Pendleton Court Care Home

Pendleton Court is a care home which provides support for up to 58 people who require either; residential care, general nursing, or dementia nursing. At the time of the inspection there were 50 people living at Pendleton Court.

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

Staffing levels varied on different floors of the home. This led to some vulnerable people being left unsupervised on occasions. We have made a recommendation about deployment of staff throughout the home. Staff were recruited safely and all required documentation was in place.

Safeguarding issues were reported and escalated as required. Staff were aware of how to recognize and report any issues. Medicines were managed safely and staff had completed appropriate training.

Individual risks were assessed and monitored. Health and safety measures were in place to help ensure the safety of people using the service. We were assured infection control and prevention measures were appropriate and effective.

Care plans were person-centred and inclusivity was promoted within the home. Complaints were responded to appropriately and quality monitoring was regularly undertaken to help ensure standards remained good. The service engaged well with people who used the service, relatives and staff. People were encouraged to share their views within residents’ meetings. Relatives were kept informed of any incidents or news and staff attended meetings and one to one supervision sessions.

Learning was taken from the results of audits to help inform continual improvement to service provision. The home worked well with partner agencies and other professionals.

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 21 June 2019).

Why we inspected

We received concerns in relation to poor hygiene, poor staffing levels and poor care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at 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.

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.

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

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.

Pendleton Court is a care home which provides support for up to 58 people who require either residential, general nursing, or dementia nursing care. The home is a large converted mansion house situated in an elevated position at the rear of a residential estate. Accommodation is provided over three floors in single ensuite bedrooms. At the time of the inspection there were 36 people living at the home.

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

People felt safe living at Pendleton Court. Risk assessments and care plans provided staff with sufficient information to enable them to care for people in line with their wishes and keep them safe. Staff knew how to identify and report safeguarding concerns, with training provided and refreshed. Medicines were managed safely, by staff who had been trained and had their competency assessed. Accidents and incidents had been documented and reviewed to identify trends and help prevent reoccurrence.

The home completed a range of audits and quality monitoring procedures, to ensure all aspects of care, support and safety were regularly assessed and actions taken to address any concerns. People, relatives and staff’s views were captured via regular meetings and annual questionnaires. Staff told us they enjoyed working at the home and felt supported in their roles.

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 good (published June 2019).

Why we inspected

We received concerns in relation to safeguarding, staffing levels, cleanliness and the overall management of the home, with the home having recently experienced their third managerial change in the last six months. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained good. This is based on the findings at this inspection.

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

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.

Pendleton Court is a care home which provides support for up to 58 people who require either; residential care, general nursing, or dementia nursing. At the time of the inspection there were 56 people living at Pendleton Court.

People’s experience of using this service:

People appeared content and told us they felt safe. They were supported by caring and enthusiastic staff who provided stimulation and activity throughout the day. They were encouraged to maintain and develop interests and hobbies. Privacy and choice were respected, and confidential information was kept securely.

Staff understood safeguarding procedures and when concerns had been raised these were investigated and followed up appropriately. Similarly, there was evidence that the service learned from accidents and incidents, with follow up action to avoid further incidents occurring. Risks were identified, and steps taken to mitigate generic, individual and environmental risks.

The home was clean and well maintained; people were appropriately dressed and well groomed, and their personal care needs were generally met.

Before they moved to Pendleton Court, people told us they received a good assessment of their needs, and prior to admission the registered manager told us they considered issues of compatibility. Detailed care plans were person-centred, addressed need were regularly reviewed and people and their relatives had a say in how their care is delivered. Staff were vigilant to any changes in need.

Staff were appropriately recruited and inducted into service. All staff have access to up to date and refresher training and received supervision and appraisal.

There were enough staff throughout the service, they were able to complete tasks in a timely fashion. People told us call bells were answered promptly, and staff had enough time to spend with them. Staff worked well together and cooperated to complete and share allocated tasks.

People were offered appropriate choices. Staff had a good understanding of capacity and consent, acted in people’s best interests and didn’t always make assumptions about what people wanted.

The service had a registered manager who was respected by the staff, people and their family members. Staff felt directed and supported, and the registered manager had helped to develop a family culture in the service. People felt valued. Complaints were appropriately dealt with and used as a learning opportunity.

People and their families had a say in how the service was run through resident and relative meetings, and regular surveys and questionnaires. Feedback from recent surveys was mostly positive; adverse comments were acted upon where possible.

Regular audits and checks were undertaken including daily walkabout and management/quality checks. Where issues were noted actions were taken to improve the quality of the service.

