Pennine House

People’s experience of using this service:

The service had improved and now meets the characteristics of good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People using the service can live as ordinary a life as any citizen.

There was a manager in post who was in the process of completing their registration with us. 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 risks to people’s health and wellbeing were assessed and action taken to reduce them. This including supporting behaviours which could be challenging. There were systems to learn from mistakes including the detailed analysis of accidents and incidents. People were supported by staff who understood how to protect them from avoidable harm. There were enough staff deployed to keep people safe in the home and when they chose to go out. People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection.

Staff received training to enable them to do their jobs well. Assessment ensured people were supported to transition into the service well. They were supported to maintain a healthy diet. Their health and welfare were managed with referrals to other professionals made when required. 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.

There were kind and caring relationships between people and staff which were based on dignity and respect. People felt involved with decisions and that staff respected their wishes. People had care and support provided which met their preferences. Complaints were handled in line with the provider’s complaints policy. People did not currently receive end of life care but people had discussed their wishes with staff.

Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

More information is in the full report.

Rating at last inspection: The service was last inspected on 29 November 2018 and was rated requires improvement.

Why we inspected: This was a scheduled inspection to follow up on previous enforcement when we issued a warning notice around the governance and oversight of the home.

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

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

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect these areas. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this 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 provider demonstrated to us that improvements had 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.

Heathcotes Chesterfield (Pennine House) 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a manager in post who was in the process of completing their registration with us. 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 not always protected from potential harm or abuse because one person was restricted in their home without legal authority. The provider had not ensured that they were always supporting people in a lawful way to safeguard them. Risk was not always fully assessed, reviewed and managed to ensure that people were safe and that lessons were learnt when things went wrong. Staff did not always have the training and competence to support people to minimise the risk of harm to themselves or others. Medicines were not always managed in line with national guidance.

The provider’s own quality audits had recognised the issues with risk and training; however, no immediate action had been taken to protect people, nor to provide additional support to the manager and team at the home.

There had been improvements in providing a consistent staff team to support people. Staffing was planned around individual need and included having additional staff available to support people to go out when they chose to. Safe recruitment procedures were followed.

The manager supported staff and people within the home. Staff felt that they could raise any concerns with them. There were staff meetings and supervisions in place to support them.

The provider had worked with partner organisations to make improvements and was clear about their continued development points to improve the service. They ensured that we were notified of significant events in line with their registration.

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 and appeals have been concluded

We inspected the service on 16, 24 and 29 August 2018. The inspection visits were unannounced on all days. This was the first inspection of the service.

The service did not have a registered manager. There had been no consistent management of the service since it opened in August 2017. 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 provider has breached regulations, you can see what action we told the provider to take at the back of the full version of the report.

People were not always kept safe through the use of effective care planning, risk assessment and management. There was not always sufficient trained staff who were given clear directions on how to care for people, and had their performance was reviewed and managed. While staff were aware of their duty of care to keep people safe they did not act on this appropriately.

Staff were not deployed in the best interests of people and they worked very long hours without a break. Records did not always reflect what was happening in the service such as staffing levels and staff hours worked. Records were not always stored safely. The service was clean and fresh and there were processes in place to keep the service infection free.

Medicines were stored and administered as prescribed. Staff endeavoured to ensure they had the person’s consent to care for them. However this did not always happen and people were not always consulted on how they wanted their care delivered.

Care plans were not always up to date and reflective of people’s needs and wishes. This impacted on the risks to people as up to date information on risk was not always available. Due to the lack of consistent management, communications were not always effective.

People’s dignity was promoted and staff were caring in their interactions with people. However peoples’ independence was not promoted as there was not always enough staff to ensure they had an active social life outside the service.

There was a complaints process in place. There was a quality assurance process in place. However it was ineffective and had not reflected the concerns raised during this inspection process.

The home has been rated inadequate and has been put 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, 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.