Archived: Penmeneth House

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We previously carried out a comprehensive inspection of 31 May 2016. At that inspection we identified one breach of the legal requirements. This related to the assessment of risks to the health and safety of people who used the service, and the registered provider taking suitable steps to mitigate these risks. We subsequently issued one requirement and told the provider to take action to address the breach of the regulations. The provider sent the Care Quality Commission an action plan following the publication of the report.

We carried out this focused inspection to check to see if the service had made the required improvements identified at that comprehensive inspection.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Penmeneth House on our website at www.cqc.org.uk

During this inspection we spoke with the registered manager, and other senior staff to check actions taken since the last inspection. We were told people’s risk assessments had been reviewed, for example, if people were at risk of falling. We were also told the temperature of hot water was controlled and the registered provider was in the process of fitting thermostatic valves to basins in people’s bedrooms and in bathrooms. This was to minimise any risk of scalding. Lastly we were told suitable checks were being completed to ensure medicines errors did not occur due to how medicine administration instructions were recorded. We subsequently checked relevant documentation and this was to a suitable standard. We therefore judged satisfactory action had been taken regarding the action we asked the provider to take.

We could not improve the rating for the question ‘Is it Safe’ from 'requires improvement' because to do so requires the service to demonstrate consistent good practice over time. We will review the rating during our next planned comprehensive inspection.

Penmeneth House is a care home which offers care and support for up to 14 predominantly older people. At the time of the inspection there were 14 people living at the service. Some of these people were living with dementia. The service is situated in a detached house over two floors.

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. The registered manager was one of two owners. The registered managers husband was the other owner. The couples son was training to join his parents in the running of the service.

We looked at how medicines were managed and administered. We found it was possible to establish if people had received their medicine as prescribed. However, staff had transcribed medicines for some people on to the Medicine Administration Records (MAR) following advice from medical staff. These handwritten entries were not always signed and had not been witnessed by a second member of staff. This meant that there was a risk of potential errors and did not ensure people always received their medicines safely. Some people had been prescribed creams and these had not been dated upon opening. This meant staff were not aware of the expiration of the item when the cream would no longer be safe to use. Regular medicine audits were not identifying these concerns.

Risks to some people and staff had been identified. However, such risks had not always been addressed and monitored. Some risk assessments had not always been reviewed to take account of changes in people’s needs that had occurred. This meant accurate and current guidance was not always provided for staff to help ensure risks were reduced.

The service had signs above sinks stating; “Danger hot water”. The water coming from the taps in sinks in people’s bedrooms and toilets was very hot. People living at Penmeneth House were living with dementia and some people were seen using the hot water independently. This meant there was a potential scald risk to people.

In the newly fitted assisted bathroom we found sponges, flannels and a razor. These items were not named and we were told were used communally. Sharing sponges, flannels and razors is an infection risk.

Penmeneth House was in the process of having a great deal of refurbishment work done at the time of this inspection. The service was clean, comfortable and bedrooms were personalised to reflect people’s individual tastes. There were no malodours throughout the service.

People were treated with kindness, compassion and respect.

The service had identified the minimum numbers of staff needed to meet people’s needs and these were being met.

Staff were supported by a system of induction training and support. The registered manager of the service did not provide formal recorded supervision or staff meetings for the staff team. However, the staff told us they could always talk anything through as a team and with the registered manager at any time, and felt well supported. We were told there were plans to start providing annual appraisals for staff in the near future.

Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided, such as dementia training.

Staff attended a full handover at the beginning of each shift. This helped ensure communication between staff and management was effective.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained details of how each person wished to be cared for. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Activities were provided. All the staff helped provide various activities which were not formally planned. Some planned entertainment was arranged with external groups who visited the service. People told us they enjoyed singing and music. Some people were supported to go out in to the local community.

The registered manager was supported by a stable staff team. Several staff working at the service were related to the owners and had been there many years.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

Yes, overall, on the day of the inspection we judged the service was safe.

People we spoke with were generally positive about the staff who worked with them. People told us staff were caring and supportive. For example people said staff were 'nice,' 'they are very good here', 'do a grand job, they do it well,' and 'very attentive, all lovely.' However two concerns about staff attitudes were shared with us, and we reported these to the registered provider to investigate and take appropriate action as necessary.

We saw that the home was clean, suitable for people's needs, well decorated and well maintained. People said they felt warm and comfortable.

We inspected the staff rota and these showed staffing levels were satisfactory. However we did receive some comments there could be more staff to support people in the morning and at meal times. However, people we spoke with said call bells were always answered promptly, and staff were unrushed and patient with them.

Records were generally to a satisfactory standard. Care plans were appropriate and there was evidence of review. Records regarding visits from some medical professionals could be more thorough for example it was difficult for staff to check when individuals had last seen some medical professionals such as a dentist.

Is the service effective?

Yes, overall, on the day of the inspection we judged the service was effective.

People all had an individual care plan which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

People said staff met their needs and staff responded promptly when people needed assistance.

People had access to doctors, district nurses, chiropodists and opticians.

People were positive about the meals provided.

Is the service caring?

Yes, overall, on the day of the inspection we judged the service was caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were generally taken into account and respected. However, although the registered provider said people were provided with a choice, some people said they would like more flexibility when staff assisted them to get up in the morning. There were some activities available, although some people said there was not much to do and they would like more opportunity to participate in activities in the home and in the community.

Most people who used the service said staff were caring and professional .

Is the service responsive?

Yes, overall, on the day of the inspection we judged the service was responsive.

The majority of people we spoke with said staff treated them with respect and dignity. The care practice we observed, on the day of the inspection, was professional and supportive. Comments we received from people who used the service included 'They are very good here, ' 'I am very happy, everyone is quite pleasant,' and 'It is very good'I get the best of attention'the people with dementia are also well looked after.'

The home had appropriate links with local health services. For example we were told people could see a doctor, optician or a chiropodist. There were mixed views about the availability of dentists, but the registered provider said a domiciliary service was available.

Is the service well-led?

Yes, overall, on the day of the inspection we judged the service was well led.

The registered providers worked in the home and we were told they were available each day. Although there was limited evidence of a formal quality assurance process, the registered provider said they had regular conversations with staff, people who used the service, and their representatives. The building was well maintained, pleasantly furnished and decorated. Records were satisfactory and people were generally happy with the service received. The majority of the people we spoke to were happy with the service they received.

The registered provider had recently submitted an application for one of the partners to be the registered manager.

Each person had a care plan in place which stated their individual needs. People had access to a range of services including a hairdresser, chiropodist and GP'S. People who lived at Penmeneth House told us they were 'well looked after' and the staff were 'very nice'.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The staff were supported by the registered manager. Training had been provided for areas such as manual handling and first aid.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw that the care plans did not contain sufficient detailed information to inform staff about how to care for people that lived in the home.

Staff were unaware of the safeguarding process and had not received appropriate training about safeguarding.

The home did not have a robust system that ensured homely non prescription remedies were documented. Medication was held in an unsecured fridge which also held food products.

Staff told us they felt supported by the providers.