Archived: Perrins House Residential and Nursing Care Home

Perrins House is located near to the town of Malvern. This service provides nursing and personal care for up to 43 people. On the day of our inspection there were 32 people living at the home.

There was manager at this home who was not registered with us for this service. The provider was in the process of re-registering the home as part of another service. The manager was registered for the other service and would be applying for registration with this service when re-registration was complete. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People and their relatives said they were happy with the support that staff provided people that lived at the home. They told us staff were caring and promoted people’s independence. People told us they were able to maintain important relationships with family and friends. Relatives said they were welcome to visit as they wished. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were included in regular meetings to ensure they had a say in the choices available to them. People told us they had access to health professionals as soon as they were needed. People we spoke with said they had access to interesting things to do.

We found that people had not been protected against the risks associated with medicines because some people had not received their medicines as prescribed. The management team took immediate action and had a plan in place to ensure people received their medicines. Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. However we found that guidance for staff about regimes to ensure people did not have sore skin were not always carried forward to ensure staff had up to date knowledge. The unit manager had ensured this guidance was updated and all staff were aware between our two visits. We saw this was now in place.

Relatives we spoke with said they felt included in planning the support their relative received and were always kept up to date with any concerns. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The management team ensured people were listened to, we saw that complaints were investigated and action taken to resolve them.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. Staff knew people well, and took people’s preferences into account and respected them. Staff had the knowledge and training to support people they provided care for. Staff ensured people agreed to the support they received.

The management team had identified that applications to the local authority to deprive people of their liberty were needed for some people living at the home. These applications had not been completed to ensure people were not deprived of their liberty unlawfully. There was a plan in place to ensure these were completed.

The manager promoted an inclusive approach to providing care for people living at the home. People, their relatives and staff were encouraged to be involved in regular meetings to share their views. The provider sent out questionnaires to ask for feedback from people, their relatives and professional involved with the service. The management team had an action plan to address the feedback received. For example they had increased how they provided interesting things to do by providing activity staff at the weekend.

The provider and manager had systems in place to monitor how the service was provided. The management team had identified areas of improvement and were providing the resources to complete these actions. The management team reviewed accidents and incidents and took steps to learn from these.

You can see what action we told the provider to take at the back of the report.

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with a total of eight people who used the service and two relatives and asked them for their views. We also spoke with three care workers, one registered nurse, the catering manager, the activities organiser and the registered manager. We looked at some of the records held in the service including the care files for 16 people. We observed the care and support people who used the service received from staff and carried out a tour of the building.

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found that people's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe. We found the provider had involved people in writing their care plans and recorded how they had given their consent.

There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to. One newly appointed member of staff told us, "I was able to check things out with the manager and nurses whenever I needed to".

People were protected from the risk of abuse because the provider had ensured that safeguarding policies and procedures were in place and available to staff. We found the provider had taken appropriate actio when safeguarding concerns had arisen. Staff had been trained in safeguarding and knew what to do in the event of abuse being suspected, witnessed or alleged.

There were systems in place to protect people against the risks associated with medicines. These systems were monitored by the provider. We found the provide had taken appropriate action when errors had been made with the administration of medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had submitted one application and was awaiting its outcome. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We saw people being cared for and supported in accordance with their plans. Staff had received training to meet the needs of the people living at the home.

We saw in care plans that risk assessments had been completed that promoted people's independence. We saw in care plans that where people undertook aspects of their care independently this was clearly stated. Staff members we spoke with told us they thought it was important to promote people's independence.

Is the service caring?

People were supported by kind and attentive staff. We saw staff talking with people in a kind, calm and respectful manner. We saw staff took care to ensure people had enough to eat and drink. We saw that activities were planned and that people's involvement was monitored, with individual one to one activities offered to people who did not wish to participate in group activities.

Family representatives we spoke with told us, "The staff are generally good". One staff member told us, "Staff are polite to people and treat them with respect. Another said, "The staff are very good and know what they're doing".

Is the service responsive?

We found that each person's needs were regularly reviewed with care plans updated if needed. Records showed that people were supported in line with these plans.

People had access to activities and had been supported to maintain relationships with their friends and relatives. We found that activities people had requested had been provided.

We found that call bells were provided and that these were answered promptly by staff attending people. The manager told us, "We monitor how long it takes to respond to calls and can track the room numbers and staff responding".

Is the service well-led?

We found that quality assurance processes were in place. People's views had been obtained by the provider along with the views of family representatives and staff. The provider had taken action as a result.

People supported and their relatives told us they would feel able to raise any concerns they had with the provider and were confident their concerns would be dealt with.

We found that quality checks were carried out by the provider and that the health and safety of people was monitored.

We were told by one person supported, "The staff are well led".

We also spoke with a medical professional and a person who was visiting relatives, the manager and six members of staff including nursing, care and catering staff.

We watched staff as they cared for people. They provided care and support that met people's needs. We found that staff knew about the needs of the people they cared for. We looked at care records for four people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs had been reviewed regularly.

People told us that they were happy with the food that they had been given and that they had been offered choices.

People had been protected from the risk of harm and abuse because staff had received training and had a clear understanding of their roles and responsibilities with regard to safeguarding. The registered manager had taken reasonable steps to ensure that suitable people had been employed to work at the home. Records had been maintained appropriately and stored securely.

People who used the service were complimentary of the service and told us that they were cared for well. We found that people who used the service were encouraged to express their views and make decisions about their care and how they wanted to spend their time.

We found that people's individual needs had been assessed and supporting care plans had been developed. This ensured their needs would be met by staff and that they received appropriate care.

Staffing levels had been increased since our last inspection and the majority of people we spoke with told us there was enough staff most of the time.

The service had appropriate arrangements in place for the recruitment and training and development of staff.

Staff employed by the service had a good understanding about what constituted abuse and the action they should take if they had any concerns about the people they cared for.

We saw that there were arrangements in place for monitoring the quality of the service. People who visited the service and the staff we spoke with told us that they had no difficulties raising issues of concern if necessary and knew that they would be listened to.