Housing 21 - Pantiles House

Housing 21 – Pantiles House provides personal care and support to people living in an extra care housing scheme. This consists of 33 individual flats within a staffed building with some communal areas. At the time of our inspection there were 33 people using the service. The organisation also manages the building. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

At the last inspection the service was not always caring. People and their relatives said that not all staff were friendly, caring and compassionate when providing care.

At this inspection most people and their relatives said the staff team now provided care and support in a friendly, caring and compassionate way which met their needs.

People told us they liked the way staff provided care and support for them. This was carried out in a manner that made them feel comfortable and relaxed. People and their relatives said staff acknowledged and respected people’s privacy, dignity and confidentiality. People were encouraged and supported to be independent and do the things, they still could, for themselves. This promoted their self-worth and improved their quality of life.

At the last inspection the service was not always well-led. Concerns were raised by people and their relatives regarding the management of the service. The registered manager had left, and an interim manager was in place.

At this inspection a new manager was appointed and had applied for registration with the Care Quality Commission (CQC). Most people and their relatives were far happier with the service now being provided.

At the last inspection the Quality Assurance (QA) and care planning system had not always ensured people received their calls on time and for the full duration even when shortfalls were identified.

At this inspection the quality assurance and care planning system ensured people received their calls on time and for the full duration.

At the last inspection due to people’s misunderstanding of the service provided, the support they received did not always correspond to their expectations.

At this inspection people understood what they could and could not expect from the service.

The service culture was open, honest and there was a clearly defined vision and values that staff we spoke with understood and followed in a caring, kind and sympathetic way. The quality Assurance systems (QA) and audits identified issues, and they were addressed. Areas of responsibility and accountability were identified, with staff willing to take responsibility and report any concerns. There were well-established working partnerships with health care professionals. Records including people’s daily logs and care plans were up to date, as well as staff information. People praised the caring approach of the manager and staff.

People and their relatives told us, and we found, that effective care was provided, people were not discriminated against and their equality and diversity needs were met. Staff were well-trained, appropriately supervised, and appraised. People and relatives said staff provided care well, and it met their needs. People were encouraged by staff to discuss their health needs, any changes to them and they were passed on to appropriate community-based health care professionals. The provider was part of a professional’s network that enabled seamless joined up working between services based on people’s needs, wishes and best interests. It included any required services transitioning as people’s needs changed. People were protected by staff from nutrition and hydration risks, and people were encouraged to choose healthy and balanced diets that also met their likes, dislikes and preferences.

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 requires improvement (published 5 January 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. A decision was made for us to inspect and examine the risks associated with these issues.

Care Quality Commission (CQC) has introduced focused inspections to follow up on previous breaches and to check specific concerns.

We undertook a focused inspection approach to review the key questions of Effective, Caring, and Well-led where we had specific concerns about people not always being treated with dignity and respect, the findings of the QA system not being addressed, shortfalls of the care planning systems placing people at risk and the support available not meeting their expectations.

As no concerns were identified in relation to the key questions Safe and Responsive, we decided not to inspect these questions. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Housing 21 – Pantiles House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Housing 21 – Pantiles House provides personal care and support to people living in an extra care housing scheme. This consists of 33 individual flats within a staffed building with some communal areas. At the time of our inspection there were 33 people using the service. The organisation also manages the building. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

The service was not always well-led. Concerns were raised by people and their relatives regarding the management of the service. The registered manager had left, and an interim manager was installed. They were supported by the Extra Care Operations Manager. We were told that this had led to an improvement in the quality of the service provided and accessibility to management. However, people and their relatives were cautious about the improvements being sustained when a new manager starts in post at the beginning of December 2021.

The service was not always caring. People and their relatives said that now most staff provided care which met their needs. They generally liked the way staff provided them with care and support which was friendly, caring and compassionate. But this was not so for all staff. They told us most staff acknowledged and respected people’s privacy, dignity and confidentiality. People were encouraged and supported to be independent and do the things, they still could, for themselves. This promoted their self-worth and improved their quality of life.

The service provided was safe for people to use and staff to work in. People said that most staff did their best to meet their care needs, but not all. Sometimes they did not receive support at the agreed time, or their time was cut short as other people’s needs also had to be met. This had improved recently as the service had recruited new staff. Risks to people were assessed, monitored and reviewed. This enabled them to take acceptable risks, enjoy their lives and live safely. Accidents, incidents and safeguarding concerns were reported, investigated and recorded. There were suitable numbers of appropriately recruited staff to meet people’s needs. Medicine was safely administered by trained staff. We were assured that the provider was meeting shielding and social distancing rules, personal protective equipment [PPE] was effectively and safely used and the infection prevention and control policy was up to date and audits took place.

