Peel House Nursing Home

Peel House Nursing Home is a nursing home providing personal and nursing care to people aged 65 and over, some of whom live with dementia and/or mental health conditions. The nursing home can accommodate up to 52 people over two floors which are accessible by stairs or a lift. There were 44 people receiving a service at the time of inspection.

People’s experience of using this service and what we found

The registered manager and senior management team had made improvements within the home since our last inspection. Governance systems were operating effectively and had enabled the registered manager to identify further improvements such as with care records and communication. A visiting health and social care professional told us, “There were concerns around care planning however this has since been improved and more importantly we have seen evidence that this has be sustained. I have been impressed with the management within the home they are always very proactive at seeking support.”

People told us they felt safe at Peel House Nursing Home and staff knew them well, one person stated, “Yes I am safe, nothing is too much hassle [for care staff]. If I have a problem, they will do whatever they can to sort it.” Staff supported people in a kind and compassionate way, considering their dignity and respecting people’s rights. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Care plans and risk assessments were person centred.

The culture of the home was open and transparent. The registered manager demonstrated joint working with health professionals who provided specialist support to people, involving their families and other professionals as appropriate. Staff demonstrated a good understanding of providing people with person centred care and spoke knowledgably about how people preferred their care and support to be given.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 November 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Peel House Nursing Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Peel House is a Nursing Home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The nursing home can accommodate up to 52 people over two floors.

People’s experience of using this service and what we found

The provider did not always ensure safeguarding incidents were reported to the local authority and CQC.

The provider did not have enough staff trained in end of life care. We made a recommendation about this.

The provider did not always have effective governance systems to monitor the service and drive the necessary improvement. At times, there was a lack of detailed records regarding medicines, recruitment and complaints management.

Staff were not always supported with regular supervision but told us they felt well supported by the registered manager and had enough training to undertake their roles effectively.

Despite this, people were happy living at Peel House Nursing Home and told us they felt safe. There were enough staff to meet people’s needs.

People were supported by staff who were kind and caring. People had access to a range of activities and were supported to maintain links with the community and those important to them.

People were positive about the food and drink. Where they needed external health input they were supported to receive this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (report published 20 February 2019) and there were three breaches of regulation. At this inspection we found the service had improved and was no longer in breach of those three regulations. However, a new breach of regulation was identified in relation to appropriate reporting of significant events. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This was a responsive inspection to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

The provider demonstrated a willingness to make improvements and during the inspection acted to mitigate some of the risks to ensure the service worked towards consistently providing good, safe, quality care and support.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Peel House Nursing Home on our website at www.cqc.org.uk.

Follow up

We identified a breach of regulation and because this is the fifth consecutive time the service has been rated as requires improvement we will request a clear action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following receipt of this plan. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• People did not always receive a service that provided them with safe, effective, compassionate and high-quality care.

• The management of risk was ineffective and placed people at risk of harm.

• People’s human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not adhered to.

• People were not always empowered to make choices and have control over their care and people were not always provided with support that was personalised to them.

• The service was not always well led and there was a lack of robust and effective quality assurance processes in place.

• People did not always live in a clean environment. People told us staff were kind and treated them with respect.

• More information is in the detailed findings below.

Rating at last inspection:

The service was last inspected in May 2018 where we undertook a focused inspection (report published July 2018). It was awarded a rating of Requires Improvement.

About the service:

Peel House Nursing Home is a service that provides nursing care and support. It was providing a service to 40 people, two of whom were in hospital for the duration of our visit. It is registered to provide accommodation for 52 people who require personal care or nursing as well as treatment of disease, disorder or injury.

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection

Follow up: At the last inspection this service was rated ‘Requires Improvement’, at this inspection the rating remained the same. This is the fourth consecutive inspection whereby the service has been awarded a rating of Requires Improvement. During the inspection, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. Full information about CQC's regulatory response to the concerns found during inspections will be added to the report after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

We carried out an unannounced comprehensive inspection of this service on 1 November 2017. After that inspection we received concerns in relation to the way the directors of Chilworth Care Limited had operated another care home they owned that meant people were not safe. As a result we undertook a focused inspection to assess whether similar concerns were happening at Peel House. This report only covers our findings in relation to the Safe and Well-led sections. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Peel House on our website at www.cqc.org.uk

This inspection took place on 22 May 2018 and was unannounced.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

At the last inspection we identified that improvements were needed to the environment to make it more suitable for people living with dementia. At this inspection we found the registered manager and provider had started work to improve the environment. The provider had asked a specialist consultant in dementia care to help them improve their care for people living with dementia. Further work was needed to ensure these changes were implemented by all staff and embedded in daily practice.

At the last inspection we identified that improvements were needed to the governance systems in the service. The Nominated Individual for the provider told us that they had asked consultants to complete their quality monitoring reports for the service. They also said they were in the process of submitting an application to have a different Nominated Individual for Chilworth Care Limited.

People who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Staff respected people’s choices and privacy and responded to requests for assistance.

People told us they felt safe living at Peel House. Systems were in place to protect people from abuse and harm and staff knew how to use them. Medicines were stored safely in the home and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

There were sufficient staff available to provide safe care. Staff understood the needs of the people they were supporting and had the knowledge and skills to meet their needs.

The registered manager regularly assessed and monitored the quality of care provided. Feedback from people and their relatives was encouraged and used to make improvements to the service.

The provider had failed to fully implement best practice guidance in creating a dementia friendly home.

The provider did not consistently apply effective quality assurance monitoring systems to drive improvement in reasonable time.

