Pavilion Care Centre

Pavilion Care Centre is a residential care home providing personal care to up to 30 people. The service provides support to people aged 65 and over, some of whom were living with dementia. At the time of our inspection there were 24 people using the service. The accommodation is across three floors, with communal areas on the ground and first floors and more independent living in flats on the third floor.

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

Medicines were not always safely managed. Medicine administration records were not always legible. Medicines were not given in a timely manner. Records relating to medicines which were required 'as needed' did not provide staff with instructions how to safely give these types of medicines and reasons for their administration were not always recorded. There were not always enough staff on duty to safely meet people’s needs. Emergency evacuation plans were not always in place or updated. People were able to access high risk areas of the home such as the kitchen and laundry as they were unlocked.

Staff were not able to spend quality time with people and did not always respect people’s privacy and dignity. Personal care was not always given in a timely manner and had impacted on people’s dignity. Communication between staff was not always respectful as care needs were discussed loudly in a communal area and people were referred to as room numbers.

We have made a recommendation about complaints as records for received complaints were not maintained and there were no lessons learned. Accidents and incidents were not monitored for trends, quality assurance checks were completed remotely on care records held electronically. Management audits and checks were not regularly completed, and actions were not always identified or followed up.

People were not always offered a balanced diet and alternative choices were not always offered. Signage to support people to orientate was limited. Staff received regular training and specialised training such as dementia. 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.

Relatives were not always sure of the outcomes of complaints. Care planning information was not always reflective of care given and end of life wishes in one person’s care plan contained conflicting information.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 04 January 2019).

Why we inspected

This was a scheduled inspection based on previous rating.

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 COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to medicines management, quality assurance systems, staffing and maintaining people's privacy and dignity. 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.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

The service met the characteristics of good in all areas.

People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt from when mistakes happened.

The care that people received continued to be effective. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received training and support to be able to care for people well. They ensured that people were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The environment was adapted to meet people’s needs.

People continued to have positive relationships with the staff who were caring and treated people with respect and kindness. They were able to get involved in activities and pursue their interests. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint and the registered manager managed any complaints in line with the provider’s procedure.

The registered manager was approachable and there were systems in place which encouraged people to give their feedback. There were quality structures in place which were effective in continually developing the quality of the care that was provided to them.

More information is in the full report.

Rating at last inspection: Good: report published on 5 May 2016

Why we inspected: This was a scheduled inspection based on previous rating.

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 inspection took place on 19 January 2016, it was unannounced. The service was last inspected on 23 September 2013 when all standards were met.

The service offers personal and social care for a maximum of 32 people, at the time of the inspection 28 people were living in the Pavilion Care Centre, some of them were living with dementia. Nursing care is provided from the local community nursing teams.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained and confident to meet their individual needs. Staff supported people to access health care as required. Staff received one to one supervision sessions with their line manager to support them in their caring responsibilities.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training to provide them with the skills and knowledge they needed to look after people. We saw good relationships between people and the staff caring for them and also that consideration was given to people’s privacy and dignity. Safe recruitment procedures were followed and appropriate pre-employment checks had been carried out, including evidence of identity and satisfactory written references.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure medicines had been stored, administered and reviewed safely.

People were supported to make decisions in their best interests. The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People enjoyed a nutritious and varied diet and were involved in the menu planning to ensure they enjoyed the meals that were offered.

There was a formal complaints process in place and people were encouraged and supported to express their views. Staff were responsive to comments about the way people wanted to receive their care.

Three people told us they were generally satisfied with their care, support and the meals provided and we found people were supported to eat and drink sufficient amounts to meet their needs. Two people felt menus lacked variety. However we saw that arrangements were made to review these in consultation with people.

Three people told us, that activities and entertainments were organised, which they choose whether to join. One person told us, 'Staff respect my privacy and uphold my choice to do what I want, when I want and as I am able.' Another person said, 'Staff are caring and kind, they help me and listen when I am not having a good day.'

People we spoke with told us the home was usually kept clean, tidy and fresh from odours and we found that that risks to people's safety were properly managed. We also found people's comments and concerns were often taken into account to improve the service.

People told us that staff were friendly and always provided care and support that met their needs. One person told us "I'm pretty independent and do a lot myself but the staff are giving me the support and company that I need".

We found that there were issues relating to the safe storage, recording, handling, dispensing and safe administration of medicines within the home. People were not protected against the risks associated with medicines because the provider was not effectively managing medicines.

We saw that the provider had effective recruitment and selection procedures in place when staff were employed at the home.

Staff were supported by the provider and received regular supervision and access to training. Staff we spoke with said that they felt supported and enjoyed working at the home.

We saw that care plans and personnel files were accurate, fit for purpose, stored securely and remained confidential.