Archived: Penkett Lodge

Penkett Lodge is a care home that provides accommodation for up to 27 people who need help with their personal care. At the time of the inspection 14 people lived in the home. Some people living in the home, lived with dementia.

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

People told us they felt safe and were treated well. People and relatives were very positive about the staff and manager. They told us they were happy with the care provided.

Risks to people were assessed and their safety was monitored. Improvements made to the environment offered safer living facilities that had been improved and maintained especially within the gardens and grounds of the service.

People’s safety was monitored and records showed ongoing support to keep people safe and comfortable. People were safeguarded from the risk of abuse. Staff were knowledgeable about the different types of abuse and followed guidance in line with the providers and the local authority safeguarding procedures.

Staff followed safe infection, prevention and control (IPC) practices. They had continual access to the required personal protective equipment (PPE) used to prevent infections and keep people safe.

Safe recruitment processes were followed to assess the suitability of staff to work at the service. Staff had received regular training to ensure they were able to meet the needs of the people they supported.

Medicines were safely managed by staff; they received up to date training and had the relevant skills to support people with their medicines.

The providers systems and processes for monitoring and improving the service had shown a lot of work and investment to improve records, management of health and safety, recruitment, training and supporting staff and improving the environment. Further development was needed to continue the refurbishment and decoration of the home, continue the development of all care records and training records for staff.

Within the context of the Covid-19 infection risk, 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.

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 inadequate published December 2019 and there were multiple breaches 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. This service has been in special measures since November 2019. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures. The evidence that inspectors could review was limited as many of the improvements were recently made and improvements needed to be embedded and sustained over a longer period of time to achieve a rating of good.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since the last inspection in November 2019. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of Safe and Well-led. 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 coronavirus and other infection outbreaks effectively.

Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Follow up

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Penkett Lodge is a care home that provides accommodation for up to 27 people who need help with their personal care. At the time of the inspection 17 people lived in the home. Some of the people living in the home, lived with dementia.

People's experience of using this service

At the last inspection, the provider was rated requires improvement. At this inspection, we found the service had deteriorated to inadequate.

There were no adequate or effective systems in place to monitor the quality and safety of the service. This resulted in people being exposed to ongoing risks. The provider has persistently failed to take action where improvements have been required.

The home’s environment was unsafe. Fire safety standards were poor and serious safety concerns were identified with regards to the both the exterior and interior of the home, including the garden. Despite assurances from the provider at the last inspection that they would improve the environment in which people lived, they had failed to do so. The provider’s failure to ensure people lived in a safe and suitable environment placed them at serious risk of harm.

The Mental Capacity Act 2005 was not always been followed to ensure people’s legal right to consent to their care was respected. Risks in relation to people’s health were not clearly identified and staff lacked suitable guidance on the support they required to keep them well. Assistive technology designed to help prevent falls was not set up correctly and as a result was not effective in identifying when people needed help.

Safe recruitment procedures had not always been followed by the provider to ensure staff were safe and suitable to work with vulnerable people. Some staff had not received the training and support they needed to do their job effectively.

People received enough to eat and drink and a diet suitable for their needs. People told us the food and drink on offer was good and that they were given a choice at mealtimes.

The number of staff on duty was sufficient to meet people's needs. People told us they came quickly when they needed help and that they felt safe living in the home. Staff were kind and caring and knew how to safeguard people from the risk of abuse.

The atmosphere at the home was homely and staff spoken with knew people well and spoke about them fondly. The new manager had only been in post a month and they were upbeat and passionate about improving the service. Staff told us they felt they were a positive influence in the home.

Rating at last inspection and update

The last rating for this service was requires improvement (published 06 November 2018). At their last inspection we identified breaches of regulations 10 (Dignity and respect) and 17 (Good governance). After this inspection, the provider completed an action plan to show us what they would do and by when, to improve.

At this inspection, we found that improvements with regards to Regulation 10 had been made but there was a continued breach of regulation 17 (Good Governance). We also identified additional breaches with regards to regulations 11 (Need for consent), 18 (Staffing) and 19 (Fit and Proper Persons). This meant the provider’s overall rating has declined to inadequate.

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.

We will meet with the provider following the publication of this report to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service will be placed in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Penkett Lodge 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

Penkett Lodge is registered to provide support for up to 27 people. At the time of our inspection 23 people were living there. The registered manager explained that the home has some double rooms, these are only used by people who ask to share a room.

The home 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 our last inspection of the home in March 2017 published in May 2017 the service was rated requires improvement overall. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 11, 12 and 17.

This was because day to day care practices did not always enable people's consent and freedom of choice to be respected. The moving and handling techniques used by staff in support of people's mobility was not always safe and did not always mitigate risks to their health, safety and welfare, and medicines were not always managed or administered in safe way. We had also found that some of the provider's quality monitoring systems were ineffective in identifying and addressing inappropriate care and unsafe medication practices.

