We inspected Piper Court on 27 May and 9 June 2015. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. We started the inspection at 5.30 am as a routine way to review the night time provision.
Piper Court is a 60 bedded purpose built care home providing nursing and personal care to people within three separate units. There is a 22 bedded functional mental health unit, 10 bedded nursing unit providing both general nursing and dementia care nursing and a 28 bedded unit providing personal care to people.
The home has 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.
At the inspection in August 2014 a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We issued warning notices in respect of regulation 13 Medicine management and regulation 20 Records. At the inspection in November 2014 we found that these breaches had not been addressed and the registered provider failed to meet five other regulations. In January 2015 we completed a focused inspection because of concerns raised around staffing levels and found there were sufficient staff to meet people’s needs and the registered manager was making improvements to the home.
At this inspection we reviewed the action the registered provider had taken to address the above breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We also completed a full review of the care and treatment provided at Piper Court.
We found that the provider had ensured improvements were made and the home was meeting the above regulations.
People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.
People we spoke with told us that there were enough staff on duty to meet people’s needs. One nurse, a head of care, three senior care and eight care staff were on duty during the day. On the first day we visited there was one nurse, two senior care and five care staff on duty overnight. Staff told us that this left them stretched. We discussed this with the registered manager who immediately increased the staffing level to six care staff. In addition ancillary staff such as cooks and domestic staff were on duty throughout the week. The registered manager, administrator, and an activities coordinator worked weekdays.
Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and clearly understood the requirements of the Act which meant they were working within the law to support people who may lack capacity to make their own decisions. We found that action was taken to ensure the requirements of the act were adopted by the staff. The provider recognised that staff needed additional support to ensure they had the skills and knowledge to consistently work with the Mental Capacity Code of Practice.
We saw that the activities coordinator engaged people in a wide range of meaningful occupation and this was tailor made to each person’s preferences. However, we discussed with the registered manager that the sole activities coordinator had to rotate across the units and this led to some people having limited access to activities.
The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.
People told us that they made their own choices and decisions, which were respected by staff. We observed that staff had developed positive relationships with the people who used the service. Where people had difficulty making decisions we saw that staff gently worked with them to find out what they felt was best.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.
Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia and Parkinson’s disease. We found that the provider not only ensured staff received refresher training on all training on an annual basis but routinely checked that staff understood how to put this training into practice.
We found that there were appropriate arrangements in place for obtaining medicines; checking these on receipt into the home; and storing them. We looked through the medication administration records (MAR’s) and it was clear all medicines had been administered and recorded correctly.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.
We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.
The registered provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the provider had implemented these and used them to critically review the service. This had led to the systems being effective and the service being well-led.