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Archived: Perry Locks Care Home Requires improvement

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Reports


Inspection carried out on 10 January 2017

During an inspection looking at part of the service

This focused inspection took place on 10 and 11January 2017. Our last inspection of this service was on 29 and 30 June 2016. At that time we found that although improvements had been made since the previous inspection in June 2015 some further developments were required to ensure that the service was fully compliant with the regulations. Following our inspection in June 2016 we received some concerns about staffing levels at the service and there was also information that raised concern about people’s safety.

This report covers our findings in relation to this unannounced focused inspection where we only looked at the domain of ‘Safe’. We visited the service at night and returned the next day to complete the inspection. You can read the report from our last comprehensive inspection by

Selecting the 'all reports' link for Perry Locks Nursing Home on our website at www.cqc.org.uk.

Perry Locks Nursing Home is registered to provide accommodation and nursing care for 128 people who have nursing or dementia care needs. There were 118 people living there at the time of our inspection. The home is purpose built and consists of four separate buildings. Perry Well House is for people with dementia. Brooklyn House, Calthorpe House and Lawrence House provide nursing care for older people. The service had a number of intermediate beds across the four houses. Intermediate beds means specialist care to people who have been discharged from hospital but need extra care and support before they return home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People did not always receive care and support in a timely manner and improvements were needed to ensure that there were enough staff to care for people safely at night. Improvements were needed to the management of medicines, to the support people received to eat safely and to ensure that systems in place for ensuring people’s safety were well established. You can see what action we asked the provider to take at the back of this report.

People were protected by robust recruitment procedures and staff received training and told us they were aware of their responsibility to protect people from the risk of abuse. Staff told us that they knew what to do to ensure people’s safety in the event of a fire and or an emergency.

Inspection carried out on 29 June 2016

During a routine inspection

The inspection took place on 29 and 30 June 2016. The first day of the inspection was unannounced.

We last carried out a comprehensive inspection of Perry Locks Nursing Home on 23 and 24 June 2015. At that inspection we found there were three areas where the service was not meeting regulations. These related to the monitoring of the service, staffing levels and failure to inform the commission about information we are required to be notified about. We served a warning notice regarding staffing levels. At a follow up inspection on 21 October 2015 we found that improvements to the arrangements for staffing had been made and the warning notice was met. The provider sent us an action plan detailing what action they had taken in respect of the other areas where they were not meeting the regulations.

During this inspection we found the provider had made many improvements to the service. Although improvements had been made on how the service was monitored some further improvements were needed.

Perry Locks Nursing Home is registered to provide accommodation and nursing care for 128 people who have nursing or dementia care needs. There were 107 people living at the home when we visited. The home is purpose built and consists of four separate buildings. Perry Well House is for people with dementia. Brooklyn House, Calthorpe House and Lawrence House provide nursing care for older people. The service had a number of intermediate beds across the four houses. Intermediate beds means specialist care to people who have been discharged from hospital but need extra support before they return home.

A registered manager was in place and was present throughout our 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.’

Improvements to the service had been made to ensure that a good quality service was provided to people that used the service. Although many improvements had been made to the service some further improvements were needed.

Improvements were needed to the management of medicines to ensure people received their medicines safely and as prescribed.

People felt safe using the service and they were protected from the risk of abuse because the provider had systems in place to minimise the risk of abuse.

People were supported by staff that were kind and caring. People were mainly treated with dignity and respect.

Staff understood people’s needs well. Staff received the training and support they needed to carry out their role and meet people’s individualised needs. There was sufficient staff to meet people’s needs.

People received sufficient food and drink to remain healthy and choices were available. Most people were happy with the meals they received.

People were able to consent to the care they received where they had the capacity to do so. Where people did not have the capacity to make decision systems were in place to ensure that their human rights were protected, but were not fully effective.

People were supported to have things to do either in a group or on an individual basis.

People felt listened to and able to raise any concerns they may have.

Systems were in place to monitor and improve the quality of the service and the service people received had improved although further improvements were needed.

Inspection carried out on 21 October 2015

During an inspection looking at part of the service

This inspection took place on 21 October 2015. The inspection was unannounced.

