Polventon Residential Care Home

Polventon Residential Care Home is a residential care home providing personal care and accommodation for up to 19 people who are predominantly elderly. The service is a detached property that has accommodation over two floors. A lift enables people to access all parts of the service. Some bedrooms have ensuite facilities and people shared communal lounges and have access to large gardens. Polventon Residential Care Home is situated in the village of St Keverne which is in south west Cornwall.

People’s experience of using this service and what we found

Since the last inspection the management team had reviewed their safeguarding procedures. The provider had effective systems in place to protect people from abuse and staff had a good understanding of what to do to make sure people were protected from harm. People told us they felt safe and relatives echoed this view.

The registered manager was now notifying us of events that they are legally required to inform us of, promptly.

Since the last inspection the management team structure had changed. They had implemented new systems to assess and monitor the quality and safety of the care provided. They were effective in assessing quality and identifying and driving improvement. The service had clear and effective governance systems in place.

Since the last inspection the management team had reviewed their risk assessment process and implemented new documentation. The documentation clearly evidenced how risks were assessed, and what action was needed to mitigate and minimise risks.

People and relatives were positive about the care and support that they received. Comments from people included; "I am really happy here”, “It’s like a hotel if you want a cup of tea at 3am you get it”, “It’s like a family here” and “The staff are all lovely, [staff members name] is always smiling and brings a smile to my face.” Relatives comments included “It really is a home from home", I can't think of anything they could do better" and “We have no concerns about the home or the care".

People, and their relatives were involved in the development and review of their care plans which detailed their needs and preferences. Staff knew people's care needs well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Peoples medicines were managed safely. Staff responsible had the necessary skills to administer medicines. Oversight was in place to ensure medicines were managed safely.

There were enough staff to meet people's needs and ensure their safety. People told us; "If you call the buzzer (call bell) the staff come quickly” and “Staff looked after me really well when I was ill.”

Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.

The service was clean and there were additional cleaning procedures in place to limit infection control risks within the service.

Staff felt supported by the management team. They told us; “We get good support from each other and the managers are approachable”

The management and staff team engaged well with health and social care professionals. Comments included “I consider the home to be a safe and caring service, in fact I am proud to work alongside them, their ethics and values are exemplary” and “I have a really positive view of the home, They are warm and welcoming, its residence are supported to live in a way that they would wish to live. The home feels as if it belongs to the residents, it is not clinical and they always meet the needs of the residents in a safe and effective way”.

The environment was spacious and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place.

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 and update

At our last inspection we found breaches of the regulations in relation to reporting safeguarding, managing risk, notifications required by law by the Care Quality Commission, and management oversight of the service. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting these regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16 and 21 December 2020. Breaches of legal requirements were found in relation to safeguarding, safe care and treatment, notifications required by law by the Care Quality Commission, and good governance.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions Safe 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 requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Polventon Residential Care Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Polventon Residential Care Home is a residential care home providing personal care and accommodation for up to 19 people who are predominantly elderly. Accommodation is spread over two floors. The service also had a supported living service adjacent to the care home. This does not provide personal care, and subsequently is not registered with CQC. Polventon Residential Care Home is situated in the village of St Keverne which is in south west Cornwall.

People’s experience of using this service and what we found

Safeguarding procedures were not always robust so suitable action had not always been taken to minimise the risk of abuse.

Risk assessment procedures were not always satisfactory. Documentation did not always accurately detail what risks were and how risks should be minimised. Suitable action to mitigate risk was not always taken.

The service had a pleasant atmosphere, people were happy and assistance with people's lives was well organised. People who used the service, and staff members, were positive about the registered persons, and supervisory staff. However quality assurance systems were not always effective at picking up problems and ensuring these were resolved.

People we spoke with were all happy with the service. Comments received included, “It is very good, it has always been good,” and “I cannot find fault with anything.” A relative reported, “Everything is first class.” A visiting professional said, “I wish I could place all my clients here.” People were positive about the food, said they had enough to eat and were offered a choice. People could make a hot or cold drink when they wanted. People said there were some activities available such as arts and crafts, singing, quizzes, bingo, and baking. The service employed an activities co-ordinator.

Staff were recruited appropriately and satisfactory recruitment procedures were followed. The service had sufficient staff available to assist people. Staff were observed as attentive, kind and caring. Comments, from people who used the service about staff included, “They always do their best,” and “They are excellent.”