The provider had appropriate arrangements in place to safeguard people from potential abuse.

The registered manager had robust recruitment systems in place.

Arrangements were in place to protect people from the risk of infection.

Staff had received relevant training and on-going support and development.

Staff understood the requirements of the Mental Capacity Act 2005 and documentation demonstrated peoples' choices were respected.

People were treated with dignity and respect.

Staff engaged with people in a supportive and patient manner.

Care records reflected peoples' choices.

People were supported to participate in meaningful activities.

The provider had an effective complaints procedure.

Risks to peoples' welfare were assessed and managed appropriately.

The provider had effective policies and procedures in place for notifying the relevant organisations about safeguarding issues.

The registered manager had created an open culture in the home which allowed people to comment about the quality of care they received.

There was a registered manager in place. 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.

There was a lack of systems in place to effectively manage infection control and the risks this posed to people living at the home. There was a lack of personal protective equipment (PPE) in place within the home to protect people from the potential risk of the spread of infection.

Environmental risks to people were not managed well so as to protect and respect people’s freedom of movement within the home. However, risks related to people’s individual health needs were managed well by nursing staff.

Annual required training updates had not been completed by all staff which could prevent them from being able to carry out their roles effectively and in line with the latest guidance and best practice regimes. Staff demonstrated a lack of understanding regarding the principles of the Mental Capacity Act 2005. There was some understanding of the need to gain consent when caring for people. Whilst Deprivation of Liberty Safeguards (DoLS) applications had been completed fully, there was no management process in place to ensure that records were kept up-to-date and that applications had been returned, renewed or reviewed. This could mean that people’s liberties were being restricted without formal authorisation having been granted.

The home was in a poor state of decoration with most areas; including people’s bedrooms, requiring attention. The design of the home was not dementia friendly and did not support orientation for those with memory problems.

There was a lack of management systems in place to effectively audit the quality of service provision to identify areas for improvement.

Care workers did not always engage with people living at the home and people did not always have their privacy and dignity promoted and respected. People did feel able to contribute to discussions and decisions regarding their care and support.

There were few meaningful activities for people to participate in. Care plans were personalised and identified people’s preferences and wishes. Care plans were reviewed regularly.

Medicines at the home were ordered, stored and recorded safely. Staff administering medicines had completed annual training updates. Safe recruitment practices were followed.

People were supported to maintain a balanced diet and sufficient fluid intake. They were able to access health care professionals if needed and were supported by staff to achieve this.

Staff were supported in their roles by regular supervision sessions and annual appraisals with their line managers.

There was a complaints procedure in place and relatives told us that any concerns or complaints they raised had been dealt with appropriately and in a timely manner.

There had been relatives, residents and staff meetings held. Relatives told us that they did not feel the meetings were of benefit as feedback given was not always acted upon sufficiently. People and staff told us that they felt they could raise issues with the registered manager and that they would be listened to and their concerns acted upon.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We set out to answer our five questions; Is the service caring? Is the service Responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is the service safe?

People told us they felt safe in the home and when being cared for by staff. People were cared for by staff who had the appropriate skills and experience to ensure their safety and welfare. Staff received a variety of training including; dementia awareness, first aid, food hygiene. The provider encouraged staff to complete the Health and social care qualification. Staff had a good awareness of the needs of people who lived at the home.

People were treated with respect and dignity by the staff. People told us they felt safe. The service had a safeguarding policy which outlined the procedure staff should follow. Staff had undertaken training in safeguarding and understood their role in safeguarding the people they supported.

We saw that the home had authorised Deprivation of Liberty Safeguards (DoLS) in place where appropriate. Management we spoke with had a good understanding of DoLS and their responsibility in this.

This meant people received care which ensured their safety and welfare.

Is the service effective?

People's health and care needs were assessed prior to moving into the home and care was then planned to ensure this was delivered to meet people's needs in a way that suited the person. Risk assessments had been carried out to ensure that any risks were assessed and support measures to reduce such risks were identified and implemented.

Staff felt supported and received training which helped them in their role.

Is the service caring?

Staff were knowledgeable about people's preferences and demonstrated patience and understanding when supporting people. We observed staff communicating with people in a calm, dignified and respectful way, ensuring they were given opportunities to express their needs and communicate with others. One person told us 'They (the staff)are sympathetic and listen, they always spend time with you. They are very friendly'.

People's preferences and interests had been recorded and people were able to attend regular meetings to discuss the home. Because of this care and support could be provided in accordance with people's wishes. We saw that people's needs were supported in a calm, dignified and respectful way. This meant people were cared for in a kind and respectful manner.

Is the service responsive?

Care plans were reviewed regularly to ensure they were kept up to date and all staff were made aware of any changes to people's needs.

People could participate in a range of activities if they chose to. All people we spoke with felt listened to and able to make suggestions. One person told us 'The staff are respectful and polite, they are kind and are helping me to get back home'.

People and their relatives knew how to make a complaint if they were unhappy. They were confident that the manager would take action to address any concerns.

Is the service well-led?

All of the staff told us they would not hesitate to raise any concerns with the manager or provider and they felt confident their concerns would be listened to and the manager would take action to resolve these.

Staff told us they received support from the management and regular one to one supervision meetings and a variety of team meeting were held where any issues of concern or suggestions could be discussed.

Satisfaction surveys had been completed to gain people and their representative's views and 'resident meetings' took place regularly.

We saw that the service had a number of audits in place to monitor and assess the quality of the service including infection control, health and safety, care plans, falls and equipment. We saw where improvements were identified actions were taken to address these.