Poldhu

Poldhu is a residential care home providing personal and nursing care to 63 people aged 65 and over. At the time of this inspection 40 people used the service. Poldhu is part of the Swallowcourt group which has two other nursing homes in West Cornwall.

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

The service had suitable safeguarding systems in place, and staff had received training to help them to recognise and know what to do if they suspected abuse was occurring.

Relatives told us they were happy with the care their family member received and believed it was a safe environment. Comments included, “Yes, it all seems very good. The place is very clean and does not smell at all. (Person’s name) is very happy here.”

Care plans were managed on a recently implemented electronic system and included risk assessments and guidance for staff on how to meet people’s support needs. Risk assessment were satisfactory and any risks to people were minimised.

Due to recent staff shortages and a period of inconsistent leadership, the effective implementation of this system had been delayed. Senior management were aware of the recent challenges at the service, and the impact of staff shortages and changes in management and had been providing additional support.

Medicines were managed on an electronic system. People were given their medicines safely. People’s medicine support needs had been assessed and were recorded in care plans. Care plans included additional risks related to medicines. Some prescribed creams had not always been recorded.

At this inspection we found some gaps in care and medicine records and have made recommendations about this in the report.

Staff were recruited safely. There were sufficient numbers of staff to ensure people’s needs were met. Although, there had been a couple of shifts when staffing levels had dropped below planned levels, due to short notice sickness absences, which could not be covered by other staff or agency.

There were sufficient trained and qualified staff on duty to meet people’s needs. Many staff had been provided with supervision this year, although this had not been as regularly as planned due to the impact of recent staffing pressures and the challenges of the pandemic. We saw a more robust programme of supervision and competency checks was being implemented for all staff.

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. People who wished to remain in their bedroom did so. Those spoken with confirmed this was their choice.

People enjoyed the food provided and confirmed they had choices provided. Comments included, “Yes, the food is fine. We can choose what we want and there is plenty of it.”

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Suitable visiting arrangements were in place for families to visit as per new government guidance.

The service has experienced a period of time without a registered manager. However, a new manager had been recently recruited along with a new clinical lead. Both had joined the service in the last few weeks. They were being supported by the clinical matron and the operations manager at the time of this inspection.

Staff morale had suffered recently due to staffing shortages and the pressures of the pandemic. Although staff we spoke with at this inspection told us things had improved and they were working well together. They told us, “Things are getting better, we are getting more support” and “The new manager helps us on the floor and they are being given support so we all benefit.”

There were appropriate audit and quality assurance systems in place. Senior management had recently implemented a new monitoring system which provided them with effective oversight of the service.

Any changes in people’s health were escalated to the relevant professional and relatives were kept informed. Suitable mobile lifting equipment and mobility aids were in place to meet people’s needs.

People, and their relatives were asked for their feedback on the service’s performance. There was a stable staff team who knew people well and worked together to help ensure people received a good service.

Any concerns raised by people or their families were recorded, investigated and responded to appropriately.

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 (report published 4 January 2019).

Why we inspected

We received concerns in relation to low staffing levels and a lack of stable management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 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.

The overall rating for the service remains good.

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

People’s experience of using this service:

At previous inspections we found staff did not always respond quickly to call bells and people were often left waiting for support. As a result of these concerns robust call bell audits were introduced. This enabled the management team and the provider to identify how long people were waiting for support and make changes to help ensure people’s experience of the service improved. People and relatives were positive when asked about waiting times and audits showed the majority of call bells were answered very quickly. During the inspection we observed staff were quick to respond to requests for support and were patient and unhurried in their approach. There had been some changes to the nurse staff team but this had stabilised when the inspection took place.

The management team and staff knew people well and understood their likes and preferences and health needs. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us they were welcome at any time and any concerns were taken seriously and responded to. Records showed the registered manager arranged to meet with people, and their relatives, privately to discuss any worries they might have.

Care plans were up to date and reflected people’s current needs. When people were identified as being at increased risk, monitoring records were kept to help ensure staff would quickly be aware if there were any changes to their health. The registered manager was keen to work with other healthcare professionals to develop and improve people’s experience of care.

Staff were well supported by a system of induction, training, supervisions, appraisals and staff meetings. They had opportunities to raise concerns or suggestions and be involved in the development of the service. Quality audits were carried out to identify any areas for improvement.