After that inspection the provider wrote to us to say what they would do to meet their legal requirements. At this inspection we identified that improvements had been made with regards to regulation 12, safe care and treatment and regulation 11, need for consent. During this inspection we found breaches in relation to Regulations 10, and a remaining breach to regulation 17 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 the report.

Staff did not always treat people with dignity and respect. Some of the language staff used in front of people, such as “feed her”, was not respectful. We also found that the way in which the building was maintained and looked after was not always safe or dignified. For example, we found that towels and face clothes were faded and fraying, people’s bedrooms and communal areas were not always well looked after. This included curtains that were missing hooks, chipped and peeling wallpaper and paint and stained table mats and dirty condiments.

On the first day of our inspection we found that the call bell system was not consistently working correctly and that an outside door had not had a keypad fitted although this had been identified as required by the registered manager.

Systems were in place for checking the quality of the service provided. However, these were not effective at identifying and addressing improvements needed within the service. This included improvements to the environment, repairs and ensuring people were always treated with dignity.

Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. People said they felt safe living there and staff knew what action to take if they felt people were at risk of abuse. A system was in place for raising concerns or complaints and people living at the home and their relatives told us they would feel confident to raise a concern.

People’s medication was safely managed and they received their medicines as prescribed. Staff provided people with the support they needed to manage their physical and mental health care needs.

A series of assessments of people’s care needs had been carried out and regularly reviewed. Where people required support, this was addressed in their care plans which provided guidance for staff on how to meet people’s needs. Plans were regularly reviewed although we discussed with the registered manager how these reviews could be more meaningful.

Equipment and the building were monitored regularly to check they were safe, however this system was not always effective.

The building had adaptations and equipment to support people with their mobility and personal care. This included grab rails, adapted bathing facilities and a passenger lift.

There were enough staff working at the home to meet people’s care needs, although people told us that at busy times they sometimes had to wait for support. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

Staff had received training to help them understand and meet the care needs of people living at the home. Staff told us that they felt supported and we saw that they had regular staff meetings and supervisions with senior staff.

A series of activities were arranged at the home each afternoon and people living there told us that they enjoyed taking part in these.

People had a choice of meals and were offered plenty of drinks and snacks throughout the day. People told us that they liked the meals provided and always had a choice. Mealtimes were not always relaxed sociable occasions with staff available to provide support when people needed it.

The provider met the requirements of the Mental Capacity Act 2005. People were supported to make choices and decisions for themselves. Where people lacked the capacity to make important decisions for themselves then the provider took steps to protect them. This included applying to the local authority for a Deprivation of Liberty Safeguard (DoLS) for the person.

Records in the home were stored confidentially in locked offices.

Penkett Lodge provides personal care and accommodation for up to 27 people. Nursing care is not provided. The home is a detached four storey building in Wallasey, Wirral. A small car park and garden are available within the grounds. There are twenty one single bedrooms and three shared bedrooms with communal bathrooms on each floor. Some of the rooms are en-suite. A passenger lift enables access to bedrooms located on upper floors and specialised bathing facilities are available. On the ground floor, there are two communal lounges and a dining room for people to use. At the time of our visit, there were 26 people who lived at the home.

The home 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 registered manager had been employed at the home for over five years.

During this inspection, we found breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to respecting people’s right to choose and safe medication management. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the care files belonging to four people. We saw that people’s capacity was assessed where their ability to make informed decisions was in question. Where people were assessed as lacking capacity, a best interest decision process had been undertaken before any decisions were made on the person’s behalf. It was clear from looking at people’s records that the manager had considered the Mental Capacity Act 2005 (MCA) when assessing people’s capacity but at times the way people’s capacity was assessed did not comply in full with the MCA legislation. We spoke with the registered manager about this.

During the visit, we saw that one person’s ability to decide for themselves where they wanted to spend their time was not always respected or followed. This meant that this person’s liberty was restricted. There was a risk that this restriction was unlawful. We spoke with the registered manager about this. They told us that staff did not act on the person’s wishes to go to their room as they were worried they may have a fall. They acknowledged that the person’s right to choose where they spent their time should have been respected and facilitated by the staff team and the risks managed appropriately.

We observed a medication round. We saw that staff did not always observe people taking their medication before they signed the person’s medication administration record. This meant that staff could not be certain that the person had actually taken it before they signed to say that they did. We found that some of the eye drop medication at the home was not stored safely and some of the medication had exceeded it expiry date but was still in use. This placed people at risk of harm.

We saw two incidences staff supported people’s moving and handling needs in an inappropriate way. On both occasions the staff members supported people’s weight to transfer to or from a seat using an underarm lift. This type of lifts can cause physical injury to both the person requiring support and the staff member. We spoke with the manager about this.

