Background to this inspection
Updated
5 January 2023
Inspection team
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Penbownder House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection, we reviewed information we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.
We used all of this information to plan our inspection.
During the inspection
We reviewed four people's care plans and risk assessments. We reviewed staff training and supervision. We also reviewed other records relating to the management of the service. We spoke with nine people and six staff including the registered manager and the provider. We spoke with one visiting healthcare professional. We spoke with five relatives on the phone.
Updated
5 January 2023
About the service
Pendownder House is a residential care home providing personal care to up to 34 people. The service provides support to younger adults, people with mental health needs, older people and people living with dementia. At the time of our inspection there were 34 people using the service. The service was separated in to two units one for people living with dementia and one for people with mental health needs.
People’s experience of using this service and what we found
Medicines were not always managed safely. Some medicines information provided in the care plans was not accurate. Medicines that required stricter controls were not always recorded correctly.
Risks were not always identified or safely managed. An open sharps bin containing used needles and syringes was kept on top of a cupboard in the dining room. People who were living with dementia had easy access to this bin.
Staff did not always have the necessary guidance in care plans to help them support people to reduce the risk of avoidable harm. One person, had assaulted staff and other people living at the service. However, their care plan did not contain any risk assessments to guide and direct staff on how to reduce this identified risk, such as noting specific triggers to the behaviour or detailing what worked to de-escalate the situation.
Everyone in the service had an electronic care plan. However, some information provided on the profile page was not accurate. There was a lack of detail in all the care plans we reviewed. Some guidance provided was not good practice.
Infection control processes and procedures were not always robust. Prior to this inspection the registered manager had agreed to all staff dispensing with the wearing of face masks. Staff were guided to wear a mask when working closely with people such as during personal care. This was not in line with the current guidance. The registered manager took advice and re-instated the wearing of masks.
Visitors were still being asked to make arrangements in advance before visiting loved ones. This was not in accordance with current guidance and we advised the provider that visiting should be entirely open and unrestricted.
The Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DOLS) were not always implemented effectively at the service. The registered manager did not have an accurate record showing which people had authorisations in place for restrictive care plans.
Some people had been assessed as requiring pressure relieving mattresses to help ensure they did not develop pressure damage to their skin. These mattresses were not always set correctly for the person using them.
There was very little activity provided for people. There was a ‘magic table’ (the Magic Table is an interactive light projector designed to increase physical and social interactions for people living with dementia) and several headsets to enable people to listen to their choice of entertainment, however, staff confirmed to us, “They are hardly ever used.”
The staff mostly provided task-based interaction with people. On the day of our inspection everyone in the dining room was given the same meal in the same quantities, with no comment made by the staff.
Comments from people about the food where mixed and included, “No choice,” “The food is good, very good, I like it. I just eat what is put in front of me” and “The food is alright sometimes. Not really a choice.”
The registered manager and the provider shared the audit programme providing an overview of the service provided. However, the audit process was not effective and had not identified concerns found at this inspection.
New staff were recruited safely. There were sufficient numbers of staff on shift to meet people’s needs.
Staff were provided with training to ensure they had the knowledge and skills to meet people’s needs. Staff were provided with supervision.
People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.
People were asked for their views in a survey. The registered manager communicated with families when they visited, or by email.
There was a registered manager at the service at the time of this inspection. The provider supported the registered manager at the time of the inspection.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (Published 20 September 2018). At this inspection the rating has changed to requires improvement
Why we inspected
We received concerns in relation to the care provided by staff. We carried out a focused inspection covering Safe, Effective and Well led.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We found breaches of the regulations relating to safe care and treatment, consent, person-centred care and good governance.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Penbownder House on our website at www.cqc.org.uk
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.