Archived: Peregrine House

Peregrine House is a residential care home providing accommodation and care for up to 36 people who are older and people who have mental health and physical disability support needs. Peregrine House is a purpose built home where accommodation provided is divided into four units on two floors. It is part of Gold Care Homes.

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.

At the last inspection on 15 December 2014 the service was found to Require Improvement overall. There were two breaches concerning medicine administration and the guidance given to staff in risk assessments to minimise risks to people and others. We found these breaches had been addressed at this inspection.

During our inspection visit we found three breaches concerning people’s legal rights, maintaining premises and auditing.

The service had applied for Deprivation of Liberty Safeguards (DoLS). These are a legal requirement under the Mental Capacity Act (2005) when people do not have the capacity to agree to their care and treatment. However they had failed to renew the applications when these had expired. This meant the service was not upholding people’s legal rights.

We found that some parts of the premises were not being maintained appropriately for the purpose for which they were used. For example one kitchenette needed work surfaces replacing to maintain good levels food hygiene when preparing food. The hairdressing room and a bathroom had items stored in them and the outside courtyards were not kept in a manner that was inviting for people to use. The signage around the service was poor and did not consider the needs of people with a cognitive impairment.

The service undertook auditing to ensure the quality of the service offered. There had been a change in the way auditing was undertaken in May 2016 but the new system had not had sufficient time to embed. We found that there were some areas such as supervision, Deprivation of Liberty Safeguards and people’s money records that were not being audited in a robust manner.

We found the service had systems in place to enable the staff to recognise and report safeguarding adult concerns. People and the environment were risk assessed to minimise the risk of harm. There was guidance to staff in the risk assessments we looked at.

Medicine administration and storage was undertaken appropriately and staff administering medicines could tell us what medicines were used to treat people. The service had systems in place for the auditing of medicines administration.

Some people told us there was not enough staff, however we saw the service had increased some staffing levels, had changed the rota, and had organised shifts to ensure staff were available at busy times. Bank staff were used to cover staff absence.

Not all staff had received supervision in a timely manner. There was however was an induction period and training to support staff to undertake their role.

People were supported to receive appropriate health care services.

Some people liked the food at Peregrine House but others did not. People were supported to eat and drink enough to remain healthy but we recommended the service consider how they could work with people to improve their satisfaction with the food served.

People had individualised care plans that specified their preferences with regard to their care, however information in the records was sometimes difficult to find due to the format used. The service was in the process of changing to a more accessible format.

The service responded well to complaints by investigating and addressing the concerns. They kept a complaints matrix to enable them to recognise trends in the service.

People, staff and relatives spoke positively about the registered manager. There were regular ‘residents’ meetings and feedback forms.

We found three 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 the report.

We visited the home and spent some time with people on the four units. We spoke with residents and care staff and looked at a sample of files. One person told us 'I like living here' and another person told us 'I like living here because they take good care of me'.

We looked at some care plans which we found reflected people's individual needs and preferences. They had been reviewed and updated regularly with changes in people's needs when necessary. We saw that risk assessments were completed and were up to date.

We spent time observing and talking with residents on all the units. We saw care staff treat people kindly in Peregrine House. We looked at recent rotas to check that there had been enough staff on shift during the day and night and we found that the recent rotas reflected the staffing levels which were needed by the home.

We found that the systems were in place to make sure that people who used the service, their family and representatives and other professionals were able to provide feedback and opinions about the service. We saw that there were regular residents and staff meetings so that people could share their opinions and preferences in different ways.

We found that people were generally satisfied with the care provided at Peregrine House. They liked the staff and found them to be polite and helpful. Comments included; "I like it very much" and "I have been living here for 8 years and wouldn't want to be anywhere else." Three people said the activity programme was not enough and that they would like more to occupy their time. A few people did not have up to date care plans and risk assessments detailing their needs. They said they were happy with their care but a lack of up to date care plan could put people at risk of not receiving the care they need.

We saw staff interacting well with people and there was evidence that staff knew people's needs well. Staff felt supported by the manager.

The minimum staffing levels agreed for the home had not been met at all times. There was a risk that people's needs may not be fully met if there were not enough staff on duty.