Rating at last inspection: Requires Improvement (report published 1 August 2018)

Why we inspected: Our last comprehensive inspection of Poldhu was carried out in January 2018 when we rated the service Requires Improvement and found the service was in breach of the regulations in relation to consent, safe care and treatment and good governance. As a result we issued two requirement notices and a warning notice. We subsequently carried out two focused inspections in March 2018 and July 2018 to check action was being taken to improve the service. At these focused inspections we found the breaches of the regulations had been met. We did not change the rating as we wanted to be sure the improvements would be sustained. At this inspection the service had embedded changes sufficiently to improve the overall rating to Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because the concerns received were in areas covered by these key questions.

Poldhu is a ‘care home’ that provides nursing care for up to a maximum of 63 predominately older people. At the time of the inspection there were 40 people living at the service. Some of these people were living with dementia. The accommodation is arranged over three floors. Poldhu is part of the Swallowcourt group which has several nursing and residential homes in Cornwall.

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.

The service is required to have a registered manager. 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. The registered manager had left the service in December 2017.

Poldhu was being overseen by a manager with experience and knowledge of the service. They were in the process of applying to be registered manager and were waiting for an interview date to be arranged. They were supported by a ‘designated manager’ and deputy manager. The long term plan for the service was for the manager to work with the designated manager for a period of time until they were familiar with the service. At that point the designated manager would take a more active and formal role in the management of the service.

At this focused inspection we found lessons had been learned and action taken to minimise the risk of untoward events reoccurring. Arrangements for staff handovers had been altered to help ensure there were staff available in shared areas at all times. Staff had been reminded of the need to be pro-active when supporting people with personal care. The manager was investigating the use of technology so people would be able to call for assistance wherever they were in the building. Response times to call bells were being monitored and audited. People told us staff were quick to answer any requests for assistance.

Following a medicines error, arrangements for the administration of short term medicines had been tightened so staff would be aware when the person no longer needed them.

Staff confidence in the management of the service had improved. The manager and deputy manager were committed to improving standards of care within the service. Audits highlighted when there were any shortcomings in the delivery of care and action was taken to address this.

We carried out an unannounced focused inspection of Poldhu on 22 March 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 12 January 2018 inspection had been made. The team inspected the service against three of the five questions we ask about services: is the service safe, effective and well led. This is because the service was not meeting some legal requirements in these areas.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Poldhu is a ‘care home’ that provides nursing care for up to a maximum of 63 predominately older people. At the time of the inspection there were 42 people living at the service. Some of these people were living with dementia. The accommodation is arranged over three floors. Poldhu is part of the Swallowcourt group which has several nursing and residential homes in Cornwall.

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.

The service is required to have a registered manager. 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. The registered manager had left the service in December 2017. Poldhu was being overseen by a manager with experience and knowledge of the service and Swallowcourt. They told us they intended to apply for the registered manager position and were waiting for background checks to be completed.

At this focused inspection we found improvements had been made and the service was no longer in breach of the Regulations. Response times to call bells were being monitored and audited. Call bell logs showed average response times had improved significantly. People told us staff were quick to answer any requests for assistance.

Some people had been identified as being at risk due to poor nutrition and/or hydration. These people had their food and fluid intake monitored so the management team and nursing staff would be aware of any increased risk to people’s health. The records were regularly reviewed and action taken to mitigate against any increased risk. The records were not sufficiently detailed to give an immediate overview of people’s intake and we have made a recommendation about this in the report.

Safe arrangements were in place for the storing and administration of people’s medicines. People received their medicine as prescribed. Medicine Administration Records were appropriately completed. Arrangements for the storage and administration of medicines which require stricter controls by law were robust.

Applications for DoLS authorisations had been made for some people. Capacity assessments were in place to evidence this was appropriate. The records clearly showed when Power of Attorney arrangements were in place.

New staff completed a thorough induction and period of shadowing more experienced staff before they started working independently. Training was regularly refreshed and covered a wide range of subjects to help ensure staff were able to meet people’s needs. Regular supervision sessions and staff meetings were arranged to provide additional support for the staff team.

People told us the food was good and we saw choices were offered to meet people’s preferences. Kitchen staff were aware of people’s dietary needs and preferences.

Auditing systems were comprehensive and highlighted when improvements were required to improve standards. The manager was aware of their responsibilities to inform CQC of specific events.