We last inspected Perry Locks on 23 and 24 June 2015 when we found the provider had breached the Health and Social Care Act 2008 in three regulations. Following the inspection in June 2015 we spoke with representatives of the provider to discuss our findings. We issued two requirement actions; for not ensuring CQC had been notified of applications to restrict people’s liberty and or not ensuring that quality monitoring systems were effective. We also issued a Warning Notice for not ensuring staffing arrangements were adequate to meet people’s needs. These are formal ways we have of telling providers they are not meeting people’s needs or the requirements of the law, and that improvements are required. The provider sent us an action plan detailing the improvements they would make. They have updated us regularly and informed us that the actions had been completed.

This was a ‘Focused’ inspection and this report only covers findings in relation to the warning notice we issued in regards to Staffing arrangements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Perry Locks Nursing Home on our website at www.cqc.org.uk.

Perry Locks Nursing Home is registered to provide accommodation and nursing care for 128 people who have nursing or dementia care needs. There were 107 people living at the home when we visited. The home is purpose built and consists of four separate buildings. Perry Well House is for people with dementia. Brooklyn House, Calthorpe House and Lawrence House provide nursing care for older people. The service had a number of intermediate beds across the four houses. Intermediate beds means specialist care to people who have been discharged from hospital but need extra support before they return home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the arrangements for ensuring that adequate staffing levels were provided. However, we observed that further improvements were needed on one ‘house’ to ensure people’s needs were well met.

Inspection carried out on 23 and 24 June 2015

During a routine inspection

This inspection was carried out over two days on 23 and 24 June 2015 and was unannounced.

We last inspected Perry Locks Nursing Home on 16 and 17 July 2014. At that inspection we found there were four areas where the service was not meeting regulations. These related to the monitoring of the service, staffing levels, failure to make applications to the local authority where restrictions were in place and staff training and support. The provider sent us an action plan detailing what action they had taken. During this inspection we found the provider had made applications to the local authority as required. Improvements had been made to staff training and support. We found that there were repeated concerns about staffing levels. Although improvements had been made on how the service was monitored further improvements were needed.

Perry Locks Nursing Home is registered to provide accommodation and nursing care for 128 people who have nursing or dementia care needs. There were 107 people living at the home when we visited. The home is purpose built and consists of four separate buildings. Perry Well House is for people with dementia. Brooklyn House, Calthorpe House and Lawrence House provide nursing care for older people. The service had a number of intermediate beds across the four houses. Intermediate beds means specialist care to people who have been discharged from hospital but need extra support before they return home.

A registered manager is required to manage this service. At the time of our inspection there were interim management arrangements in place. A manager had been appointed and was due to commence employment on 20 July 2015. 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 not always enough staff on duty to ensure that people were adequately supervised and arrangements in place to determine safe staffing levels had not been effective. People were not always cared for in a timely manner and in a way that met their needs. This was a breach of the regulations.

There were systems in place to protect people from abuse and staff were trained and understood their responsibility to protect people from harm. However, we found that some incidents had not been dealt with in a timely manner.

People were supported to receive their medicines but some people did not receive their medicines as prescribed.

Staff understood how to gain people’s consent from people and how to involve them in their care. However, we had not been notified when the local authority had approved DoLS (Deprivation of Liberty safeguards) applications. Improvements had been made to how staff training was planned and delivered. However some staff responded to people in a way that demonstrated a lack of understanding of people’s needs.

Most people received food and drink based on their preference’s and were provided with the support they needed to eat their meal. Some people were not offered food choices in a way that respected their needs.

People were supported to receive care and treatment from a variety of healthcare professionals and received treatment if they were unwell.

People and their relatives knew how to raise concerns if they needed to. The arrangements for managing concerns had not always been robust and timely.

Systems were in place to monitor the quality of the service but they had not always been effective and timely action had not always been taken to bring about the improvements needed. This was a breach of the regulations.

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

Inspection carried out on 16 and 17 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. 

This inspection was unannounced.

In February 2014, our inspection identified breached regulations relating to staffing, medicine management and the care of people with dementia. Following the inspection the provider sent us an action plan to tell us the improvements they were going to make. We found that some improvements had been made to the care of people with dementia and medicine management. However there remained breaches relating to safe staffing, and we found additional breaches of regulations in relation to Supporting workers and Assessing and monitoring the quality of service provision. 

The home did not have a registered manager in post when we inspected.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has legal responsibility for meeting the requirements of the law: as does the provider.

