142 Petts Hill Care Home

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people with mental health needs. At the time of our inspection, three people were living in the home.

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

Staff did not follow the provider’s procedure for recording and administration of medicines and we could not be assured people received their medicines safely and as prescribed. Similar issues were found at the last two inspections.

Risks to people's wellbeing and safety had not always been assessed. As in our previous inspection, one person admitted in April 2022 did not have a care plan or any risk assessments in place, and another person’s care plan had not been updated and did not reflect the care they were receiving.

Although there were risk assessments in place for another person, these were not always reviewed and updated regularly so risks were appropriately identified and mitigated.

The provider did not carry out regular safety checks including fire safety checks. The premises fire risk assessment had not been reviewed regularly. People’s emergency evacuation plans (PEEPS) were in place for one person, however, two people did not have these in place. This placed them at risk of harm should there be a fire or an emergency.

The provider’s infection control systems were not always effective. Some areas of the home were dusty and the fridge and some cupboards in the kitchen were unclean. There was no date of opening on food items. Some areas of the home were worn and needed updating and repairs were not always carried out in a timely manner.

People did not have access to meaningful activities and their care plans did not reflect what they liked doing or any interests they might have.

There were no records of any meetings with people who used the service and there was no evidence people were supported to feedback about the service.

The staff did not always communicate effectively with each other about the running of the service and there was little management oversight.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider’s monitoring systems were not regular or effective and had failed to identify the shortfalls we found during the inspection. Furthermore, there was no evidence of lessons learned as issues we had found at previous inspections were repeated at this inspection.

The provider had processes in place for the recording and investigation of incidents and accidents. The registered manager told us there had not been any since our last inspection.

There were enough staff on duty at all times to meet people’s needs in a timely manner. Nobody had been recruited since the last inspection.

Staff had received training in safeguarding adults and demonstrated a good knowledge of this and what they would do if they thought someone was at risk of harm.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 October 2021). 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 the provider remained in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We undertook the inspection to see if the provider had made improvements since the last inspection, and to find out how well the provider was meeting the key questions not inspected at our last two inspections.

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 and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, person-centred care, premises and equipment and good governance at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people with mental health needs. At the time of our inspection, three people were living in the home.

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

Staff did not always follow the provider’s procedure for recording and administration of medicines and we could not be assured people received their medicines safely and as prescribed. Similar issues were found at the last inspection.

Risks to people's wellbeing and safety had not always been assessed. One person did not have a care plan in place, and, where there were risks to this person’s safety and wellbeing, the provider had not taken appropriate action to mitigate these. Although there were risk assessments in place for other people, these were not always reviewed and updated regularly.

The provider did not always carry out regular fire safety checks. Fire risk assessments had not been reviewed regularly. People’s emergency evacuation plans (PEEPS) were in place for two people, however, one person did not have this in place. This placed them at risk of harm should there be a fire or an emergency.

The provider’s monitoring systems were not always regular or effective and had failed to identify the shortfalls we found during the inspection. Furthermore, there was no evidence of lessons learned as issues we had found at previous inspections were repeated at this inspection.

The staff told us they had regular staff meetings and met with people who used the service. However, there were no records of these, so we could not be sure they took place. We saw evidence the staff did not always communicate effectively with each other about the running of the service.

The provider had processes in place for the recording and investigation of incidents and accidents and none had been recorded since our last inspection.

There were enough staff on duty at all times to meet people’s needs in a timely manner. Nobody had been recruited since the last inspection.

There were systems in place to protect people from the risk of infection although further improvements were required. Staff had received appropriate training in infection prevention and control. There hads been no cases of COVID-19 at the home. The home was clean.

People felt safe when staff were providing support. Staff had received training in safeguarding adults and demonstrated a good knowledge of this and what they would do if they thought someone was at risk of harm.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 October 2020). At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced inspection of this service on 10 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 142 Petts Hill on our website at www.cqc.org.uk.

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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people with mental health needs. At the time of our inspection, two people were living in the home.

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

Staff did not always follow the procedure for recording and the safe administration and recording of medicines. There were systems in place to monitor the management of medicines but these had not identified shortfalls.

There were systems in place to protect people from the risk of infection and staff had received appropriate training in this. However, some areas of the home were unclean, and staff did not always follow safe procedures in relation to personal protective equipment (PPE).

The provider had put a number of systems in place to monitor the quality of the service and put action plans in place where concerns had been identified. However, these systems had failed to identify the issues we found during the inspection.

Risks to people's wellbeing and safety had been assessed, and, where risks had been identified, the provider had taken appropriate action to mitigate these. The provider’s risk assessments were regularly reviewed and updated. The provider had processes in place for the recording and investigation of incidents and accidents. Risks to people’s safety were identified and managed appropriately. There were enough staff on duty at all times to meet people’s needs in a timely manner.