People’s care plans described their individual needs. People’s wishes and preferences in the delivery of care were documented. There was clear guidance for staff to follow to ensure that people’s needs were met and their risks managed. We saw that people received care from a range of health and social professionals. For example, doctors, dentists, district nurses, occupational therapy, community dieticians and chiropody services.

We found information in relation to people’s health needs was brief. For example, there was limited information about the signs and symptoms to spot should a person’s medical condition decline. The staff we spoke with however did have an understanding of these needs and how to manage them.

People we spoke with were very complimentary about the staff, the manager and the service they received. People told us that they were well looked after, treated kindly and that the home was a nice place to live. All of the people we spoke with felt that staff had the skills and abilities to meet their needs and said that the manager was approachable and easy to talk to.

Staff were recruited safely and had received the training and support they needed to do their job effectively. People’s feedback on staffing levels was mixed. During our visit we saw that staff were busy supporting people with personal care with little time to sit and chat to people socially. A visible staff presence in communal areas was also sometimes not evident. We observed however that the support people received was unrushed and we did not see anyone waiting long periods of time for staff to support them. People looked happy and relaxed in the company of staff and it was clear that staff and the manager knew people well.

People had access to sufficient quantities of food and drink and suitable menu choices at each mealtime. The cook and staff had a good knowledge of people’s dietary needs and preferences and people we spoke with told us the food was of a good quality.

During our visit, we observed that staff treated people kindly and supported them at their own pace. People looked smartly dressed and well cared for and actively participated in the activities on offer. This promoted people’s emotional well-being.

People told us they felt safe at the home and they had no worries or concerns about their care. Staff we spoke with were knowledgeable about potential signs of abuse and how to protect people from harm. They spoke warmly about the people they cared for and from our discussions it was clear they knew about ‘the person’ as opposed to just the care that they had to give.

The home and its equipment were safe and regular audits were undertaken to monitor the quality and safety of the service. Some improvements to the overall management of the service were however needed to ensure that risks in the day to day practices of staff were picked up and addressed.

We discussed our concerns with both the manager and the provider during our visit in May. An action plan was put in place by the home outlining the improvements they intended to make. During this visit we checked the home's action plan had been achieved and compliance with the regulations now reached.

As part of our visit, we reviewed the home's maintenance records and found that suitable systems to check the equipment used by people living at the home was in good repair, free from defect and safe for use, were now in place.

We saw that staffing levels at the home between 8-10a.m. in the morning and 5-10p.m. at night had been increased by one staff member. We observed staff caring for people in the morning and noted that the extra staffing had a positive effect on the availability of staff and their ability to be respond to people's needs in a timely and responsive manner.

We examined the care records for three people who lived at the home and found them to accurately and appropriately reflect people's needs. We also reviewed the records maintained in relation to the staff rota and found they clearly identified which staff member was on duty on any given day.

We found the home had undertaken all the actions outlined in their action plan and had sufficiently improved in all areas of concern previously identified.

We looked at three care records. We found they were personalised to the individual and gave staff simple instructions on how to care for each person. All care plans were regularly reviewed and daily written records showed people had received care and support.

We saw staff spoke to people kindly and with familiarity. We observed however that there were insufficient staff on duty in the morning to tend to people's needs in a timely and responsive manner. This meant there was a risk of people's needs not being met.

Staff we spoke to knew how to identify and respond to signs of abuse appropriately. A safeguarding procedure was in place and staff had regular training in safeguarding.

We reviewed the provider's arrangements for the safe use of equipment. We found the provider did not have a suitable system in place to check that equipment remained free from defect and safe for use.

Due to concerns raised at our last visit, we looked at the quality and security of records. Records were now held securely and complaints/compliments documented appropriately. There were inconsistencies however in the updating of care plans and the staff rota. This meant people's needs were not fully reflected and that arrangements for staff cover were unclear.

"I am treated very well and my needs are tended to'

'I have no complaints about anything, I am very happy here"

"The staff are very good"

People told us they were involved in their care and able to make choices in every day living activities such as food choices, meal times and the level of assistance needed with personal care.

We observed that people were well cared for and treated with dignity and respect. People's needs were assessed and reviewed. We found care records contained relevant information in relation to personal details, individual needs and preferences. Care plans and risk assessments were in place and individualised. However review records were not accurate and risk assessments/care plans were not updated in line with changes in people's needs. This meant that people using the service could be at risk of not having their needs met. Staff completed daily evaluations sheets which showed that people received the care they needed.

Care records were not stored safely which posed a risk to confidentiality. Care records were kept in an unlocked office accessible to all care staff, other healthcare professionals and visitors to the home.

Staff were appropriately trained, supported and appraised to care for people's needs. They demonstrated an awareness and understanding of how to protect people from abuse.