Archived: Pensby Hall Residential Home

This was an unannounced inspection carried out on 17 and 20 August 2015. Pensby Hall Residential Home provides personal care and accommodation for up to 30 older adults. Nursing care is not provided.

The home is a detached house situated within walking distance of local shops and public transport. Accommodation consists of 30 single bedrooms, four of which have en-suite facilities. A passenger lift enables access to all floors for people with mobility problems. On the ground floor, there is a communal open plan lounge/ dining room for people to use and a conservatory.

There was no registered manager in post. 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 our visit, the provider was acting as the manager at the home but was not registered. This meant that the provider had not been verified by The Care Quality Commission (CQC) as a ‘fit’ person. The provider was requested to submit a registered manager application by CQC but failed to do so.

People we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives and friends also told us they felt people were safe. During our visit, however we identified serious concerns with the safety of the service.

We found b reaches in relation to Regulations 9, 10, 11, 12, 13, 15, 17, 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found a number of safeguarding incidents had not been documented or appropriately reported. This meant that there was no evidence these incidents were properly investigated and responded to by the provider. There was no evidence that staff members had received safeguarding training as no training records had been maintained. This meant there was risk staff would not know what to do in the event of an allegation of abuse being made.

People’s dependency needs had not been considered in the way that staffing levels were determined. The provider did not have a clear understanding of people’s needs and the care they required. We found that staffing levels, and the deployment of staff during the day, required improvement.

Staff were recruited safely but there was insufficient evidence that staff had received a proper induction or suitable training to do their job role effectively. Some staff had been supervised but the competency of staff had not been assessed to identify and addressed any training needs they had. This meant there was a risk that staff lacked the required skills and knowledge to care for people safely.

The premises was unsafe, unclean and poorly maintained. Some bedrooms were cluttered with trailing electrical wires which posed a trip hazard. There were unsafe windows in a number of bedrooms, some carpets were stained and worn and parts of the home were malodorous. No environmental audits were undertaken to ensure the environment was safe and suitable for purpose. Smoking took place inside the home without adequate safety provisions being made and the provider did not have an up to date fire risk assessment or adequate emergency evacuations procedures in place to keep people safe.

Infection control standards at the home were poor and standards were not monitored and managed. The provider had scored poorly at a recent NHS infection control audit and had not taken appropriate action in a timely manner. This placed people at risk from infection.

We observed a medication round and saw that the way medication was administered was safe. Records relating to people’s medicines matched what had been administered. Medicines were not always stored safely and there was no evidence that staff administering medication were trained and competent to do so.

We reviewed three care records. Care plans were brief and poorly written. They did not accurately reflect people’s needs and wishes and were not person centred. Dementia care planning was poor and support for people’s behavioural and emotional needs inadequate. The majority of risk assessments were poor and failed to provide staff with any guidance on how to manage people’s risks and care for them safely. Where risk management actions had been identified, they had not always been carried out to ensure people received the support they needed to keep them safe. This placed people at risk of harm.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. The provider told us the majority of people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. People’s capacity to make their own specific decisions had not been assessed and there was no evidence that any best interest meetings had taken place or least restrictive options explored. There was no evidence that staff were trained to support people with these needs.

People we spoke with said they had no complaints. The provider told us two complaints had been received over the last 12 months but no complaint records were available to verify this.

People had access to sufficient quantities of nutritious food and drink and were pleased with the choices and standard of the food on offer. They said they were happy with their care and everyone we spoke with gave positive feedback about the staff and the way in which they were looked after. We observed that staff treated people kindly and supported them at their own pace. It was clear from our observations that staff knew people well and people were comfortable and at ease with staff.

We found that some staff were not always observant to people’s general welfare and dignity needs, for example, two people were served meals that they could not reach comfortably and some people’s continence needs were not addressed in a way that protected people’s right to privacy. People’s independence was not always sufficiently promoted and some people had not received a bath or shower for significant periods of time.

The service was not well led. There were no adequate systems in place to ensure the service was safe, effective, caring, responsive and well led. There were no building audits, infection control audits, care plan audits or adequate accident and incident monitoring in place to ensure people were safe and well cared for. All the policies and procedures we looked at were out of date and there was no evidence they were followed. At the end of our visit, we discussed the serious concerns we had about the service with the provider and deputy manager. The provider was unable to provide a satisfactory explanation as to why the issues we identified during our inspection had not been picked up and addressed.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. 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 take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.