Perth House

We found the following examples of good practice.

There were PPE stations throughout the service and hand sanitiser outside each room.

Staff had been allocated to provide one to one support for people living at the service, this reduced the risk of cross contamination.

Staff had been trained in infection prevention and control, food hygiene and COVID-19. They had also been trained in hand washing and donning and doffing personal protective equipment. Staff were also assessed as to their competency with infection control practises.

Senior staff and managers all have laptops so that they are not sharing equipment. All staff have mobile phones and there is a separate phone for residents and also and two tablets so that people can make video calls to relatives.

The registered manager had adapted staff training and now train in smaller groups used to have eight staff members now do hour slots with two people.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

We saw that cleaning took place throughout the service, even in areas which were unoccupied. Staff had individual rooms where they took their breaks and they also had a separate room for donning and doffing personal protective equipment.

During the first outbreak of COVID-19 staff had not shared transport to reduce the risk of cross contamination and where necessary the service had paid for taxi’s where other transport was not available. This practice had continued throughout to reduce the risk of cross contamination.

The registered manager had developed a range of folders for the staff to be able to quickly reference information on COVID-19. There was a notice board which had clear information about caring for people who tested positive and those who were negative. There was also a COVID-19 risk assessment on the board which was regularly reviewed.

There was a robust infection prevention and control audit in place. If there were any areas for improvement identified, there was a clear action plan on how this had been followed up.

Professional visitors had a sign in sheet where it asked for lateral flow test result and vaccine status. The registered manager had a log of professional visitors who regularly entered the service.

Perth House is situated in the Chaddesden area of Derby and is owned by Derby City Council. Perth House provides personal care and accommodation for up to 36 older people and younger adults. The service supports people who require rehabilitation following a hospital admission; prior to returning home or to another care service. The intermediate care team who worked with the staff at Perth House had their offices within the building. At the time of our inspection there were 11 people using the service.

We found the following examples of good practice.

¿ A Covid 19 screening questionnaire was required for all visitors, to complete upon entry, hand washing facilities and hand gel were in place to comply with the required guidance.

¿ People were supported to contact their relatives and friends during their stay through video and telephone calls.

¿ A one-way system was in place from the entrance to enable social distancing and staff adhered to one person in certain places throughout the home.

¿ On the ground floor there was a red zone for people that had been discharged from hospital with a positive Covid 19 result and a green zone for people that had been discharged from hospital who were awaiting the results of their Covid 19 test. Both zones had their own cohort of staff. This minimised the risk of transmission.

¿ The first floor was used for people accessing the service to support their rehabilitation. They had their own cohort of staff and were supported in their rooms. Games and puzzles and daily newspapers were available to everyone using the service and televisions had also been purchased for all bedrooms.

¿Personal protective equipment (PPE) was worn by staff following government guidance. A PPE training pack had been developed by the registered manager. This was comprehensive and included a competency test to ensure staff understanding.

¿ Staff received a Covid 19 test at the start of their four-day shift . If any staff member tested positive, they would follow government guidance and self-isolate for ten days.

¿The premise was hygienic and clean. All areas were cleaned regularly throughout the day with hotspots such as door handles, and light switches cleaned frequently.

¿ People were enabled to access ventilation as for fresh air, through the windows throughout the service.

¿ Perth House had an established core of staff. A contingency plan included using one particular agency, if needed. Agency staff would be tested and trained in the same way as contracted staff.

¿ A detailed IPC policy was in place. However, this policy did not mention Covid 19. This was mitigated by the registered manager's comprehensive training and information pack and by using government guidelines in place.

¿ Risk assessments were completed for staff to ensure staff from black, Asian and minority ethnic groups and staff with health conditions, were supported effectively. Any staff assessed as vulnerable would not work in the red or green zones.

¿ Regular IPC audits were undertaken to identify any areas for improvement.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

A comprehensive inspection took place during December 2016 and the overall rating awarded was ‘Good.’ We carried out a further inspection on 14 August 2017 concentrating on two areas ‘safe’ and ‘well-led due to concerns received.’ However, the overall rating for the service awarded following this inspection changed to ‘Requires Improvement’. The provider was not meeting one of the regulations that we checked and was in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to take action to make improvements to promote people's safety and to improve systems and processes to monitor the quality of the service. The provider submitted an action plan outlining their plan for improvements.

