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Inspection carried out on 9 August 2018

During a routine inspection

We carried out an unannounced inspection of Perran Bay Care Home on 9 August 2018. Perran Bay is a care home which provides care and support for up to 42 predominantly older people. At the time of this inspection there were 34 people living at the service. 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. The service is on three floors with access to the upper floors via stairs, chair lift or a passenger lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, an open plan dining room with seating areas, garden and patio seating area at the front and rear of the service.

There was a registered manager in post who was responsible for the day-to-day running of 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 24 April 2017. In April 2017 we found some people did not have a current accurate accessible care plan or risk assessment in place to guide and direct staff on how to meet people’s needs. Some specific guidance in people’s care plans was not being followed by staff. Some people had been assessed as being at risk from pressure damage to their skin and the service had provided pressure relieving mattresses for them. However, the correct settings for these mattresses were not being effectively monitored. The risk associated with accidents and incidents were not robustly managed. The processes for managing medicines were not robust. The management team were not able to easily access electronically held information relating to people’s care needs. Quality assurance systems were not satisfactory. The service was not regularly auditing areas such as care plans and medicines management therefore had not identified the areas of concern found at this inspection.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the last inspection the registered manager had ensured all care plans had been reviewed and reflected the current needs of people using the service. Risk assessments were regularly reviewed with evidence of changes in people’s needs and how staff should respond to them.

The electronic care planning system was fully operational and all staff were using this system effectively. Where people’s risks involved the need for pressure relieving mattresses they were being checked regularly to ensure they were accurate.

Auditing procedures took account of all areas of operation within the service to ensure systems were effective. Accidents and incidents were being reported and recorded as they occurred. These were audited to ensure any trends or patterns were evident and the service learned from them to make changes to mitigate risks to people.

Medicine procedures had been reviewed with changes made to some of the processes. For example, consent and risk assessment for people choosing to self-administer their medicines. Medicine audits were identifying where errors had occurred and stock control of medicines had been reviewed. There were no medicines or creams which were out of date. This meant the service was meeting the requirements of regulations.

People received care and support that was responsive to their needs because staff had the infor

Inspection carried out on 24 April 2017

During a routine inspection

This unannounced comprehensive inspection took place on 24 April 2017. The last inspection took place on 3 and 4 December 2014. The service was meeting the requirements of the legislation at this time.

Perran Bay is a care home which provides care and support for up to 42 predominantly older people. At the time of this inspection there were 34 people living at the service.

The service had transferred people’s care plans from a paper based format on to an electronic system in July 2016. Staff had been provided with training on how to use the system. Some people did not have a current accurate accessible care plan or risk assessment in place to guide and direct staff on how to meet people’s needs. Some specific guidance in people’s care plans was not being followed by staff. However, we judged that staff had a good knowledge of people’s needs and that these needs were being met. Staff monitored people’s needs and reported any changes in a timely manner.

Some people had been assessed as being at risk from pressure damage to their skin and the service had provided pressure relieving mattresses for them. However, the correct settings for these mattresses were not being effectively monitored. The risk associated with accidents and incidents and the self administration of medicines were not robustly managed.

The processes for managing medicines were not robust. There had been a medicine error reported by the service in April 2017. Out of date medicines were found to be available for use. Handwritten entries on to the Medicine Administration Record were not always signed by two staff to help ensure the risk of errors was reduced. The service was not auditing their management of medicines.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. However, the service did not hold an accurate up to date DoLS policy. The service was not following its own policy as had not provided training in this legislation for all staff.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Staff monitored all food and drink taken by people who lived at the service.

The service was not regularly auditing areas such as care plans and medicines management therefore had not identified the areas of concern found at this inspection.

We walked around the service which was warm, comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect. People reported that the management team and staff, "Went the extra mile" when supporting people's individual needs and wishes. The management team were passionate about providing good care and helping people to live the life they chose. People were encouraged to be active both mentally and physically where possible.