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. Management of the service had been vigilant in their approach to minimising the risk of Covid 19 infection, and very good procedures were in place to ensure people were protected.

The team worked well together and had the shared goal of providing a good service to people who lived at the service. A staff member told us, “I love working here. It is like my family.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 15 March January 2018).

Why we inspected

The inspection was prompted by whistleblowing concerns about a series of incidents when people had been put at risk by another person who used the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the ‘Safe’ and ‘Well Led’ sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Polventon Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

At this inspection we have identified breaches in relation to safeguarding, safe care and treatment, notifications required by law by the Care Quality Commission, and good governance.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Polventon is situated close to the village of St Keverne on the Lizard peninsula. The service provides single room accommodation for up to nineteen predominantly elderly people who need assistance with personal care, including those with a dementia related illness. At the time of the inspection there were nineteen people using the service. The service is situated over two floors which are served by a passenger lift and stair lift. There is also a lower ground floor with two rooms. People using these rooms require mobility to use a small flight of stairs. There were two rooms with en suite facilities and two bathrooms including an assisted bath on the ground floor and shower room on the first floor. A lounge/dining room is situated on the ground floor as well as another main lounge. There are a range of aids and adaptations to support people with limited mobility.

Guidance for staff in respect of managing risk were not always in place. One person had been assessed as being at risk of hot surfaces and radiators. There was a mobile radiator in the person’s room. The staff knew about this risk and took actions to prevent harm by additional monitoring. However this information was not being recorded meaning staff might not have the information they needed to keep the person safe. The registered provider took immediate action to address this issue. We have made a recommendation about this in the well led section of this report.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff, relative and ‘resident’ meetings to seek their views about the service provided.

We found staff had been recruited safely, received on going training relevant to their role and supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who lived at the home.

We observed staff providing support to people throughout our inspection visit. The staff were kind, patient and treated people with respect.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff were supported by a system of induction training, supervision and appraisals.

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

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

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, although these records were not always completed by staff for each meal, or checked to ensure people had sufficient food and drink. People told us the food was good.

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

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. Supplies were available around the building for staff to use when they needed them.

There was a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

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

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We inspected Polventon Residential Care Home on 11 and 12 January 2016. The inspection was unannounced. The service was last inspected in February 2014 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “Staff are very nice,” and “Everything is pretty good all round.” A health professional told us “I can absolutely say that Polventon is a caring, well managed home where people are respected and listened to, and their needs are taken care of, emotionally, socially as well as medically.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia, and minimising conflict and aggression.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included two written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals. We received positive comments from health professions such as, “The management have been quick to respond to any issues that may arise and contact the GP, social workers or Community Psychiatric Nurses seeking the appropriate support when needed.”

There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs.

The service had a programme of organised activities. These activities included musicians, group activities such as exercise sessions, bingo, and arts and crafts. Some external activities were available. The service has a vehicle which was used for outings.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were very happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included “Absolutely gorgeous, “and, “Brilliant, could not wish for more.” People said they received enough support when they needed help with eating or drinking.

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. We were told “(The registered manager is) very nice.” Staff told us “(The registered manager) has worked very hard to build a good team. He is very approachable,” and “(the owners) are genuinely caring people.” There were satisfactory systems in place to monitor the quality of the service.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Each person had a care plan in place which stated their individual needs. People had access to a range of services including hairdresser, chiropodist and GP's. People who lived at Polventon Residential Care Home told us the 'care is exceptionally good' and the staff were 'very nice'.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Not all the staff were supported formally by the registered manager. There was not an effective system in place to ensure staff had received the appropriate training in line with their job role and responsibilities.

The provider had an effective system in place to gain the thoughts and experiences of people who lived at the home, their representatives and medical professionals.

People told us how they spent their day. The staff respected the likes and dislikes of the people who lived at the home.

Staff demonstrated a sound knowledge of the care needs of the people that lived in the home. Everyone had a care plan in place.

There was a robust system in place to ensure that if requested people's money was held securely and was accessible to them should they require it.

There were systems in place to ensure the environment and equipment was safe for the people that lived at the home and for the staff.

Staff felt supported by the manager. However we did not see any evidence of formal supervisions. Some staff had not completed training for manual handling or safeguarding.