Archived: Pennine Care Centre

Pennine Care Centre is a residential care home providing accommodation and personal care to up to 64 people. At the time of the inspection there were 39 people living there. There are two units, Pennine and Moorland Suite. Pennine is for older people, including people living with dementia. Moorland Suite is a male only unit and supports older and some younger people with mental health conditions.

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

A wide variety of activities were provided, these were designed to be relevant to people’s interests. People told us they enjoyed the activities and did not get bored. Staff knew which relationships were important to people and supported them to maintain these. People and their representatives played an active role in planning and reviewing care.

People told us they were cared for staff who were kind, caring, patient and compassionate. Staff and people enjoyed each other’s company and many pleasant, meaningful interactions were seen. People were supported to be as independent as they could be, with some people going out daily.

The two separate units of the home were decorated and designed differently to meet the needs and preferences of the people who lived there. There was a variety of communal areas for people to enjoy spending time alone, with family or in the company of the other people who lived there. These included a pub, a dementia café, a hairdressing salon, a barbers shop, a gaming area and a secure pleasant garden.

The registered manager proactively assessed and managed risks to people’s safety. Staff understood safeguarding procedures and were confident they could recognise potential signs of abuse. There were enough staff on duty to keep people safe and provide companionship. People received their medicines as prescribed.

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.

The service had a positive culture that was person-centred, open, inclusive and empowering and achieved good outcomes for people. The provider had clear and effective governance arrangements. The registered manager retained oversight of all areas of the service by completing regular audits and analysis of all areas of care planning and delivery. People, relatives and staff all spoke highly of a fair, approachable and supportive management team who led by example.

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 November 2018).

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

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Pennine Care is registered to provide residential care for up to 64 people in one building. Some of these people were living with dementia and mental health issues. At the time of the inspection 42 people were using the service. The service was divided into two distinctive areas Pennine and Moorland with Moorland being a male provision.

The service does not have 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. However a manager was in post and had applied for registration with CQC.

During the home’s previous inspections in May 2015 and April 2017, we rated the home overall as Requires improvement. At this inspection we continued to find areas of concern. The overall rating continues to be ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

People felt safe living at the home. Staff understood the processes for protecting people from avoidable harm. However some staff did not always put the protection of people first. People’s medicines were generally managed safely however they were not always stored in a manner that ensured they were safe to use.

The risks to people’s safety had been assessed and care plans were in place to support people safely. There were enough staff to keep people safe. Although staff were trained to deliver person centred care, this did not always happen and some care was task led. This could place people at risk of poor care. Accidents and incidents were regularly reviewed, assessed and investigated by the registered manager. The home was clean and fresh.

People’s physical, mental health and social needs were not always assessed and provided in line with current legislation and best practice guidelines. People were supported by trained staff who had their performance regularly assessed. People did not always speak highly about the food. People were not always assisted to eat in a manner that promoted their dignity.

The manager had built effective relationships with external health and social care organisations and people’s health was regularly monitored. The environment had been adapted to ensure people who had mental or physical disabilities were able, where possible to move freely. There was directional signage to support people living with dementia to orientate themselves independently around the home.

Staff mostly treated people with dignity and respected their privacy, however we saw occasions where people did not have their dignity supported. Some people felt able to make decisions about their care and felt the staff respected those decisions. People were encouraged to lead as independent a life as possible and some were prepared for a more independent life back in the community. People were provided with access to an independent advocate if they needed one.

People’s care records were person centred and guidance was provided for staff on how each person would like to be cared for.

People did not have their social care needs recognised and met. Group activities were available but these were not suitable to everyone. People were not always encouraged to attend these and were planned a year in advance. They did not always include activities that were important to individuals. People felt able to make a complaint and were confident it would be dealt with appropriately. The service received many compliments. End of life care was not currently provided, however, systems were in place to support people with this if they needed it.

Care had not been taken to ensure there was a skill mix of staff on duty each day. We saw a marked difference in care provision between days. Records were not maintained appropriately and were not always contemporaneous.

The quality assurance processes that were in place to continually assess the quality of the service people received were not always effective. They had not identified the concerns raised during this inspection. Staff were not always held accountable for their actions.

People felt able to give their views about the service. Staff felt valued and able to give their views and formal team meetings were in place. The manager was supported by a knowledgeable and experienced deputy manager.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

Pennine Care Centre comprises of two units, Moorland Suite and Pennine Suite. It provides nursing and personal care for up to sixty four people, some of whom are living with dementia. On the day of our first inspection visit there were 46 people living there.

