Archived: Pilling Care Home

The last scheduled inspection at Pilling Care Home home took place on 24 March 2015 and 01 April 2015. The home was rated as Requires Improvement overall with an inadequate rating in the Responsive domain.

The home has a condition of its registration with the Care Quality Commission (CQC) that a registered manager is in place. 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. At the time of the first two visits of the inspection 20 January 2016 and 26 January 2016 there was a registered manager in place. However, they submitted their resignation on 8 February 2016, so the service did not have a registered manager in place after this date.

Pilling Care Home provides nursing and residential care for older people and people with dementia. Long term and short term care is provided and the home is registered to accommodate up to 29 people. There were 26 people living in the home when we first visited. The home is close to the centre of the village of Pilling, which has a small number of cafes, churches, shops and pubs. Communal lounges are on the ground floor, with bedrooms on the ground and first floors. The home has a passenger lift. There is a car park at the front of the home and gardens to the rear.

We engaged with all people who lived at the home. Feedback varied due to some people having limited communication skills. We spent time observing care delivery and spoke with people who visited the service.

We found that people were not protected against avoidable harm and quality assurance systems at the home failed to identify or resolve associated risk and therefore people were placed at significant risk of harm and neglect. We communicated our concerns to associated commissioning teams.

We found that people’s safety was being compromised in a number of areas. This included how people were assisted to eat and drink, use of equipment during moving procedures, how well medicines were administrated and suitability of pre-employment checks for staff prior to recruitment.

Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make particular decisions. For example, the provider had not ensured that people’s rights were actively assessed under the Mental Capacity Act of Deprivation of Liberty Safeguards, even though their liberty was being significantly restricted.

We found that people’s health care needs were not appropriately assessed and therefore individual risk factors had not been fully considered, which placed people at risk of avoidable harm.

People’s views about the service varied. Some people were very happy, but others were not. Also, our own observations did not always match the positive descriptions people had given us.

We did not find evidence of robust management systems in the home and quality assurance was not effective in order to protect people who lived at the service from risk.

Staff were not provided with effective support, induction, supervision, appraisal or training. The home did not have any effective governance systems in place to ensure that improvements could be made.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for safe care and treatment, need for consent, person centred care, good governance, safeguarding service users from abuse and improper treatment, dignity and respect, meeting nutritional needs, staffing and fit and proper persons employed. In accordance with our judgement framework we have deemed the overall rating for this service to be inadequate.

As the overall rating for this service is now inadequate, the Care Quality Commission (CQC) have placed the home into special measures and further enforcement action has been taken. Our guidance states that services rated as inadequate overall will be placed straight into special measures. We want to ensure that services found to be providing inadequate care do not continue to do so. Therefore, we have introduced special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

•Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to cancel their registration.

Where we have identified a breach of regulation during inspection which is more serious, we will make sure action is taken. We will report on any action when it is complete.

We found the provider had taken steps to ensure the premises were adequately decorated and maintained.

Some bedrooms had been redecorated, with new carpets fitted. There was a programme for refurbishing more of the bedrooms. Five new beds had been purchased, with six more soon to be delivered. New carpets had been fitted to parts of the home, with new flooring planned and ordered for other areas. A full time maintenance worker was in post.

The manager confirmed they would be monitoring the upkeep of the building and making improvements as shortfalls were identified.

The quality of the service was being monitored. Audits and checks were being recorded, with action taken to address any shortfalls.

The two relatives we spoke with were also very complimentary about the standard of care provided at the home. One relative told us how staff were very patient, encouraged his relative to eat more and contacted the GP as necessary. The other relative said, 'All the staff are lovely and take care with privacy and dignity.'

Staff received a good level of training and support. Individual and group meetings provided opportunities for staff to discuss their work and share ideas.

Parts of the home needed attention, to make it a pleasant environment for residents. Some areas remained in need of refurbishment and redecoration. Although the areas for improvement had been identified, there had been no progress in making the necessary changes.

The provider has responsibility for the upkeep of the premises and although potential safety issues identified at the last inspection had been addressed, the premises still required attention.

Two health care professionals visiting clients at the home provided excellent feedback regarding the capabilities and professionalism of the staff team.

The relatives we spoke with were satisfied with the quality of the service. Comments included; 'Staff have got her eating again, her health has improved, she has gained weight.' And 'The staff are lovely. I am confident they would let me know of any problems.' We were told that staff were polite and friendly and relatives were kept up to date with any changes.

Staff had good information about the needs of those they cared for and were able to describe how they delivered appropriate care and support. People were treated with respect and there was good information about each person's past life, which helped the care staff to get to know them.

There were inconsistencies regarding the supervision and training of staff. Medication arrangements needed to be improved and we found some potential areas of risk, not identified by the current health and safety and quality monitoring arrangements.