Perry Locks Nursing Home is registered to provide accommodation and nursing care for 128 people who have nursing or dementia care needs. There were 112 people living at the home when we visited. The home is purpose built and consists of four separate buildings. Perry Well House is for people with dementia. Some of the beds on Brooklyn House are intermediate beds (This means short term specialist care to people who have been discharged from hospital but need extra support before they return home). Calthorpe House and Lawrence House each have 30 beds, for nursing care for older people.

Most people that we spoke with told us that they received good care from staff and they were happy with the staff that cared for them. People described staff as kind, helpful and caring. Some people and their relatives told us that there was not always enough staff on duty to care for them especially at busy times of the day, for example, meal times and early evening. Our observations during the inspection supported this. The provider did not have an effective system in place to determine the level of staff needed, to promote people’s safety.  

Staff had not followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We saw that some people had restrictions in place but an application had not been made to the local authority. This meant that some people were potentially unlawfully having their movements restricted.

Staff knew about people’s needs. However some of their training needed updating including fire safety, safeguarding and moving people so that they maintained the level of knowledge needed to care for people safely. Training was needed in MCA and DoLS so staff understood their responsibility in relation to this legislation. Nurses told us that they needed training specific to their role so they had the skills they needed to carry out their clinical duties effectively. 

People had access to health care professionals such as doctors and dieticians so that they received the healthcare support needed.

People and their representatives had not always been provided with opportunities to attend regular meetings to express their views about the home. People told us that they knew how to make a complaint and we saw this information was displayed in the home. Some people told us that they had not been satisfied with how their complaint had been dealt with.

The home had not been well led. There were systems in place for monitoring the service however, these had not been effectively applied to identify where the improvements were needed.

We found the provider had breached the regulations related to staffing levels, DoLS, support for staff, and monitoring of the service. The service lacked effective leadership. You can see what action we told the provider to take at the back of the full version of the report.  

Inspection carried out on 25 February 2014

During an inspection in response to concerns

We visited the home as we had received concerns about the care of people who lived in Perrywell House. These were about medicine management, the high use of agency staff who did not know people, not enough staff to meet people�s needs and lack of meaningful activity for people who lived there.

We only visited Perrywell House during this inspection. There were 30 people living there on the day of our inspection. We spoke with two people who lived there, two relatives of people who lived there and four members of staff. We looked at records of nine people who lived there, observed how staff interacted with staff and looked around the home. We provided feedback of our findings to the deputy manager and the quality manager.

People had access to healthcare professionals to help meet their healthcare needs.

We found that there were not enough activity staff available for people to take part in meaningful activities which did not promote their wellbeing.

Medicine management systems did not ensure that people always had their medicines as prescribed. This meant that people�s health needs were at risk of not being met.

There were not enough staff available to meet people�s needs and ensure their safety and wellbeing at all times. One person told us, �Most of the staff are very good but they are very busy and don�t have enough time to speak to me.� We observed that staff interacted well with people who lived there. One relative said, �Staff are considerate and kind and always there when needed.�

Inspection carried out on 3 June 2013

During a routine inspection

We visited each of the four units during this inspection. There were 106 people living in the home on the day of our inspection. We spoke with 19 of the people living there and 11 of their relatives, one visiting professional, 17 members of staff and the manager.

Staff knew how to support people to meet their needs and ensure their health needs were met. One person told us, �If I am not well they get the doctor.�

A relative said, � I have no concerns at all about this home, my relative is well looked after here.�

People had their medicines as prescribed to ensure their health and wellbeing.

There were enough staff to support the people living there to meet their needs and ensure their safety.

Staff were supported to ensure they had the skills and knowledge to meet the needs of the people living there.

People were asked for their views about the home and audits of the quality of care that people received were completed.

Inspection carried out on 28 June 2012

During a routine inspection

There were 101 people living there when we visited. Nobody knew we would be visiting that day. The home was split into four houses. We visited three of these - Brooklyn, Lawrence and Perrywell.

Some of the people living at the home had dementia and other conditions which meant that they were not able to tell us about their experiences. To help us to understand the experiences people have, we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We spoke with eight people living there who were able to tell us about their experiences. We also spoke with the manager, deputy manager, seven members of staff and five relatives who visited during the day. We looked at the records of eight of the people living there and sampled the provider's records.

People told us they were happy living at the home. One person said, " I'm happy living here, it's not too bad."

