The Care Quality Commission
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  • Care home

Archived: Peat Lane House

Overall: Requires improvement read more about inspection ratings

Peat Lane, Sandylands, Kendal, Cumbria, LA9 6LA (01539) 773073

Provided and run by:
Cumbria Care

All Inspections

9 March 2015

During an inspection looking at part of the service

Peat Lane House provides accommodation for up to 19 people who have a learning disability and/or a physical disability and require support of varying degrees. Accommodation is set out in one large building divided into five separate flats. These flats accommodate between three and five people, and a further provides a three bedroomed flat for short respite breaks. Each flat has its own kitchen, living room, bathroom and bedrooms. A separate staff team is provided to each flat.

We carried out an unannounced comprehensive inspection of this service on 12 September 2014 at which a number of breaches of legal requirements were found. This was because: there were insufficient staff to meet people’s needs: the home was found not to be clean and infection control measures were not being followed; and people’s needs were not being met as the choices offered to them were limited. We told the provider to take action to improve and provide us with an action plan to set how they would do this.

After the comprehensive inspection, the provider sent us an action plan to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 9 March 2015 to check that they had followed their plan and to address the areas of concern highlighted by our inspection. This report, of 9 March 2015, only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Peat Lane House’ on our website at www.cqc.org.uk’

The home had 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 and associated Regulations about how the service is run.

At the inspection of 12 September 2014 we found that the design and delivery of the services meant that people’s choice of how to spend their time was limited. We found that everyone was expected to leave the home and attend a day service on weekdays between 9am and 4pm. This aspect of the service was not tailored to people’s individual needs.

We told the provider that people should be offered more choice, and that the type of service they were providing people with was institutional and out-dated. The provider began to look at options available that would meet people’s needs in a more person-centred way. In the action plan the consultation process described how everyone in the home, their relatives and other stakeholders would be involved in redesigning the service.

At this focused inspection on the 9 March 2015, we found that the provider had met some areas, and had made progress towards meeting their plan in others. When we looked at the progress of redesigning the service to offer people more choice we found that while some progress had been made, this had been limited.

The provider told us the steps they had taken and said that the process had been complex. One of these factors being that Peat Lane House was owned by a housing association. People living in the home had license agreements, while the local authority had a lease agreement with the housing association. Any changes to the building and the type of services offered had to be negotiated, and with the agreement of the housing association, the people living in the home, and with the local authority funding and commissioning teams.

The provider had held relatives meetings and had started to work with the local social work team to ensure that everyone had an up to date review of their care needs. These reviews were to ensure that all the needs of people were known so that services offered would be designed around meeting these individual needs.

We alerted the provider to practices that may place restrictions on people’s ability to make choices, such as the model of care imposed upon them, as described. The provider had assured us that as part of the full review of people’s needs that deprivation of liberty assessments where being carried out, and appropriate referrals made to ensure people’s rights were being lawfully protected.

We found that the home was now kept clean and that infection control measures had been actioned to reduce risk to people living and working in the home. This ensured that people where provided with a safe place to live and that their personal care was carried out to high standards.

We saw that staffing levels had been increased. There were now domestic staff hours for the whole home, instead of these only covering the communal areas. The staffing levels at night had been increased to two waking night staff and one sleep-in supervisor. This meant that people had a better level of supervision and more responsive care during the night shift. Extra hours had also been added to the day shift to allow staff to take people out at weekends.

On the inspection of 9 March 2015 we explored with the provider the details of people’s licence agreement. This indicated that people held tenancy agreements with the housing association, and this requires the service to be registered under a different regulated activity with the Care Quality Commission (CQC). In effect anyone with a tenancy agreement is regarded as living in their own home and where this is the case the home cannot be registered as a care home. The provider was taking action to ensure that they were registered correctly with us, CQC.

While improvements had been made we have not revised the overall rating of ‘Requires Improvement’. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice, and for the reconfiguration of the service to demonstrate that it was meeting people’s needs. We will review our rating at the next comprehensive inspection.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and this corresponds to 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.

12 September 2014

During a routine inspection

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

They helped us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

People were not always protected from the risks of unsafe or inappropriate care and treatment. The building was not designed to meet the needs of people with complex healthcare needs and mobility difficulties. Staffing levels were not safe at night to meet people's increasingly complex needs. Staff were expected to carry out both care and support duties as well as domestic and cleaning roles. We judged that the hours allocated were not sufficient to carry out both of these roles effectively. The home was not always kept clean. Infection control procedures were hard to follow due to the restrictions of the building. Some records relating to infection control were not up to date. We concluded that staff had too many duties to perform and had prioritised care meaning that sometimes cleaning and housework tasks were overlooked.