At this comprehensive inspection we checked to see if the provider had made the improvements necessary to meet the breaches identified at the inspection in July 2017. We found improvements had been made in some of the areas of concern. Action taken to address other concerns had not been sufficient to meet the breaches of the Regulations. This is the third consecutive time the service has been rated Requires Improvement.

Applications for DoLS authorisations had been made for some people. Capacity assessments were not in place to evidence this was appropriate. Although improvements to auditing systems had been made there were still some areas where audits were ineffective or action to address areas for improvement had not been made.

Response times to call bells were being monitored and audited. However, people again raised concerns about the length of time staff took to respond to call bells. Records showed that, on average four times each day, staff took longer than 20 minutes to respond to a call bell. The provider had attempted to introduce new working practices to address this issue but they had proved unsuccessful. In response further changes to working practices were being considered but had either not yet been introduced or been in place long enough for us to be assured of the effectiveness of the systems. While we felt some improvements had been made in this area we found it was too early to be confident the systems were fully embedded and would be sustained.

Some people had been identified as being at risk due to their health conditions. Action to protect people from identified risk was not consistently sufficient across all areas.

At this inspection we found improvements had been made to auditing systems although these had failed to identify the problems highlighted at the inspection. We concluded a longer period was required to ensure that systems and processes had been embedded sufficiently to enable staff to provide consistently safe, effective and good quality care.

Care plans were in the process of being reviewed and updated. Many of these had been completed and the information and guidance was up to date, relevant and guided staff on the best way to support people at all times. Monitoring records were consistently completed and provided a record of the care people had received. We did not find any evidence of restrictive practices being implemented. People’s right to privacy was protected. We found the service was no longer in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Poldhu is a ‘care home’ that provides nursing care for up to a maximum of 63 predominately older people. 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. At the time of the inspection there were 43 people living at the service. Some of these people were living with dementia. The accommodation is arranged over three floors. Poldhu is part of the Swallowcourt group which has several nursing and residential homes in Cornwall.

The service is required to have a registered manager. 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. The registered manager had left the service in December 2017. Poldhu was being overseen by a manager with experience and knowledge of the service and Swallowcourt. They told us they were in the early stages of applying for the registered manager position.

At our previous inspection in July 2017 we identified issues in relation to the safety of the environment. Potentially hazardous substances were left unattended and we had concerns relating to infection control. At this inspection we found improvements had been made. All cleaning products were kept securely and keypad locks had been fitted to sluice rooms. Hand gel, gloves and aprons were easily available for staff. The deputy manager was acting as an infection control lead to help embed good working practices.

People told us they felt safe. Staff were knowledgeable about processes for reporting safeguarding concerns and believed these would be addressed. The induction process for new staff included information on equality and diversity and how to help ensure people’s rights were protected. Staff training was regularly updated to enable them to keep up to date with any changes in legislation or working practices. There were robust recruitment processes in place. All staff were supported by an on-going programme of supervision and annual appraisals. There were enough staff on duty to meet people’s needs.

There were safe arrangements were in place for the storing and administration of people’s medicines. People received their medicine as prescribed. Medicine Administration Records were appropriately completed. Arrangements for the storage and administration of medicines which require stricter controls by law were robust.

People told us the food was good and we saw choices were offered to meet people’s preferences. Kitchen staff were aware of people’s dietary needs and preferences. The manager was working with the chef to find ways they could become more involved with the service and engage with people on a regular basis.

There were two activity co-ordinators in post who helped arrange activities for groups and individuals. External entertainers visited the service to provide additional entertainment. The atmosphere in the service was pleasant and people chatted together and with staff. There were plenty of visitors and they told us they were able to visit at any time.

Changes to the management team were seen as positive by people, relatives and staff. The manager was addressing areas of concern and had started to make changes to the way the service was organised. People and staff told us things were starting to improve and they had confidence in the management team. One member of staff commented; “We are asked about proposed changes. Any ideas are listened to, we did not used to be heard.”

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Poldhu is a care home that provides nursing care for up to a maximum of 63 older people. At the time of the inspection there were 50 people living at the service. Some of these people were living with dementia. The accommodation is arranged over three floors.

There was not a registered manager in post at the time of the inspection. 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. There had been some changes to the management of the service. There were two new managers in post, one of whom was also the clinical lead. The clinical lead told us they would be seeking to become the registered manager.

