20 and 21 May 2015
During a routine inspection
This inspection took place on 20 and 21 May 2015 and was unannounced. We had received information of concern which we looked at as part of this inspection. Our last inspection was in August 2013.
Pondsmead Care Home provides personal and nursing care for up to 76 older people. At the time of our inspection there were 60 people living in the home. The home is situated in the village of Oakhill on the main route between Bath and Shepton Mallett. Currently rooms are situated over three floors.
There has been a registered manager in post since December 2014. 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.’
Following an incident which could be seen as abuse the registered manager failed to take the appropriate action to report the incident to Somerset safeguarding team or ourselves as required. . However action was taken to alleviate the risk of a further incident involving the two people concerned.
The provider had not taken steps to make sure risks to people were minimised. When recruiting some members of staff the necessary checks had not been carried out to establish and ensure the fitness of the potential employees.
People we spoke with had varied views about the availability of staff to respond to their requests for assistance. Some people said they had to wait for long periods and staff were always busy and “rushed”. Other people said staff responded well to their requests particularly at night. Changes had been introduced in the staffing arrangements however there was no system in place to demonstrate how staffing levels were decided.
There were generally good arrangements for the administration and management of medicines. However there had been medicines administering errors and whilst some action had been taken we were not assured the necessary measures had been taken to ensure the competency of nursing staff in relation to medicines.
There was a failure to ensure people’s legal rights were upheld through the use of arrangements available in the Mental Capacity Act 2005. There were not robust arrangements to ensure decisions made about people safe care and protection were taken either with their consent or under best interest process.
People were not being cared for by staff who were appropriately supervised or supported. Staff had not received one to one formal supervision for a period of six months. Nursing staff were not being provided with clinical supervision.
There had been no opportunities for staff to undertake training to ensure they were updated in their skills and competence and had the confidence to fulfil their role and responsibilities effectively.
The registered manager had failed to take action in relation to monitoring and reviewing the competency of a member of staff. Whilst people had the opportunity to discuss their care needs there were no formal arrangements for reviewing their care arrangements.
People and staff did not feel they had a positive relationship with the registered manager. A number of people told us they did not know who the registered manager was and how he was not seen around the home.
People told us they felt safe in the home and “Trusted” staff. There were many positive comments from people about the caring nature and kindness of staff. Staff were very clear about their responsibility to report any concerns about the health and welfare of people living in the home. They understood how they had the right to go to outside organisations if they wished to report any such concerns.
Risk assessments were in place which identified potential risks to people’s health and welfare in such areas as fall, skin integrity and nutrition.
People told us they appreciated the quality of the meals and food provided. Comments included: “I always enjoy my meals they are very good and there is always a choice”, “I always get the food I like, the staff know my likes and dislikes.”, “You can’t fault the food it’s very nice”. There were arrangements for people’s nutritional needs to be assessed and specialist advice and additional support provided to ensure these needs were met.
Peoples specific care needs were being met and improving their health and welfare. One person said “The staff have been wonderful………now I feel so much better.”
People told us they found staff “Caring and kind”. People’s right to privacy and respect for choices were upheld. One person told us “The staff always respect my privacy, they know my privacy is important to me” We observed staff supporting people and providing assistance in a caring and sensitive way. The home provided a welcoming environment to visitors and people told us their visitors were always made to feel welcome.
Care was arranged to ensure people’s personal needs were identified and met. People told us how their preferences and choices were respected. One person told us “Staff appreciate what my choices and likes are and try to fit round them, they are very good.”
There was a range of meaningful activities which offered varied choices for people. People told us how much they enjoyed the activities. One person told us how “It is lovely to have a proper chat.”
People felt confident in telling staff if they had any worries or concerns and they would be listened to. One person told us they were aware they could make a formal complaint if they wanted to and felt able to do so. However some people did not feel confident the registered manager acted on concerns raised.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.