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Archived: Plymouth House Good

Reports


Inspection carried out on 19 December 2016

During a routine inspection

This inspection took place on 19 December 2016 and was unannounced.

The provider of Plymouth House Nursing Home is registered to provide accommodation with personal and nursing care for up to 24 people. Care and support is provided to people with dementia, personal and nursing care needs. At the time of this inspection 23 people lived at the home.

There was a registered manager in post at the time of this inspection who was also one of the provider’s. 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 had no concerns about their safety. Risks to people’s safety had been identified and staff had training in how to recognised and report abuse.

Staff were recruited in a safe way and had relevant training and support to develop their skills in meeting people’s needs. People were cared for by staff who knew them well and responded to their needs. Staff were visible in communal areas where they supported people at times they needed assistance and similarly people received support when they remained in their own rooms. Staffing arrangements were reviewed regularly to ensure there were enough staff to meet people’s particular needs.

People had their medicines when they needed them and staff had been trained to manage medicines both safely and effectively. Staff used an electronic system to assist them in making sure medicines were administered at the right times and in the right doses to meet people’s health needs.

Staff told us their training was up to date. All staff felt they supported each other and worked well as a team in order to effectively and safely meet people’s needs. Staff were aware of people’s individual needs and how to respond to risks to their health, such as falling or developing sore skin. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed. People who lived at the home and their relatives were complimentary about the quality of the care staff provided.

Staff had ensured that people's rights were respected by helping them to make decisions for themselves. Where people lacked capacity to make informed decisions these were made by people who knew them well and had the authority to do this in people’s best interests. Staff practices ensured people received care and support in the least restrictive way to meet their needs. When people’s needs changed staff responded to these and sought the advice of health and social care professionals so people had the care and treatment they needed.

People who lived at the home and their relatives had built trusting relationships with staff who they had come to know well. Staff had a high degree of knowledge about people's individual choices and preferences. Staff recognised people's right to privacy, promoted their dignity and respected people’s confidential information.

People were happy with the access and availability to participate in thing they liked to do for fun and interest. People who lived at the home and their relatives were supported to provide their views about the support and care offered. The provider had responsive systems in place to monitor and review complaints to ensure improvements were made where necessary.

Staff understood their roles and responsibilities. The providers and management team showed they had an accountable and responsive approach and were motivated to continue to make on-going improvements to ensure people received a good quality service at all times.

Inspection carried out on 20 November 2014

During a routine inspection

This inspection took place on 20 November 2014 and was unannounced.

Plymouth House provides accommodation for people who require nursing care for a maximum of 25 older people some of who have a dementia related illness. There were 23 people living at the home when we visited and there was 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. On the day of the inspection the registered manager was not available. We met with the provider and deputy manager who had responsibility for the day to day running of the home.

People told us that they felt safe and well cared for. Staff were able to tell us about how they kept people safe. During our inspection we observed that people received their medicines as prescribed and at the correct time.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. At the time of our inspection one person had a DoLS in place and two further people had an application in progress.

We found that people’s health care needs were assessed, care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People were supported to eat and drink enough to keep them healthy. People had access to drinks during the day and had choice of meals. People’s likes and dislikes had been considered alongside any specialist dietary needs and these were known by the kitchen staff.

People were relaxed and chatting with staff. The atmosphere was calm and staff responded to people’s request. Staff also recognised people’s needs by looking at visual clues. Relatives said that they were very happy with the care of their family member. Our observations and the records we looked at supported this view.

Staff had received both internal and external training which they felt reflected the needs of people who lived at the home. People, their relatives and staff told us that they would raise concerns with the nursing staff, the deputy manager or the registered manager and were confident that any concerns were dealt with.

The management team had kept their knowledgeable current and they led by example. The management team were approachable and visible within the home which helped to look at culture of the service. The provider ensured regular checks were completed to monitor the quality of the care that people received and look at where improvements may be needed.

