PNP Care Home

We found the following examples of good practice.

¿ The provider had implemented an appropriate policy around visitors during the pandemic. Visits were restricted and management risk assessed each visit. Staff checked all visitors for any signs or symptoms of infection before they were allowed into the home. Visitors were required to follow best practice guidance and wear appropriate personal protective equipment (PPE). The need to restrict visits to the home had been discussed with people and their relatives.

¿ Staff supported people to maintain their relationships with their families and friends. People connected with families and friends through video calls and over the telephone.

¿ The provider had implemented measures to reduce the risks when people returned from hospital. This included people having to isolate in their bedrooms and followed national guidance.

¿ People who lived at the home and staff were supported with regular testing for COVID-19.The provider had plans around cohorting and zoning the premises, which helped to reduce the risk when a positive result was received.

¿ Staff were provided with training around COVID-19 and the correct use of PPE. Staff used additional PPE when supporting people who had tested positive for COVID-19. We observed staff wore PPE appropriately during our inspection.

¿ We observed the home looked clean and hygienic. Staff told us high touch areas such as door handles received additional cleaning. The provider had assessed risks related to infection control, COVID-19 and the general environment, in order to reduce the level of risk and keep people safe.

Further information is in the detailed findings below.

PNP Care Home provides personal care to 14 people aged 65 and over at the time of our inspection. The service can support up to 19 people. PNP Care Home provides accommodation spread over three floors with lift access and all bedrooms offer en suite facilities. There are three lounges and a dining area for people’s choice and comfort. PNP Care Home will be referred to as PNP within this report.

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

People and relatives confirmed they felt safe. One person told us, “The staff are very good at making sure we’re all safe.” The management team completed risk assessments to guide staff to retain people’s safety. Staff were able to describe good practice in preventing harm or unsafe care.

Staff concentrated on one person at-a-time to administer medicines safely, explained what they were doing and provided a drink. They signed records afterwards to demonstrate people received their medication on time.

The registered manager maintained a sufficient workforce to meet people’s needs in a timely way. A relative commented, “Yes, I think they have enough staff on duty.” Staff said they had good levels of training to enable them to be confident in the delivery of care.

Staff had training to underpin their skills in safe food handling and assisting individuals with their nutritional support. People and relatives told us meals were of a good standard and they had menu options to choose from.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported each person to make their day-to-day decisions.

People and relatives told us staff were very caring and they felt happy at PNP. One person stated, “They look after me, the staff are good.” The management team had good processes to ensure care delivery was responsive to people’s requirements.

The registered manager was keen to engage with staff, people and visitors to improve the quality of care. They developed an open culture at PNP and encouraged people and their relatives to be involved in improvements.

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 requires improvement (published 31 July 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

PNP Care Home 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.

There is a registered manager at the service. 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.

At the last inspection of the service we found 7 breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. These breaches were Regulation 9 (Person centred care), Regulation 10 (Dignity and respect), Regulation 12 (Safe care and treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing), Regulation 19 (Fit and proper persons employed) and Regulation 18 Registration Regulations 2009 (Notifications of other incidents).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations. During this inspection we checked to see if there had been improvements at the service. We found all the breaches of regulation had been improved.

We found people were protected from risks associated with their care because the registered provider had completed risk assessments. These provided updated guidance for staff in order to keep people safe.

We found improvements had been made in medicines management. Monthly audits were being completed and management had oversight of these. Staff had received training and support around medicines management.

We found that maintenance checks were completed and there had been improvements. A range of checks were carried out on a regular basis to help ensure the safety of the property and equipment was maintained.

We looked at how accidents and incidents were being managed. There was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these.

The service had procedures to minimise the potential risk of abuse or unsafe care. Staff had received safeguarding training and were able to describe good practice about protecting people from potential abuse or poor practice.

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

Staff received supervision and appraisals and told us they felt supported. Staff training was ongoing and evidence was seen of staff completing training. We saw evidence people's care and support was delivered in line with legislation and evidence based guidance.

We found in depth assessments were carried out by the registered manager before any person received a service. Peoples needs for nutrition and fluids had been considered. Files contained likes and dislikes with regards to food and drink. We observed people eating in a relaxed manner and they seemed to enjoy their meals.

We received consistently positive feedback about the staff and about the care people received. Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights.

Each person had a care plan which was tailored to meet their individual needs. We saw care records were written in a person-centred way. People told us they were encouraged to raise any concerns or complaints. The service had a complaints procedure.

We found the management team carried out audits and reviews of the quality of care. We found some concerns with the oversight of supplementary recording which management addressed during the inspection.

Staff we talked with demonstrated they had a good understanding of their roles and responsibilities. We found the service had clear lines of responsibility and accountability with a structured management team in place.

The provider and registered manager had clear visions around the registered activities and plans for improvement moving forward. The management team were receptive to feedback and keen to improve the service. The manager worked with us in a positive manner and provided all the information we requested.

