Pennwood Lodge Nursing Home

Pennwood Lodge Nursing Home is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 62 people. Care is provided across four separate units. At the time of our inspection visit, one unit was closed awaiting refurbishment work.

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

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 support this practice. People had access to a balanced diet and were supported to eat and drink in a safe way. Referrals to health professionals were made when required. The environment was appropriately designed and adapted to meet people's needs.

The service was well-led by a management team who were passionate about improving care and achieving the best possible outcomes for people at the home. Quality assurances systems were effective in monitoring the safety and quality of the care provided through robust audits and checks. People, relatives, staff and professionals spoke positively about the leadership of the service. One professional told us, "I would say things have improved over the last couple of years. The permanent staff seem on the whole pretty clued up and caring. One of the positive things to come out of COVID is probably we are in closer contact than we were before March 2020.”

The provider had infection control processes in place to protect people and prevent the spread of infection. There was plenty of personal protective equipment (PPE) available, and staff followed the provider’s guidance and expectations.

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 13 September 2019).

Why we inspected

We received concerns in relation to staff practice. As a result, we undertook a focused inspection to review the key questions of effective and well-led only.

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 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 the same. 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 Pennwood Lodge Nursing 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.

Pennwood Lodge Nursing Home is a residential care home providing personal and nursing care to 29 people living with dementia, aged 65 and over, at the time of the inspection. The service can support up to 60 people in one purpose built building. The care is divided up into four separate units. At the time of our inspection visit, two units were closed awaiting refurbishment work.

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

People were safeguarded from the risk of abuse and from risks from receiving care. People were supported by sufficient numbers of staff. People’s medicines were safely managed.

Staff received support to develop knowledge and skills for their role. There were arrangements in place for people and their representatives to raise concerns about the service.

People's individual needs and wishes were known to staff who had achieved positive relationships with them. People were supported to engage in a range of activities.

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.

Effective quality monitoring systems were in operation. The manager was visible and accessible to people and their visitors.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

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.

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

Pennwood Lodge Nursing 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.

Pennwood Lodge Nursing Home provides residential and nursing care for up to 60 people living with dementia. At the time of our inspection there were 27 people living there. The home has four 15 bedded units, each with their own communal lounges, dining rooms and bathrooms. One of the units was closed and due to be refurbished. Of the other three units two accommodate people with nursing care needs. All bedrooms are for single occupancy and the majority of rooms had en-suite facilities.

We previously inspected the service in August and September 2017 and rated the service ‘Requires Improvement’ overall. We found the service did not meet the requirements of three of the regulations. Risks to people had not been sufficiently identified and action had not always been taken to reduce or mitigate risk to keep people safe from harm. Staff had not always received the support they needed to undertake their roles effectively. Systems and processes used to monitor the service had not identified these shortfalls and had not led to improved outcomes for people.

We asked the provider to complete a plan of action to show how they would make the required improvements. We also told the provider they needed to meet the regulation relating to Good Governance by 31 January 2018.

At this inspection we found improvements had been made and the service met the regulations. However, further improvements were needed before the service could be rated ‘Good’ overall. We again rated the service 'Requires Improvement' and this is the second time the provider has been rated 'Requires Improvement' overall.

People’s risks had been assessed and risk management plans were in place. We found improvements had been made to the monitoring of those people at risk of weight loss. Nurses had managed risks relating to people’s skin and wounds were treated appropriately. However, people’s wound records and behaviour support plans were not always comprehensive and completed in a timely manner. Plans were in place to complete these with support from the newly appointed mental health nurse. This was so staff and visiting professionals had access to clear guidance and up to date information about people’s care.

The provider’s quality assurance systems had resulted in improvements having been made to the service since our last inspection. These systems had been effective in ensuring the service met the required regulations. The quality monitoring of the service needed at times to be more effective to ensure when shortfalls were identified, for example in relation to people’s records, the action taken to drive improvement would always result in shortfalls being addressed promptly. The provider had recruited a new manager, clinical lead nurse and mental health nurse to support these require improvements.

There was no registered manager at the time of our inspection but the provider had recruited a new experienced manager from one of their other services. They were already working in the service and were planning to register with CQC to ensure the provider met their registration requirements. 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’s prescribed medicines were stored and administered safely. We observed staff following best practice when administering people’s medicines and the medicine records were complete.

People were cared for in a safe and well maintained environment. Following our previous inspection a more dementia friendly environment had been created; with interactive scenes and objects of interest for people to touch and use around the home. People were supported by staff who were trained to keep them safe and had access to training to develop their knowledge.

People made independent decisions and choices about their care when possible. When people did not have the capacity to make decisions staff followed the Mental Capacity Act. 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 support this practice.

We observed people had a positive dining experience and were helped to choose their meals and assisted when required. People were treated with kindness and respect and they and their relatives told us how good the staff were. We observed staff engage with people in a caring manner to reassure them and promote their wellbeing. People had access to the community on trips out and completed group and individual activities with staff.

People and their relatives were given support when making decisions about their preferences for end of life care. We found people had compassionate end of life care and individual attention to ensure they were always comfortable and free from pain. Staff routinely sought the assistance of health care professionals to guide them in managing people's more complex needs.

People, their relative and supporters were able to voice their opinion of the home and they were listened to. For example, during a recent meeting, at reviews and weekend surgeries. Staff told us the managers were approachable and there had been positive changes within the home.

