The Care Quality Commission
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Archived: Pitchill House Nursing Home

Overall: Good read more about inspection ratings

Pitchill, Salford Priors, Evesham, Worcestershire, WR11 8SN (01386) 870092

Provided and run by:
HC-One Limited

Important: The provider of this service changed. See old profile

All Inspections

5 February 2015

During a routine inspection

This inspection took place on 5 February 2015 and was unannounced.

Pitchill House Nursing Home is a two storey residential and nursing home which provides care to older people including people who are living with dementia. Pitchill House is registered to provide care for 52 people. At the time of our inspection there were 41 people living at Pitchill House.

At our last inspection in August 2014 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the care and welfare of people, the number of suitably qualified and skilled staff and cleanliness and infection control. The provider sent us an action plan telling us the improvements they were going to make by December 2014. At this inspection we found improvements had been made.

There was a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

All of the people we spoke with told us they felt well cared for and felt safe living at Pitchill House. People told us staff were respectful and kind towards them and staff were caring to people throughout our visit. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent, before any care was given.

Care plans contained accurate and relevant information for staff to help them provide the individual care and treatment people required. We saw examples of care records that reflected people’s wishes. We found people received care and support from staff who had the clinical knowledge and expertise to care for people.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained, qualified and experienced staff.

Systems were in place to make sure people were not placed at risk of infections through cross contamination. Staff knew how to keep people safe and wore personal protective equipment when required.

Systems and processes were in place to recruit staff that were suitable to work in the service and to protect people against risks of abuse.

Staff understood they needed to respect people’s choice and decisions. Assessments had been made and reviewed to determine people’s capacity to make certain decisions. Where people did not have capacity, decisions had been taken in ‘their best interest’ with the involvement of family and appropriate health care professionals.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, no applications had been authorised under DoLS for people’s freedoms and liberties to be restricted. The registered manager had recently contacted the local authority and referred to them a number of applications for people to ensure people’s freedoms were not restricted unnecessarily.

Regular checks were completed by the registered manager and provider to identify and improve the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People told us they were pleased with the service they received. If anyone had concerns, these were listened to and supported by managers or staff and responded to in a timely way.

26 August 2014

During a routine inspection

This inspection was completed by one inspector. During our visit we spoke with a relief manager, a business administrator, two nursing staff, two care staff, two cooks and a laundry assistant. At the time of our inspection the provider did not have a registered manager in post. '

We also spoke with three people who lived in the home, a volunteer and four visiting relatives.

We carried out observations of care throughout the home. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

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, staff and visiting relatives told us.

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

Is the service safe?

People and relatives told us they felt they and their relatives received the care they expected. We were told: 'The staff are really caring and kind' and 'We have had a review and we have no problems.'

People told us they had concerns with the time it took staff to help them when they required assistance. One person told us: 'I wait about 20 minutes if I ring my bell. Another person said: 'I have waited 40 minutes for someone to help me from the toilet.'

We found concerns during our visit with regards to the number of staff available and how those staff were deployed in the home to meet people's individual care needs.

We spoke with staff who told us they had not read or accessed people's care records for some time which had the potential to place people at risk of receiving inappropriate care and support. Staff we spoke with also raised concerns with us about the numbers of staff available and the impact it was having on people's care and welfare. Staff told us people's care needs were not always met. We asked a staff member what they thought about the staffing levels at the home. They told us: 'It's ridiculous' Another staff member said: 'Staff get the basics done but there is not time for extra's which makes life were living.' We have asked the provider to tell us how they will make improvements to ensure staffing meets people's individual needs.

The home was clean and tidy with no apparent odours. We saw inconsistencies with staff that did not wear appropriate personal protective equipment when required. We have asked the provider to send us an action plan informing of how he inconsistencies will be addressed.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We spoke with the relief manager and discussed the recent High Court ruling in relation to people at the home. The relief manager was not aware of this ruling and agreed to make themselves more familiar. The relief manager said that people's mental capacity and DoLS was discussed at care reviews and people's best interests were considered. The relief manager understood their responsibilities in relation to this legislation.

Is the service effective?