At the comprehensive inspection on 20 February 2017 we found a number of concerns. The inspection had taken place, in part due to an incident in which a person had fallen in their bedroom. The person had used their call bell to alert staff, however it had taken them over 40 minutes to respond. This put the person at risk of harm. We had concerns about the length of time it took staff to answer call bells. At this inspection, we continued to have concerns about this. The service had set itself a target of responding to call bells within 20 minutes. Although they were mostly meeting this target by day, there were very frequent incidents where people waited longer than this to be assisted by staff during the night. We saw an example where this had happened 25 times in one night. The longest time we saw that somebody had waited for staff to answer their call bell at night was over 55 minutes.

The service used a dependency tool to calculate how many staff were needed to be on duty to support people well. We saw that the staff on duty matched the levels indicated by the dependency tool. Some staff reported that staffing levels were low and this meant people were sometimes responded to less promptly. One person and a relative also said they thought there were not enough staff.

At the inspection in February 2017, we had concerns around how the service responded to complaints. Complaints were not always recorded or action taken to minimise the possibility of incidents reoccurring. At this inspection, we saw that improvements had been made to how complaints were investigated and that any lessons learned were shared to reduce the likelihood of the issue happening again wherever possible.

At the inspection in February 2017, we had concerns that care plans did not always give a comprehensive overview of people’s needs. We continued to have concerns about this during this inspection. Information in care plans was not always accurate. In addition, care plans did not contain enough guidance for staff on how to provide people with personalised care. We saw that care plans were based on risk assessments which were out of date and therefore no longer an accurate reflection of the person’s needs.

At the inspection in February 2017, we found that auditing systems were not fully established. There were gaps in medicines audits. Infection control audits were not taking place. At this inspection, we found that audits were being undertaken regularly, however there were not always action plans to address issues identified. There had been no follow up to medicines errors which were highlighted on the medication audit. In addition, audits had not identified other areas of concern which we found at the inspection.

People’s rights were not always protected because the principles of the Mental Capacity Act (MCA) were not always followed. We saw examples where relatives had signed to consent on a person’s behalf without the correct legal authority to do so. A person was subject to restrictions which were not proportionate or authorised by a lawful process.

We had concerns relating to the safety of the environment. For example, a number of shared bathrooms contained items which were potentially harmful, such as disinfectant. The water from the tap in one person’s bedroom was extremely hot and posed a potential scald risk

The environment was bright and spacious with spectacular sea views and lots of areas to relax. However the service was not dementia friendly. There was a lack of signage or methods for people to orientate themselves.

Medicines were generally safely managed, however we saw that errors recorded on audits were not followed up, meaning that learning from them might be missed. We also saw that one person’s records suggested they could have their medicines covertly. However, there was no covert medicine agreement from this person’s doctor in place, to support this being done.

People’s health care needs were not always effectively monitored. People had monitoring forms in their rooms, which were stored in disorganised files. We saw that these were inconsistently completed by staff and there was no recorded monitoring of these records. This meant the records were not effective or an accurate picture of the person’s treatment.

Staff were kind and caring. We observed warm, positive interactions between people and staff. Staff spoke to people with respect and promoted their dignity and independence. People told us they were happy living at the service. People’s records evidenced that they had access to advocacy services. People’s confidential information was securely stored.

People were supported by staff who had undergone training to carry out their role. Staff were supported by an induction and an on-going programme of supervision and appraisal. There were regular team meetings in order for staff members to meet as a group, support one another and share any ideas or concerns.

People were supported by staff who had been safely recruited. Checks had been undertaken to ensure they were suitable to work with people who were vulnerable.

At this inspection we identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Poldhu is a care home with nursing for up to a maximum of 63 older people. At the time of the inspection there were 49 people living at the service. Some of these people were living with dementia. The accommodation is arranged over three floors.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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 and associated Regulations about how the service is run. Following the inspection the nominated individual contacted us to let us know the registered manager had since resigned. Arrangements for the running of the service were in place.

Before the inspection we had received concerns about the care provided at Poldhu. One person had fallen and care staff had not responded to the call bell in a timely manner. Since this incident regular audits were taking place to check that call bells were responded to quickly. This system was not robust and we found that staff were still taking too long to respond to call bells.

