Background to this inspection
Updated
22 June 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 1 inspector and a British Sign Language interpreter.
Service and service type
Pendean Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under 1 contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since their registration. We used all this information to plan our inspection.
During the inspection
Inspection activity started on 3 May 2023 and ended on 12 May 2023.
An unannounced inspection visit was carried out by 1 inspector and a British Sign Language (BSL) interpreter on the 3 May 2023. We visited the service and spoke with five people about their experience of the care provided.
The inspector visited the service on the 4 May 2023 and met with the regional manager, manager, deputy manager and spoke with 5 staff. We reviewed the providers care records and documentation.
We reviewed a range of records. This included 3 people's care records and medication records. We looked at 2 staff files in relation to recruitment and staff supervision. We also looked at a variety of records relating to the management of the service and quality monitoring systems.
We spoke with 3 relatives and a health and social care professional about their experience of the service on the telephone. We received a further 2 emails from health and social care professionals and 2 emails from staff.
Updated
22 June 2023
Pendean Court is a residential care home providing personal care for up to 8 adults who have a hearing loss, some of whom may have a learning disability or a physical disability. At the time of the inspection 6 people were living there.
Pendean Court is a detached, single-storey service that is fully wheelchair accessible and adapted to suit the needs of people. Each person has their own en-suite bedroom and access to communal areas and a garden. Pendean Court is situated in Liskeard, Cornwall.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of “Right Support, Right Care, Right Culture.
Right support:
The service is staffed by a small staff team who know people well. Staffing levels had increased which meant people’s physical care and social needs were now met.
Staff supported people to make choices about their daily lives and engage in activities, that were tailored to their individual needs and promoted their independence. People were supported to maintain and develop relationships.
Staff had attended communication training in British Sign Language and Makaton. This meant staff were able to communicate with people and understood their individual communication needs.
Staff demonstrated an understanding of people's individual care, behavioural and communication needs. This helped ensure people's views were heard and their diverse needs met.
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.
Staff were recruited safely. The staff team had the appropriate levels of knowledge and skills to support people and responded to their individual needs and choices. Staff were supported by a system of induction, training, and the re-introduction of supervisions, appraisals and staff meetings.
People received their medicines in a safe way and were protected from abuse and neglect.
Right care:
People and relatives were complimentary about the changes at the service. Comments from people included, “You don’t have to worry about me now” and “I like living here”. Relatives commented, “I have no worries I’m much happier with the care.”
The manager had implemented a new care plan format that included information about people’s individual needs, routines, and preferences. This care plan directed, informed, and guided staff in how to meet a person’s care needs. The manager assured us this care plan format would be introduced for all people they supported.
Other records such as communication plans and risk assessments were also being reviewed to ensure they reflected people’s current communication and care needs.
It was recognised that people’s care needs were being met but records still required improvement.
There was a strong person-centred culture within the staff team. Positive behaviour support plans had been developed for some people, to help staff understand how to support someone in distress, and provided guidance to ensure consistent approaches were used when supporting them.
People received good quality person-centred care that promoted their dignity, privacy, and human rights. Staff were observed talking to people in dignified and respectful way.
Right culture:
The staff at Pendean Court were committed to ensuring people were leading the lives they wanted. Staff created an environment that inspired people to understand and achieve their goals and ambitions.
People led lives that reflected their personalities and preferences because of the ethos, values, attitudes and behaviours of the management and staff. People were treated with dignity, respect, and care.
People, relatives, and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service.
Mental Capacity Act
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Rating at last inspection and update
The last rating for this service was requires improvement (published 10 November 2022). At our last inspection we found breaches of the regulations in relation to governance, communication, activities, and staffing. The provider completed an action plan after the last inspection to tell us what they would do and by when, to improve.
At this inspection, we found the provider remained in breach of a regulation.
Why we inspected
We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The warning notice was served in respect of a lack of oversight of the service. At this inspection we found improvements had been made. However, the provider acknowledged that work to implement further changes, especially in regarding to documentation, remained in progress. We therefore have converted this to a requirement notice.
We also checked whether the Warning Notices we previously served in relation to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The warning notices were served in respect of a lack of communication and activities. At this inspection we found improvements had been made and the provider was now meeting this regulation.
We also checked if the Requirement Notice we previously served in relation to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. At our last inspection we found the provider had not ensured there were enough suitably qualified, skilled and experienced staff to provide support to people using the service. At this inspection we found improvements had been made and the provider was now meeting this regulation.
The overall rating for the service has not changed following this targeted inspection and remains requires improvement.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pendean Court on our website at www.cqc.org.uk
Enforcement
We have found a breach of regulation in relation to governance at this inspection. Following the inspection managers told us about actions they had taken to mitigate risk.
Please see the action we have told the provider to take at the end of the full version of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.