At this inspection we found that the provider had made improvements and were now meeting fundamental care standards, resulting in a rating of ‘Good.’

Perth House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Perth House is situated in the Chaddesden area of Derby and is owned by Derby City Council. Perth House is registered to provide personal care and accommodation for up to 39 older people and younger adults. The service has intermediate care beds for people who need further therapy or treatment following a hospital admission and social care beds for people who are being assessed and supported prior to returning home or to another care service. At the time of our inspection there were 20 people using the service.

A registered manager was in post. 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.

People told us they felt safe with the care provided by staff. Staff we spoke with understood their responsibility in protecting people from the risk of harm. Staff told us they had received training and an induction that had helped them to understand and support people.

People were supported with their medicines in a safe way. Staff were available to support people when they required it.

Recruitment procedures were thorough to ensure prospective staff were suitable to care and support people at Perth House.

Risks were managed according to individual need and we saw staff support people safely and appropriately with transfers.

People were protected by the provider's infection control procedures, which helped to maintain a clean and hygienic environment.

People were supported to have maximum choice and control of their lives. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported with their dietary needs.

People were cared for by staff who were kind and caring. Staff respected people's privacy and dignity. People were supported with their independence by staff. Visitors were welcomed at Perth House.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint and felt the provider would take action to address any concerns.

People received a service which was well-led. The service monitored the quality of the service people received, where shortfalls were identified actions were taken to improve. People were asked for their views about the service and were listened to

This inspection took place on 14 August 2017 and was unannounced. At our previous inspection on 30 December 2016 and 6 January 2017 the provider was meeting all the regulations we checked and we rated the service as Good.

This inspection was focused following concerns received about medicines management at the service. The inspection only covered two of the key questions, safe and well-led. This report covers our findings in relation to the identified concerns. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the ‘all reports’ link for Perth House on our website at www.cqc.org.uk

There was a registered manager in post. 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 that the provider's quality assurance systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements.

Risk assessments were not always in place to ensure people received safe care. Not all risks to people’s health and safety were identified and action put into place to reduce them.

The provider had procedures in place for the management of medicines, to ensure people were receiving their medicines as prescribed. However we found that medicines audits were not clearly documented, which did not make it easy to identify if there were any shortfalls.

People and relatives told us that there were enough staff to support them. However a couple of staff felt that staffing levels were not adequate on the early shifts as it was the busiest time of day.

People and relatives we spoke with felt people were safe at Perth House. The provider had taken steps to protect people from harm. Staff had an understanding of potential abuse and their responsibility in keeping people safe. Recruitment procedures ensured suitable staff were employed to work with people who used the service.

People told us they were happy with the care they received and felt their concerns would be listened too. Staff told us they enjoyed working for the provider and they felt supported.

People were encouraged to share their opinions about the quality of the service to enable the provider to make improvements.

We found a breach 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.

Perth House is situated in the Chaddesden area of Derby and is owned by Derby City Council. Perth House is registered to provide personal care and accommodation for up to 39 older people and younger adults.

The service caters for people who need short-term care following a stay in hospital. The service has 16 intermediate care beds for people who need further therapy or treatment and 16 social care beds for people who are being assessed and supported prior to returning home or to another care service. At the time of our inspection there were 36 people using the service.

The service has a registered manager. This 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.

The ethos of the service centred on reablement and supporting people to be as independent as possible. Staff focused on encouraging people to do things for themselves. Records showed that people’s well-being improved during their stay at Perth House and in most cases they returned to their own homes.

People told us they thought Perth House was well-staffed and there were enough staff on duty to meet people’s needs in a calm and unhurried manner. Staff had time to talk with people, answer their questions, and provide them with reassurance. Staff were safely recruited to ensure they were suitable to work with the people using the service.

Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they had concerns about a person’s well-being. When people were admitted to the service staff identified any areas where they might be at risk and put measures in place to minimise these. For example people at risk of falls might be given walking aids and have staff supervise them when they moved about the service.