The culture of the service was open and honest with the interim manager acknowledging that there were issues and explaining the action they had taken to remedy them. Quality Assurance systems (QA) and audits had identified these issues, in up to date records. There was a clearly defined vision and values that most staff understood and followed, in a kind, sympathetic and caring way. Areas of responsibility and accountability were identified, with staff willing to take responsibility and report concerns. The service had well-established working partnerships with health care professionals. Post lockdown, the interim manager and staff said it was difficult promoting people’s participation and reducing social isolation, as they were in the routine of staying in their individual flats, although staff had supported and encouraged them to participate in the scheme’s community. Records including people’s daily logs and care plans were up to date, as well as staff information. The newly appointed manager was applying for registration when starting in post.

The service was responsive. The interim manager had responded to concerns and complaints raised by people and their relatives who mostly said previously when they raised concerns changes were not always made to improve their care and support. Some people felt nothing had changed or not enough. Complaints were recorded and investigated. People had their needs assessed, reviewed and received person centred care. They were given choices, supported to follow their routines, interests and hobbies. People were given enough information to make their own decisions and end of life wishes were identified, if appropriate.

People were supported to have maximum choice and control of their lives staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service support this practice.

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 (published 9 November 2018).

Why we inspected

This inspection was prompted in part due to ongoing concerns received that there weren’t enough staff available to meet people’s needs, and ineffective management including not always identifying issues in relation to late or visits not taking place. There were also concerns about lack of action on feedback received from people and their relatives, people’s care not being appropriate to their needs and that action taken was not always clear. A decision was made for us to inspect and examine the risks associated with these issues.

Care Quality Commission (CQC) has introduced focused inspections to follow up on previous breaches and to check specific concerns.

We undertook a focused inspection approach to review the key questions of Safe, Caring, Responsive and Well-led where we had specific concerns about people’s needs being met, in a timely way, responsiveness to concerns raised and ineffective management.

As no concerns were identified in relation to the key question Effective, we decided not to inspect this question. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to people not being treated with dignity and respect by all staff, good governance as service shortfalls identified by the quality and assurance [QA] system were not always addressed and person-centred care as some people and their relatives were not clear regarding the care they could expect to receive from the service, at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in April 2016, we rated the service Good overall. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated any serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

An experienced 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 2008 and associated Regulations about how the service is run.

People using the service told us they liked living at Pantiles House and felt safe there. They said they were treated in a respectful and caring manner by regular staff members who knew them well and supported them effectively.

People were supported by sufficient numbers of staff who were trained and well supported in their job roles. Staff members had been safely recruited and had received a full induction to the service. Staff we spoke with were confident that they provided a good service to people and said they would recommend Pantiles House to their family and friends. They had access to supervision and additional support when required.

Staff understood how to help protect people from the risk of abuse. The service had procedures in place to report any safeguarding concerns to the local authority. People and staff were protected from potential risk of harm as the service had identified and assessed any risks to them and reviewed these on a regular basis. People had assessments which were individual to the person and their strengths and needs.

Medicines were administered in a safe way. Staff received training and a competency framework was in place to make sure they understood and followed safe procedures for administering medicines. Regular audits took place to make sure people received their medicines as prescribed.

Staff had received training in the MCA (Mental Capacity Act) and understood the importance of gaining people’s consent before assisting them.

The service completed a detailed personalised care plan for each person. They kept people’s needs under review and made changes as required.

People using the service felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues. Staff also said they felt comfortable in raising any concerns should they have any.

The service was well led. A longstanding registered manager monitored the quality of the service and new systems were being introduced to further ensure this. Staff and people who used the service found the management team approachable and responsive.

Pantiles House is registered to provide support for older people who require personal care and support in their own homes to enable them to retain their independence. The service is provided within an extra care housing scheme and some people receive domiciliary care support in their own flats from staff who are based in the same building. On the day of our visit there were 23 people receiving care and support.

People felt safe and were protected from abuse by staff that had a good understanding of how to identify abuse, and knew how to respond appropriately to any concerns to keep people safe.

Specific and general risks to people’s safety had been assessed and were detailed clearly within their care plans. Staff used these to assist people to remain as independent as possible.

There were sufficient staff to support people in their own homes with their required care needs. Staff had been recruited using a robust recruitment process.