Rating at last inspection:

Our last comprehensive inspection of Pendleton Court was in September 2016. The overall rating was ‘Good’, and the report was published on 27 October 2016. We undertook a further focussed inspection in January 2017, and the ratings for the sections we inspected (‘safe’ and ‘well led) were good. This report was published on 31 March 2017.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Inspection timescales are based on the rating awarded at the last inspection and any information and intelligence received since we inspected. As the previous inspection was Good this meant we needed to re-inspect within approximately 30 months of this date.

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

This unannounced focused inspection took place on Thursday 05 January 2017. Our last full comprehensive inspection at Pendleton Court was in September 2016 where the home was rated as ‘Good’ in each of the five key questions against which we inspected. These included Safe, Effective, Caring, Responsive and Well-led. This full comprehensive report from this inspection can be found on our website at www.cqc.org.uk/location/1-320530068 .

Following this inspection, we received information of concern relating to two areas; management of pressure sores and management of pain. This focused inspection was conducted to look at these two areas and this report is based around these findings only. As such, we have reported only on the ‘Safe’ and ‘Well-led’ key questions.

There had been a failure to send us a notification about the concerns relating to a grade four pressure sore in May 2016. We are following this up outside the inspection process. The registered manager told us they were aware that notifications of this nature should have been submitted. Since this time the home has consistently sent notifications to the CQC about all other incidents such as deaths, serious injuries and safeguarding incidents.

We looked at how the home cared for people who had, or were deemed to be at risk of developing pressure sores and found good systems were in place. People’s skin was assessed on admission with any marks or areas of potential skin break down recorded on a body map. This would enable staff to monitor people’s skin if there were concerns and take necessary action. The feedback from people living at the home who needed assistance to re-position, was that it was done well by staff.

We found ‘waterlow’ risk assessments were also undertaken for each person. This meant staff could respond accordingly if people were deemed to be at risk. Where people were deemed to be at risk, action for staff was recorded in the skin integrity care plans.

We looked at 13 skin integrity care plans during the inspection. This provided an overview of each person’s skin and the care staff needed to provide to help keep people safe. There was also accompanying information for staff to refer to about how frequently people needed to be turned/re-positioned, any equipment to be used and what to do if they had concerns.

Where required, we saw people received adequate pressure relief during the day and at night with accurate records maintained by staff. This provided people with the pressure relief they needed if they were unable to manoeuvre themselves in either their chair or when they were in bed. When people were re-positioned, staff also made a record of if their skin was intact.

Several people living at the home required the use of specialist equipment such as pressure relieving cushions and mattresses to help keep their skin safe. Where this requirement had been identified, we checked in bedrooms and lounge areas and saw this equipment had been provided for people. One pressure relieving mattress we checked was at the wrong setting and we immediately raised this with the manager who rectified this.

We found people received visits and that the home worked closely with services such as District Nurses. People’s care records clearly detailed when District Nurses had visited and if creams were applied to people’s skin or dressings were changed or applied.

We looked at how the home managed people’s pain. We found each person’s Medication Administration Record (MAR) detailed if they required any pain relief such as paracetamol, morphine or codeine. The staff were also able to give a good account of people who frequently asked for, or routinely asked for pain relief and that a time gap of four hours needed to be left in between each dose. People living at the home and their relatives told us they felt their pain was well managed. We observed staff giving pain relief when asked, with several people telling us staff offered pain relief at regular intervals rather than them having to make the request themselves.

Where people were administered pain relief, we found PRN (when required) protocols were in place. This provided staff with guidance for staff around when pain relief needed to be given, under what circumstances and what signs to look for if people were unable to communicate pain such as through facial expressions and body language.

Staff received training in relation to ‘Promoting Healthy Skin’. The registered manager had also introduced themed supervision sessions in relation to people’s skin where staff were asked about their knowledge and understanding and they had an opportunity to discuss any concerns.

The home also had quality assurance and governance arrangements in place with regards to pressure sores. The registered manager completed a monthly overview of pressure sores, the current waterlow score, when the sore developed, when it healed and how it was progressing. This fed into the homes internal quality assurance system known as ‘Datix. and was monitored accordingly. This system would ensure the home could respond accordingly if there were concerns.

The home is a large converted mansion house situated in an elevated position at the rear of a residential estate. The home is registered with CQC to provide care for up to 58 older people. Accommodation is on three floors in single en-suite bedrooms. A passenger lift provides access to each floor. The home is within walking distance of a local park and shops. It is also close to the local bus routes into Manchester city centre and Salford/Eccles and is close to the motorway network. There are three units at the home including nursing, residential and dementia. On the day of the inspection there were 25 people living on the nursing unit, 24 people living on the residential and nine people living on the dementia unit. As a result the home was at full occupancy.

