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Archived: Petteril House Requires improvement

Reports


Inspection carried out on 11 July 2018

During a routine inspection

The inspection took place on 11 and 17 July 2018 and was unannounced.

At our last inspection of this service, the provider was meeting the legal requirements and the last rating was Good.

Petteril House 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.

Petteril House is registered to accommodate up to 37 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. Accommodation is provided over two floors. At the time of our inspection there were 24 people living at the home.

The service had 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.

The service had ineffective systems in place to ensure there were sufficient numbers of staff on duty at the home. This was of particular concern at night when, at times only two members of staff were on duty for the whole of the home.

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

The service did not effectively monitor and manage the risks associated with poor nutrition and hydration. Support with eating and drinking was inconsistently provided and records relating to nutrition and hydration were poorly maintained.

The service had systems in place to help monitor the quality and safety of the service. The systems were not always effective in identifying where improvements should be made.

These are breaches of the Regulations.

The care records that we reviewed did not always reflect the most up to date and accurate information about people’s care and support needs. There were protocols in place to help ensure people were supported appropriately at the end of their life.

Medicines were not always managed safely. Gaps in records meant that people either did not receive their medicines as their doctor had intended or that staff had not recorded the administration of some medicines correctly.

Written information about other support services that people and their relatives could access was available. However, these formats would not meet the communication needs of some of the people using this service.

We have made a recommendation about involving people in decisions about their care.

There was little information recorded about people’s hobbies and interests. Staff organised activities such as bingo and quizzes on a day to day basis, if they had the time. Care and support planning did not take account of the social needs of people using this service.

We have made a recommendation about supporting people to follow their interests and participate in relevant social activities.

The provider had systems in place to help ensure people were protected from the risks of abuse. Staff were recruited safely and provided with training to help them understand the actions they should take if they suspected someone was being abused.

Staff employed at the service had access to, and attended training programmes to help keep their skills and knowledge up to date. Staff attended team meetings and supervisions, which provided a platform for them to discuss their work and performance.

Staff followed good infection control practices. The service ensured that safety checks at the home and maintenance of equipment had been regularly carried out.

Staff attended to people’s needs in a friendly and kin

Inspection carried out on 27 February 2017

During a routine inspection

This was an unannounced comprehensive inspection which we carried out on 27 February 2017.

We last inspected Petteril House on the 16 and 24 of November 2015. At that inspection we found the service was not meeting the legal requirements in force at the time relating to staffing and to person centred care planning. We found staffing levels were insufficient to meet people’s needs and person centred care was not always being delivered. On this inspection the home was now meeting these regulations.

Petteril House is a care home registered to provide accommodation for up to 37 people requiring personal care. The property is a two storey building with a passenger lift to assist people to access the accommodation on the first floor. People live in small units, each with a sitting and dining area. One unit specialises in providing care for people living with dementia. At the time of our inspection there were 21 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

Appropriate training was provided and staff were supervised and supported. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

People told us they felt safe and well cared for. They appeared content and relaxed with the staff who supported them. People and relatives said staff were very kind and caring.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People who used the service had been assessed to determine if a DoLS application was required. When people were unable to make decisions themselves then best interest meetings were held. People were supported to make choices where they were able, about aspects of their daily lives.

We recommend that the service reviews how it records people’s capacity and ability to give consent to make this more clear within care plans.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Records had been updated and they were regularly reviewed to reflect people’s care and support requirements.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people.

Staff and people who used the service said the registered manager was supportive and approachable. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people's care and support needs and the running of the service.

People had the opportunity to give their views about the service. The registered manager acted on feedback in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided.

A complaints procedure was available. People told us they felt confident to spe

Inspection carried out on 16 November 2015

During a routine inspection

We carried out this inspection over two days, the 16th and 24th of November 2015. We last inspected Petteril House on the 9th and 12th of March 2015 when all the regulations we inspected were met.

Petteril House is a care home registered to provide accommodation for 37 people requiring personal care. The home is located on the outskirts of Carlisle and is close to local shops and public transport routes.

The property is a two storey building with a passenger lift to assist people to access the accommodation on the first floor. People live in small units, each with its own sitting and dining area. One unit specialises in providing care for people living with dementia and other complex needs. At the time of our visits there were 29 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

We found at this inspection that there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not always sufficient numbers of support staff to meet the assessed needs of people living in the home.

You can see what action we told the provider to take at the back of the full version of the report.

We made the following recommendations.

We recommended to the registered manager that staff should receive further training in how best to support people with complex needs and behaviour that may challenge the service.

We recommended that details of an advocacy service be accessed and the information be on display throughout the home.

We spoke to people who lived in Petteril House and received favourable comments about the care and support they received. They said, “I like living here and I feel safe. The staff are very kind and nothing is too much trouble”.

We spent time on all three units speaking to people and their relatives. On the first day of our inspection visit we saw there was only just sufficient staff to meet all the assessed needs of the people. Staff said, “We are short today so we are very busy. If we had any more people we would not be able to manage”.

We saw, from the care plans that people had nutritional assessment in place with weights being regularly monitored and recorded.

Medicines were being safely administered and stored and we saw that accurate records were kept of medicines received and disposed of so they could be accounted for.

Some activities were provided if people wanted to join in. People could follow their own interests and maintain relationships with friends and relatives.

Staff were recruited correctly ensuring only suitable people were employed to work at Petteril House