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Inspection carried out on 18 February 2019

During a routine inspection

About the service: Potton House is a nursing home that provides accommodation for persons who require nursing or personal care. The service can accommodate up to 24 people who may have dementia care needs. At the time of inspection, 24 people were using the service.

People’s experience of using this service:

• Administration of medicines was not always recorded.

• Audits we found did not always contain accurate information.

• People received safe care. Staff understood safeguarding procedures.

• Risk assessments were in place to manage risks within people’s lives.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Staffing support matched the level of assessed needs within the service during our inspection.

• Staff were trained to support people effectively.

• Staff were supervised well and felt confident in their roles.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• People were supported in the least restrictive way possible.

• Care plans reflected people likes dislikes and preferences.

• People were able to take part in a range of activities and outings.

• People and their family were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required

• The service had a registered manager in place, and staff felt well supported by them.

Rating at last inspection: Good (report published 22/07/16)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Follow up:

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

Inspection carried out on 22 June 2016

During a routine inspection

This unannounced inspection took place on 22 June 2016. At our previous inspection in June 2015 we found that there was insufficient staff to provide one to one support for people who required it at all times, or to provide people with the support that they wanted in a timely manner. During this inspection we found that there were sufficient staff to provide the support that people needed and people’s needs were responded to without delay.

Potton House provides nursing care and support for up to 24 older people with dementia and needs relating to their mental health. At the time of our inspection there were 20 people who lived at the home.

The home had a registered manager, as required by the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were enough skilled, qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They received training to ensure that they had the necessary skills to care for and support the people who lived at the home and were supported by way of supervisions and appraisals.

People’s needs had been assessed before they moved into the home and they had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met. People or relatives acting on their behalf had been involved in determining their care needs and the way in which their care was to be delivered. Relatives were involved in the regular review of people’s care needs and were kept informed of any changes to a person’s health or well-being. However, people were not well supported to maintain their hobbies and interests and had not been encouraged to use the activity and stimulation equipment that had been introduced by the registered manager.

People had choice of good nutritious food and their weight was monitored with appropriate referrals made to other healthcare professionals when concerns were identified.

There was an up to date complaints policy in place and a notice about the complaints system was on display in the entrance of the home. There were a number of other information leaflets on the notice boards around the home which included information about the service and organisations that could be contacted for support or to report concerns.

There was a very friendly, family atmosphere about the home. People, relatives and staff were able to make suggestions as to how the service was provided and developed. An effective quality assurance system was in place.

Inspection carried out on 22 June 2015

During an inspection looking at part of the service

This unannounced inspection took place on 22 June 2015. At our previous inspection in October 2014 we found that there had been breaches in a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which have now been replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches had included the layout of the premises, safeguarding of people, providing suitable and adequate food and drink, providing staff with effective supervision and training, promoting people’s dignity and failure to have an effective complaints system in place.

During this inspection we found that considerable improvements had been made in all areas. However, there was still insufficient experienced staff to provide care and support for people with complex needs at all time.

People felt safe living at the home and enjoyed the food they were offered. They had choice and were supported to eat their meals. Their weight had been monitored and suitable steps taken when concerns were identified.

People received their medicines as prescribed and protocols were needed for medicines given ‘as and when’ required. People had been involved in developing their care plans and relevant people had been informed of any changes. However, people’s needs had not always been responded to in a timely manner and their assessed needs were not always met. Their rooms were personalised and they enjoyed the activities provided at the home. Staff, including the activity coordinator, had received specialised training to enable them to work with people who were living with dementia more effectively.

Relatives and friends were free to visit people at times that suited them. People were assisted to access the services of other healthcare professionals to maintain their health and well-being and had access to an advocacy service.

There were personalised risk assessments in place which were reviewed regularly and environmental risk assessments were in place with regular checks of equipment made. A new emergency call system had been installed and people could access their call bells easily.

Staff were caring, compassionate and promoted people’s dignity. They were provided with training, supervision and an annual appraisal. The recruitment system was robust which enabled the provider to be confident that staff were suitable for the roles in which they were employed. Staff were able to defuse situations when people’s behaviour had a negative impact on others and were kept advised of learning from incidents and identified best practice by the manager.

A registered manager had been appointed and this has had a positive impact on the home. The requirements of the Mental Capacity Act 2005 and related Deprivation of Liberty Safeguards were understood and implemented. There was an effective formal complaints system in place as well as an informal system for recording minor issues. There was also a robust quality assurance system in place. Relatives and staff were encouraged to attend meetings at which aspects of how the home was run were discussed.

During this inspection we found that there was a breach of Regulation 18 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.

Inspection carried out on 20 October 2014 and 24 November 2014

During a routine inspection

This inspection took place on 20 October 2014 and 24 November 2014 and was unannounced.

Potton House is a nursing home that provides accommodation and nursing care for up to 24 older people living with dementia.

The registered manager had recently left Potton House. The home is required to have a 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our last inspection In April 2014 we found that the provider failed to comply with their legal requirements in respect of consent, care and welfare, cleanliness and infection control, staffing and quality assurance processes. During this inspection we found that the provider had made improvements in regard to consent, cleanliness and infection control and quality assurance processes. However the required improvements had not been made in respect of staffing or care and welfare.

