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Archived: Partridge Care Centre Requires improvement

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Reports


Inspection carried out on 5 May 2016

During a routine inspection

The inspection took place on the 5 May 2016 and was unannounced. Partridge Care Centre is a purpose built home set over three floors. It provides personal and nursing care for up to 117 older people, some of whom live with dementia. At the time of our inspection 65 people were using the service. Following our inspection of the service on 23 July 2015 we imposed a condition on the provider’s registration to prevent them from admitting any further people to Partridge Care Centre because of the concerns that we found. This condition remains in place.

At the time of our inspection there was a manager who had been in post for nine weeks but they had not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. However, following our inspection we were informed that the manager had left the service.

When we last inspected the service on 14 and 15 January 2016 we found the provider was not meeting the required standards. We found breaches of the Regulations in relation to safe care and treatment, staffing, safeguarding people, consent, privacy and dignity, person-centred care, meeting nutritional and hydration needs, receiving and acting on complaints and good governance. At this inspection we found that some improvements had been made although systems to sustain improvements were still under development.

People told us they received care from staff which was safe and met their needs. The provider was using a high number of agency staff to cover for staff vacancies and planned and unforeseen absences. When we last inspected the service the high use of agency staff was poorly managed and put people at risk of harm due to the lack of information given to agency staff. We found that this had improved and agency staff working at the service were regular, pre-booked for a longer period of time to help ensure people had consistency in the care they received.

People were assisted by care staff who had been trained and had their competency assessed to help ensure the care provided to people was safe and met their needs. We found that staff followed recommendations from social and health care professionals involved in people`s care. However, we found that not all the nursing staff working at the service had the necessary skills and knowledge required to meet the needs of the people living at the home.

When we last inspected the service in January 2016 we found that people’s freedom of movement had been restricted and restrained in ways that did not comply with nationally recognised good practice or the deprivation of liberty safeguards (DoLS). At this inspection we found that the manager has stopped these practices and where people required restrictions to their freedom, this had been done following the right processes.

Accidents and incidents were monitored and reported to the local safeguarding team and CQC where necessary and appropriate. We found that the internal systems to identify trends and patterns had improved and the manager and a consultant were working to develop the system further to ensure information and learning points were shared with staff to prevent accidents and incidents from reoccurring.

We found that both permanent and agency staff`s knowledge about safeguarding people from harm or any possible abuse had improved since the last inspection. Staff were able to tell us the process of reporting any concerns both internally and externally. Information about safeguarding and contact details for the manager and external safeguarding authorities were prominently displayed around the home.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs. However, there was still a high turnover of staff as the provider was not able to recruit and retain a permanent staff group.

We found that people had their medicines administered by nurses who were trained and had their competencies monitored by the manager. There were regular audits carried out in relation to medicines. However we found that records for administered medicines had not always been signed by the staff responsible. One person had missed two doses of their medicine, although this had been available staff had recorded that it was out of stock.

Records were reflective of people`s needs and were regularly reviewed by staff. We saw that improvements had been made to care records in relation to person centred information about people`s likes and dislikes. The manager, deputy manager and clinical lead had held meetings with relatives and people who used the service and involved them in reviewing their plan of care.

People had mixed views about the quality of the food provided. Although it was in sufficient quantities people told us that the choices and alternatives offered if they were not happy with the main meal on offer were not appropriate for main meal choices, like sausage rolls.

All the people we talked with and their relatives were highly complementary about the new manager. Everybody knew the manager by name although they had only been in the service since March 2016. People told us they had faith that anything they asked for or reported to them was taken seriously and resolved.

Staff told us they were well supported by the new manager and they appreciated how approachable and open they were. Staff told us the new manager had put systems in place to improve the service people received and that they were consistent in imposing high standards of care.

Inspection carried out on 14&15 January 2016

During an inspection to make sure that the improvements required had been made

The inspection took place on the 14 and 15 January 2016 and was unannounced. Partridge Care Centre is a purpose built home set over three floors. It provides personal and nursing care for up to 117 older people, some of whom live with dementia. At the time of our inspection 73 people were using the service. Following our previous inspection of the service in July 2015 we imposed a condition on the provider’s registration to prevent them from admitting any further people to Partridge Care Centre because of the concerns that we found.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, there were management arrangements in place as the deputy manager was performing the role of manager and the clinical lead was acting as their deputy. The provider contracted an independent health and social care consultant to help support the interim managers of the service in the absence of a registered manager.