The people we spoke with said that they were given choices about what they wanted to do and how they liked to be supported. One person said, "My bedroom is painted blue and I chose this."

We saw that staff respected people's privacy. One person told us, "Staff always knock on my bedroom door before they come in."

Records showed staff how to support each person to meet their needs and do the things they liked doing. Staff spoken with showed that they knew what each person liked and how to support them.

Staff referred people to other health professionals, where needed, to ensure their well being. We saw that staff followed the advice of health professionals, so ensuring that people's health needs were met.

We saw that staff engaged people in activities and spent time talking to them about their interests and hobbies. This helped to keep the person motivated and helped to ensure their well being.

People told us they felt safe living at the home. Staff told us how they supported people to make sure they were safeguarded from abuse.

People and their relatives told us that the staff were caring and treated them with respect. A relative said, "Staff are friendly, nothing is too much for them, they listen to us."

Staff had the training they needed so they knew how to support the people living there to meet their needs and keep them safe from harm.

People told us they knew who to talk to if they were unhappy about the care they received. They and their relatives told us that if they had complained, something was done about it and improvements were made.

People were asked for their views about the home and what could be done to make improvements to the lives of the people who lived there.

Inspection carried out on 30 September 2011

During an inspection looking at part of the service

We saw that people who lived in the home appeared to be clean and dressed appropriately for the time of year. A relative told us that their family member who lived in the home was always particular about their clothes. This relative asked the staff to make sure that their family member always had items of clothes on that colour matched. Staff made sure that this was done. A person told us that staff helped them to have a shower or a bath and was told that what ever she wants, she�s only got to ask. A relative told us that their family member who lived in the home was always particular about their clothes. This relative asked the staff to make sure that their family member always had items of clothes on that colour matched. Staff made sure that this was done. Other relatives told us gave us their views about how staff provided care and support to their family member, ��Looked after very well�� and ��Very well cared for.��

A relative told us that their family member had been losing weight and not eating properly but staff had now managed to resolve this so that the person was eating normally again. This relative told us that they were ��more than pleased�� with care provided in the home.

People who lived in the home that we spoke with told us how they spent their days. A person told us that they chose not to go in the lounge and staff respected their wishes. This person said that staff gave them books and magazines to read. Another person told us they liked to have a cigarette and read newspapers which staff supported them with. We also received some comments about activities from relatives, ��A lot of activities, bingo and quizzes�� and ��People go out to the pub with staff for lunch��.

We spoke with some relatives about staff support and their views upon staffing levels. Comments that we received were, ��Quite a lot of staff who are very friendly�� and ��Great bunch, know X personally��.

There were systems in place so that people who lived in the home could share their views about how the home was run. For example, relatives that we spoke with told us that they had attended a recent meeting and other relatives said that they had been invited to the meetings but had not attended the last one due to other commitments.

Inspection carried out on 11 January 2011 and 18 September 2012

During an inspection in response to concerns

Some of the people who live on Perrywell House have difficulties in communication, due to their dementia; we were not always able to gain their views verbally. However, some people were able to say yes or no, shake their heads or nod to simple everyday questions. However we observed staff supporting people. We saw that staff were kind and caring in their approach, and took time to explain things to people, for example, we saw staff assisting people with gentle reassurance and some people were joining in activities.

We found that staff had written down people�s individual needs and how these were to be met whilst acknowledging any risk factors. However, this approach was not always in place as we saw that one person did not have all their needs written down and some risk assessments were not being regularly reviewed. These aforementioned issues were also identified by other professionals who had visited Perrywell House. All information that is written down needs to link to all records that are held about each person who uses this service, as we found that there were shortfalls in weight recordings. By staff doing this, it will ensure that people receive consistent care and support to promote each person�s health and wellbeing.

There has been an increase in relation to incidents within Perrywell House and safeguarding referrals being made. It is positive that staff are reporting incidents which may affect people�s health and welfare. However it is a concern that there has been an increase in incidents such as people hitting others.

Relatives told us that in the main care provided was appropriate to meet their family member�s needs but staffing levels were not always maintained to acceptable levels to ensure people�s safety at all times. Staff we spoke with said that people who live at Perrywell House have complex needs and staffing levels can be an issue at times. Other professionals who have visited Perrywell House have commented that there appears to be issues with regards to staffing levels together with the need for a unit manager and a Registered Mental Nurse (RMN).

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