Robust recruitment and selection processes were also in place; however we found that there was still insufficient staff to provide safe care and support that people living at the home required. Also, staff training and development was ineffective and staff did not receive regular supervision.

We found that the systems in place to protect people from harm or abuse were insufficient. People’s privacy and dignity was not always protected and they did not always receive their care when they wanted it.

We found that people did not get a choice of what they ate, were not offered drinks and did not get the support that they needed to eat their food.

Care was not delivered in accordance with people’s care plans and people had little to occupy their time. People did not feel listened to and the provider’s complaints system was ineffective.

People’s medicines were managed and administered appropriately and people were supported to maintain their health and well-being.

The requirements of the Mental Capacity Act 2005 were met and where appropriate applications to deprive people of their liberty for their own safety had been made. Processes were in place for personal risks to be identified and managed to enable people to have as much independence as possible whilst keeping them safe. Processes were also in place to manage risks in connection with the operation of the home.

People were involved in the planning of their care and visitors were welcome at any time. There was an advocacy service available for people who had no friend or relative to support them. Staff felt supported and able to raise matters with the management.

During this inspection we found that there were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 22 April 2014

During a routine inspection

Our Inspector gathered evidence to help answer five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 22 April 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

We saw that risk assessments had been completed and regularly reviewed in relation to a range of issues relevant to people�s care needs. These included assessments relating to the management of medicines, nutrition and hydration, mobility, physical and mental health.

However, we saw that not everybody who lived at the home appeared to have received care and support at a time that best suited them or their individual needs and personal circumstances. Many people remained in bed throughout the morning of our inspection as they required the support of two members of staff to help them get up and complete their personal care.

One member of staff said, �We are still getting people up and its past lunchtime so dinner will be pushed back. We don�t have time to chat [with people] or do one to one work or activities. We do eventually meet people�s needs but mostly it�s late and not necessarily when they need it�

A range of policies had been put in place that gave staff guidance, information and advice about infection control practices and procedures. We also looked at records which showed that most staff employed at the home had received infection control training. Members of staff confirmed they had received training appropriate to their role and were knowledgeable about the infection control procedures used at the home.

However, during our inspection we toured the home and checked people�s bedrooms, including their en-suite facilities, toilets, bathrooms and communal areas. We found that in some areas the required standards of cleanliness and hygiene had not been met. For example, the carpets and toilet bowls in some bedrooms were dirty and heavily stained.

We saw that effective recruitment policies and procedures were in place to ensure that staff employed at the home were of good character and appropriately skilled to meet people�s needs. This included carrying out appropriate checks before staff began work.

Most of the people we spoke with during our inspection expressed concerns that staffing levels had not always been sufficient. A relative of a person who lived at the home said, �They [the provider] need more staff. Often I need assistance but can�t find anyone because they are all too busy."

Is the service effective?

During our inspection we saw that staff explained to people what was happening by using a range of both verbal and non-verbal communication methods. They made efforts to establish people�s wishes and obtain their consent before care and support was provided.

However, we looked at the 'Do Not Attempt Cardio Pulmonary Resuscitation' (DNACPR) records in respect of five people who lived at the home. In all cases we found it unclear as to whether or not valid consent about the decision not to resuscitate had been properly obtained in line with the provider�s own policy, published guidance and the Mental Capacity Act (MCA) 2005.

We looked at care records relating to seven of the 24 people who lived at the home. We saw that people�s individual care and treatment needs had been assessed, documented and reviewed on a regular basis. They were personalised and gave staff clear guidance about the care and support people needed in most cases.

However, some relatives expressed concerns about the length of time it had taken to get people up and the delays experienced in meeting their care and support needs. One relative commented, �I often arrive late afternoon and they [staff] are still getting people up. They meet my [family member�s] needs but are always late doing so.�

Is the service caring?

During our inspection of Potton House we saw that in most cases the people who lived at the home were supported in a kind and caring manner. We spoke with staff who demonstrated a good knowledge and understanding of people�s individual welfare requirements, health needs and personal circumstances.

Most people who were able to communicate with us said they were happy at the home and had been well looked after. One person told us, �I love it here. The staff are absolutely first class. They work wonders and I get looked after very well.� A relative commented, �I think people are well looked after in general. They are very good at getting doctors in quickly if there is a problem and following up on medical issues. All of the staff are dedicated, caring and good.�

However, when we observed lunch being provided in the communal dining room we saw that staff were rushed and that people were not offered a choice of meal or drink.

Is the service responsive?

The provider had put a complaints policy and procedure in place. People told us they knew how to complain if the need arose and we saw that information and guidance about the process had been prominently displayed in communal areas.

Staff told us that some of the people who lived at the home frequently displayed challenging, aggressive and occasionally violent behaviour towards other people and staff. We looked at the care records relating to one person who had displayed such behaviour on a regular basis.