When we last inspected the service on 23 July 2015 we found it was not meeting the required standards. We found breaches of the Regulations in relation to safe care and treatment, staffing, safeguarding people, consent, privacy and dignity, person-centred care, good governance and notifiable incidents to CQC. At this inspection we found the provider continued to be in breach of regulations. Although some improvement had been made the provider had not taken sufficient action to ensure people received safe, effective and compassionate care.

We found that there were inconsistencies in meeting people’s needs safely at all times. The provider was using a high number of agency staff to cover for staff vacancies and both planned and unforeseen absences. This was poorly managed and the agency staff used had not been given access to up to date information about how to care for people in a safe way. For example, a safe induction process was not operated for agency staff who had not had their skills and competency assessed to ensure they were able to provide care safely. Care records were available for agency staff to read however these were not detailed enough to ensure they were able to support people safely and appropriately.

People identified as being at risk through falls had experienced harm because the risks had not been managed effectively.

People were assisted by staff who used unsafe moving and handling techniques. For example, helping people to stand up by lifting and pulling under their arms. Recommendations from occupational therapy staff were not always reflected in the people’s care plans or put into practice. Staff were not familiar with the recommendations made on how to use equipment to assist people with their transfers.

Some people’s freedom of movement was restricted and restrained in ways that did not comply with nationally recognised good practice or the deprivation of liberty safeguards (DoLS). For example, people’s freedom of movement was restricted by the use of tables, mobility equipment such as Zimmer frames being removed or placed out of reach, and by physical restraint observed by the inspection team. The processes designed to ensure people were safe with the least restrictions on their freedom were not followed.

Accidents and incidents were monitored and reported to the local safeguarding team and CQC where necessary and appropriate. However, there were lack of internal systems to identify trends and patterns and there was a lack of action taken to prevent accidents and incidents from reoccurring.

People who needed their food to be pureed and their drinks thickened to mitigate the risk of chocking were administered some of their medicines in tablet form. This was not discussed with the GP or the specialist speech and language therapist team (SALT) to ensure that having medicines in tablet form had not increased the risk of choking.

There were significant differences in the skills and knowledge demonstrated by permanently employed staff and agency staff. Permanently employed staff had comprehensive training and were able to tell us their responsibility towards people under the safeguarding procedure, signs of abuse and they were confident that their report will be taken seriously by the management team and acted on. Not all agency staff was familiar with the safeguarding procedure or knew how to recognise and report possible abuse.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs. However, there was a high turnover of staff; the provider told us permanent staff vacancies were difficult to fill due to candidates not meeting the standards required.

We found that people had their medicines administered by nurses who were trained and had their competencies monitored by the manager. There were regular effective audits carried out in relation to medicines which identified any errors and these were dealt with promptly.

People had mixed views about the quality of the food provided, however they all said there were alternatives and always two choices offered.

Communication between management, staff and people who lived at the home had improved since our last inspection. There were more effective hand over processes and also a daily meeting where staff had the opportunity to report any concerns they may had about people`s needs. Staff, relatives and people told us about the management arrangements and confirmed that management was visible and approachable.

Records were reflective of people`s needs and were regularly reviewed by staff. However, we found that care plans were generic and had little person centred information about people`s likes and dislikes. There was little involvement from people or their representative in care reviews, particularly when peoples` needs changed.

The management team had implemented systems to monitor and improve the quality of the service provided; however some areas like accident and incident analysis were not as effective as they should have been. There were regular relatives and staff meetings.

We found a number of continuous breaches 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 this report.

Inspection carried out on 19 August 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced focused inspection of this service on 23 July 2015 in response to concerns raised. At that inspection we found that the provider was not meeting a number the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This focused inspection took place on the 19 August 2015 and was unannounced. We undertook this inspection to assess the level of risks to people who used the service following information of concern received from partner agencies. This report only covers our findings in relation to this area. You can read the report from our comprehensive inspection carried out 23 July 2015 by selecting the ‘all reports’ link for Partridge Care Centre on our website at www.cqc.org.uk.

