Puddingstone Grange

Puddingstone Grange is a residential and nursing care home providing regulated activities of personal and nursing care for up to 62 people. The service provides support to people living with dementia, nursing and mental health needs. At the time of our inspection there were 62 people using the service. The home is purpose built with four units spread across two floors.

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

We have made a recommendation about the management of records.

People told us they felt safe living at the home, and they had no concerns regarding abuse or neglect. People were protected from the risk of avoidable harm because risks to people had been identified, assessed and had appropriate risk management plans in place.

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 were supported by enough staff on each unit to ensure their needs were safely met. The service completed appropriate recruitment checks before new staff began working at the home.

Medicines were managed safely, and people were receiving their medicines as prescribed by healthcare professionals. The home was clean, staff followed appropriate infection control practices to minimise the spread of infections. The service followed current COVID guidance. Lessons were learnt from accidents and incidents to prevent repeat occurrences.

The service was well-led by a management team who had good oversight of the service. Managers were visible in the home and people told us they came around daily to greet them and ask about their welfare. There were system in place to assess and monitor the quality and safety of the service and to drive improvements. People, their relatives', professionals and staff's views were sought to improve on the quality of the service provided.

The service worked in partnership with key organisations including health and social care professionals to deliver care and support that met individual needs. Staff knew of their roles and responsibilities, they told us they felt the culture of the service was moving in the right direction.

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 15 January 2020)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. This was because the provider had taken action to mitigate the risk of falls and their actions had been effective.

Please see the safe and well led key questions sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Puddingstone Grange on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Puddingstone Grange provides residential and nursing care for up to 62 older people; most of whom were living with dementia and mental health needs. At the time of this inspection, 60 people were using the service. The home is purpose built and spread across four units and over two floors.

We found the following examples of good practice.

Appropriate measures were in place to prevent visitors from catching and spreading infections. All visits were booked in advance and visitors were screened for any acute respiratory infections which included a temperature check and a COVID-19 test. All visitors, including health and social care professionals were supported to wear appropriate personal protective equipment (PPE). A dedicated staff member was available to support and oversee all visits, and to ensure government guidance, including social distancing rules, were followed. The service had designated visiting areas to meet individual needs. Staff cleaned these areas between visits to minimise the risk of the spread of infections.

The service had arrangements in place to test both people and staff for COVID-19 in line with current national guidelines. People and some staff had received their first and/or second dose of the COVID-19 vaccines.

Appropriate procedures were in place to ensure people were admitted safely into the service. New admissions needed a negative COVID-19 test result before they moved in. Newly admitted people were also isolated for the first 14 days after admission, in line with national guidelines. Whilst in isolation, staff supported the person with hourly monitoring checks and daily temperature checks to identify and minimise any risks of infection.

Staff were supported through regular training in infection prevention and control (IPC). This training included staff awareness of COVID-19 and the use of PPE. Staff had access to the PPE they needed to keep them and the people they supported safe. The home had designated areas for donning and doffing (putting on and taking off) PPE. Staff wore PPE appropriately and, where preferred, people were supported to wear face masks.

The home appeared clean and free from odour. A cleaning schedule was in place to promote consistent levels of cleaning. The provider had a comprehensive set of policies and procedures, risk assessments and audits in relation to the management of infection control risks and that of COVID-19.

Puddingstone Grange provides residential and nursing care for up to 62 older people; most of whom were living with dementia and mental health needs. At the time of this inspection, 60 people were using the service. The home is purpose built and spread across four units and over two floors.

People’s experience of using this service

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. We have made a recommendation about working within the principles of the Mental Capacity Act (MCA) 2005.

People were supported to participate in activities that interested them; however, there was not enough activities available throughout the day to keep people stimulated. The registered manager informed us they had identified this issue and were acting to ensure people were involved in activities that were relevant and met their needs. We will check on this at our next inspection.

People, their relatives and health care professionals were complimentary about the home. People received care and support that was personalised to their need and felt safe living at the home. People were protected from the risk of avoidable harm as potential risks to their health and wellbeing had been identified, assessed and had appropriate risk management plans in place for staff to mitigate these risks. People were supported to safely manage their medicines. There were enough staff available to ensure people’s needs were safely met; people said they did not have to wait for long to be attended to. The provider followed safe recruitment practices and ensured all staff were properly checked before they began working at the home.

Before people started using the service, their physical, mental, and social care needs were assessed, including their likes and dislikes to ensure their needs could be met. People received care and support from staff had been supported through induction, training and supervision. People were supported to eat and drink sufficient amounts for their health and wellbeing. People were living in a home which was designed and decorated and personalised to meet their needs.

People received care and support from staff that were kind, compassionate, respectful and promoted their privacy, dignity and confidentiality. Staff understood the Equality Act and supported people in a caring way and without any discrimination. People and their relatives were involved in making decisions about their care and support needs and their views were respected.