Is the service caring?

People were cared for by warm and friendly staff who were knowledgeable about the people they cared for. Everyone we spoke with said the staff 'worked really hard' and were 'warm and enthusiastic'. We saw relaxed and skilful interactions between staff and that person in the home and we observed staff responding sensitively and picking up cues from body language when they needed assistance or reassurance. We were told and saw that staff were being as creative as possible to offer people choice within the limitations of both the model of care and the restrictions of the building.

Is the service responsive?

We found that people were fitting in around the design and delivery of the services rather than services being tailor-made to their individual needs. This restricted all aspects of their lives including their ability to make choices, their lifestyle and how they chose to have care.

Following this inspection an action plan was sent to us very quickly and we could see that promoting people's choice, independence and offering a person centred approach was at the centre of future improvements. Consultation to seek the views of people living at the home, their relatives and all other stake holders was set out by the provider, Cumbria Care, as the first step.

Is the service effective?

Within this model of how the home was run we did see how staff in the home had tried their best to be effective and responsive to people's needs and wishes. We saw that for those people with less complex needs they were doing a variety of interesting activities in and outside of the home. For example choosing to have friends for tea, popping into town for coffee, going to the gym and day trips to the seaside. However, for those people with more complex healthcare needs and care their opportunities were much more limited and restricted. Staff reported that nearly all of their time was taken up with care tasks and little time was left for activities or one to one stimulation.

Is the service well led?

We judged that the home had been running as an institution for a number of years and had failed to move with the times and with recent good practice national guidance. Overall we found there had been no attempt to redesign the service to provide person centred care. We met with the provider Cumbria Care, after this inspection to put forward our concerns. They reported that they had given the service high priority and took all the issues we had raised very seriously. A further action plan had been sent to us after this meeting and we could see that promoting people's choice, independence and offering a person centred approach was at the centre of future improvements. Consultation to seek the views of people living at the home, their relatives and all other stake holders was set out as the first step.

21 September 2013

During a routine inspection

We visited the home on a Saturday and found the majority of people were spending time in the home; some people were out shopping, while a few people had gone to relatives for the day or weekend. Comments we received from people living in the home included, 'I like to go out with staff into town.' Other people we spoke with said, "Staff are great' 'I like them all' and 'They are kind and they know me really well.'

On this occasion we found that staffing levels were below what was required to give people the support they needed. This was particularly the case in the units were people required a lot of support with all aspects of personal care. This meant that some people were not getting personal care when they needed it and were not getting out or being offered activities both within and outside the home.

During the week the majority of people went every day to a day centre. Staff reported that it was often difficult to get people ready in time for the transport in the mornings.

This is what one person told us, 'I don't like it when staff change about'. We observed one person becoming agitated as they could not go out until much later that afternoon when other staff arrived. Residents' families told us, 'Although I think the staff are very good the staffing levels are terrible, I feel it's an accident waiting to happen.' And another said, 'There's very little stimulation, many people wouldn't get out if families didn't visit, or pay separately for other agencies take them out.' And, 'The staff are all well-intentioned but gradually the staffing levels have got worse. We 'rescue' our relative at weekends and bring them home with us.'

We found that a safeguarding incident had occurred when staffing levels were unacceptably low. We found that low staffing levels had impacted on other areas such as paperwork and record keeping which were not always up to date and some risk assessments were unclear.

We found that staff were well trained and we observed professional and skilled interactions with people living in the home. Staff morale was low as they were working under pressure to cover shifts and they felt they were not always meeting people's needs.

The building design made it difficult to offer care to people with mobility problems, having stairs and narrow corridors. Some people who required specialist bathing equipment could not have baths. The home was due to have an extension to the building to offer improved facilities.

1 October 2012

During a routine inspection

When we visited people were mostly out and about doing different activities. Some people were at day services, others at work and voluntary placements, while other people had individual staff support to get out and enjoy activities they liked doing on their own. Comments we received from people living in the home included, 'I am supported to go to community events.' Another said, "Staff look after me really well, staff support me, staff understand me."

Some people in the home had limited verbal communication; we therefore spent time observing people's behaviour and interactions with staff. We observed lively and positive interactions between staff and people in the home which made for a relaxed and friendly atmosphere. We also observed staff responding sensitively to people and picking up cues from body language when they needed assistance or reassurance.

We received the following comments from relatives of people receiving care at Peat Lane House,

'Staff care for my daughter very well and always make me feel welcome.'

'Provides good respite.'

'Very clean and tidy.'

'Meets all aspects of my family members needs.'

'Staff always very friendly and happy atmosphere in building.'

We judged that people were leading interesting and meaningful lives and were being supported to stay healthy and well by a competent and well trained staff team.