Partridge Care Centre is a purpose built home set over three floors. It provides personal and nursing care for up to 117 older people, some of whom live with dementia. At the time of our inspection a total of 80 people used the service, two of whom were in hospital.

We found that some actions had been taken to mitigate the immediate risks to people’s health, safety and well-being and that the provider was working with an external consultancy arranged by the local authority to identify priorities and make improvements. This included in areas of shortfall such as staffing deployment, responding to incidents and concerns and the administration of medicines. We found that some actions had been taken to start addressing these concerns and mitigate the immediate risks to people but further work was needed to ensure people’s safety and well-being.

There was a manager in post who was not currently registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

We did not change the ratings as a result of this inspection. To improve the rating for a key question requires consistent improvement over time. We will check this during our next comprehensive inspection.

At our inspection on 23 July 2015 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we did not have sufficient evidence to demonstrate that these breaches had been met.

Inspection carried out on 23 July 2015

During a routine inspection

The inspection took place on the 23 July 2015 and was unannounced. At our last inspection on 28 April 2015, although we found no breaches of the regulations, we asked the provider to make several improvements. This was because the service was not consistently Safe, Effective, Caring, Responsive or Well Led. At this inspection we found the provider had not taken sufficient action to remedy these concerns.

Partridge Care Centre is purpose built home set over three floors. It provides personal and nursing care for up to 117 older people and for people who live with dementia. At the time of our inspection 83 people were using the service.

There is a manager in post who is currently not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. However, the manager was in the process to register with CQC.

This inspection was carried out in response to information of concern received by CQC. The inspection considered whether the service was safe, effective, caring, responsive and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Partridge Care Centre on our website at www.cqc.org.uk.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had not been made forall thosepeople whose freedom had beenrestricted. We saw staff using some forms of restraint. People were sat in wheelchairs with belts on and on several occasions staff held residents hands down to ensure they were moved out of the way if they refused to move, or to prevent them physically assaulting the staff who was closely supervising them.

We found that the effectiveness of staff deployment lacked consistency across the home and there were insufficient staff to cope with the demands placed upon them. The quality of care provided suffered across the home mainly because of lack of staff. People and staff told us that they felt their needs were not met safely at all times due to lack of staffing.

Where incidents of avoidable harm or potential abuse had been identified, the management team had not taken appropriate action to investigate and report these. As a result people’s care had suffered and they remained at risk of harm or abuse.

Safe and effective recruitment practices were not followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs, gaps in employment were not investigated.

We found that medication had not been administered following best practice guidelines. We found that records were signed to indicate that medicines were administered, however when we counted the medicines we found that there were more in numbers that it should have been.

People were not protected from the risk of infections. The environment was well maintained however the equipment used for manual handling was not clean. Wheelchairs that had dark brown stains on the seats and staff used these to move people. Crash mattresses and alarm mats were stained and sticky.

Some of the staff we spoke with could not recall training they had received in how to safeguard people against the risks of abuse. However records were seen that demonstrated to us staff signed the training attendance. They were not able to describe what constituted abuse and the reporting procedure they would follow to raise their concerns.

Communication was not effective between management, staff and people. People were not aware of the recent management changes in the home and not able to tell us who the manager was. This meant that leadership in the home was not visible at all levels.

Records were not current and had not been reviewed when people’s needs changed, or when required by the provider’s policy.

As a result the provider failed to recognise and report incidents to the local safeguarding team.

The manager had not implemented robust systems to monitor and improve the quality of the service provided. They were not monitoring or analysing the high staff turnover and the inability of the service to retain the employed staff.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.

Inspection carried out on 28 April 2015

During a routine inspection

The inspection took place on the 5 May 2016 and was unannounced. Partridge Care Centre is a purpose built home set over three floors. It provides personal and nursing care for up to 117 older people, some of whom live with dementia. At the time of our inspection 65 people were using the service. Following our inspection of the service on 23 July 2015 we imposed a condition on the provider’s registration to prevent them from admitting any further people to Partridge Care Centre because of the concerns that we found. This condition remains in place.

At the time of our inspection there was a manager who had been in post for nine weeks but they had not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. However, following our inspection we were informed that the manager had left the service.