Whilst the service had improved since the last inspection. Standards need to be embedded to demonstrate good practice over time. We will check this during our next planned comprehensive inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

PNP Care Home 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.

PNP Care Home was newly registered on 23 November 2016. Consequently, this was their first inspection.

There was a registered manager in place. 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 asked the registered manager how they monitored accidents within the home. We were told all accidents were reported using accident forms. We reviewed the records and found no oversight of the accidents and no action taken following these to lessen the risk of accidents happening again.

We looked at medicine administration records (MARs) of people who lived at PNP Care Home. We checked the records and found several omissions in the documentation. We checked against individual medicines packs and found some discrepancies in the totals. This meant that we could not confirm that all administered medicines could be accounted for.

We viewed three care records to look how risks were identified and managed. We found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.

We viewed maintenance records which had documented water temperatures of 46°C, 50°C, and 45°C. No action had been taken by the service as a result of these readings. This could have put people at risk of scalds.

From the documentation reviewed we saw that fire safety equipment audits had not been completed at the home since September 2017. Therefore we could not be assured that the fire safety equipment at the home was safe, this put people at risk.

The above paragraphs amounted in a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2008 (Safe care and treatment.)

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

This failure to follow the code of practice amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent.)

We spoke with the registered manager to assess their understanding of their responsibilities regarding making appropriate Deprivation of Liberty (DoLS) applications. We noted three people had alert alarms in place. These are alarms which are used to minimise the risk of falls. We asked the registered manager if DoLS applications had been made regarding the use of the alarms and the locked door that is in place at the home. The registered manager told us they had not.

We found that staff were able to tell us about safeguarding principles and recognised signs of possible abuse. However, they did not always put this knowledge into everyday practice. For example, we found that not all safeguarding incidents had been appropriately reported to the relevant authorities, in line with current legislation and the policies and procedures of the home.

The above paragraphs amounted in a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2008 (Safeguarding service users from abuse and improper treatment.)

There was no training matrix in place at the time of the inspection so the registered manager was not aware which staff were trained. We asked for this to be completed and sent to us following the inspection. Staff completion of training was low with only three out of 21 staff having dementia training. Nine out of 21 staff had completed health and safety training. Staff we spoke with told us that they would like further training.

These shortfalls in training of staff amounted to a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We reviewed five care files and found people’s current needs were not always identified. Care plan information was not always an accurate, complete and contemporaneous record. Person centred information in care files was inconsistent.

We looked at what arrangements the service had taken to identify, record and meet communication and support needs of people with a disability, impairment or sensory loss. We viewed one care file for a person who was nonverbal we could not see any care plan in place for this assessed need.

We saw, from care records, staff had not discussed people's preferences for end of life care. This meant the provider would not know what the person's preferences were and would not be able to respect these on death. At the time of our visit, no one living at the home was receiving palliative or end of life care.

The above paragraphs amounted in a breach of regulation 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the management and registered provider to tell us how they monitored and reviewed the service to make sure people received safe, effective and appropriate care. We found the service did not have a robust quality auditing system.

The lack of consistencies we found across the service also demonstrated the lack of oversight from the registered provider. From the evidence we found during the inspection it was apparent that the leaders in the home lack the knowledge to ensure that the home is run effectively. The Registered manager demonstrated insufficient knowledge of the regulations.

These shortfalls in leadership and quality assurance amounted to a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Providers of health and social care services are required to inform the Care Quality Commission, (CQC), of important events that happen in their services. The registered manager of the service had not informed CQC of significant events as required. This meant we were unaware of the events and could not check appropriate action had been taken.

This resulted in a breach of Regulation 18 (Notification of other incidents) CQC (Registration) Regulations 2009.

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

Following the inspection the provider has provided us with an action plan to address the concerns that we highlighted, this is considered good practice. We found the whole staff team receptive to feedback and keen to improve the service. They worked with us in a positive manner and provided all the information we requested.

We received consistent positive feedback from people who used the service.

We reviewed staff rotas and observed that there were enough staff on duty to meet people’s needs. People who lived at the home told us, “There are enough staff they come when I ask.” And, “The staff come straight away when you need them.” Staff we spoke with confirmed that they felt that there was enough staff on duty. We have made a recommendation about assessing staffing levels.

We looked around the home and found it was clean and tidy. The management team employed designated staff for the cleaning of the premises and cleaning schedules were completed.

We found the home was pro-active in supporting people to have sufficient nutrition and hydration. People we spoke with told us they enjoyed the food served at the home. Comments about the food included, “The food is very good.” And, “I like the food if you don’t like the choices they will get you something else.”

There were activities for the residents to engage in and people were supported and encouraged to take part. One person told us, “We have a singer who comes in and we play pass a ball.”

Following the inspection the provider has provided us with an action plan to address the concerns that we highlighted, this is considered good practice.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usua