People felt safe when staff were providing support. Staff had received training in safeguarding adults and demonstrated a good knowledge of this and what they would do if they thought someone was at risk of harm.

People who used the service, relatives and professionals were consulted about their views of the service and the care provided. There were regular staff meetings and the staff supported each other. The provider liaised with the local authority and other managers to discuss issues and make improvements.

People were supported to have maximum choice and control of their lives and staff supported hem in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 (published 8 March 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the management of medicines, so we widened the scope of the inspection to become a focused inspection which included reviewing the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook a comprehensive inspection on 29 and 30 August 2017 to check if the provider had made the necessary improvements. We found that the provider had not met the requirements of the warning notice and in addition was breaching other aspects of the regulation in regards to Safe Care and Treatment. As a result we rated Safe as Inadequate and issued the provider with two warning notices for a repeated breach of Regulation 12, Safe Care and Treatment and Regulation 17, Good Governance, telling them they must make the required improvements by 2 October 2017. We also found a breach of regulation in relation to Person-centred care.

At this inspection on 6 February 2018, we found that the provider had made the necessary improvements, had met the requirements of the warning notices and was meeting the Regulations they previously breached.

142 Petts Hill is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people with mental health needs. At the time of our inspection, three people were living in the home, two of whom had been living there for over 25 years.

The home was owned by a group of family members. There was a registered manager at the service at the time of 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.

Staff followed the procedure for recording and the safe administration of medicines. There were systems in place to monitor the management of medicines. All staff had received medicines training and had their competencies regularly assessed.

The provider carried out regular health and safety audits. There were systems in place to protect people from the risk of infection and the environment was clean and free of hazards.

Risks to people's wellbeing and safety had been assessed, and where risks had been identified, the provider had taken appropriate action to mitigate these. Risk assessments were regularly reviewed and updated.

The provider had processes in place for the recording and investigation of incidents and accidents. Risks to people’s safety were identified and managed appropriately.

There were enough staff on duty to meet people’s needs in a timely manner.

People felt safe when staff were providing support. Staff had received training in safeguarding adults and demonstrated a good knowledge of this and what they would do if they thought someone was being abused.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were reviewed and updated monthly or more often if necessary and included instructions for staff to follow to ensure people’s needs were met. Care plans contained information about people’s daily routines and preferences.

The provider had a number of systems in place to monitor the quality of the service and put action plans in place where concerns were identified.

Staff had received training identified by the provider as mandatory. This equipped staff with the skills to provide appropriate and effective care for people using the service.

Activities were organised according to people’s choices and needs. People we spoke with confirmed this.

People’s capacity to make decisions about their care and treatment had been assessed. At the time of our inspection, nobody was being deprived of their liberty unlawfully.

Staff received regular supervision and an annual appraisal, and told us they supported each other.

Recruitment records were thorough and complete and the provider had ensured that a criminal record check was completed prior to staff starting work.

There was a complaints procedure in place and people told us they knew who to complain to if they had a problem. Relatives were sent questionnaires to gain their feedback on the quality of the care provided.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care. Relatives and professionals we spoke with confirmed this.

We saw people being supported in a calm and patient manner.

People gave positive feedback about the food and told us they were offered choice. People had access to healthcare professionals as they needed, and the outcomes of the visits were recorded in their care plans to provide an audit trail.

People, relatives and professionals we spoke with thought the home was well-led and the staff and management team were approachable and worked well as a team.

At the inspection of 29 and 30 August 2017, we checked if the provider had made the necessary improvements with regards to the management of medicines. We found the provider had not met the requirements of the warning notice and in addition was breaching other aspects of the regulation in regards to safe care and treatment.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people who have mental health needs. At the time of our inspection three people were living in the home, two of whom had been living there for over 25 years.

The home was owned by a group of family members. There was a registered manager in post at the service at the time of 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.

Medicines management remained unsafe. The registered manager had not put systems in place to monitor the management of medicines therefore had not identified recording errors and discrepancies in stock. This resulted in people being at risk of not having their medicines properly administered.

The provider had not undertaken recent health and safety audits. Some areas of the home were cluttered and there were trip hazards in communal areas. Some cleaning products and chemicals had not been locked away safely and were found in a toilet.

Risks assessments were carried out but these were general and did not always reflect the specific risks for each individual. Risks had not always been reviewed when people’s needs changed.

The care plans contained assessments of people’s needs and information on how care was to be provided. However, these were not always reviewed and updated and did not always contain up to date information. Visits by health care professionals were recorded.

The provider did not have robust systems in place to monitor the quality of the service and had not identified shortfalls in relation to the management of medicines, health and safety and care planning.

The staff team supported each other. Formal staff supervision was taking place but nobody had received an annual appraisal in recent years.