Inspection carried out on 13 June 2013

During a routine inspection

When we carried out this inspection 24 people were using the service.

We spoke with the deputy manager, one of the providers and two care workers. We spoke with four people who used the service and two visitors.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. This was confirmed by people who were using the service. From our observations we saw that people were provided care to meet their individual care needs. People were complimentary about the care they received.

We found that appropriate arrangements were in place to ensure the safe use and management of medicines.

We saw that people who were using the service were protected from the risk of abuse.

Appropriate checks were carried out before staff commenced employment.

We saw that the provider had developed systems for monitoring the quality of the service.

Inspection carried out on 7 December 2012

During a routine inspection

During our last two inspections at Plymouth House in January 2012 and July 2012, we set compliance actions to address issues identified with the management of medicines.

There were 23 people who used the service at the time of our inspection.

While at Plymouth House we saw that staff were being courteous and respectful towards people who used the service. Care workers spoke about how they upheld people’s privacy and dignity and this was seen to happen during our inspection.

The provider had introduced a system to identify any shortfalls in the management of medicines. During our inspection we found that the medicine administration and management were not always effective and therefore people were at risk from not receiving their medicines as prescribed.

Systems were in place to make sure that checks were carried out on new members of staff to make sure that they were suitable to work with vulnerable people. We found that these checks were not always fully completed before staff began working.

Inspection carried out on 30 July 2012

During an inspection to make sure that the improvements required had been made

We inspected Plymouth House to assess areas where we previously found improvements were necessary in order to ensure the health, welfare and safety of people who used the service.

When we visited Plymouth House we spoke with a few people who used the service as well as some people who were visiting. We also spent time observing what was happening in the home.

The care of people was planned although some areas of the recording could be improved to provide staff with more guidance. People told us that they were pleased with the standard of care provided. They told us that the home is “wonderful” and that the “care is fantastic here “.

We found that people were cared for by staff we were aware of the current care needs of people who used the service.

We had previously identified a shortfall in the management of medication. Although improvements were made following our visit a number of shortfalls were seen during this inspection requiring further action on behalf of the provider.

Since our previous inspection the provider has introduced a quality assurance system in order to identify areas needing improvement.

Inspection carried out on 30 January 2012

During a routine inspection

Some people using the service were able to tell us about their experience of Plymouth House. We also spoke with staff and two visitors.

We saw staff interacting appropriately with people. Staff were seen to be caring and respectful to people. One person described the care workers as “very good” and that they “look after me well”. Another person also described the carers as “good” but “run off their feet”. People were generally complimentary of the food; one person described it as “wholesome and good”. People were offered drinks and encouraged to drink throughout the day. One person told us that staff got her a drink whenever she needs one.

Some relatives described the home as “marvellous” and told us that their relative looked better since their admission into Plymouth House.

We viewed the records of three people who lived at the home. These showed that care plans were being reviewed regularly and usually updated on a monthly basis. The information on some care records needed to be clarified as they were not necessarily clear and could lead to confusion about people’s current needs, although as Plymouth House had a stable staff team this risk was reduced. Fluid charts were maintained and added up to show an overall input each day however, there was no guidance as to the desired fluid intake and what to do if that level was not reached. We did not however see anybody who appeared to be dehydrated.

Care workers were able to describe to us the care needs of people living at the home.

The vast majority of MAR (Medication Administration Records) charts were completed appropriately with a signature to show that people had received medicines as prescribed.

We did however find that people’s medicines were not always managed safely. Procedures for the obtaining, recording, using and administration of medicines were not always followed, which increases the risk of a medicine error.

Our concerns about the medication systems at Plymouth House were discussed with one of the providers and other people present at the time. An assurance was given that a full audit would happen and that systems would be put into place to prevent any further reoccurrence of the shortfalls identified.

At the time of our visit no quality assurance system was in place. We were however informed that one was about to be introduced.

During our visit we took the opportunity to have a look around the home. During this we noticed a number of concerns which we brought to the attention of the provider.