Pennington Court Nursing Home

Pennington Court Nursing Home is a residential care home providing personal and nursing care to 48 people at the time of the inspection. The Registered Provider is registered to accommodate a maximum of 62 service users at Pennington Court Nursing Home. Attached to the building are 8 extra care apartments each comprising of a bedroom with attached lounge, bathroom, and kitchen area.

Pennington Court Nursing Home accommodates people over 2 floors. People who live in Ash require residential care. Willow provides support for people who require nursing care. People living in the extra care flats are provided with personal care support. Not everyone who used the housing with support service received personal care, although the contract provides for two hours support each day. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Some care intervention records were incomplete, and some evidenced contradictory information. Quality assurance processes had not highlighted or addressed issues to ensure improvements were made.

Some of the risks to people's safety and wellbeing had not been recorded, to ensure actions were put in place to protect people from harm. Recorded risk reduction measures did not always show the necessary control measures were in place.

Medicines were not always managed safely with gaps in stock checks and MAR charts. Medication was not consistently stored safely including the fridge temperatures being incorrect.

Most people and their relatives told us they were safe at the home and most people we spoke with told us they were happy living there. We observed that people were well groomed and dressed appropriately.

People were not supported to have maximum choice and control of their lives. staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 requires improvement (published 6th September 2021). The service remains rated requires improvement. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We carried out an unannounced focused inspection of this service. Breaches of legal requirements were found. You can see what action we have asked the provider to take at the end of this full report

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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, need for consent and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Pennington Court Nursing Home is a residential care home providing personal and nursing care to 47 people at the time of the inspection. The Registered Provider is registered to accommodate a maximum of 62 service users at Pennington Court Nursing Home. Attached to the building are eight extra care apartments each comprising of a bedroom with attached lounge, bathroom and kitchen area.

Pennington Court Nursing Home accommodates people over two floors. People who live in Ash require residential care. Willow provides support for people who require registered nurses to provide their care and treatment. People living in the extra care flats are provided with personal care support. Not everyone who used the housing with support service received personal care, although the contract provides for two hours support each day. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

The quality of care had deteriorated since our last inspection and this service was no longer considered to be providing outstanding care. Some care intervention records were incomplete and contained gaps to evidence care had been provided. Quality assurance processes had not highlighted or addressed issues to ensure improvements were made.

Some of the risks to people’s safety and wellbeing had not been recorded, to ensure actions were put in place to protect people from harm. Recorded risk reduction measures did not always show the necessary control measures were in place. Care plans often contained conflicting information, and information in people's rooms did not contain information about how to manage all of their clinical needs. We were not assured infection control measures were consistently managed in line with current best practice. Some communal areas required de-cluttering and deep cleaning.

Medicines were managed safely. Staff involved in handling medicines had received recent training around medicines and had their competencies assessed. The application of cream records was inconsistently recorded.

Most people and their relatives told us they were safe at the home and people we spoke with told us they were happy living there. People were well groomed, and the hairdresser attended on both days of our inspection. We received positive feedback from the advanced nurse practitioner attached to the GP surgery. They told us the service was very proactive when a person’s needs had changed and obtained the services of the relevant health professionals.

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 Outstanding (Published 10 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about how the service managed complaints and in relation to end of life care. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. Ratings from previous comprehensive inspections for those key questions not inspected against were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pennington Court Nursing Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in November 2015, we identified a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 Safe care and treatment. This was because equipment used to support people had not been subject to regular examination to ensure it remained safe to use. We asked the provider to complete an action plan to show what they would do and by when to improve the key question; ‘Is the service safe?’ to a rating of at least good.

At this inspection we saw there had been improvements made in this area and the service was compliant with all relevant health and social care regulations. The breach we identified in November 2015 had been addressed and the rating for the key question; ‘Is there service safe?’ is now good.

Pennington Court Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service provides residential, nursing and intermediate care services for a maximum of 62 people. Accommodation is arranged over two floors with communal lounges, dining areas and bathing facilities available. All bedrooms are single occupancy and many have ensuite toilet facilities.

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 extremely passionate about delivering very high standards of care to people using the service. They had established excellent links within the local community and worked collaboratively with other professionals.