When we last inspected the service on 14 and 15 January 2016 we found the provider was not meeting the required standards. We found breaches of the Regulations in relation to safe care and treatment, staffing, safeguarding people, consent, privacy and dignity, person-centred care, meeting nutritional and hydration needs, receiving and acting on complaints and good governance. At this inspection we found that some improvements had been made although systems to sustain improvements were still under development.

People told us they received care from staff which was safe and met their needs. The provider was using a high number of agency staff to cover for staff vacancies and planned and unforeseen absences. When we last inspected the service the high use of agency staff was poorly managed and put people at risk of harm due to the lack of information given to agency staff. We found that this had improved and agency staff working at the service were regular, pre-booked for a longer period of time to help ensure people had consistency in the care they received.

People were assisted by care staff who had been trained and had their competency assessed to help ensure the care provided to people was safe and met their needs. We found that staff followed recommendations from social and health care professionals involved in people`s care. However, we found that not all the nursing staff working at the service had the necessary skills and knowledge required to meet the needs of the people living at the home.

When we last inspected the service in January 2016 we found that people’s freedom of movement had been restricted and restrained in ways that did not comply with nationally recognised good practice or the deprivation of liberty safeguards (DoLS). At this inspection we found that the manager has stopped these practices and where people required restrictions to their freedom, this had been done following the right processes.

Accidents and incidents were monitored and reported to the local safeguarding team and CQC where necessary and appropriate. We found that the internal systems to identify trends and patterns had improved and the manager and a consultant were working to develop the system further to ensure information and learning points were shared with staff to prevent accidents and incidents from reoccurring.

We found that both permanent and agency staff`s knowledge about safeguarding people from harm or any possible abuse had improved since the last inspection. Staff were able to tell us the process of reporting any concerns both internally and externally. Information about safeguarding and contact details for the manager and external safeguarding authorities were prominently displayed around the home.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs. However, there was still a high turnover of staff as the provider was not able to recruit and retain a permanent staff group.

We found that people had their medicines administered by nurses who were trained and had their competencies monitored by the manager. There were regular audits carried out in relation to medicines. However we found that records for administered medicines had not always been signed by the staff responsible. One person had missed two doses of their medicine, although this had been available staff had recorded that it was out of stock.

Records were reflective of people`s needs and were regularly reviewed by staff. We saw that improvements had been made to care records in relation to person centred information about people`s likes and dislikes. The manager, deputy manager and clinical lead had held meetings with relatives and people who used the service and involved them in reviewing their plan of care.

People had mixed views about the quality of the food provided. Although it was in sufficient quantities people told us that the choices and alternatives offered if they were not happy with the main meal on offer were not appropriate for main meal choices, like sausage rolls.

All the people we talked with and their relatives were highly complementary about the new manager. Everybody knew the manager by name although they had only been in the service since March 2016. People told us they had faith that anything they asked for or reported to them was taken seriously and resolved.

Staff told us they were well supported by the new manager and they appreciated how approachable and open they were. Staff told us the new manager had put systems in place to improve the service people received and that they were consistent in imposing high standards of care.

Inspection carried out on 30 July 2014

During an inspection in response to concerns

During our inspection, we spoke with six of the 101 people who used the service. We also spoke with three visitors and nine staff members. We looked at various aspects of the care records of nine people who used the service. We also looked at staff rotas, staff deployment records and a staff and manager meeting agenda.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We saw that staff practice during moving and handling transfers supported people who used the service in a safe way that respected their dignity.

A visiting relative told us that the person who used the service told staff that they loved them, and that the person would not have done this unless they felt safe and comfortable with the staff.

We found that care records were not always complete, accurate and fit for purpose. This meant that care was not accurately planned for the individual in a way that provided staff with consistent guidance and to limit the risks to their safety and well-being.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the care records, and the improvements they will make in relation to their accuracy and completeness.

Is the service effective?

We found that people who used the service received care and support that met their needs. Staff used their knowledge of individual people’s needs and personalities, for example to reassure and support people effectively when they became agitated or upset.

People were encouraged and supported to eat and drink to ensure they maintained a good nutritional and fluid intake.

Is the service caring?

We observed that staff were kind to people they supported and interacted with people in a caring and professional way. We noted that staff addressed people by name and took time to talk to them and reassure them if they were worried or upset.

A visiting relative told us, "Staff are very patient and very caring."

Is the service responsive?

