Pentree Lodge Residential Care Home

At this inspection we found the evidence continued to support the rating of Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Pentree Lodge is a care home which provides accommodation for up to 15 people with mental health needs who require personal care. At the time of the inspection 14 people were using the service.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service requires a registered manager and there was one in post at the time of the inspection. 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 the inspection visit we were informed the registered manager had left the service with immediate effect. The provider gave us assurances about the arrangements in place to help ensure the smooth running of the service.

Where risks were identified, action was taken to protect people from harm while allowing people to continue to live independent lives. Staff were aware of their responsibilities under safeguarding and took these seriously. They were able to describe to us the action they would take to keep people safe.

Staff were sympathetic and compassionate in their approach to people. The registered manager had a clear set of values which were known to the staff team. Staffing levels were consistently met. One person had no references in place and we have made a recommendation about this in the report.

Roles and responsibilities were clearly defined and understood by all. Systems for communicating about changes in people’s needs were effective. Staff were supported by a thorough system of induction, training, supervision and staff meetings.

Family contact was valued and encouraged. Relatives told us they were kept informed of any changes and were invited to take part in care plan reviews.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being in daily logs.

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 a range of quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by the registered manager, staff and the provider.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We previously carried out a comprehensive inspection of Pentree Lodge in March 2016. At that inspection we identified one breach of the legal requirements. This related to how people’s monies and cigarettes were managed in relation to the Mental Capacity Act 2005. We subsequently issued one requirement and told the provider to take action to address one breach of the regulations. The provider sent the Care Quality Commission an action plan following the publication of the report.

We carried out this focused inspection to check to see if the service had made the required improvements identified at that comprehensive inspection.

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

During this inspection people told us they accepted they needed help with managing their monies and cigarettes. Decisions about the help staff gave people were documented in people’s care plans. There was evidence staff had consulted with external professionals and decisions were reviewed.

We could not improve the rating of 'requires improvement’ in respect to the question ‘Is the service effective?’ because to do so requires the service to demonstrate consistent good practice over time. This decision will be reviewed when we complete our next planned comprehensive inspection.

At the time of the inspection, the manager at the service had been in post for three months, and was not, at the time, registered with the Care Quality Commission. However an application had been submitted to the Care Quality Commission for the person to be registered with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

We inspected Pentree Lodge on 22 and 23 March 2016. The inspection was unannounced. The service was last inspected in May 2014 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “I feel safe enough,” and “Nothing bad has happened here in the last 8 years which is when I first came here.” A relative told us “I think Pentree Lodge provides a home where residents are able to feel safe and secure…my son seems to be reasonably happy there.” Another relative told us “I cannot begin to tell you how happy I am with the service (my relative) gets, and long may it last. The staff are caring.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had the skills to recognise potential signs of abuse, although some of the new staff needed to receive formal training about recognising and reporting alleged abuse. However staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a satisfactory standard although some of the new staff needed to receive formal training in areas such as first aid, medicines and infection control in line with legal and ‘Skills for Care’ (industry) standards. Staff members received regular supervision, and staff who had been in post for over a year had received an appraisal.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was enough to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals, although records about whether people needed and wanted support from these services could be improved.

There were enough staff on duty and people said they received timely support from staff when it was needed. People said staff would help them promptly, and we saw staff being attentive to people’s needs.

Some activities for people were available, mostly on an individual basis. Most people could go out on their own for example for a walk to the shops. Some people used public transport. Some people did not want to participate in activities. People could have an annual holiday. Some people and relatives thought there should be more activities available.

Care files contained information such as a care plan and these were reviewed. There was however limited involvement of people in the development and review of their care plans and the manager agreed to look at ways to increase involvement.

We were concerned some restrictions were in place around people looking after their own money and cigarettes. Some people received some cigarettes and money, at regular intervals, to help them to manage the limited amounts they had. However there was no records or evidence of consultation with people, or external professionals involved in their care, about the decisions made. There was no evidence that consideration had been given to the legislation and guidance contained in the Mental Capacity Act 2005 You can see what action we told the provider to take at the back of the full version of the report.

People were happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included, “The food is good, there are healthy options and there is a variety which changes from week to week.” A relative told us “The staff will always make sure there is a vegetarian option available.”

People said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. We were told by staff that management were, “Really helpful,” “Approachable,” “Very Friendly,” and “Supportive.” There were satisfactory systems in place to monitor the quality of the service. The new manager, at the service, had submitted an application to be registered with the Care Quality Commission.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, we judged the service was safe.

