16 and 17 Septmeber 2015
During an inspection looking at part of the service
The overall rating for this provider is ‘Inadequate’. The service was placed into ‘Special Measures’ by CQC at our last inspection on 28 and 29 April 2015. The purpose of special measures is to:
1. Ensure that providers found to be providing inadequate care significantly improve
2. Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
3. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
The service had not sufficiently improved at this inspection. As a result of this it remains in Special Measures.
At the last inspection on 28 and 29 April 2015 we found that problems with the safety and suitability of the premises continued. We also found the service was breaching five other regulations; person centred care, the need for consent, safe care and treatment, good governance, and ensuring staff are suitably trained and supported to care for people.
CQC received an action plan from the provider on 22 July 2015. This contained information about the corrective action the provider would take to address the issues we raised at the last inspection.
This inspection was unannounced, and took place on 16 and 17 September 2015. We found the service had improved in relation to consent and cleanliness. However, it had not made sufficient improvements in; person-centred care, safe care and treatment, good governance and supporting staff and remained in breach of these regulations. In addition to this the service is in breach of the regulation relating to staffing levels and safe care and treatment.
Pennyghael Residential Home is a care home which provides residential, personal and social care for up to 16 people who are living with dementia. The home is on two floors with one staircase, two bedrooms are shared occupancy, although only one person was living in them at the time of our inspection. None of the bedrooms have en suite facilities. The home is in Selby. At the time of our inspection on 16 and 17 September ten people were living there.
The registered manager had left the service since our last inspection. At the time of the inspection they had not yet applied to cancel their registration with the care quality commission (CQC). A new manager had been appointed, they had been in post three weeks, and they told us they intended to register with CQC. 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.
We found some cosmetic improvements had been made to the environment. For example there were more photographs and art work on the walls. People had access to the conservatory which meant there was more quiet space. The immediate risks we identified at the inspection in April 2015 had been addressed however, there were still areas of improvement required and we identified further concerns.
There were insufficient staff available to meet people’s needs at key times of the day. Care was planned and delivered based on how many staff were available rather than people’s choices. This meant people did not receive person centred care.
Risk assessments contained basic information. Where risks were identified there was a lack of information for staff about what they needed to do to manage the risk. People’s ability to request help from staff via the call bell system had not been assessed. The system needed updating and because of this a key was used to identify where the call bell had been activated. This meant there could be a delay in response which placed people at risk of harm.
Medicines were not safely managed. We saw staff had not completed medication administration records which meant staff could not be sure whether medication had been given and people could be at risk of receiving their medication again. This meant people could be at risk of harm.
Staff understood how to safeguard people from abuse. They could tell us about the procedures for reporting concerns. The service had made appropriate safeguarding referrals to the local authority.
All of the training staff had completed was on line and there were no systems in place to check whether staff had understood this learning and how they implemented this when providing care and support to people. There remained gaps in staff training. Of particular concern was the lack of moving and handling training by staff who worked overnight. This meant people were at risk of being supported by staff who did not have adequate training in safe moving and handling techniques. The manager had developed a training matrix and was monitoring the completion of training.
There was an improvement in relation to staff seeking consent from people. We saw staff offered reassurance and explanation to people and sought their permission to carry out care tasks. Staff were able to explain the basic principles of the mental capacity act and provided examples of how to support people to make decisions. In addition to this mental capacity assessments had been updated and we could see best interest decisions were recorded for people who were unable to make their own decisions.
We did not see any evidence of weight loss however; meals were planned around staff availability rather than individual’s choices. One example of this was that everyone had a hot meal at lunchtime, this was because the chef finished work at 1pm and on an evening there were two care staff who worked. They made the evening meal which consisted of snack type food such as sandwiches and spaghetti on toast. We did not see evidence of meals being planned to take into account the need for a nutritious and varied diet. The meal time experience could be improved to make this a more enjoyable experience for people.
Staff interactions with people had improved. We saw staff were kind, caring and responded appropriately to people’s distress. However the majority of interaction between staff and people was task orientated.
Although staff knew about people’s preferences they were not using this information to plan, deliver or review people’s care. This meant the service could not be sure people were receiving care and support which was based on their preferences and lifestyle choices.
Care plans were difficult to follow and were task based. They contained limited information about what was important to the individual receiving care and support. There was a lack of meaningful activity and stimulation for people, this took place at set times which was based on availability of staff rather than people’s choices.
We saw evidence of institutional care practices. For example people were supported based on the routine of the service rather than individual choice. There was a lack of respect for people’s confidentiality and privacy. Conversations about people took place in the main area of the service with other people and visitors around.
Relatives told us they knew how to make complaints and were confident in the new manager.
Staff morale was high despite the range of issues across the service. Staff expressed confidence in the manager and felt well supported.
The service was not well led. We found the manager was addressing issues as they arose, effectively fire fighting. Despite the range of issues we raised at the last inspection and the support being provided by the local authority staff we did not see an overarching service improvement plan. This meant we could not be assured the corrective action required would be completed and resulted in people receiving an inadequate standard of care and support.
We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.