People’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. This included ensuring people received only food that was in line with their beliefs and ensuring that particular clothing was worn.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service well-led?

Prior to our inspection we were made aware that the registered manager had resigned and that a new manager had been appointed. This meant that there was an identified person in post with clear responsibility to lead the service. Our records showed that the new manager had made enquiries to begin the process of registration with us as required. We have referred to this person as the manager throughout this report.

Staff told us that they had noted positive changes in the short time the new manager had been in post. They told us about the manager’s unannounced night visits to ensure that the quality and levels of care were satisfactory, the introduction of care team leader posts in all units to support good leadership and the increased staffing levels throughout the service to support responsive and effective care.

Inspection carried out on 26 November 2013

During an inspection to make sure that the improvements required had been made

We previously inspected Partridge Care Centre in May 2013 and again in September 2013. During those inspections we found that the provider did not have an effective system in place to monitor the quality of service people received or to identify, assess and manage risks to people's health safety and welfare. We also found that record keeping practices were not satisfactory and that records were not accurate or fit for purpose. We required improvements to be made.

When we inspected the home again on 26 November we found that the provider had implemented a new quality monitoring process that enabled the provider to identify where improvements were required and to take action. We also found that care plans were effectively audited and that this ensured risks were identified and managed.

We also found that people's records were diligently maintained. A new record keeping system had been implemented and this contributed to care and treatment being provided safely and effectively, particularly in relation to the management of pressure ulcers.

Inspection carried out on 5 September 2013

During an inspection to make sure that the improvements required had been made

We inspected Partridge Care Centre on 05 September 2013 to follow up a warning notice we issued arising from our previous inspection on 16 May 2013.

During our previous inspection on 16 May 2013 we found that the individual needs of people living on the Mallard 1 and Mallard 2 units were not being met. This was in relation to their participation in life enriching activities, the risks of receiving poor nutrition, delays in receiving medicines and the risks of developing pressure ulcers.

When we inspected the home on 05 September 2013 we found that the provider had made improvements. We noted that staff were able to interact with people using the service and that there were more activities available.

We noted that food was served on time and it looked and smelled appetising. One person said, “The food is actually quite good.”

We saw that medicines were administered on time.

We found that staff were knowledgeable about the management of the risk of people developing pressure ulcers and that people had up to date tissue viability care plans.

However, records about the positional changes of people who were at risk of developing pressure ulcers were not accurate and not fit for purpose.

Inspection carried out on 16 May 2013

During an inspection in response to concerns

We previously inspected Partridge Care Centre on 07 January 2013 and found the provider had failed to plan and deliver care in such a way as to meet people's individual needs and ensure their safety and welfare. We judged this had a moderate impact on people living there and we required the provider to make improvements. The provider wrote to us setting out their action plan which stated that they would be compliant by 31 March 2013 or sooner.

When we inspected the home again on 16 May 2013 we found the provider was still not compliant. This was because there was a delay in supporting people living in the Mallard units with their personal care requirements. This adversely affected other aspects of care such as providing people with breakfast or medication. We saw that people were not protected against the risks of receiving care and support that was unsafe because care plans for pressure ulcers were not in place.

The provider supported staff to deliver care by means of a training and supervision programme.

The provider did not have an effective system to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. This was because audits had failed to identify that there were shortfalls in the standards of care delivered on the Mallard units.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

Inspection carried out on 7 January 2013

During an inspection to make sure that the improvements required had been made

The inspection carried out on 7 January 2013 was to check whether the provider was compliant with the three areas in which required improvements were identified during our last inspection in August 2012. During the inspection we also looked at other areas for which information that raised concerns had been received. Improvements had been made in the three areas in which required improvements had previously been identified. We were satisfied that people were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others and records were kept securely and could be located promptly when needed. The registered manager had recently left and an acting manager was in post.

We spoke with three people during our inspection. They told us that they were able to make decisions such as what time they got up in the morning, what they had to eat and how they spent their time. One person told us that they were asked what they wanted to wear each day. One person said, "They're very good. It's lovely." A second person said it was, "Fine."

During our inspection we found that the care plans for the two people most recently admitted to the home were incomplete. An initial assessment had been completed prior to their admission but the detailed information and risk assessments for each condition had not been completed.