People’s capacity to make decisions about their care and treatment had been assessed. At the time of our inspection, nobody was being deprived of their liberty unlawfully.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

The provider had processes in place for the recording and investigation of incidents and accidents.

All staff working at the service had a Disclosure and Barring Service (DBS) check carried out.

There were enough staff on duty to meet people’s needs in a timely manner, and bank staff were available to provide cover in the event of staff shortage.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care and support. Relatives and external professionals we spoke with confirmed this.

There was a complaints procedure in place and people told us they knew who to complain to if they had a problem. Relatives were sent quality questionnaires to gain their feedback on the quality of the care provided.

We found the provider was breaching the regulations relating to safe care and treatment, person centred care and good governance. In regards to the breach of regulation for person centred care, you can see what action we told the provider to take at the back of the full version of this report. We are taking further action against the provider for breaches of regulations in relation to good governance and safe care and treatment. Full information about CQC’s regulatory response to these concerns will be added to the report after any representations and appeals have been concluded.

This unannounced inspection took place on 5 July 2017. The last inspection of the service took place on 22 February 2016, when we rated the service as ‘Good’ overall but ‘Requires Improvement’ in the key question, ‘Is the service safe?’ and identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines.

At the inspection of 05 July 2017, we checked if the provider had put in place adequate systems to make the necessary improvements. We found the provider had not made the necessary improvements in the way they managed people’s medicines, therefore risks to people’s health and safety remained.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Petts Hill Care Home’ on our website at www.cqc.org.uk.

Petts Hill Care Home provides accommodation, support and care for up to three people who have mental health needs. At the time of our inspection, there were three people living at the service.

The home is family owned through a partnership. There was a registered manager in post at the time of 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.

Medicines management remained unsafe. The provider had improved the way in which medicines were stored. However, records still did not ensure that a clear audit trail was provided to confirm people received their medicines as prescribed. The provider had still not put adequate systems in place to monitor the management of medicines. This resulted in people being at risk of not having their medicines properly administered.

We are proposing to take further action against the provider for the breach of regulation in regards to safe care and treatment. We will add full information about CQC’s regulatory response at the back of the full version of the report after any representations and appeals have been concluded.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people who have mental health needs. At the time of our inspection three people were living in the home, two of whom had been living there for over 25 years.

The home was owned by a group of family members. There was a registered manager in post at the service at the time of 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.

Medicines management was unsafe. Medicines were not stored securely and records did not ensure that a clear audit trail was provided. The manager did not have systems in place to monitor the management of medicines. This resulted in people being at risk of not having their medicines properly administered.

Staff told us they felt supported by their manager. Formal staff supervision had taken place in the past but had not been carried out since 2013. Staff had not received an annual appraisal since 2013. The manager told us that they carried out informal supervision but those meetings were not recorded.

People’s capacity to make decisions about their care and treatment had been assessed.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

People’s needs were assessed and care and treatment were planned and delivered in line with their individual care plan. The care plans contained assessments of people’s needs and information on how care was to be provided. The care plans contained information about people’s daily routines and preferences. Visits by health care professionals were recorded.

Care plans were reviewed and updated regularly and signed by people (where they were able) or by their representatives. Individual risk assessments were carried out, so that people were cared for safely.

The provider had processes in place for the recording and investigation of incidents and accidents.

Health and safety audits were undertaken which indicated that all areas of the home were checked for safety and any areas requiring maintenance were identified.

All staff working at the service had a Disclosure and Barring Service (DBS) check carried out.

There were enough staff on duty to meet people’s needs in a timely manner, and bank staff were available to cover in the event of staff shortage.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care and support. Relatives we spoke with confirmed this.

There was a complaints procedure in place and people told us they knew who to complain to if they had a problem. Relatives were sent quality questionnaires to gain their feedback on the quality of the care provided.

People said they liked living at 142 Petts Hill Care Home. One person said, “It’s paradise here.” People were complimentary about the approach of the staff and managers. We observed a calm and friendly interaction between staff and people living at the service. People were supported to undertake activities of their choice, and those were recorded in their care records.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

We were informed by one person using the service, 'Staff always ask me before they do anything; the people are very good they tell me everything up front.'

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We observed that people's needs were assessed appropriately and care plans were individualised and person centred.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person using the service informed us, 'I feel safe, not in danger in any way.'

There were enough qualified, skilled and experienced staff to meet people's needs. People received effective and safe care from suitably skilled staff who understood their individual needs. We saw records of a very extensive programme of training that all care staff had taken part in.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We observed that all records were stored securely and all records were up to date.

We found the provider had completed all of the required work to improve the premises for people using the service. This included refurbishing and redecorating the kitchen, improving fire safety measures, updating staff training and ensuring that checks were carried out on staff before they started work in the home.

We spoke with one person using the service. They said "I've lived here a long time, it's looking good now, they've done a lot of work".