Information in care plans was not always detailed enough to give staff a complete picture of people’s social needs, backgrounds and interests. Monitoring records, intended to record any necessary interventions or document when food and fluids had been given, were not consistently completed. The detail in some of these records was not sufficient to give an overview of the care people had received.

Systems for gathering people’s views were not robust. People told us they were not regularly asked for their feedback of the service they received. Complaints had not always been recognised as such and recorded or acted upon. A relative told us the senior management and provider had been responsive and transparent with them following recent concerns and; “Things are so much better.”

There were enough staff on duty to meet people’s needs. Nursing and care staff had clearly defined responsibilities and told us they worked together well. Information about people’s needs was shared between staff to help ensure they were aware of any changes. The care staff were supported by domestic, kitchen and maintenance workers to help ensure the smooth running of the service. Staff completed a thorough recruitment and induction process to ensure they had the appropriate skills and knowledge for their role.

The environment was pleasant and arranged to meet people’s needs. People were able to choose where they spent their time and where they met with any visitors.

People received their medicines on time. People had their medicines given by nurses or care staff who had received additional training, and had been assessed to make sure they gave medicines safely. This group of staff were known as 'specialists.' There were clear records of medicines administered to people or not given for any reason. This helped to show that people received their medicines correctly Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians.

People were assessed in line with the Mental Capacity Act 2005 (MCA) where relevant and the management team followed the legislation to help ensure people’s human rights were protected. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been made appropriately.

Two activity co-ordinators were employed to organise planned sessions, events and trips out. They were creative and imaginative in their approach to organising activities. They were aware of people who were at risk from social isolation and took steps to include them in activities or engage with them on a one to one basis.

We identified breaches of the regulations. You can see what action we have asked the provider to take at the back of the full version of this report.

Poldhu is a care home with nursing for up to a maximum of 63 older people. At the time of the inspection there were 53 people living at the service. Some of these people were living with dementia. The accommodation is spread over three floors.

The service is required to have a registered manager. 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. There was a registered manager in place.

Care plans contained risk assessments for a range of circumstances including moving and handling. These were updated regularly to reflect any changes in people’s needs. There was clear guidance for staff on how to support anyone who had been identified as at risk.

All staff received training in moving and handling and this was also part of the induction process. Training was refreshed every two years. Following concerns about poor practice the senior management team were considering increasing this refresher training to yearly intervals. Staff told us they felt confident when assisting people to move and thought the training gave them the necessary skills to carry out their roles safely. People told us they felt safe when being supported to mobilise. One commented; “They always use the hoist, it’s safer that way.”

The registered manager told us supervisions had lapsed recently but this had been addressed and all staff would be receiving regular supervision every six to eight weeks. Staff said they felt well supported and able to approach the management team or nursing staff for any advice or if they felt unsure about anything.

We observed people being supported to move from standing to sitting positions and being assisted to move using a hoist and sling. Staff appeared confident and competent in their approach and we did not witness any examples of poor moving and handling practices.

There were sufficient staff to meet people’s needs. Staff were quick to respond to any requests for support and were patient and unrushed in their approach.

All staff had received training in safeguarding. There was information available on noticeboards regarding the local authorities safeguarding processes.

Below is a summary of what we found. The summary is based on information gathered during the inspection, which included conversations with people who used the service, relatives, staff and the management of Poldhu.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. One person told us, 'Everyone is so kind and helpful'. Another said, 'It's not like home but I feel safe here, there is always someone around for me'. Also, 'I can't find a fault here not really. I've made two friends and I'm not lonely.'

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve.

We found that improvements had been made to the way medicines were managed and handled, but these improvements had not yet been completed.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant people would be safeguarded as required.

We looked at staffing levels in the home to ensure they were safe to meet the needs of people living there. We saw there were both nurses and carers on duty providing nursing care and support to people living at Poldhu, in numbers which met the needs of people living there. Staff told us that recent changes to staffing levels had improved the time staff had to carry out their individual roles and responsibilities.

We found that improvements had been made to the way records were being managed, but these improvements had not yet been completed.

Maintenance service certificates were in place and up to date to ensure systems in the home were safe.

Is the service effective?