Inspection carried out on 8 August 2012

During a routine inspection

During our inspection on the 7 and 8 August 2012, we spoke with five people who used the service and five relatives.

One relative that we spoke with said that the care had, "Improved a lot. It was bad." They said that they now felt safe in the knowledge that their relative is being cared for at the service. They said, "There were too many temporaries and agencies. [My relative] likes consistency of people as they know [their] ways. Now we see the same faces."

A person who used the service said, "I've got Alzheimer’s. I get a bit forgetful. They remind me what day it is and say, 'Your family's coming today'. They went on to explain that they don't see many new members of staff but that when there are, they were introduced to them.

Later in our inspection, we spoke with this person's relative. They said that their relative was treated "with the utmost dignity and respect." They said, "Things have got better. There's more awareness. [My relative] is an independent person." The person who used the service then interjected, "They don't just let you sit there. They don't force you to do anything; they encourage you."

The people in the second Mallard Suite were living with dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We spent 40 minutes observing at lunchtime and found that overall people had positive experiences. The staff supporting the people knew what support they needed and they respected their wishes if they wanted to manage on their own. We saw staff interacting well with the people, showing them the different meal options that were available and offering people encouragement to eat their meals.

Inspection carried out on 12 March 2012

During an inspection to make sure that the improvements required had been made

People told us that they were satisfied with the care they received at Partridge Care Centre and that were able to make choices in their daily lives. They told us that they enjoyed the activities available, including the use of the gym.

People said that the quality of the service had improved because there were more permanent staff now and they preferred to have familiar staff. We were also told that the staff were great but that there was some staff turnover and the issues can be agency staff but this depended on the individual staff.

People told us that that they had all the equipment they needed and confirmed that they enjoyed the experience of bathing at Partridge Care Centre. One person said the home was ‘beautiful’.

Some of the people using the service were unable to tell us their views on the care they received due to cognitive impairment or dementia. We saw that people were well supported and that care was delivered with sensitivity and respect. Overall, staff offered people choices in a way suitable to their needs and supported them to make decisions where they were able.

We spoke with relatives who told us they had no complaints and that the care provided at Partridge Care Centre was very good. One relative said that the home was improving.

Inspection carried out on 8 December 2011

During an inspection in response to concerns

People with whom we spoke told us that they were happy living at Partridge Care Centre and they found the staff to be nice and caring. Comments included “The staff are marvellous, they cannot do enough for you” and “I think the staff are very good here and I am well looked after and cared for.” Another person told us “The staff leave me to it as I prefer my own company. Staff respect this and when I do need support they are there.” Relatives of people living in the home made positive comments about the improvements they had noted over the last few months. These included the increased numbers of permanent staff employed resulting in the reduced usage of agency staff, the environment and the general atmosphere at the home.

Inspection carried out on 10 October 2011

During an inspection to make sure that the improvements required had been made

Two people with whom we spoke told us they felt very safe living in Partridge Care Centre.

People using the service and their relatives told us that the laundry service had improved considerably in recent times.

People using the service told us: “Most of the time it’s alright here but the carers are rushed off their feet, it’s a shame that a lot of the good staff are leaving.”

We spoke with relatives of people living in Partridge Care Centre and they told us “Things are a lot, lot better; there are more staff and more awareness of peoples’ needs.” and “They seem to be getting to grips with everything, my relative is very happy here and I am much happier with their care now.”

Inspection carried out on 14 September 2011

During an inspection to make sure that the improvements required had been made

People living in Partridge Court Nursing Home told us there had been significant improvement throughout the home in such areas as cleanliness, food provision, laundry and staffing levels. People with whom we spoke said “There seems to be a lot more staff than there used to be. In a way it doesn’t really affect me at all because I can do most things myself.”

Relatives, with whom we spoke, made positive comments about general improvements in the service provided for the people living in Partridge Court Nursing Home. One person said "We have really noticed so much improvement in the cleanliness, staffing numbers and the general care."

People told us they were offered some social stimulation, one person said “Last week we went in to town with a couple of carers. We went around the shops and had lunch in a café, ending up with ice creams. We thoroughly enjoyed ourselves. We have asked when we could do it again; they said they needed to make sure that everyone gets a chance to go out. This is the first time I have been out of the home in 18 months.”