Pennwood Lodge Nursing Home provides residential and nursing care for up to 60 people living with dementia. At the time of our inspection there were 38 people living there. The home has four 15 bedded units, each with their own communal lounges, dining rooms and bathrooms. One of the units was closed and due to be refurbished. Of the other three units, one is for people with personal care needs (residential care) and the other two are for people with nursing care needs. All bedrooms are for single occupancy and the majority of rooms had en-suite facilities.

We last inspected the service in June 2015 and we rated the service Good. At this inspection we have rated the service Requires Improvement and we will require an action plan of how and when the improvements will be made.

There was 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.

People were at risk of unsafe care and treatment because assessments of their needs were not always reflective of their current risks and support requirements. People's care plans did not always provide the care staff with clear guidance to follow to know how to support people safely. Care plans were not always personalised to meet people's individual needs when they were living with dementia.

Systems were in place to monitor the quality of the service and risks, however these quality assurance systems were not always effective in driving improvements. The provider had identified improvements were needed in relation to staff supervision and care planning, but timely action had not been taken and we found these areas continued to require improvement.

Medicine practices required improvements to ensure medicine records would always be completed and medicine stock kept would be sufficient to ensure people received their medicines as prescribed.

Some pressure relieving equipment was not used correctly and placed people at risk of skin damage.

People living with dementia did not always have a positive dining experience and we made a recommendation to support the provider to make improvements. People had access to healthcare professionals and their health and welfare was monitored by them.

People made most decisions and choices about their care when possible. When people did not have the capacity to make decisions staff followed the Mental Capacity Act guidance to protect them and helped people to make choices.

People were treated with kindness and respect. They told us staff were good when they supported them with their care. Staff knew how people liked to be supported. People told us they felt safe in the home. People were supported by staff who were trained and had access to training to develop their knowledge.

Some people joined in with activities provided which included ball games, musical entertainment, visits by the therapy dog, nail pampering, crafts and boards games. There was minibus and the registered manager was looking at increasing opportunities for people to access the community. People and their relative's views and concerns were taken seriously. They completed surveys and contributed in regular meetings. Staff meetings were held monthly and staff were able to contribute to the running of the home. The registered manager was approachable with relatives, staff and people and had plans to improve the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations have been concluded.

This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Pennwood Lodge’ on our website at www.cqc.org.uk.

Pennwood Lodge Nursing Home is registered to provide residential and nursing care for up to 60 people living with dementia. At the time of our inspection there were 35 people in residence. The home has four 15 bedded units, each with their own communal lounges, dining rooms and bathrooms. However, one of the units was closed in 2015 and has remained closed since. This reduces the capacity of the home to 45. Of the other three units, one is for people with personal care needs (residential care) and the other two are for people with dementia and nursing care needs. All bedrooms were for single occupancy and the majority of rooms had en-suite facilities.

At the time of the inspection there was no registered manager in post. There has been no registered manager since November 2015 and the provider was required to have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The provider had taken steps to recruit a permanent manager but not been successful. In the interim, the provider had allocated ‘turnaround managers’ to manage the service. The current turnaround manager commenced the application process to be the registered manager during our inspection visit.

At this inspection we have looked at care plans and other related care documents. We have looked at the staff rota’s for a six week period and discussed the staffing arrangements.

We found some shortfalls in the care documentation for two people. The provider took immediate action to address the issues and put measures in place to conduct spot checks and random night checks to ensure the expected standards were implemented and sustained.

Because we did not look at the procedures in place and working practices for all 35 people in residence, we have not revised our rating of the service.

Whenever we undertake a full inspection of a care home we look to ensure that the service is safe, effective, caring, responsive and well-led. When we visited on 9 September 2014 we found some aspects of the service were not safe and not well-led.

Is the service safe?

The registered provider and registered manager have ensured the appropriate action had been taken when safeguarding concerns, or possible safeguarding concerns, have been raised. Robust reporting procedures have been put in place to ensure that appropriate steps are taken to safeguard people from further harm.

Is the service well-led?

Notification forms have been submitted to the Care Quality Commission in respect of previous events that had not been reported. Notifications have also been submitted regarding events that have occurred since our last visit.

There remains an outstanding compliance action in respect of people's care records. The registered provider submitted their action plan on 28 October 2014. They told us what action they are taking to improve care documentation. We will follow up that these improvements have been made when we next inspect.

People had dementia and were unable to tell us about their care but they made positive comments. 'Everything is good', 'I like it here and the staff all fuss over me' and 'I get a bit down and confused at times but staff help me sort things out'. Relatives were complimentary about the way their loved ones were looked after.

Staff were knowledgeable about the people they looked after. They were able to relate the individual needs, choices and preferences of people.

We spent a period of time watching what was going on in Willow unit and observed how people spent their time and the staff interactions. On the whole people had positive experiences and there was good interactions between individuals and groups of people. We told the manager about areas where improvements were needed.

We looked around the whole home: it was clean tidy and well organised. The home had an ongoing programme of refurbishment and redecoration and was smarter then when we had previously visited.

People told us staff were kind and patient with them, helped them when they were anxious and were professional in their roles.

People and their families/friends, were asked for their views about their care and support and the provider took account of any comments made to improve their service.