There was not a registered manager in post. The service was being managed by a peripatetic manager employed by the provider. The provider was taking active steps to recruit to a new 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Effective infection controls and measures were not sufficiently robust to ensure people were kept safe from the risk of infection. Medicines were not always managed safely and signatures were missing from medication administration records (MAR) charts.

People felt safe living at Pennine Care Centre. Staff we spoke with had a good understanding of different types of abuse and understood their roles and responsibilities in recognising and reporting any potential abuse. Care plans contained information about how to minimise risk for people. There were sufficient staff to keep people safe but not enough to spend adequate one to one time with people on their hobbies and interests.

Pre-employment checks had been carried out on staff to help ensure people were kept safe. New staff participated in an induction which included shadowing an experienced member of staff.

Staff had received the required training to help keep people safe and meet their wishes and needs. Training had been undertaken in areas including safeguarding and infection control. Staff received supervision and induction to help meet people’s needs.

The manager and staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. People’s consent was sought before care was provided.

People had sufficient to eat and drink and special diets were catered for. People were supported to access health and social care when this was required.

Staff knew people and were aware of the importance of treating them with dignity and respect. Staff were kind and caring and people were involved in the planning of their care.

People weren’t always supported to take part in daily activities and they were not always supported to follow their interests. However, the manager had introduced a scheme whereby all people living in the home were being supported to express their interests and wishes and staff were working towards meeting those.

Information regarding how to make a complaint was available and people knew how to raise concerns and complaints.

The manager and deputy manager were aware of their responsibilities and improvements that were required in the home. They were open and approachable in their work.

At this inspection we found a breaches of 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 the report.

Below is a summary of what we found.

Is the service safe?

People we spoke with were mostly happy with their care and support. One person receiving care told us, "It's okay for me."

The provider was not fully ensuring risks to peoples' welfare and safety were identified and managed. Risks were not always identified promptly and appropriate action was not taken for planning and delivering safe care. This included where incidents of behaviours that challenge (for example verbal or physical aggression) had occurred between people receiving care, or between people who used the service and staff.

The registered manager was aware of the correct procedures to prevent and respond to allegations of abuse. However, staff were not aware of how to record and respond if concerns arose about possible abuse or neglect.

We notified social services and the police about our findings at a meeting on 6 August 2014. This meeting had been arranged to discuss concerns previously reported the local authority and CQC.

Is the service effective?

People's needs were assessed and some information was provided for staff about their care needs. However, records did not contain information about any diagnosed health conditions or disabilities. Some risks that could affect people had not been adequately assessed and managed as part of the care planning process, including where people had dementia. This meant that care delivered did not fully meet people's individual needs.

Is the service caring?

We observed that people were not always cared for in a way that met their needs. Some people were not provided with adequate support to eat their meals, or with personal hygiene and continence.

We saw the provider did not always ensure people with sensory disabilities, for example hearing loss, were properly supported to use and look after their hearing aids. This meant people's needs were not being fully met.

Care planning did not always take account of people's wishes, preferences and routines to ensure staff could provide personalised care that met their needs.

Is the service responsive?

Systems were in place for obtaining people's views about the service provided and information was collated and results produced. The provider had a complaints procedure and relatives of four people receiving care told us they felt any concerns would be responded to appropriately.

We saw action was not always taken when needed in response to people's care needs. This included where incidents of aggression had occurred and where people need help with their mobility.

Is the service well-led?

Some checks of care practice were completed by the registered manager. Systems were not adequate for analysing incidents that could cause harm. The registered manager did not have an effective system for identifying and managing risks or a full overview of current concerns or areas for development at the home.

We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us observing in the dining room for an hour over the lunch period. This enabled us to see how the staff spoke with people, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff spoke with people in a polite and professional manner. We saw staff offering support and encouragement in a way that met people's needs. We saw staff making good eye contact, and bending down to speak to people on their level.

We spoke with two people who live at Pennine Care Centre. The first person said: 'I'm all right. I've got everything I need, and the staff are OK.' A second person said: 'I can't grumble, the staff are nice, and I've got my own bedroom which is very nice.'

We saw that since our last inspection visit in August 2012 there had been a number of improvements at the care home, particularly in relation to the environment and infection control.