Archived: Plymouth House

Updated 26 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection visit took place on 25 April 2018 and was unannounced. The inspection was undertaken by two inspectors, a special advisor and an expert-by-experience. The specialist advisor was a registered nurse. An expert-by-experience is a person who has personal experience of using, or caring for someone who uses this type of service.

We looked at the information we received from the provider and management team. This included events which we had been notified about, such as any serious injuries to people. We asked various organisations who funded and monitored the care people received, such as the local authority and the clinical commissioning group. We also sought information from Healthwatch who are an independent consumer champion, which promotes the views and experiences of people who use health and social care.

We spoke with eight people who lived at the home, two relatives and two visitors to gain their views about what it was like to live at the home. During different parts of the day we spent time with people and saw the care they were offered and support. We looked at five people's care plans and sampled seven daily records to see how their care was planned and delivered. In addition we sampled people's medicine records and saw how medicines were administered to gain an insight into how people were supported with their medicines.

We spoke with three care staff, a nurse and administrator. We talked with the acting manager about the management arrangements and met one of the directors.

Records which showed how staff were trained to provide care and support appropriate to each person's needs. We looked at accidents and incidents, compliments and complaints and the staffing rota. In addition, we saw some quality monitoring systems however these were not up to date records.

Following the inspection we were sent documentation to reflect the assessments of people’s dependency.

Updated 26 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an announced inspection on 25 April 2018.

This is the first inspection of Plymouth House following the new provider’s registration with us.

Plymouth House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Plymouth House accommodates 25 people in one adapted building. At the time of our inspection there were 16 people living at the home.

The provider did not have a registered manager in post at the time of our inspection as the former registered manager had left the provider's employment in April 2018. There was an acting manager in place whilst the provider was making arrangements to fulfil their legal responsibility of having 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 inconsistencies in the management oversight did not ensure safe and best practice was followed in all areas. The provider could not demonstrate they had strong quality checking mechanisms, to consistently identify the shortfalls in the aspects of care provision. The opportunities for people to voice their opinions about the quality of the service were in place however their feedback had not always been acted upon on.

We found the provider needed to make improvements to ensure people's needs were effectively met and they were safe. We saw staffing arrangements did not ensure people's individual needs were met in a timely way which compromised people's wellbeing and safety.

Staff were knowledgeable about how to reduce cross infections within their caring roles. There were some areas of staff practices together with the home environment which did not consistently reduce the risk of cross infections.

People's medicines were stored securely and made available to people as prescribed. The systems in place to ensure the safe disposal of medicines were ineffective.

The provider had recruitment procedures in place however they were not always followed to ensure people’s safety was not compromised.

Staff showed a good understanding of how to recognise abuse and how to report if concerns were raised. Staff were aware of how to minimise risks to people's safety. We saw they used specialist equipment to ensure people's needs were met and the risks of injuries were reduced.

Improvements were being made to ensure all staff had the opportunity of receiving regular training to support them in their roles. We saw staff did not always apply their knowledge into their daily practices. People’s personal information was not consistently stored to ensure their privacy and confidentiality was maintained.

People’s wellbeing was not consistently enhanced with their individual needs considered due to the lack of improvements planned and taking place on the home environment.

Health and social care professionals were involved in people's care to ensure they received the care and treatment which was right for them. More consideration was needed to make sure

people had the support they required to eat their meals without any unreasonable delays and it was a sociable occasion for people.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the provider’s policies and systems supported this practice. Staff respected people's right to consent to and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions, systems were in place to support the ethos of people’s decisions being made in their best interests.

People felt staff were caring and valued the relationships they had built with longer standing staff. However, staffing arrangements and the lack of leadership had impacted upon the time staff invested into providing care which was not always led by tasks staff needed to do. There was also little consideration made in how people were supported to maintain their dignity which reflected people were not always placed at the heart of staff practices.

People knew how to make a complaint if they wished to do so and felt comfortable in doing so. There were limited opportunities for people to follow their own interests and socialise. Staff missed opportunities to introduce into their caring roles time to spend socialising and supporting people with fun and interesting things to do.

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.