Safe systems and processes were in place to ensure that medicines were handled, administered and disposed of safely.

New staff received a robust induction to the service to help them prepare for their role and responsibilities. Staff were also provided with a variety of training, based upon people’s needs, to help them to carry out their roles effectively. They had regular supervision meetings with the registered manager and annual appraisals to support them to meet people’s needs.

Policies and procedures were in place in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected.

People’s dietary requirements had been assessed. They were supported to make menu choices and encouraged to be independent in meal preparation if this was appropriate.

Appropriate action was taken in response to illness or changes in people’s physical and mental health. When required, staff supported people to attend healthcare appointments, if they could not be supported by relatives.

Staff treated people courteously, with kindness and care, respecting their expressed wishes and preferences. They provided care and support based upon assessed needs and worked hard with people to maintain their privacy and dignity.

People were able to contribute to the assessment and planning of their care packages. Staff provided care and support based upon assessed needs.

People knew how to make a complaint if they needed to, and were confident that the service would listen to them. The registered manager investigated and responded to people’s complaints in accordance with the provider’s complaints procedure.

The registered manager consistently monitored and reviewed the quality of care people received. The service encouraged feedback from people and their representatives. This was then used to identify, plan and make improvements to the service.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Was the service safe?

People who use the service were treated with respect and dignity by staff. They told us they liked their care worker to wear their badges and uniforms as it helped them to feel safe; one person said, 'Yes my support worker wears their uniform and they wear their badge. I now know the person anyway'. Other people told us it helped them to feel safe, 'to know who the people were who were knocking on their doors'.

Recruitment practice was safe and thorough. The manager ensured that support staff were appropriately qualified to meet the care needs of people who used the service. Risk assessments were undertaken to minimise the risks both to the person using the service and to support staff. This has helped to ensure that people's needs were met safely.

Was the service effective?

People who use the service had their care and support needs assessed, together with risk assessments and they were involved in their care and support planning. We inspected five people's care files. They included essential information about the person's needs and risk assessment information and service delivery or care plans.

We found that staff had received regular and appropriate training and supervision and were able to ensure they were able to meet the specific needs of people using the service.

Was the service caring?

One person told us, 'Yes I do have a support plan; it sets out a weekly timetable of the care I can expect to receive.' That person showed us their care folder that included their support plan together with other useful information such as the complaints procedure, which was in their flat. Another relative said, 'We are kept fully informed about the care being provided and we are asked for our views and preferences'.

People who use the service told us they had discussed their care plans with staff and that they were able to discuss relevant issues and make decisions about what they wanted to do. This reflected the caring service ethos that we found on the day of the inspection.

Was the service responsive?

People who use the service were able to ask for changes in their care and support as their needs changed. Care plans had been reviewed regularly.

We spoke to six people and four relatives about the quality of the care they received. One person said, 'The staff can't do enough for me, they are fantastic'. Another person said, 'It's the best decision I made ' the quality of care here is excellent'. A relative told us, 'The care that my relative receives here is excellent, I have always found the staff here to be helpful and friendly, I have no complaints at all'.

All the people we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and although no complaints had been made since the last inspection staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

The manager and the care team leader carried out regular checks to assess and monitor the quality of service provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the service, their representatives and staff were listened to. People told us that they were asked for their feedback on the services they received and that they filled out a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the agency. This helped to ensure that people received a good quality service.

People told us they were happy with the care they received. Comments included that staff were "so helpful" and "I feel supported." Care was provided taking into account people's welfare and safety.

People told us they were happy and felt safe at the home. We saw that staff had been trained effectively in safeguarding vulnerable people. Records showed us that the provider had responded efficiently when there was a change in people's health care needs.

Staff were appropriately checked before they commenced employment. The provider had taken steps that ensured that all staff were qualified and trained to provide an effective service for people who lived at the home.

People we spoke with told us they were involved in how the service was run. The provider undertook appropriate checks to monitor the quality of the service.

We looked at the plans in place to provide care and support to people using the service. We found there were instructions and guidance for staff about how to meet people's care and support needs. We saw risks to their health, safety and wellbeing had been identified with a plan in place for staff to manage these.

We found guidance and instructions had been made available to staff on prevention and control of infection and how to maintain cleanliness.

The service had systems and records in place to audit medications and carried out regular checks to make sure staff correctly administered medication to people using the service.

Staff employed by the service had access to suitable training and development opportunities.

There was a system in place for dealing with complaints. People using the service had been given appropriate information about how and to whom they could make a complaint to.