We last inspected Pendleton Court Care Home on 04 June 2015, when the home was rated as ‘Requires Improvement’ overall and in the Safe, Effective and Well-led key questions. During that inspection we identified a breach of regulation with regards to staffing levels. We also found a breach and issued a warning notice with regards to medication. This inspection focussed on whether improvements had been made since the last inspection. We found at this inspection that the action required to address the breaches had been completed.

People living at the home told us they felt safe living at Pendleton Court. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

We found medication was now being given to people safely, ensuring people weren’t placed at risk. Both the manager and provider also undertook regular audits to ensure there were no shortfalls in practice.

Staff were recruited safely with references from previous employers being sought and DBS (Disclosure Barring Service) checks undertaken.

There were sufficient staff working at the home to meet people’s needs. Feedback from people living at the home, visitors and staff was that staffing levels were sufficient. Staff in particular, told us there were now enough staff working at the home to look after people safely.

Staff received an induction when they started working at the home, as well as receiving appropriate training and supervision to support them in their role.

The home worked within the requirements of the MCA (Mental Capacity Act), with the manager completing appropriate assessments if there were concerns about a person’s capacity. The home also worked within the requirements of DoLS (Deprivation of Liberty Safeguards) and supported people to access outside space, whilst keeping them safe at the same time.

We saw people received enough to eat and drink, with people also making positive comments about the food provided at the home.

All of the people we spoke with during the inspection including people living at the home, visitors and health professionals made positive comments about the care provided.

People told us they felt staff treated them with dignity and respect and promoted their independence where possible.

We observed several caring interactions during the inspection between staff and people living at the home, such as when people became distressed and upset.

People felt the home was responsive to their needs and we saw examples of staff doing this during the inspection.

Each person living at the home had their own care plan, which was person centred and detailed people’s choices and personal preferences.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. There were no active complaints at the time of the inspection.

All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach the management with concerns.

There were systems in place to monitor the quality of service such as audits, resident meetings, staff meetings and accident/incident monitoring.

Staff told us they enjoyed their work and liked working at Pendleton Court.

We looked at the care files of six people who used the service and found there were nutrition/hydration assessments, care plans and risk assessments in each file. We noted where people were judged to be at risk, there were prevention measures in place. Each file we looked at contained a Malnutrition Universal Screening Tool (MUST) and records to identify people were being weighed monthly or when required.

We observed staff had a good understanding of people's nutrition and hydration requirements on the day of our inspection. Examples of this included staff being aware of which people required either a soft or pureed diet, and being aware of which people required assistance to eat and drink.

In order to ensure peoples nutrition and hydration requirements were consistently being met, all staff were required to attend further nutrition/hydration training, risk assessments had been updated and the registered manager had introduced a food audit system to check the quality of food being served and to ensure people's specific dietary needs and requirements were adhered to.

One person who used the service told us; 'Yes, it's ok here. I like the carers. They come and help me to get washed and dressed each day. The food is nice, there's plenty of choice. Everything seems fine I have no complaints'.

We spoke with four families as part of our inspection and comments included; 'The staff really do work hard. They are very caring. Although I think people's needs are met at this home, I think they could have done with an extra member of staff or two on occasions'. Other comments included; 'The care is great. They (the staff) go through the care plan with me sometimes to let me know what is going on'.

We found that there were to suitable arrangements in place to protect people from harm and abuse and that staff had received recent Safeguarding adults training.

We looked at how Pendleton Court Care Home monitored the quality of service provision at the home and also how they had dealt with previous complaints that had been received. We found that there suitable systems in place in both areas.

The provider subsequently submitted evidence to show that 83% of staff were provided with the training in October 2012 and the manager told us that a further training session had been arranged for the five staff who had been unable to attend.

We found that people could express their views and were involved in making decisions about their care and treatment.

People we spoke to during the visit said they had been consulted about their care. For example, one person said "The manager came to visit me before I was admitted to find out what my needs were and tell me what the home could provide". Two relatives told us they had been kept informed of any changes in their relatives' needs.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People we spoke with told us they were satisfied with the care they were receiving at the home. Comments included "I like it here" and "I'm very happy here and well looked after".

People we spoke with said that there were enough staff to meet their needs and that staff answered call bells promptly. One relative said they had previously had concerns about staffing levels, but these had been raised with the management and they were now happy with the numbers of staff provided.

There was a shortfall in staff training, in that only the manager had received training in the Mental Capacity Act and Deprivation of Liberty safeguards. This could potentially put people who lack mental capacity at risk of receiving inappropriate care.