• Care Home
  • Care home

Penhellis Nursing Home

Overall: Good

Cross Street, Helston, Cornwall, TR13 8NQ (01326) 565840

Provided and run by:
Glencare Homes Ltd

Latest inspection summary

On this page

Background to this inspection

Updated 29 September 2018

We carried out this comprehensive inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was carried out by two adult social care inspectors a specialist advisor and an expert by experience. The specialist advisor had a background in nursing and the expert by experience had personal experience of using or caring for someone who uses this type of care service.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR and other information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.

We spoke with a range of people about the service; this included eight people who lived at Penhellis. During and following the inspection we spoke with eleven staff members, the registered manager and nurse on duty. We contacted five professionals whose contact details were provided prior to the inspection. There was one response.

We looked at care records of four people who lived at the service and training and recruitment records of three staff members. We also looked at records relating to the management of the service. In addition, we checked the building to ensure it was clean, hygienic and a safe place for people to live.

During our inspection, we used a method called Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with people in their care. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Overall inspection

Good

Updated 29 September 2018

We carried out an unannounced inspection of Penhellis on 14 August 2018. Penhellis is a care home which provides nursing care and support for up to 26 predominantly older people. At the time of this inspection there were 22 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 a detached historical house on two floors with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include a lounge on the ground floor and first floor, a first-floor reminiscence room and a dining room. The service stands in its own grounds with accessible mature garden areas as well as a central courtyard.

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 28 June 2017. In June 2017 we found people’s medicines were not always managed safely. We found several errors which had occurred within the previous month, which did not appear to have been followed up or reported. The registered manager undertook an annual medication audit; however, this was too infrequent to address the errors and areas for improvement that it identified. The medicines room was small, warm and cramped. When nurses were preparing medicines, they needed to prop the door open as it quickly became too warm. The temperature of this room was not being monitored to ensure that the medicines were kept at a suitable temperature. Similarly, the temperature of the medicines fridge was not recorded daily. There was a lack of continuity of nursing care due to a high use of agency and bank nursing staff. This, in part had resulted in one person running out of their prescribed medicines.

At the inspection in June 2017 there was an inconsistent approach to the monitoring of some people’s health conditions meaning it was not always possible to understand if their needs were being met and their treatment was appropriate. People’s rights were not always protected as the principles of the Mental Capacity Act were not always followed. Some people’s records indicated that they lacked capacity to make certain decisions, without saying what the specific decisions were. Nor did the records contain a capacity assessment. Audits to monitor the quality of the service had failed to identify or address the areas of concern identified during our previous inspection in relation to capacity and medication management.

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.

The registered manager had implemented a more robust review and medicines audit system to identify and address any errors more frequently. Medicine audits were being carried out twice weekly by a registered nurse and registered manager. Medicine administration records [MAR] were being checked at the end of every medicines round. When errors had occurred, there was an error log where it was recorded by the nurse, signed and dated. This information identified any particular trends or patterns. For example, it had been noted errors were being found during a specific staff shift pattern by agency staff. The registered manager was able to address this with the supplying agency as they were not part of the services staff team.

The medicines room remained as the previous inspection. A small compact room where staff could only work with the door propped open. There were proposals in place for it to be resited as part of a planned extension of the service. However, in the interim period a fan had been put in place and daily temperature checks were being made and recorded. The records showed the rooms temperature had been satisfactorily maintained. Daily fridge temperatures were now being monitored and were satisfactory.

The registered provider had recently installed a surveillance system in the medicines room. There was a policy statement telling people using the room about the purpose of collecting information here, how the information will be accessed and stored. Also, there was a sharing of information protocol. Staff told us they were made aware of this system as were people using the service or where they lacked capacity their legal representatives. There was signage in the room to alert people to this system.

The service was being staffed satisfactorily. There remained a reliance on agency staff, however the service had managed to increase its level of bank staff which meant there was generally a level of continuity. Nobody told us they were concerned about the consistency of staff or staffing levels. Staff said there were times that were particularly busy but that they worked as a team which meant they worked together to meet people’s individual needs.

Care records were being reviewed and changes made to respond to risk. The records we viewed demonstrated the information was in good order and it was easy to find the relevant section within. There was a numerical Index at the front and each section that made it was easy for staff to navigate and find the information they needed.

Where people lacked metal capacity there was evidence to demonstrate the service acted in accordance with the Mental Capacity Act [MCA]. In order to meet the breach from the inspection in June 2017 the service had introduced a revised assessment tool. This had been used to record people’s capacity and identify any issues. Best interest meetings were taking place and applications sent to the local authority where necessary for the authorisation of restrictive care plans.

Throughout the inspection we observed staff providing support with respect and kindness. People generally told us they felt safe and comfortable living at Penhellis. Comments included, “Life is very calm and predictable, everything is spotlessly clean and the staff are always discretely on hand to help me.” and “I’m so glad I chose to live here. It’s just a lovely place to be.” Two people told us they had experienced staff members speak with them in a way they found disrespectful. They had reported these issues to the registered manager and they had not reoccurred. Staff records showed these issues had been addressed with staff through personal supervision.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, social workers, psychiatrists, general practitioners (GP) and speech and language therapists (SALT). In addition, people could choose complimentary therapies including Reiki, Indian Head Massage, acupuncture and herbal medicine. These additional services incurred additional charges which were displayed in the welcome pack.

Staff were sufficiently skilled to meet people’s needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. Existing staff received regular training, supervision and annual performance appraisals.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

The manager used effective systems to record and report on, accidents and incidents and take action when required.

The service was suitably maintained. It was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed and there were appropriate procedure in place to manage infection control risks.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

The provider had systems in place to monitor the quality and safety of the service.