Ponteland Manor Care Home

Ponteland Manor Care Home provides nursing care and accommodation for up to 52 people. At the time of the inspection, 47 people were living at the home, some of whom had a dementia related condition. Accommodation is provided across two floors which has adapted to meet the needs of people.

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

Measures had been taken to respond to the findings from our last inspection to ensure improvements were made in relation to Infection Prevention and Control [IPC], the governance of the service and duty of candour.

Policies and procedures in relation to infection prevention and control (IPC) to prevent the spread of infections were in place. The registered manager reviewed government guidance in relation to COVID-19 and a member of staff was the identified infection control champion at the home. Arrangements were in place for people to receive indoor visits from relatives or friends. Medicines were managed safely and reviews of incidents took place to assess if any improvements to staff practice could be made. Systems were in place to share this learning with the staff team.

The service was well-led. Governance systems were effective in monitoring quality at the home. The registered manager worked in an open and transparent way and understood their responsibilities in relation to the duty of candour regulation.

Systems were in place to safeguard people from the risk of abuse and the risks people were exposed to had been assessed. There were enough staff deployed to meet people’s needs. Due to difficulties in recruiting permanent staff there was a reliance on the use of agency staff. This had impacted on the consistency of care. There had been a successful recruitment campaign and plans were in place for a number of new staff to commence employment. This would reduce the need for agency staff at the home. People and their relatives were complimentary about staff and of the care provided.

Staff had been recruited safely. However, records did not always demonstrate the necessary checks had been completed for agency staff prior to them working at the home. We have made a recommendation about this.

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.

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 13 June 2022) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the management of an outbreak of COVID-19. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We also followed up on breaches identified at our last inspection.

We carried out an unannounced focused inspection of this service on 18 February 2022. 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, good governance and duty of candour.

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.

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 of safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

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

Recommendations

We have made a recommendation under the safe key question the provider reviews their agency staff induction system to ensure records evidence the necessary checks have been undertaken.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ponteland Manor Care Home provides nursing care and accommodation for up to 52 people. At the time of the inspection, 41 people were living at the home, some of whom had a dementia related condition. Accommodation is provided across two floors which has been adapted to meet the needs of people.

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

The service was not always well-led. Governance systems had not always been effective in monitoring quality or identifying issues at the home. A system to ensure duty of candour policies and procedures were followed was not in place.

Testing for COVID-19 was not always taking place in line with government guidance and safe infection prevention and control (IPC) practices were not always followed by staff. Although arrangements were in place for people to receive indoor visits from relatives or friends, this did not fully align with government guidance.

Medicines were not managed safely. Analysis of accidents and incidents were not always taking place to assess if any learning from incidents could be made to reduce the risk of repeat incidents. Risk assessments were not in place for all risks people were exposed to.

Systems were in place to safeguard people from abuse and there were enough staff deployed to meet people’s needs. During the inspection staff responded to people quickly. People and their relatives were complimentary about staff and of the care provided.

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

Rating at last inspection

The last rating for this service was good (published 16 January 2020).

Why we inspected

We undertook a targeted inspection in response to an outbreak of coronavirus at the home. We looked at infection prevention and control (IPC) 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.

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

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, duty of candour and the overall governance at the service.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Ponteland Manor Care Home provides nursing care and accommodation for up to 52 people. At the time of the inspection, 50 people were living at the home, some of whom had a dementia related condition.

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

People were complimentary about living at the home. One person told us, “I love being here as I really like having the company all of the time and I have made some new friends.”

The home had previously relied a lot on agency staff. More staff had recently been recruited. When agency staff were still required, the same agency staff were requested for consistency. An agency nurse told us, “I only go to the homes I like and this is one of them.”

Systems were in place to safeguard people from abuse. People told us they felt safe. Safe recruitment practices were followed. Staff were suitably trained and supported to enable them to meet people’s needs.

People were supported to eat and drink enough to maintain their health and wellbeing. Staff assisted people to access healthcare services and receive ongoing healthcare support.

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.

People were treated with kindness. People and relatives spoke positively about the caring nature of staff. One person told us, “Honestly, they are all just wonderful.”

People received personalised care which reflected their needs and preferences. Their social needs were met. One person told us, “I love the activities they are great, I join in with everything.”

The home had been through a period of change. A new manager was in post and the home had become more settled. People told us they were happy and spoke positively about living there. One person said, “I really like the atmosphere here, it’s a happy place.”

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 14 June 2017).

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.

The inspection took place on 2, 3 and 4 May 2017. The first day of the inspection was unannounced and the second and third day was announced. This meant staff did not know we were visiting on the first day.

We last inspected the service in September 2016 to follow up concerns from the previous inspection where improvements were required in the safe domain of the report. At the inspection in September we found that improvements had been made in the areas we found previously but we found further issues that needed to be addressed so the domain remained as requiring improvement. We returned to check all areas were now meeting the regulations fully.

