25 April 2018
During a routine inspection
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.