Penmount Grange

Penmount Grange is a residential care home providing personal care for up to 27 people aged 65 and over. At the time of the inspection 25 people were living at Penmount Grange. The service is provided in one adapted building with an accessible garden.

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

People told us they felt safe living at Penmount Grange. Staff had received training and understood how to maintain people’s safety. When people had risks related to their care needs, these were recorded in a risk assessment which included guidance for staff to reduce the risks. Staff were recruited safely.

People’s medicines were managed safely and administered on time. People told us they were supported to maintain their health and had appointments with external professionals when necessary. People told us they liked the food and had plenty of choice. People told us food and drinks were always available and any needs or preferences were catered for.

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 told us staff were trained to meet their needs and treated them with respect and compassion. Staff knew people well and treated them with compassion. People told us staff treated them equally and fairly and staff understood the importance of recognising and supporting people’s differences.

We have made recommendations about recording people’s needs relating to their protected characteristics; and about ensuring staff have the skills to meet people’s diverse needs.

People told us they were able to express their views and make decisions about their care. People’s privacy and dignity was respected, and their independence was promoted. People’s care plans described how they would like to receive their care; however, it was not clear that everyone had been consulted about what was important to ensure they spent their time in a meaningful way. We have made a recommendation about this.

People and staff told us there was a positive culture in the service. There were various ways people and staff could share their views and any ideas for improvements.

Staff at all levels, including the provider, completed regular checks of the service to ensure its ongoing quality. Any areas requiring improvement were acted on.

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 (published 05 April 2017).

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.

At the last inspection, in January 2016, we found people did not always have risk assessments in place. People’s risk assessments were not effectively reviewed to ensure they were reflective of people’s needs and provided guidance and direction to staff to follow. We also found people’s care plans did not always provide direction and guidance for staff about how to meet people’s individual needs; and that people’s care plans were not effectively reviewed.

At this inspection, we found improvements had been made. Risk assessments were in place to help reduce any risks related to people’s care and support needs. These were reflective of people’s needs and were regularly reviewed. Detailed care plans were in place which guided staff how people wanted their needs met. These were reviewed regularly with people and those important to them.

A registered manager was employed to manage the service. 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 atmosphere in the home was upbeat and vibrant and we observed people taking part in different activities. One person told us, “I love playing the games with the girls, and sometimes I’m a winner!” The registered manager had clear values which focused on enabling people to feel ‘at home’. These values were shared by the whole staff team and were evident in the way staff talked to and treated people. A staff member confirmed, “Residents first. Their welfare, comfort and safety. They’re the top priorities.”

People received support from staff who knew them well. People and their relatives spoke highly of the staff and the support provided. Comments included, “There’s no problem with the staff, they’re a good bunch.” Staff had received training relevant to their role and were supported by an ongoing programme of supervision, appraisal and competency checks.

People told us they enjoyed the food. Mealtimes were a positive experience, which people told us they looked forward to. People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. People were involved in planning the menus and their feedback on the food was sought. Comments included, “The food is very good, I look forward to my breakfast and lunch”, “The food is very good, there’s no problems there.”

People told us they felt safe using the service. Comments included, “Everybody is so nice, that’s what makes me feel safe.” People were kept safe by suitable staffing levels. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant people’s needs were met in a timely manner. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People had their healthcare needs met. For example, people had their medicines as prescribed and on time. People were supported to see a range of health and social care professionals including social workers, chiropodists, district nurses and doctors.

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA).

Staff were knowledgeable about the MCA and how this applied to their role. Where people lacked the capacity to make decisions for themselves, processes ensured their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed. People were involved in planning their care and staff sought their consent prior to providing them with assistance.

Feedback received by the service and outcomes from audits were used to aid learning and drive improvement across the service. The manager and staff monitored the quality of the service by regularly undertaking a range of regular audits and speaking with people to ensure they were happy with the service they received. People and their relatives told us the management team were approachable and included them in discussions about their care and the running of the service.

Penmount Grange provides care and accommodation for up to 27 people who are living with dementia or who may have physical disabilities. The provider also owns and operates three other residential care homes and a domiciliary care agency in Cornwall.

On the day of the inspection 25 people were living at the care home. The home is on two floors, with access to floors via a stair lift. Some bedrooms have ensuite facilities. There are shared bathrooms, shower facilities and toilets. Other areas include one lounge, a lounge/dining area, a dining room, and a patio area.

The service had 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.

People received care and support from staff who were kind and caring, treated them with respect and promoted their privacy and dignity. People, staff and visitors described the atmosphere as “a family”, “welcoming” and “warm”. People were supported by sufficient numbers of staff who had the knowledge, skills and experience to carry out their role. The registered manager provided support and training for staff, and staff told us they felt the service was well managed and they felt supported.

People felt safe. People were protected from avoidable harm and abuse that may breach their human rights. The registered manager and staff understood how the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) protected people to ensure their freedom was supported and respected. This meant decisions were being made for people with proper consultation. People’s consent to care and treatment was reflected in their care plans and staff asked people for their consent prior to supporting them.

