resident told us that "the staff here are good, and there is always someone around." Another person told us that the care workers "really do work to their best." They went on to add that "I never get the feeling that any of the staff are suffering from stress." All the people we spoke to said they were happy living at the home. They told us the food was nice, that they had a choice of what to eat, and they had enough to eat and drink. They told us the quality of care was good, a resident said 'the staffing is always adequate.'

People told us they felt safe living at Pendean House. People said that they knew how to raise issues with the manager of the home, and confident that these would be addressed. We also saw that the home had systems in place to regularly monitor and quality assure the care people received.