All the people we spoke with made many positive comments about the food served. Most of the food served was homemade and people had a choice of dishes at each meal. Staff had a good understanding of the varied nutritional needs of the people using the service. People were encouraged to eat with others in the dining rooms making meals a social event, although people could choose to eat in their rooms if they wished.

Staff worked closely with other health and social care professionals to ensure people’s needs were met. The range of expert treatment and care available at Perth House meant people had the support they needed to regain their health, confidence and independence. Staff met regularly with health care professionals to assess, plan and review people’s care and support.

Staff told us their goal was to get people back to their previous level of function or better so they were able to return to their own homes. The service’s multidisciplinary approach and joint working with other health and social care professionals made this possible as the majority if not all of people’s needs could be assessed and met at Perth House.

People told us the staff were caring and kind. Due to the nature of the service, with people only there for a limited time, staff needed to be able to build positive caring relationship with people quickly. We saw that staff were able to do this using good interpersonal skills and a warm professional approach that gave people confidence.

Activities were available at the service for people who wanted them. These included bingo, quizzes, crafts, reminiscence, dominoes and reading material. A hairdresser came to the service once a week and people told us they were pleased about this.

There was a friendly and inclusive atmosphere at the service. All the people and relatives we spoke with said the staff were approachable and they would speak to them if they had any concerns or wanted to share their views on the service.

The provider had arrangements in place to regularly assess and monitor the quality of the service. If people made suggestions about how the service could be better staff listened and took action to make improvements.

We last inspected this service on 13 August 2013. At the last inspection we found the service did not have effective procedures in place to manage medicines safely. At this inspection we found the provider had addressed the issues raised in the previous inspection. A summary of what we found is set out below.

Is the service safe?

We spoke with a relative who told us they, 'Had no concerns about the standards of care.' They said, 'If anything happens they get in touch with you right away. It's reassuring so I am not surprised if I come and see a bruise.'

The service investigated accidents and incidents and identified the actions required to improve the safety of people using the service. The manager told us they had made a safeguarding referral recently because someone had gone missing from the home. An investigation had been carried out and actions put in place to reduce the risk of a similar incident occurring again.

Is the service effective?

One person who used the service told us, 'I go to the day centre three days a week and really enjoy it. It's nice to meet other people. I get tired of sitting in the same place it's nice to have a change.'

Is the service responsive?

One person who used the service told us, 'I go to bed when I like. I like to go early and listen to the radio. I enjoy company during the day but I prefer my own company in the evenings.'

On the day of our inspection someone was concerned about their relative. We observed care staff reassure the person and they agreed to contact local health services for advice.

A relative told us, 'Care staff noticed something and contacted the GP quickly. They took [them] to the GP surgery and had it seen to right away.' They said, 'Anything I have raised has been seen to.'

Is the service caring?

We spoke with three people who used the service whilst they were waiting for tea. They told us, 'Staff are pretty good. They treat us well. We can't grumble.' One person told us, 'it's marvellous what they have done to improve things. I am looking forward to sitting in the new conservatory when the furniture arrives.' One person told us, 'The staff are very nice and work really hard.

Is the service well led?

The provider had developed a quality assurance process which consisted of audits and checks designed to identify and manage the risks to people's health and welfare. The service had also obtained feedback from people who used the service, relatives and staff.

Care staff were supported with training and supervision from their manager. We saw the manager discussed people's knowledge about supporting people, for example with dementia, as part of care staff supervision meetings.

People using the service told us they were happy with the care they received from the staff team. Comments included 'if you cannot be at home, there is no better place to be than Perth House', 'we feel safe here, the staff are lovely' and 'you have only got to ask for something and the staff are there straight away.'

We saw that people's needs were assessed, and care plans were in place. This meant they received support in a way that met their needs.

Most people told us they enjoyed their meals. People also said that they received enough to eat and drink.

The provider did not have effective procedures in place to manage medicines safely, which did not ensure people received medicines in a safe way.

Staff worked well together as a team, and felt supported by the management team.

People, who use the service, told us they had no complaints about the service and felt safe at Perth House.

In this report the name of a registered manager, Mr Kevin Jowett, appears. He was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this report.