Most of the care plans made reference to behaviour that often resulted in the person acting aggressively or violently in a way that made both them and others vulnerable to injury. Some plans gave staff guidance on how to deal with challenging behaviour if it arose, for example through distraction or by encouraging the person to go elsewhere in the home. However, we saw that plans had not been put in place to help staff recognise potential triggers to aggression or effectively manage the the behaviour.

Is the service well led?

The provider had some arrangements in place to identify and manage risks to people who used the service and to monitor and assess the quality of care and support they provided.

However, we were told that some weeks prior to our inspection the manager had been given the additional responsibility of managing another care home which meant that the leadership and management at Potton House may not have been as consistent and effective as it could have been.

We found that some of the systems used had not always been effective at protecting people against the risks of inappropriate or unsafe care and treatment. For example, audits had been carried out in relation to the environment and infection control. However, we found that problems identified with poor cleanliness and hygiene had been been responded to or dealt with effectively.

Inspection carried out on 24 June 2013

During an inspection in response to concerns

This inspection of Potton House was carried out in response to information of concern received by the Care Quality Commission (CQC). The information alleged that people were not having their nutritional needs met appropriately, with concerns that some people were missing out on meals.

During this inspection we found an environment which was welcoming, relaxed and friendly. We observed positive engagement and interactions between staff and residents. We spoke with five of the 18 people using the service who told us they were happy with the dietary care and support they received. One person said, "The food is always nice." Another person told us, "I have lots to eat."

We spoke to the cook who told us that food was cooked using fresh ingredients and locally sourced food items. Meals were designed to be nutritionally balanced and when required, were fortified to aid those people who needed increased calories.

Inspection carried out on 7 May 2013

During a routine inspection

During our visit to Potton House on 7 May 2013, we observed a calm and relaxed atmosphere. Staff supported people to participate in activities of their choice, at a pace that was appropriate to them. Two people told us that they felt happy and safe living at the home. We saw examples of this in the delivery of care, where privacy and dignity were respected.

One person told us, "The staff are kind to me and I feel safe." We reviewed five care plans and associated risk assessments and found they were person centred and reflected individual wishes and preferred routines. The four staff we spoke with were observed to be knowledgeable about peoples' specific care needs. This meant that care was safe and appropriate.

People were encouraged to participate in activities. A weekly activity schedule was in place for people, but alternatives were offered by the activity coordinator if people changed their minds. During our visit, some people were supported to go out for a walk and were encouraged to take part in other activities, including listening to music.

Inspection carried out on 28 December 2012

During a routine inspection

At the time of our inspection, on 28 December 2012, there were only 12 people at the home. Following serious concerns about the home at the beginning of 2012 the local authority had imposed an embargo on admissions to the home and the Care Quality Commission (the Commission) issued warning notices for the improvements that were needed. The organisation made improvements to the service provided and the Commission considered that the warning notices had been met in March 2012. The local authority lifted the embargo in July 2012 and the home have been able to admit people since that time.

The home has not had a permanent manager since May 2012 and at the time of our inspection there were two acting managers with clearly defined roles. During our inspection we found that the needs of people were met by a staff team who were positive about working there. Staff had a good understanding of the needs of the people who lived there and we observed staff providing support in a kind and respectful way.

Staff had received training and support which enabled them to carry out their roles effectively. There were satisfactory numbers of staff on duty. The acting managers were aware of the need to ensure staffing levels increased as admissions take place to the home.

Assessments were carried out to identify people's needs and there were care plans in place to provide guidance to staff about how to meet those needs. However, improvements were needed to the standard of record keeping.

Inspection carried out on 1 March 2012

During an inspection looking at part of the service

This review was undertaken on 01 March 2012, specifically to monitor what actions the provider had taken in response to the Warning Notices that were served in January 2012.

Although we did not speak with people who used the service as part of this review, we observed that they appeared well cared for, and at ease in the company of the staff that cared for them.

Inspection carried out on 15 December 2011

During an inspection looking at part of the service

When we visited Potton House on the 15 December 2011 we noted that everyone living at the home, had conditions which affected their cognitive functioning. This meant that their ability to communicate with, and understand us was very limited. However we observed that people looked content and comfortable, and where they required attention and support this was recognised and addressed swiftly by staff. We also spoke with the relatives of several people who lived in this home. They told us that the staff were �very kind and extremely good�. Our observations confirmed that the staff interacted with people in a caring and respectful way, and offered them choices using visual prompts whenever possible.

We observed short periods of engagement and conversation between the staff and people who lived in the home, and noted that at meal times and when physical care was being delivered, communication was positive. However we concluded that some people spent long periods of time with very limited or no mental or physical stimulation, which if increased could improve their well being and quality of life.

People were appropriately dressed and looked clean and well cared for, and where people needed support or assistance with personal care this was done in the privacy of their bedroom or the bathroom to protect their dignity.

Inspection carried out on 21 September 2011

During an inspection in response to concerns

During our visit on 21 September 2011, we were unable to speak with to people who use the service, as many of the people living in the home were unable to communicate verbally. We spent time observing and listening to the care people received.

During this visit we looked at the following outcomes, respecting and involving others, management of medicines, safety, availability and suitability of equipment, supporting staff and assessing the quality of the service. The judgements for these outcomes can be found within this report.