Patron House

Patron House is a residential care home providing personal care. The service provides support to a maximum of 12 people in one adapted building. At the time of our inspection there were ten people using the service.

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

There had been changes to the provision of meals at the home since our last inspection. We observed portion sizes to be small and where people declined the food that was offered, alternative food was not always available for them.

Staff morale was low, although this had been recognised by the provider and action was being taken. We also received mixed feedback about staffing numbers at the home.

We have made a recommendation about staffing at the home.

People felt safe and supported by staff who were kind and caring. Medicines were managed safely, and staff had the relevant training, skills and knowledge to undertake their roles.

People had residents meetings throughout the year to discuss any concerns and improvements they would like to see in the home. Maintenance records of the care home were kept up to date. The care home had a good working relationship with healthcare professionals.

Staff understood the principle of giving people maximum choice and control of their lives however during our inspection we found people had limited choice around their nutritional needs being met.

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 (5 December 2019)

Why we inspected

This inspection was prompted following concerns we had received about the service. Concerns included issues relating to staffing, nutrition and diet. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Follow up

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

What life is like for people using this service: People were relaxed, comfortable and confident in their home. The feedback we received from people and relatives was good. Staff we met and spoke with were happy working at Patron House and enjoyed their roles and responsibilities.

Medicines were well managed. People received their medicines as prescribed from staff who were training and competent to do so. People were protected by the provider’s infection control policy and procedures.

Staff understood their responsibility to keep people safe from harm. People were supported to take risks and promote their independence. Risks were assessed, and plans put in place to keep people safe. There was enough staff to safely provide care and support. Checks were carried out on staff before they started work to assess their suitability to support people in a care setting.

The service was effective in meeting people’s needs. Staff received regular supervision and training. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. People 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. People were provided with a healthy, balanced diet whilst promoting and respecting choice.

Everyone we spoke with agreed that staff were caring and kind. Comments included “Very caring and kind all the time” and “They treat you with respect.” Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service.

The service was responsive to people’s health and social needs. People received person-centred care and support. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing. People were encouraged to make their views known and the service responded by making changes.

People benefitted from a service that was well led. Staff felt the manager was approachable. The registered manager was supported by the provider. Regular audits were in place and staff were recognised for their efforts.

Quality assurance systems were in place and based upon regular, scheduled audits, which identified any action required to make improvements.

Rating at last inspection: Good. The last inspection report was published on 22 December 2016.

Why we inspected: This was a planned comprehensive inspection. All services registered with CQC must have an inspection within the first year of their registration.

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

At the last inspection, the service was rated Good there were however two breaches of regulations in relation to medicines and recruitment. At this inspection we found the service had met all relevant fundamental standards and remained rated as Good.

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

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff completed training to ensure they were suitably skilled to perform their role. Staff were supported through a supervision programme

People were supported to maintain good health and had access to external health care professionals when required.

Staff were caring towards people and there was a good relationship between people and staff. Staff demonstrated and in-depth understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Care plans provided information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service . Staff described the registered manager as supportive and approachable. Comments from surveys and compliments received by the service confirmed that people were happy with the service and the support received.

Further information is in the detailed findings below

Not all people were able to verbally tell us about the care they received.. This was because some people were living with a form of dementia. Therefore, we observed how staff interacted and supported people in communal areas and crossed referenced this with their individual care plans. This enabled us to make a judgement on how their individual needs were being met.

Overall the people we spoke with who could verbally communicate were happy with the care they received. Comments included; 'it's ok here it's in walking distance to where I used to live'; 'Yes it's nice here. I would like to be at home but I can't'; and 'Staff are nice. I get enough support and if I wasn't happy I would see the manager'.

Comments from relatives and friends included; 'overall it's really good here and the food is good. They took X out for lunch recently and that was nice, just wished it could happen more often'. 'I don't worry about X anymore now she is here, staff are lovely'. 'Some little things annoy me like the laundry system, as often clothes get damaged'. We discussed this concern with the provider and registered manager. They agreed to follow this up.

We found the provider had systems in place to effectively monitor the service provided.

We visited the service in October 2012 and found the service was not meeting the 'Essential Standards of Quality and Safety' in outcomes 4, 8,10,13,16 and 21. During this inspection we observed some good improvements had been made in all outcomes and the provider was compliant in these areas.

During our inspection we spoke with three people living in the home, two staff, and one relative. We also spoke with the manager and the registered provider. We examined the care records of four people living in the home and observed if these were an accurate reflection of people's needs.

Overall people we spoke with who used the service were happy with the care they received. Comments received included; "I am happy here really, the staff are nice", 'food is home cooked its ok'. Another person told us, "they do try hard, the staff are lovely'.

One member of staff told us things had improved since our last visit, and that the new manager was working very hard to improve things.

We spoke with one relative who was visiting the home who told us, 'the new manager appears nice. There's been a big turnaround since your last inspection. Fresh fruit around the home is a big improvement'.

We spoke with five relatives and comments included; "The staff are very welcoming, they work so hard"," the television is always on in the lounge, even if people were asleep.' "The staff are nice but just too busy, they do everything". Another relative told us they felt the home was a 'bit dirty', but also stated the care staff do clean their relative's room each day.

Some people told us they felt safe and happy in the home. One person said 'they are lovely here to me". Another person using the service told us 'It's boring here staring into space, people don't ask me anything". However this person's relative was present, and reminded the person of the activities they had been involved in recently, and confirmed photographs had been taken.

Staff comments included 'I love working with the resident's here", 'we do all the cooking, cleaning, laundry, activities and attend to people's personal care needs. That's what we do here, yes it's busy but it's ok".

A member of staff told us 'I have tried to discuss the lack of staffing, but it hasn't changed. Staffing is the same, however people's need have increased greatly over the years".