Staff we spoke with had an understanding of peoples needs and how to deliver care and treatment for people they were supporting. One staff member told us, 'Nursing and care plans are changing. I think they will give us more information'. However not all records had been revised therefore it was not possible to confirm the effectiveness of the revised recording system at this inspection.

Individual health and personal care needs were being assessed and a revised system for people to be involved in developing their plans of care was being introduced. However this had not yet been fully implemented.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. There had been improvement in the number of slings available to staff in order to enable safe moving and handling of people.

There was evidence the review process to ensure people's needs were monitored and changes made had improved. Records showed a consistent review process taking place on a monthly basis and changes had been reflected in individual care plans. This meant the home was responding to the changing needs of people using the service in their best interest.

In order to ensure people received access to a range of supporting healthcare services, staff regularly reviewed when health checks were due. People we spoke with told us, 'It's quite alright here, my optician has seen me and I was taken to see my GP last week, I enjoy being here'. Also, 'I know all the Mullion doctors. I've never had any problems. Sent to hospital when needed'.

Personal history profiles were being introduced. This provided an individual picture of each person which staff said was a useful tool to understand people's backgrounds, their likes and dislikes.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with told us, 'They are so very patient with me, and it's nice to feel cared for'.

Other comments included, 'it's great the staff are all my friends'. 'They treat me with dignity'.

We spent time in various areas of the home where we observed staff engaging with people. We saw staff showed patience and gave encouragement when supporting people. Two people living at the home were agitated and distracted at times. We saw staff members sit down with them and distract them in a way which was sensitive and diffused the situation.

When speaking with staff it was clear they genuinely cared for people they supported. One staff member said, 'I just love this job. It's different every day and every day there are challenges. As a staff team we all support each other'.

Is the service responsive?

The service worked with other agencies including social services, nurses and healthcare professionals to make sure people received care and support in a coherent way. This meant people received the right care and support to meet their individual needs and remain as independent as possible.

People using the home, their relatives and advocates had recently completed a satisfaction survey. The results were used to inform the development and quality of the service. Results we saw demonstrated people were satisfied with the care and support they were receiving whilst living at Poldhu.

Staffing levels had increased following a review of the dependency levels of people using the service. Staff and people using the service told us they thought the staffing levels had made a big improvement on time available to carry out their roles and time available to spend with individual residents. This meant the service was responding to the needs of people living there.

Is the service well-led?

There had been a number of changes to the management of the service. This included the development of care planning and review systems. Revised audit systems had been introduced including areas of falls risk management. This meant the management team were able to monitor the quality of the service being provided.

The service worked with other agencies and services to make sure people received their care in a co-ordinated way. The service was continuing to develop quality assurance systems. Records seen identified shortfalls were being addressed including gaps in care planning records and review. As a result the quality of the service was improving.

Staff told us they were clear about their roles and responsibilities. Staff had an understanding of the ethos of the home and quality assurance processes were in place.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe? People told us they felt safe. Systems were in place to help the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

People were put at unnecessary risk because of the unsafe medication administration procedures.

Poldhu alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Poldhu had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people's needs were met.

Is the service effective? People's health and care needs were assessed with them, although people were not involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were not always up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

The quality of recording seen was variable, and could lead to information being missed or incorrect information being used by nurses or carers.

Is the service caring? We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'wonderful' and 'Staff are very friendly' and 'Very considerate carers'. When speaking with staff it was clear that they genuinely cared for the people they supported.

People's preferences and interests had usually been recorded although life histories were not evident.

Poldhu had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive? Many people who lived at Poldhu had complex health needs and were either not able, or chose not to join in group activities. The care records did not evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities.

The service worked well with other agencies and services to make sure people received care in a coherent way.

The report contains two comments that were also made at the previous inspection in May 2013. The provider had not responded to these comments at this inspection.

Is the service well-led? Poldhu had a new manager, who had only been in place for approximately three weeks, but one person stated 'It's gone downhill recently, although there has been a noticeable improvement since the new manager arrived'

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw staff respond appropriately and respectfully to requests for assistance.

People were protected by the services' management and administration of medicines.

We saw the service operated a consistently robust recruitment procedure in order to protect the people who lived at Poldhu.

We saw there was usually sufficient staff to meet people's care needs, although the infectious outbreak had also affected staff and there were a number of staff off sick at the time of the inspection.

We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted.

Staff told us that training was provided, and also confirmed that staff supervision took place.