Information was presented in formats that met people’s communication needs. The service had an effective system in place to manage complaints; however, people told us they had nothing to complain about. There were appropriate plans in place to ensure people’s end of life wishes were respected and met.

The service was well led, and the management team demonstrated a commitment to provide high quality care and knew they had to be honest, transparent and open when things went wrong. The home had systems in place to assess and monitor the quality of the service and had sought feedback from people and their relatives to improve on the service delivery. The service worked in partnership with key organisations and health and social care professionals to deliver an effective service. Staff knew of their individual responsibilities, they told us they felt supported in their role and were happy working at the home.

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 23 June 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 this inspection on 09 and 10 May 2017 we found that improvements had been made and that there was clear guidance for staff on how to manage covert medicines as prescribed by the GP. Staff followed this guidance when administering medicines. We saw that quality assurance system in place were effective in identifying shortfalls.

Puddingstone Grange provides residential and nursing care for up to 62 older people most of whom are living with dementia. At the time of our inspection there were 60 people using the service.

There was a registered manager who had been in post since March 2015. 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 told us that they felt safe. There were safeguarding adults’ procedures in place that were robust and staff understood how to safeguard people. There was a whistle-blowing procedure available and staff said that they would use it if they needed to. Risk assessments were carried out and reflected current risks for people and ways to try and reduce the risk from occurring. Medicines were appropriately managed and stored. There were enough staff deployed to meet people's needs. The provider had carried out appropriate pre-employment checks to ensure staff were suitable and fit to support people using the service.

Staff received adequate supervision, appraisals and training suitable to their needs and the needs of people who they supported. New staff were inducted into the service appropriately. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005(MCA) and Deprivation of Liberty safeguards (DoLS). Staff asked people for their consent before they provided care. People received enough to eat and drink and had access to a range of healthcare professionals when needed.

Staff knew people well and they were treated with kindness. People's privacy and dignity was respected. People were supported to be independent as possible such as attending to some aspects of their own personal care. People's cultural needs and religious beliefs were recorded to ensure that staff met people's needs and wishes.

People and their relatives were involved in the care planning process and the care and support they received was person-centred. Care plans and risk assessments provided clear information for staff on how to support people and were reviewed on a regularly basis.

People and their relatives said they knew about the service's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

Regular resident and staff meetings took place and people’s views had been sought about the service. People and staff spoke positively about the service and the registered manager who they said were supportive. Systems were in place to monitor and evaluate the quality and safety of the service and obtain feedback from people and staff.

Puddingstone Grange provides residential and nurse care for up to 62 older people most of whom are living with dementia. At the time of our inspection there were 59 people using the service, with two residents currently in hospital.

At the last inspection on 15 and 16 April 2015, we found breaches of legal requirements and asked the provider to take action to make improvements to medicines storage and administration, risk assessments, mental capacity assessments and staff supervision. These actions have been completed.

At the current inspection we found that the provider had not always followed best practice in relation to checking on medicines storage and administering medicines covertly and improvements were required. However, there were regular medicine audits in place. Staff had completed medicines training and the home had a clear medicines policy in place which was accessible to staff.

The service maintained sufficient staffing levels to support people both in the home and the community. Staff received regular supervision and an annual appraisal, and the service undertook appropriate pre-employment checks on staff before they started work. Records showed that staff were also subject to regular training refresher requirements.

People were protected from the risk of abuse. Staff had access to procedures and policies relating to safeguarding people from harm. Most staff had completed training in safeguarding adults and we saw training was booked for those staff who were still due to attend. Staff we spoke with demonstrated an understanding of types of abuse that could occur and knew how to raise safeguarding concerns if needed.

Risks to people using the service were assessed, reviewed, recorded and managed appropriately. Detailed current risk assessments were in place for all people using the service which explained how to identify and manage risk and the provider was in the process of implementing a new format in order to capture appropriate reviews of need.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred. People were treated with dignity and respect.

People’s capacity and rights to make decisions about their care and treatment where appropriate were assessed in line with the Mental Capacity Act 2005 (MCA 2005). These safeguards are there to make sure that people are receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way. The manager and staff understood the principles of Deprivation of Liberty Safeguards (DoLs) and acted according to this legislation.

People were supported to eat and drink. People were consulted about weekly menu choices and supported to prepare their own meals. People are supported to maintain good health and have access to healthcare services. Referrals are made quickly when concerns are noted as regards to people's health.

People’s concerns and complaints were investigated and responded to in a timely and appropriate manner. We saw that the provider carried out compliance audits. However, issues in relation to medicines management were not always identified and actioned promptly. The registered manager and team leaders were accessible to people, and staff spoke positively about the support available to them.