Archived: Pengover Residential and Nursing Home

We found the following examples of good practice.

There had been a recent outbreak of Covid-19 at the service. During this time the registered manager had communicated with people, staff and families regularly to ensure everyone understood the measures put in place to help keep people safe.

All areas of the service were clean and uncluttered. Effective cleaning routines had been put in place to ensure infection control risks were minimised and people were kept safe. Housekeeping hours had been increased at the start of the pandemic and further increased when the outbreak occurred. The provider had decided to maintain these additional cleaning hours, on an on-going basis, because of the benefits in helping to prevent the spread of infections of any type. There were ample supplies of PPE and anti-bacterial wipes around the service for staff to use. There were posters to prompt and remind staff about the infection control procedures in place.

Appropriate testing procedures had been implemented for all staff and people who used the service, following national guidance regarding the frequency and type of testing. The registered manager said both staff and people were happy to participate in regular testing. Where rapid testing was appropriate, there was a designated area for staff and visitors to be tested before entering the main building, as well as a separate area for them to wait for the results.

Staff put on and took off their uniforms in a spare bedroom, close to where they entered the building, and uniforms were laundered at the service. This helped to reduce the risk of infection because staff did not enter areas of the home, where people lived, until appropriate infection control measures were in place.

Staff had completed online infection prevention and control and Covid-19 training. Additional PPE had been provided for staff, such as visors, to use during the outbreak. The service had maintained good stocks of PPE and the registered manager worked with care and housekeeping staff teams to ensure infection prevention and control measures were followed.

The design of the service had enabled staff to create zones, where people who were Covid positive were cared for in designated areas, to prevent the risk of the virus spreading to others. Some people found it difficult to maintain social distancing and staff supported people to walk around the zone they were living in, to help them avoid close contact with others. Staff worked in smaller groups, allocated to specific areas of the home, to limit the number of staff people had contact with.

The registered manager had worked closely with external healthcare professionals to enable people to have access to appropriate health care and equipment such as hospital beds and oxygen. There were daily calls with the GP where staff reported people’s daily observation results, such as oxygen levels. Most people living at the service had some level of cognitive impairment which reduced their ability to effectively communicate if they felt unwell or had Covid symptoms. Staff observed and reported any changes in people’s behaviour and discussed this with the GP at the daily calls, when additional testing could be carried if necessary. This meant, for people who were unwell with Covid, the right care could be provided in a timely manner.

Due to the recent outbreak the service was closed to visitors at the time of the inspection. However, staff helped people to stay in touch with family and friends through phone and video calls. The registered manager was in discussion with people and their families about resuming visiting in line with recent changes to government guidance.

The provider had reviewed the infection control policy in response to the pandemic. Specific Covid-19 policies had also been developed to provide guidance for staff about how to respond to the pandemic and the outbreak.

The provider had recently appointed two new infection prevention and control leads and new infection control audits had been devised and implemented. This had enabled the organisation to analyse and learn from the infection control measures that had been in place throughout the pandemic and make any changes to improve practice.

Further information is in the detailed findings below.

Pengover is a care home that provides personal care for up to 40 older people. At the time of the inspection 31 people were living at the service. Some people were living with dementia.

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

People and their relatives told us they were happy with the care they received and felt safe living there. One person said; “I am happy here, the staff are kind.” A relative said; “I am extremely happy with my wife’s care.” People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

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 were supported by a staff team who completed an induction, regular training and were supervised. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activities with staff. Staff knew how to keep people safe from harm.

The environment was safe, with upgrades and redecoration ongoing and people had access to equipment where needed. Staff completed appropriate training and support to enable them to carry out their role safely, including dementia care and safeguarding training.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified, and some people had end of life wishes explored and recorded.

People were involved in menu planning when possible and staff encouraged everyone to eat a healthy and well-balanced diet. Special diets were catered for.

People were supported by a service that was well managed. Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service. People, their relatives and staff told us the management of the service were hands on, approachable and listened when any concerns or ideas were raised.

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.

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

Rating at last inspection

The last rating for this service was Good. (Report published on 31 August 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

We carried out this inspection on 1 August 2017. At the last inspection, in May and June 2015, the service was rated Good. At this inspection we found the service remained Good.

People who were able to talk to us about their view of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people and visitors included, “It’s good here”, “No complaints” and “Very satisfied with the service.”

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People had meaningful relationships with staff and staff interacted with people in a caring and compassionate manner. Comments from people and visitors included, “I can’t find fault with the staff”, “The staff are as good as gold, I have no complaints whatsoever”, “Staff treat the residents extremely well” and “Staff put their arms around people, they show love and compassion.”

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Pengover. Staff supported people to access healthcare services such as occupational therapists, GPs, chiropodists and specialist professionals such as dementia liaison and stoma care nurses. A visiting healthcare professional told us, “The care is good and well organised. This works well in partnership with the general practice.” Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

People were able to take part in a range of group and individual activities. These included armchair exercises, baking, craft work, reminiscence sessions as well as external entertainers and religious services. Where people stayed in their rooms, either through their choice or because they were cared for in bed, staff spent one-to-one time with them. This helped to prevent them from becoming socially isolated and promoted their emotional well-being.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. People were given plates and cutlery suitable for their needs and to enable them to eat independently wherever possible. People and their relatives told us, “The meals are excellent”, “The food is good” and “Very happy with the food.”

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Comments from staff included, “Management value me”, “We feel listened to. We have monthly staff meetings and a carer’s support group”, “I like working here” and “Management listen to us.”

People and relatives all described the management of the home as open and approachable. There were regular meetings for people and their families, which meant they could share their views about the running of the service. People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

We saw people who used the service were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We observed the lunch time meal and saw staff respected peoples' dignity when assisting them to eat.

During our inspection, we found people's privacy, dignity and independence were respected. Where people were able to express their views and experiences, these were taken into account in the way the service was provided and delivered in relation to their care.

People were protected from abuse and staff were trained and supported to carry out their roles.

Staff told us training was provided, and also confirmed they had received supervision.

Care plans and associated documentation provided sufficient detail to direct and guide staff as to the actions necessary to take in order to meet people's assessed care needs. People's records were personalised and provided clear information about the person's wishes and abilities.

that could told us the staff were kind and always did their best.

Staff told us they liked working at the home, and they confirmed the availability of training

courses and staff supervision.

We spoke with two visitors who told us they were pleased their relative lived at Pengover. We spoke to people and spent time observing people and staff over a meal period. We saw people's privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff. One person said, 'Its lovely here, the staff are good and polite'. Another person said, 'The staff ask us what we want and give us choices, I have no complaints'.

We were told that people could go to bed and get up in the morning when they wish to do so. People told us the staff answer call bells quickly. Two people said they were aware of their care plans and were involved in reviews of their care.

During our observations we saw staff helped people to move around the home. We saw staff assisting people to the bathroom. We saw people talking to each other in the lounges.

We witnessed staff interaction with people which was positive.

We heard care workers ask people what they would like to do and gave they them ideas if they could not make a choice.