The registered manager and staff understood their safeguarding responsibilities. People were protected by safe recruitment procedures as the registered manager ensured new employees were subject to necessary checks which determined they were suitable to work with vulnerable people.

People did not always have risk assessments in place. People’s risk assessments had not always been effectively reviewed to ensure they were reflective of people’s needs, and provided guidance and direction to staff to follow. People had personal evacuation plans in place, which meant people could be effectively supported in an emergency. The environment was assessed and monitored to ensure it was safe at all times.

People’s medicines were managed safely. People were cared for at the end of their life. People, had access to health professionals, such as district nurses and GPs and staff had undertaken related training. People’s wishes for their end of their life had not always been recorded so staff would know how people wanted to be cared for. The registered manager told us immediate action would be taken to ensure this was rectified.

People’s care plans did not always provide direction and guidance for staff about how to meet people’s individual needs. People’s care plans were not effectively reviewed which meant care may not always be provided consistently, or in line with people’s wishes and preferences. The registered manager was receptive to our feedback. People were able to continue with their own interests and participate in arranged social activities.

People told us the meals were nice, and staff supported them with their individual nutritional needs and took appropriate action when concerns were identified. People could access health care services. The registered manager had systems in place to ensure staff shared information about people’s health care to help ensure prompt action was taken when required. Health and social care professionals spoke positively about their working relationship with the service and felt the service was responsive and met people’s needs.

People and those who mattered to them were encouraged to provide feedback about the service they received. People told us if they had any concerns or complaints they felt confident to speak with the staff or registered manager.

The provider had some systems and processes in place to help ensure people received a high quality of care. The provider was also currently making improvements to make these more effective. The Commission was notified of all significant events which had occurred in line with their legal obligations. For example, in the event of someone passing away unexpectedly.

The registered manager and provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

We found 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 the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection of Penmount Grange we saw evidence to support a judgement that this service was safe.

People were treated with dignity and respect by the staff. Some of the comments received from people who lived at Penmount Grange included 'the staff are patient, polite and caring, they are as good as gold', 'I have no complaints'.

People were safe because staff knew what to do when complaints were raised and where concerns had been raised we found the home had taken appropriate action to ensure people were safe from harm. People told us they would feel able to 'speak their minds'.

We saw Penmount Grange understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

We found there was enough qualified, skilled and experienced staff to meet people's needs. We were told the service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.

Is the service effective?

During our inspection of Penmount Grange we saw evidence to support a judgement that this service was effective.

People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.

People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people that did not have the capacity to consent, they acted in accordance with legal requirements.

We spoke with two visitors and they confirmed they were able to visit the home whenever they wished.

Is the service caring?

During our inspection of Penmount Grange we saw evidence to support a judgement that this service was caring.

We saw and heard staff ask permission and then explain what was going to happen when they provided care. For example, 'is that okay?', 'may I?' and 'please can you?' We saw staff paid attention to the choices we all make in daily lives, such as 'would you like salt and pepper?' or 'would you like some sugar in your tea?' We observed staff responded to people in a kind and sensitive manner.

People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people's families to write details of their known daily routines on their behalf. We saw staff provided support in accordance with people's wishes.

Is the service responsive?

During our inspection of Penmount Grange we saw evidence to support a judgement that this service was responsive.

People confirmed they could have what they wanted at meals if they did not like what was offered. People were able to take part in a range of group and individual activities such as dancing, bingo, crosswords, painting and craft work.

People who used the service and their representatives were asked for their views about their care and treatment.

Is the service well-led?

During our inspection of Penmount Grange we saw evidence to support a judgement that this service was well-led.

We were able to talk with staff and they were all positive in their attitude on how the home was organised and run and we were told by two staff members that it was a good home and they enjoyed working there.

During our observations we saw staff help two people to mobilise. We also saw staff talked with people when they were laying up tables for lunch. We saw people talked to each other at lunch.

We witnessed staff interactions with people which were positive. People told us staff answered call bells promptly. One person said staff were 'polite and friendly'. Another person said, 'I am very happy here, no complaints'. People told us the food was good and they were offered choice. We were told visitors were welcome. One person said 'I can go to bed when I want, if I wanted to go out someone would take me'. Another person told us they were involved in the planning of their care. We saw evidence to indicate that people gave consent to their care. We heard care workers ask people what they would like to do and they gave them ideas if people could not make a choice.

We saw people were safe from abuse and they received their medication in a safe way.

We found staff were recruited in an appropriate way, supported and trained.

We spoke to people who lived at Penmount Grange and all the comments we received were positive. One person told us, 'I am happy here, the staff are always so happy'. Another person told us, 'The staff are kind and look after us'.

We spoke to a relative of a person who lived at Penmount Grange. We were told they were satisfied with the care provided and they were informed of the progress concerning the person they were visiting.

We observed a happy, relaxed and jovial atmosphere throughout the course of the inspection.