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Inspection carried out on 27 November 2017

During a routine inspection

Plymbridge House is a residential care home which provides care and accommodation for up to 40 older people, some of whom are living with dementia.

This inspection took place on 27, 28 and 29 November 2017 and 6 December 2017. The first day of the inspection was unannounced.

At the last inspection in August 2015, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.:

At the time of the inspection, 39 people were using the service.

There was a 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.

People and their relatives told us staff were caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. People told us their privacy and dignity was promoted and they were actively involved in making choices and decisions about how they wanted to live their lives. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process and to attend or contribute to care reviews where possible. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were personalised and guided staff to help people in the way they liked.

Risks associated with people’s care and living environment were effectively managed to ensure people’s freedom was promoted. People were supported by consistent staff to help meet their needs in the way they preferred. People’s independence was encouraged and staff helped people feel valued by engaging them in everyday tasks where they were able, for example laying the table and tidying their rooms if they wished. The registered manager and provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were managed safely.

People received care from staff who had undertaken training to be able to meet their unique needs. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards.

People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

Policies and procedures across the service were being developed to ensure information was given to people in accessible formats when required. People were treated equally and fairly. Staff adapted their communication methods dependent upon people’s needs, for example using simple questions and information for people with cognitive difficulties and information about the service was available in larger print for those people with visual impairments.

The service was well led by the registered manager and provider and supported by a dedicated team. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which might require improvement. Complaints and incidents were learned from to ensure improvement. The registered manager and provider promoted the ethos of honesty and admitted when things had gone wrong. The service kept abreast of changes to maintain quality care.

Inspection carried out on 30 August 2015

During a routine inspection

The inspection took place on the 30 August 2015 and was unannounced. 

 

Plymbridge House is a residential care home which provides care and accommodation for up to 40 older people, some of whom are living with dementia. On the day of the inspection 40 people were using the service.  

The service had a 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.

 

During the inspection people and staff were calm and relaxed; the environment was homely, clean and clutter free. There was a happy, peaceful atmosphere. Comments from people, relatives staff and health professionals were exceptionally positive. People moved freely around the home where possible and enjoyed living in the home. 

 

Care records were focused on people’s needs and wishes and encouraged people to maintain their independence where possible. Staff responded quickly to changes in people’s needs contacting health professionals in a timely way, when needed. People and those who mattered to them were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. People’s life histories, disabilities and abilities were taken into account, communicated and recorded, so staff provided consistent personalised care, treatment and support. 

 

People told us they felt safe and secure. People told us they felt the home’s environment and care was safe.

 

Comments included “We ensure medicines are given safely, the house is safe – alarms set, we do visual checks” and “I always get my medicine, every morning before breakfast.” 

 

There was an open, transparent culture where learning and reflection was encouraged. People’s risks were monitored and managed well. Accidents and safeguarding concerns were managed promptly.

There were effective quality assurance systems in place in all areas which drove improvement. Incidents related to people’s behaviour were appropriately recorded and analysed. Audits were conducted in all areas, action points noted and areas improved where needed. Staff training was thorough and embedded into staff one to one’s and staff meetings. Research was used to promote best practice in dementia and end of life care.  

 

  

People were encouraged to live active lives and were supported to participate in community life where possible. Activities were meaningful and reflected people’s interests and individual hobbies, for example many enjoyed reading. Those with spiritual needs were supported to attend the in house services. People enjoyed activities within the home such as arts and crafts, musical events and the beautiful, secure garden enabled keen gardeners to enjoy this pastime whilst others enjoyed the flowers in the brightly painted seating areas.

 

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for, where possible. People were supported to maintain good health through regular visits with healthcare professionals, such as district nurses, GPs and mental health professionals.  

People, friends and relatives were encouraged to be involved in meetings held at the home and enjoyed visiting. Regular staff meetings enabled staff to contribute to ideas for improvement and raise any issues promptly.

                                            

People knew how to raise concerns and make complaints. People and those who mattered to them explained there was an open door policy and staff always listened and were approachable. People told us they did not have any current concerns but any previous, minor feedback given to staff had been dealt with promptly and satisfactorily. Any complaints made would be thoroughly investigated and recorded in line with the provider’s (Peninsula Care Homes Ltd) own policy. 

 

Staff understood their role with regards to ensuring people’s human rights and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff.

All staff had undertaken training on safeguarding adults from abuse; they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

 

Staff received a comprehensive induction programme and the Care Certificate had been implemented within the home. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. Training was used to enhance staff skills and the care people received. 

 

Staff were kind, thoughtful and compassionate. People, relatives and professionals were exceptionally positive about the quality of care and support people received. Supportive, kind and respectful relationships had been built between people, family members, professionals and staff. 

 

People’s end of life wishes were known and specific details sought and recorded about how people wished to be cared for in their final days. Staff had completed the local hospice end of life care programme and attended local end of life care meetings regularly. All staff had received training in providing a dignified death to enhance their care in this area.