People and relatives we spoke with told us they were happy with the care provided. One relative said: "We are told if there any changes, they are good like that.'

We found care plans and risk assessments we looked at reflected people's individual needs.

We saw care plans were evaluated monthly and had been updated when changes in people's care had been identified.

Is the service caring?

People were supported by staff who were kind and attentive. We saw and heard people were given choices throughout the day about where what they wanted to eat or drink, where they wanted to sit. We saw staff spent time with people who required assistance at lunchtime. We saw staff cared for people at their preferred pace.

Some staff we spoke with told us they felt they were not always able to provide the care they wanted to because of the numbers of staff available. One staff member told us: 'It would be nice to sit and chat or help do people's nails, they enjoy that. I don't get chance.'

Is the service responsive?

We found people received support from other health professionals that made sure people received the individual support they required.

Is the service well led?

Pitchill House has not had a registered manager in place for a period of time. The service is currently managed by a relief manager. People and relatives told us they had seen improvements within the service over the last few weeks. People told us the relief manager was approachable and had started to address some concerns within the home.

25 November 2013

During a routine inspection

We spoke with one person's advocate, five relatives of people who used the service and 11 people using the service. People expressed satisfaction with the service that they or their relatives had received. One person told us what had been done for their relative on their birthday, ''They gave X a lovely birthday and decorated X room.'

We found systems in place to allow people choice and independence. People's individual needs had been met and care identified to support those needs. The people we spoke with generally identified satisfaction with their diet. We saw during lunch people's nutrition and hydration needs were being met.

We spoke with staff, people using the service and their relatives about staffing levels at the home. People's relatives told us that 'There are more staff now.' Our discussions with four staff from the home identified differing opinions about staffing levels. We saw that shortfalls in staffing were replaced. We looked to see whether staff were sufficiently skilled within their roles and saw evidence of on-going training in place to maintain staff skills and knowledge.

We saw that the home had received seven complaints since April 2013. We did not see a robust evidence trail of communication for one of the complaints we reviewed. This meant it was difficult to judge how effective the complaints procedure had been for this individual. However, we saw that people's concerns had been acted on in another complaint we reviewed.

29 October 2012

During an inspection looking at part of the service

We inspected this home in July 2012. This inspection had identified concerns about staff shortages and how these shortages impacted on peoples' care and cancellation of staff training sessions. We also found that there had been poor staff attendance at mandatory training and staff appraisal had not been completed for 2011. We undertook an unannounced follow-up visit to check what progress had made towards achieving compliance.

The staff we spoke with told us staffing levels had improved and new staff had been recruited into post. All the staff we spoke with said clinical practice at the home was safe and people's basic needs had been met.

Staff told us they felt supported and had been able to develop and maintain their skills through attendance at trainings and supervision sessions.

9 July 2012

During a routine inspection

We spoke with two relatives, three people using the service and eight staff including the manager on the day of the visit.

People told us they liked living at the home, felt safe and had been happy with the care and support received. Some comments from people about their experiences at the home were; 'Very good living here; they look after me' and 'I have a good laugh, play games and go out on day trips'. People said they liked the food, had a choice of two meals at lunch time and had enough to drink. People said if they had concerns they would approach a member of staff or the manager at the home.

Staff, people using the service and their relatives told us they had been informed by meetings held at the home, information displayed on notice boards and at peoples' care reviews. People said they had participated in their chosen activities within the home and in the local community.

The manager said she had been managing the home since February 2012 with the support of a deputy manager. Staff told us about poor staffing levels at times resulting in a lack of available staff to meet peoples' needs at meal-times. We were also told of occasions when people had not received their washes until 3pm and 'quality time' to allow staff to speak to people was not available. Staff told us that staff training sessions had been cancelled due to staffing shortages.

The manager said there had been a lack of staff training and support mechanisms in place. We were told of a staff induction programme, staff supervision sessions and a staff appraisal system that had been recently introduced to support and guide staff at the home.

The deputy manager said the quality of documentation relating to peoples' care was improving. We were told that half of the care plans had been rewritten and trained nurses had received training in writing care plans. Monthly auditing of care plans and risk assessments had also taken place and changes communicated at shift handover sessions to carers.