Ponteland Manor provides nursing and residential care for up to 52 older people, some of whom were living with dementia. At the time of this inspection there were 33 people living at the home, including 18 with nursing needs

The service did not 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. The manager who was in the process of registering with the Commission no longer worked for the provider.

People said they received good care from kind, caring and considerate care workers. They also confirmed they felt safe living at the home. Relatives and care workers also told us the home was safe.

Care workers knew how to report safeguarding concerns. We found the provider had dealt with previous safeguarding concerns appropriately.

Where potential risks had been identified, an assessment had been completed to keep people as safe as possible. Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe. Health and safety checks were completed and procedures were in place to deal with emergency situations.

Medicines were managed safely. Only trained nurses and senior care workers administered medicines. People confirmed they received their medicines at the correct time and they were always made available to them.

We found there were sufficient care workers deployed to provide people’s care in a timely manner. However a number of people and relatives felt staffing levels were not appropriate at times. We have made a recommendation to the provider regarding review of staffing numbers.

Effective recruitment checks were in place to help ensure new care workers were suitable to be employed at the service. Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date and pre planned for the future.

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

People gave positive feedback about the meals they were served at the home, although some attention was required for those people with special dietary needs. People received the support they needed with eating and drinking. Some people had been referred to external healthcare professionals for additional specialist support, for example those at risk of choking. We have made a recommendation with regards to food choices for people with diabetes.

People and their relatives were positive about the kind and caring nature of staff. People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times.

People’s needs were assessed before they came to live at the service and then personalised care plans were developed and regularly reviewed to support staff in caring for people the way they preferred.

A new activity coordinator had just started work at the service in the same week as the inspection and was in the process of getting to know people and their likes and dislikes in terms of the activities they liked to participate in.

‘Residents’ and relative meetings were held so that people could share their views and suggestions.

People knew how to complain. Previous complaints were investigated and resolved in line with the registered provider’s complaint’s policy.

We received mixed views regarding the previous manager. Some people and relatives said they were good and seemed to get “things” done, but many staff said that they were not very person centred and many felt they could not approach them with any concerns for fear of repercussions. There was a consensus that other senior staff at the service were supportive and approachable.

There was a range of internal and external quality assurance audits in place to check on the quality of people’s care and make improvements where necessary.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we have found.

Is the service safe?

The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others however these systems did not always identify issues. For example, with care planning or staff training.

We saw risk assessments had been completed for people who were assessed as being at risk of falls.

We saw people were safe and protected from abuse. Staff demonstrated to us an understanding of the types of abuse and how they should be reported.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and the manager and deputy manager had received training in the Mental Capacity Act 2005 (MCA) and DoLS.

We saw there were sufficient members of suitably qualified and experienced staff on duty to meet people's needs.

Is the service effective?

There was evidence that people had access to professionals such as, doctors, opticians and occupational therapists.

We saw staff did not always receive the appropriate training and professional development to assist them in their role. Staff supervisions were not always up to date. Where staff had received training we saw they had not all received refresher training in that subject.

Is the service caring?

People did not always have care plans in place to provide staff with the correct guidance on how to meet people's needs. Care plans did not always contain a detailed life history for people to provide staff with the correct knowledge to allow them to care for people effectively.

People's preferences, interests and needs were recorded in people's care records. Staff were able to give examples of these when we spoke to them and displayed a good knowledge of the people living at the home and what their likes or dislikes were.

Is the service responsive?

There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.

Is the service well led?

The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service.

We spoke with eleven people who used the service and three visiting relatives to find out their opinions. Comments from people included, "It's fine here. Everyone is nice" "Everyone is kind" and "It's comfortable here. No problems." Some relatives referred to the regular use of agency nurses and care workers and described some inconsistencies in approach and advice given to them by staff.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We saw that people were supported to be able to eat and drink sufficient amounts and they were protected from the risks of inadequate nutrition and dehydration. We found that there were appropriate arrangements in place to manage medicines. People told us they got their medicines when they needed them.

There were enough numbers of qualified, skilled and experienced staff to meet people's needs, although we noted there was significant staff turnover and low staff morale. Input from agency staff was required most days and nights of the week.

We found that the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We found that people's privacy and dignity were promoted. They were asked for their consent and the provider acted in accordance with their wishes. Comments from people included, 'It's here that keeps me alright' and 'Everything is excellent here. It's delightful.' However, people were not getting the support they needed with their personal care. People commented, "I only get a bath or shower every eight weeks" and "I don't get enough baths or showers or help to wash my hair often enough."

We saw that some people were not given the assistance they needed at mealtimes to keep them safe. Overall, we found that there were robust systems in place to manage and administer medicines, apart from topical medicines that were applied by care workers.

We concluded there were not enough qualified, skilled and experienced staff to meet people's needs, as people who used the service were not getting sufficient assistance with their personal care and some were not getting the dedicated one to one assistance they needed at mealtimes. We found that staff received appropriate training for their professional development.

We found that improvements were needed in quality assurance processes to better identify, assess and manage risks to the health, safety and welfare of people who used the service.