 

Staff described the management as open, very supportive and approachable. Staff talked positively about their jobs. Staff were committed and felt proud of their work and the care they provided to people and relatives.

Inspection carried out on 15 July 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us. The summary includes our observations of care and information about 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?

Many of the staff had worked at the home for a long time and visitors commented that they appeared to enjoy their work. Senior staff were responsible for administering medication and a system was in place that minimised the likelihood of error.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager was aware of the recent High Court Judgement and was taking appropriate steps to ensure that the home became compliant with the new requirements.

Is the service effective?

People told us that they were happy with the care they received and they felt their needs were 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. One person told us "They are lovely here, oh yes they are, they are kindness itself. The gardener puts vases of sweet peas on every person's table. Little kindnesses like that make this "home�.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were encouraged to ask questions and to become involved in activities. Our observations confirmed this. We saw that people were engaged in different activities ranging from knitting to craft work. We heard one person ask staff what their medication was for. The staff member explained it to them and then offered to explain further, in privacy, after lunch. A visitor told us that they had no concerns about the care their family member received while another visitor said "My (relative) has brightened up since being here, they are more cheerier and more alert."

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been considered. Care and support had been provided that met people�s wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. Health professionals told us that the home communicated effectively with them to maintain people's well-being.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We were shown the feedback on the service that people received. We could see that people had information about how to make a complaint. However, we were told that any minor issues were resolved before they could become a complaint. The home had achieved a dementia quality mark (a local initiative for good practice in dementia care) and staff had undertaken end of life training. The home had a published statement of purpose which contained the main information that people would need in order to be able to make an informed decision regarding the home. The home complied with regulations.

Inspection carried out on 10 August 2013

During a routine inspection

People told us "Very good, excellent - caring and compassionate" and "Staff are good, polite and respectful."

People we met told us they were treated with respect, dignity and kindness. We observed this to be the case during our visit and saw the staff assisting people discreetly when they needed to use the bathroom or required personal care. People were able to choose where they wished to sit in the home and what they wanted to do with their time. Independence was encouraged where possible.

People we met told us they were well cared for and we saw this during our visit. Staff understood people's needs, knew them well, and their care was well documented in their care records. We saw a range of health and social care professionals were involved where necessary to support people to remain at Plymbridge House as long as possible. The care given was dignified and staff were well trained to met people's varied needs.

There were good processes in place to protect people from harm and people told us they felt safe. Policies and procedures were in place for staff to follow if they had concerns about unsafe practice or people being at risk of harm.

We met and observed staff who were well trained, knowledgeable and confident in their practice. Staff had regular access to one to one meetings with their manager, informal support and further training to help them meet the care needs of people at the home.

Inspection carried out on 5 February 2013

During a routine inspection

There were 40 people living at the home when we visited. We spoke with 13 people and relatives, and observed people�s care in communal areas of the home. We spoke with the registered manager and seven staff as well as a visiting health professional and asked them about how people�s care needs were met.

One person said, �Everyone is so kind and generous, I wouldn�t live anywhere else�, another said �It�s very good, my room is cleaned every day and I feel safe here�. A third person said, �I think it�s a very happy home, staff are friendly and the people are nice�.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found people experienced care, treatment and support that met their needs and protected their rights. Appropriate checks were undertaken before staff began working at the home. The home had systems in place to monitor the quality of care and made improvements in response to feedback.

We found the home was meeting the five outcome standards we looked at.

Inspection carried out on 13 September 2011

During a routine inspection

On the day of our visit we walked around the home, spoke to people that use the service and spent extended periods of time observing the delivery of care in communal areas. We also spoke with relatives, staff and visiting professionals.

People told us the care given by the home�s staff was of a good standard. One relative told us that they were very happy with the care and support that was being given to their relative.

During our visit we spoke with people and they said �staff are friendly and helpful� and �they�re (the staff) as good as gold�. However people also commented that being at the home was only �ok� and other people commented that at times they were bored. We observed the way in which staff members interacted with individuals and this was generally good. However we saw some staff practice and communication with people with dementia that was not skilful. Although, staff were to receive further training later in September 2011 dementia care practice in the service was not yet well developed.

The homes� care planning fully covered peoples mental and physical health needs but had not yet been broadened to reflect the person as an individual. There was a lack of information about the person�s leisure interests and personal preferences. This kind of information would help to support staff when they are supporting people with planning and delivering activities.

We saw that the administration of peoples� medication was well managed by the home and that the home was clean. When people that live at the home had health needs they were supported to access health services. The service was delivering intensive personal care professionally and effectively.

The care staff were generally well trained with most having obtained a National Vocational Qualification (NVQ) to at least level 2. Many of the staff had also progressed further to NVQ levels 3 and 4. At the time of our inspection further training was still to be delivered on the Mental Capacity Act and dementia care.

Reports under our old system of regulation (including those from before CQC was created)