The provider demonstrated a strong commitment to ensuring people received care based on best practice guidance, with the aim of achieving the best possible outcomes. They gave people, their relatives and staff ways of sharing their opinions and ideas for any improvements that could be made. Staff told us they were proud to work at the service. They said the registered manager was very supportive and the provider gave them opportunities for professional development.

The provider had gone to great lengths to ensure people had access to a wide range of meaningful activities. This included trips out to places that people said they wanted to visit. We saw many examples of where the involvement of the local community had enabled people to feel included and maintain the links they previously had. People were also supported by staff to develop new interests which contributed to their overall wellbeing. People told us they looked forward to things and felt excited by activities, visits and events at the service. This demonstrated activities were truly meaningful for people.

Without exception, people and their relatives gave consistent, positive feedback about the service. This included the approach of staff, the food, the range of meaningful activities that were on offer to them and the accommodation.

People and their relatives gave very positive feedback about the food at the service. People said they looked forward to their meals and relatives told us they were happy to see their loved ones with an appetite and putting weight on. The provider had a number of mechanisms in place to monitor the quality of the catering and we saw people's feedback was used to make improvements.

People told us they felt safe at the service and were well supported by staff who were caring and friendly. Staff told us they were aware of how to report any concerns and were up to date with training on how to protect vulnerable adults from abuse. We saw the provider had arrangements in place to ensure medicines were managed safely. Any risks to people were identified and plans were in place to guide staff on how to support people safely.

The provider ensured the building was safe by completing a number of safety checks on a regular basis. Continuity plans were in place to ensure staff knew what actions to take in the event of an emergency.

Staff were recruited robustly and safely. They received training which ensured they were up to date with the skills required for their roles. Nursing staff were supported to remain up to date with the requirements of their registration. New staff received an in depth induction to the service which included the support of more experienced staff.

Care plans were very personalised and focused on the person. Staff developed in depth life history documents in collaboration with people and their families. This helped staff understand what was important to people. People's communication needs were included in care plans and staff told us they were aware of these.

Care records were reviewed regularly, or when people's needs changed. People told us they had been involved in the development of their care plans. Relatives told us they always received a warm welcome when they visited people and communication from staff was consistently good. External health and social care professionals told us they experienced good levels of communication with the service.

There were enough staff to ensure people's needs were met safely and staff had time to spend time with people. Staff were aware of infection control measures and the service was clean and well maintained. Accidents and incidents were monitored by the provider and used as an opportunity for learning.

The service worked within the principles of the Mental Capacity Act and we observed people being asked for their consent throughout our visit. People were given choices and offered opportunities to spend their time however they wished. The service focused on promoting people's independence. Staff treated people with dignity and respect and were genuinely warm in their interactions with people.

During our visit, we saw staff interacting with people in a positive, respectful and caring manner. Everyone we spoke with were very complimentary about the staff who provided care to them. One person said, 'I'm getting on champion. They look after us very well here, they couldn't do any better. They always tell you what is going on ' Another person told us, 'The staff are beautiful and that's the main thing, I love them all, they really listen to me and help me whenever I need.'

We spoke with two relative. Both spoke highly of the staff and care which they provided to people. One relative said, 'I can't fault the staff here. I would recommend it here to anyone.'

The home was very clean and had systems in place to reduce the risk of infection.

We saw evidence which showed that appropriate checks were undertaken before staff began work to make sure they had the relevant experience and skills for the role.

The home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

One person told us how staff in the home supported her in regaining her mobility following an accident and a stay in hospital, to enable her return to her own home in the near future. People told us about how they were able to express their views and were involved in making decisions about their care and treatment.

People spoken with said they were happy living in the home and we saw people appeared happy and comfortable with staff in their interactions with them. We spoke with five members of staff who told us they enjoyed working at the home. One member of staff commented: 'I really enjoy working here very much' and another said: 'All the staff here are very supportive and we work well as a team.'

People spoken with said they had no concerns or complaints about the home at this time. People told us they felt able to speak out if they needed anything and believed the staff or the manager would act on their concerns without the fear they would be discriminated against for making a complaint.