Staff were supported by a system of induction training, supervision and appraisals. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. Staff meetings were held for all staff groups and allowed staff to air any concerns or suggestions they had regarding the running of the service.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

The premises were well maintained. The service had reduced the number of people living there in order to reduce the amount of disruption which may occur when the planned extension of the service begins soon. There was also a planned re-design of the décor of each floor/corridor to aid people’s orientation around the building. The service did not currently have any additional pictorial signage to aid people’s recognition of specific areas of the building such as toilets and bathr

Inspection carried out on 3 and 4 December 2014

During a routine inspection

The service provides accommodation and personal care for up to 42 predominantly older people. This service did not provide nursing care. At the time of our inspection there were 31 people using the service. The service has a registered manager supported by a deputy manager who was a qualified nurse and the service’s training officer. 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.

We saw people were well cared for, relaxed and comfortable in the home. Everyone we spoke with complimented and praised the staff who supported them. People’s comments included, “(The staff) are very patient. I’m happy here”, “I can’t fault them, they definitely treat me with respect” and, “We’re not in our own homes but we’re in the next best place”.

Care records were personalised, up to date and accurately reflected people’s care and support needs. The care plans included information about peoples’ likes, interests and background and provided staff with sufficient information to enable them to provide care effectively. We observed people were cared for compassionately and with respect. People told us they were respected by staff, “I’m treated well, with respect” and, “never once have I heard a carer get cross”.

People were cared for by an established, motivated and well trained staff team. Managers and directors provided effective leadership to the service and regular residents meetings ensured people were involved in the running of the home. The atmosphere in the home was warm, friendly and supportive and we saw staff were able to spend time chatting and laughing with people.

People said, “We’re not in our own homes but we’re in the next best place!” and staff told us, “it’s all pretty good here really”, “a brilliant place to work” and, “I love it, It’s the best job I have had in my life”. The registered manager was well supported by the provider’s directors and said, “my support network is second to none”.

People were actively involved with the local community. Staff and volunteers supported and encouraged people to engage with a wide variety of activities and entertainments available within the home. The services pendant call bell system had been designed to enable people to call for staff support from the beach and waterfront.

Professionals who worked regularly with the service told us, “it’s a great home, just fantastic”, “I have booked my place there” and, “it is probably the best home I have ever been to”.

Inspection carried out on 8 November 2013

During a routine inspection

During our inspection we spoke with the registered manager, five members of staff and nine people who lived at the home. People told us the home was "very nice", the staff "look after us very well". People’s privacy, dignity and independence were respected.

The staff we spoke with were knowledgeable about the people who lived at the home. Staff told us they "love" working at Perran Bay Care Home. We spoke with the registered manager who told us that due to a number of factors the priority had been on the high quality of care provided daily and not on the paper work and assured us this would be addressed.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 10 January 2013

During a routine inspection

People who used the service were positive in their comments about the home. We were told that there was a waiting list for rooms at the home. People said “I have been here several years, I had to wait for a room it is so popular locally”, “I go to bed when I like and I decide whether I go to the lounge or stay in my room”, “the staff are lovely, very helpful and polite and they look after me very well, this is an excellent home” and “the staff are marvellous. I can do just what I like here and cannot fault anything”.

People told us they were satisfied with the care they received. We found that the care plan documentation did not identify that people's care needs were consistently met or that concerns raised by care staff were clearly addressed.

During our visit we saw that the home was clean, tidy and hygienic and the decor and furnishings were domestic in style.

The home is owned and managed by a charity. We were told the trustees of the charity were planning to build an extension to the home to provide additional bedrooms and communal areas. People who used the service had been consulted and involved in this planning and were keen to tell us about this venture.

From reviewing care records and associated documentation we found that the reporting of incidents or concerns had not been reported to the appropriate external organisations. For example to the primary care trust regarding medication.

Inspection carried out on 11 August 2011

During a routine inspection

We talked with seven people who reside at Perran Bay, and also visitors to the home. We asked them their view of the home. People told us they were happy there and were able to make choices. They told us that they felt well cared for by the staff. Additional comments were made as follows ‘the staff are lovely’, ‘I have no complaints about the care I receive the staff are excellent’, ‘we are like a big family here and they look after me really well’ and ‘they are kind, respectful and friendly nice people who look after me so well’. People confirmed to us that they could raise concerns to staff or the manager if the need ever arose and confidence was expressed that the manager would take appropriate action. One person told us that if they need assistance from the staff they have access to a call bell which is responded to promptly.

We were told by one person that the home has recently installed a new telephone system. One person told us that this system has benefited her enormously as she is able to maintain regular contact with relatives overseas very conveniently.