People told us they felt safe and secure. The people we spoke with were positive about the staff who worked with them. People told us staff were professional and supportive. For example, one person said 'the staff are very nice, they are very good.' The people we spoke with said they got on okay with others who lived in the home. Where there were differences staff assisted to resolve any problems.

The staff we spoke with said they had confidence in colleagues' practices. For example, we were told 'This is one of the better organised homes I have worked at. Nobody who lives here is rushed about. It is friendly here. It is a happy, working environment.'

The home had a well organised medication system. We found two medication errors, although these resulted in no harm to people. Otherwise the system was well managed, medication was stored securely, and records were accurate and up to date.

We saw the home was well decorated, clean and comfortable. Furnishings were well maintained, clean and comfortable. On the day of the inspection the home was clean and there were no unpleasant odours.

We inspected the staff rotas, which showed there weresufficient staff on duty throughout the day and night to meet people's needs.

Is the service effective?

Yes we judged the service was effective.

People all had an individual care plan, which set out their care needs. Care plans contained satisfactory information and were accessible to staff. People said staff met their needs and responded promptly when they needed assistance. People said they had access to doctors, community psychiatric nurses, psychiatrists, chiropodists and opticians. However some improvement was required in recording practices forsome professional appointments to ensure they were more accurately recorded. This would ensure it was easier to find out when some people last received treatment from, for example, a dentist or an optician.

Is the service caring?

Yes we judged the service was caring.

People who used the service said they were supported by professional and helpful staff. We were positive about the care practices we observed. Comments from people who lived at Pentree Lodge included 'Staff are very helpful' and 'I have only been here two weeks but I am very happy. Staff are good and very helpful. The food is good. I have no concerns.' A community psychiatric nurse told us 'it is brilliant, I have no concerns.'

From our observations of the care provided, our discussions with people and from the records we assessed; we judged that individual wishes and needs were taken into account and respected. It was clear some of the people who lived at the home could be deemed, by the multi-disciplinary team, as challenging to services. However the service worked constructively and professionally with everyone, and provided them with suitable support.

Is the service responsive?

Yes we judged the service was responsive.

The people we spoke with all said the staff treated them with respect and dignity. The care practice we observed was professional and supportive. For example a person who lived in the home told us 'the staff are okay'they are very helpful.'

People who used the service told us there were some activities organised by the staff. It was clear that although some people at the home were difficult to engage in activities, were disinterested and/or lacked motivation to participate in organised activities, the staff did what they could to engage with people. This may have just resulted in encouraging people to go out for a walk or visit the caf'. Where people clearly did not want to get involved this was respected.

There were suitable links with the community mental health team, and other medical professionals such as general practitioners although as stated, recording of some medical input could be improved. From reviewing other records we judged care plans contained suitable information to assist the staff who worked at the home. Records showed care plans were regularly reviewed and updated.

Is the service well-led?

Yes we judged the service was well led.

Staff, people who used the service and their relatives were all positive about the management of the home. People told us management would listen and were supportive.

The home had a system to check people were happy with the service. This included systems of survey and audit. There was a system to monitor accidents and incidents.People's personal care records, and other records kept in the home, were accurate and complete.

All but one of the people who used the service were happy living in the home. The person who was not happy did not have any specific concerns about the service, and was being supported to move on. The comments we received included 'I like it here'the staff are very nice,' 'it is very good, the best'the staff are great and the food is good,' and 'the staff are very helpful and nice.'

Accommodation was furnished, decorated and maintained to a good standard. The home was clean and odour free. The medication system, health and safety standards and quality assurance systems were well maintained.

Staff recruitment checks were satisfactory. Staffing levels were adequate although we understood the registered provider was in negotiations with commissioners about funding levels. Staff training was satisfactory and a staff supervision system was in place.

One person said they were not happy living at Pentree and wanted to move. Staff were aware of this person's wishes and told us that support had been provided to this person from external professionals with regards to moving from Pentree.

Staff were knowledgeable about the care needs and support that people required but the care plans did not consistently direct and inform the staff of the action they had to take to meet these care needs.

The training records did not show that staff were provided with training to ensure they were trained and competent to meet the assessed care needs of people who used the service.

We saw that systems in the home did not consistently ensure the promotion of the control of infection and prevention of cross infection.