Penbownder House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good.

At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The were variations in the quality of care and support to engage with activities people received in different areas of the service.

The service’s overall performance had improved since our last inspection and people’s care plans were now accurate and up to date. However, the support provided to people on the first floor of the older person’s service required further improvement. This meant the service remained in breach of the regulations in relation to person-centred care.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People did not always receive person centred care. Support provided to people living on the first floor in the older person’s service was task focused. Staff did not engage meaningfully with people and their role was of a supervisory nature. People were seated around a table and in chairs around the walls. Staff were standing overlooking people instead of encouraging them to engage with activities. Visiting professionals also expressed concerns about the quality of support provided on the first floor.

Staff and managers recognised the importance of supporting people to remain mobile and to manage their own continence where possible. However, there were no systems in place to ensure toilets were cleaned regularly during the day. One toilet, which people frequently used independently, became soiled in the morning and was not promptly cleaned. This meant risks to people’s dignity were not managed effectively.

At lunch time we observed incidents when staff interrupted people at the communal table while having lunch to give eye drops and nasal sprays. This did not respect people’s dignity.

The quality of towels and bedding in use throughout the service was poor. Following feedback these items were replaced.

People’s care plans were sufficiently informative. They included sufficient guidance to enable new members of staff who did not know people well to meet people’s care needs.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The provider ensured information was shared accurately and appropriately with NHS partners or other care providers to ensure continuity of care. Summary care plans and hospital passports were used to help ensure continuity of care and help ensure people’s specific needs and preferences were understood if they moved between services.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider shared information accurately with people, their relatives and involved health professionals. Staff varied how and when they presented information to people to aid their decision making. Relatives told us they were promptly updated with details of any incidents or changes to people’s conditions.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Surveys were circulated annually to gather feedback from people, relatives and visiting professionals. Feedback had been generally positive and issues raised had been investigated and addressed. In addition, the service had attempted to organise resident meetings but this had been unsuccessful. The registered manager told us, “We have tried to have [residents] meetings but there is little interest so we do an open-door approach and that seems to suit people better. They just don’t engage with meetings. We have tried cakes and teas but with the client groups we have we have not had the interest.”

The provider’s complaints system was effective. Records showed complaints and concerns raised had been appropriately investigated to identify any areas of learning or improvement. Compliments were regularly received from people’s relative and friends. These had recently included, “I would like to thank all the staff for [my relatives] professional care she was given at all times. From the bottom of my heart, you all did an amazing job".

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The registered manager and staff team supported people to access support from health and social care professionals whenever required. Care records demonstrated prompt referrals had been made for support from GPs and dentists. In addition, arrangements had been made for a massage therapist and a chiropodist to visit some individuals regularly.
Visiting by friends and relatives was encouraged, outside of meal-times which were protected so people and staff could focus on supporting people to eat well.

Leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

The provider employed a full-time activities coordinator who was effective in supporting people to engage in activities individually and as part of small groups. The provider’s director commented, “We do afternoon tea on Friday as we have a bunch of bakers at the moment. Families can come in and join. Our previous activities coordinator was taught how to bake by the residents”.

People in the mental health unit were supported to visit the local town regularly and told us, “We went out into town this morning for 2 hours” and “We had a good walk in town and a cup of tea.”

However, the provider had not ensured all people had equal access to activities throughout the service. On the first floor of the older person’s service people appeared less well cared for and limited support or encouragement was provided for people to engage with activities. People spent the majority of the time in this communal space with little to do and we noted that 1 person who was known not to like loud noises was sat immediately next to the TV. Staff said the activities coordinator, “comes up sometimes but not a lot.” People in this part of the service had higher needs and were less able to express their thoughts and wishes. This group of people did not have the same opportunities to engage in meaningful activities as people living in other areas of the service.

There was a large window overlooking the garden and a member of staff told us 1 person enjoyed looking out. However, the area immediately in front of the window was cluttered making it difficult for people to get close to it.

Relatives told us many of the puzzles and games available were missing pieces making them impossible for people to use. Relatives comments included, “the small puzzles have bits missing, there is a lack of care about things to do. No full sets of dominos” and “I feel the activity of the residents is not a priority to the management”.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Information about people’s wishes and preferences for their end-of-life care had been documented within care records. This included information about people’s wishes in relation to resuscitation and any arrangements planned.