Relatives told us that they had noticed the difference in the premises at how much cleaner it is now. People said that the "Staffing levels were much improved" and they didn't ever worry that their relative was not cared for and never felt uncomfortable. They never saw people distressed and not attended to. They identified however that "There is a better atmosphere now." They said were satisfied with the care provided for their relative.

Inspection carried out on 13 July 2011

During an inspection to make sure that the improvements required had been made

People told us that their choices about when they went to bed or rose in the morning were not always respected.

A relative told us “Staff are very good with the people here, they match (person’s) clothes and we appreciate this. Their clothes are all labelled but we have found some things in their wardrobe that belong to other people.”

Visitors told us they were involved with their relatives’ care and they felt that they were consulted and involved.

People with whom we spoke during our visit to Partridge Court Nursing Home on 13 July 2011 were generally positive about the care and support they received. One person said “I think they look after us well” and another person said “I am perfectly happy; we did the right thing in coming here.”

Many of the people living in the home were not able to share their views with us around social stimulation and activities however one person told us “I would like to go out more; I never get a chance to leave here.”

A relative told us “As far as personal care is concerned I feel my relative is being looked after, they are kept clean and are being fed, I really can’t fault the care.”

Another relative was satisfied with the personal care their relative received but had some concerns with social engagement and stimulation. They told us “There always seems to be a shortage of money for activities. For example, they need a fence in the garden so that people can access outside and enjoy fresh air safely. This still has not been done.”

Relatives told us they felt the home was starting to improve but did not feel this was happening quickly enough. They said they didn’t feel the staff working at the home had the right skills to manage the conditions of the people living there. One person said their relative felt lonely and said they felt like a caged animal.

A relative told us “It hasn’t been very good up until now; there have been a lot of things that have gone wrong. Everything they promised such as the hydrotherapy pool, physiotherapy treatment and occupation therapy support has not been delivered. They promised us they could care for our relative but they haven’t.”

A visitor with whom we spoke said they felt their relative was safe living at Partridge Court Nursing Home. They said “I come away safe in the knowledge that (Relative) is safe and being looked after.”

People said that they were happy with the way the home manages medicines on their behalf.

A relative with whom we spoke told us “When they showed us around the home they proudly showed us the hydro therapy pool. I thought that would be really nice for my relative. However, in the last year I have not known the pool to be working at all. Staff say it is not working and that the company that installed it has gone out of business. This is a disappointment as I feel my relative would really enjoy and get much benefit from the pool.”

Relatives told us they were concerned about the number of agency staff working at the home. They said they understood the need for agency staff to cover whilst permanent staff were being recruited however different people were attending the unit daily and therefore did not have a good understanding of the needs of the people living there.

Inspection carried out on 10 March 2011

During a routine inspection

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable.

Relatives, health and social care professionals and staff members with whom we spoke during the course of this review had differing views on the quality of the care and support provided for the people living at Partridge Court Nursing Home.

One relative with whom we spoke confirmed they were happy with their relative’s care and support and found staff to be kind and caring. They told us, “We have nothing but praise, can’t fault it!” and “The food’s good, the care’s good, it’s clean at all times.”

One relative said that they felt their relative was at risk from challenging outbursts from other people living in the home, from the lack of staff to care for people and from poor hygiene practices. They said that they felt that the staff members giving the person the care were doing their best in the circumstances.

People living at Partridge Court Nursing Home with whom we spoke during our visit on 10 March 2011 told us “The food is magnificent” and “On the whole we are pretty happy with things.”

People living in the home told us that they found the environment to be clean and tidy. Others told us they liked their personal room and were able, when they moved in, to bring in personal belongings and, where appropriate, small items of furniture, so as to make it homely.

Relatives of people living in the home, health and social care professionals and staff members with whom we spoke told us that they believe there to be insufficient staff at the service to safely meet the needs of the people living there. One relative with said, in respect of one of the units providing support to people with dementia, "The problem is with consistency, a person gets used to staff and takes to them and then they are moved around to other units, and this affects the person. Staffing levels are not always enough, sometimes at weekends for example there are only two staff on this unit. If they have to go and deal with personal care in someone's room, there are no staff left to supervise those people in the lounge. It's not really safe."

Relatives of people living in the home told us they knew how to make a complaint.

Reports under our old system of regulation (including those from before CQC was created)