The Potteries

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

The Potteries is a care home providing personal and nursing care to 60 people at the time of the inspection. The service can support up to 80 people.

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

Right Support:

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.

The registered manager made a point of being available for people, relatives and staff to speak with. People and staff told us they found the management team, including the registered manager, approachable and supportive.

The provider and the management team at The Potteries listened to what people said about their experience of their or their loved one’s care there and what they wanted to happen. They acted on what people said. People were encouraged to make their wishes and preferences known.

Right Care:

People looked comfortable with staff and welcomed their company. They told us they felt safe at the service. Managers and staff understood their responsibilities for safeguarding adults and children.

Staff went about their work calmly and confirmed staffing levels enabled them to provide the care people needed. Staff had the skills required to support people safely and effectively and people had confidence in their abilities. Pre-employment checks helped ensure only suitable staff were recruited or were provided by employment agencies.

People received the care they needed to manage risks safely and in line with their preferences. Medicines were managed safely. The premises and equipment were kept clean and in good order.

Right Culture:

Staff and managers at all levels adopted a caring approach, focusing on people as individuals. This was inherent in the way staff spoke with people and about them.

People had input into planning activities programs and enjoyed the activities provided. There was a member of staff whose role was to foster links with local community organisations

The management team worked openly and constructively with local authority and NHS commissioning and safeguarding teams. Close working with health and social care professionals in relation to people’s care was routine.

The registered manager used the provider’s quality assurance processes to make sure the home continued to work safely and effectively with people, listening to their wishes and respecting their preferences.

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

Rating at last inspection

The last rating for this service was good (published 20 December 2019).

At our last inspection, in safe and well-led, we recommended the registered manager and provider reviewed how they assessed safe staffing levels, adopted national guidance in relation to ‘as necessary’ medicines and listening to staff at staff meetings. At this inspection we found the provider had acted on these recommendations and had made improvements.

Why we inspected

We received concerns in relation to call bells, staffing levels and the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 remained good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Potteries 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.

We found the following examples of good practice.

People were cared for by staff who had been trained in infection, prevention and control, (IPC), safe practices. Two members of staff held the role of IPC champions. They told us this included carrying out spot checks on staff IPC competencies, attending a monthly organisation wide IPC meeting where they could share issues and ideas and completing IPC audits.

People and staff had taken part in the vaccination programme and were taking tests in line with government guidance. Where people had been assessed as not having the capacity to make the decision, with involvement of families and health professionals, decisions had been made in their best interest in line with the principles of the mental capacity act.

Arrangements for visiting the service were being followed in line with government guidelines. This included professionals evidencing their vaccination status and all visitors having a negative LFT on the day of their visit.

Most people had a family or friend designated as an essential care giver. This person was included in weekly home testing and able to visit, even at times when restrictions were placed on visiting due to an outbreak in the home. Risk assessments were in place for visitors and risks ranged from high to low. As an example, a visitor who had not been vaccinated was rated a higher risk, and mitigation included visiting restricted to the persons room.

At the time of our inspection the home was in outbreak and following the local health team and public health guidance on restricted visiting arrangements. Visitors who were not essential care givers, were able to visit in an adapted room fitted with an intercom system that had separate external access and a screen separating the person from their visitor. One person told us, “We’ve got used to it now but not quite the same as properly seeing them”. Protocols were being followed for people making visits outside of the home. This included a risk assessment and testing. An example had been a person attending a family event and to mitigate risk all the family were vaccinated and took a lateral flow test on the day of the celebration.

Staff had access to personal protective equipment, such as gloves and masks, and we observed them using it correctly. The environment was clean and in good repair. One person told us, “They do a great job its always lovely and clean.” The communal areas were spacious enabling people to comfortably socially distance. People had their own rooms with en-suite facilities. The layout of the building enabled each floor of the home to be isolated, if necessary, with separate access arrangements.

The registered manager understood staff may need additional support with their well being and initiatives included the clinical lead holding a monthly well-being group and offering one to one support if requested. A well being board displayed signposting to external support agencies, healthy eating tips and exercise classes. A ‘leave it at the door’ board was in place for staff to write positive or negative comments about their shift rather than take them home.

The organisation had a COVID-19 team that was able to immediately respond to government changes and kept policy up to date and staff informed of any impact of changes. Managers were supported with a weekly meeting. An audit system was in place that was effective at ensuring policy and procedures were being met.

The Potteries is a nursing and care home providing personal and nursing care to 68 people at the time of the inspection. The service can accommodate up to 80 people. Each floor (suite) has separate facilities. One of suite provides nursing care and another specialises in supporting people living with dementia.

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

People and relatives said they, or their loved one, felt safe at The Potteries. People received the care they needed. Some records of care given were incomplete, but measures were in place to address this. People’s individual risks were assessed and managed, as were environmental risks. The premises were kept clean. Medicines were stored safely, and people had the medication they needed, although we have made a recommendation regarding medicines prescribed as necessary. Managers and staff understood their responsibilities for safeguarding adults.

The service had a person-centred culture. The registered manager and staff understood their roles well. Most legal requirements were met, including the duty of candour. Quality assurance processes were in operation to identify areas for improvement and address these.

The registered manager recognised staff morale had been low and was seeking to address this. There were regular meetings for people, relatives and staff. We have made a recommendation in relation to staff meetings and hearing the voice of staff.

People and relatives said their or their loved one’s care needs were met. Whilst people had the care they needed, people, visitors and staff told us staffing levels were challenging. Staff looked busy and stressed. We have made a recommendation about assessing staffing levels.

People said staff were kind and respectful. Staff knew and understood people and respected their privacy and dignity. Staff recognised the importance of promoting people’s independence, but this was not always reflected in care plans. People could receive visitors any time they wished. We have made a recommendation in relation to recording people’s end of life preferences.

The provision of activities was an area of strength. People had the support they needed with impaired speech, hearing and vision. People’s care needs were reviewed monthly. People’s needs were assessed holistically, as a basis for their care plans. People and their visitors had confidence regular staff were skilled to provide their care. They felt their or their loved one’s health needs were being met. The service participated in initiatives with local health services to promote prompt access to healthcare and optimise medicines. People had a choice of appetising food that met their dietary needs.

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

The last rating for this service was good (published 23 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Please see the action we have told the provider to take at the end of this report.

Follow up

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

The Potteries is a purpose built home which opened in October 2013 and is registered to accommodate a maximum of 80 people who require either nursing or personal care. There were 61 people living there at the time of our inspection. The home is divided into three separate living units. Two units provide care for people living with dementia and one of the units provides nursing care. The home is well equipped and has good communal facilities which include a café, cinema and hairdressing salon.

The home was led by 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.

We received only positive comments about The Potteries throughout our inspection. Staff in the home were also positive about the home and the service they provided. They told us they felt well supported by the management team that was in place.

People told us that their care and support needs were met and that staff were kind, caring and respectful. People also felt safe and had confidence in the staff.

Staff knew people well and understood their needs. Care plans were detailed and regularly reviewed. This meant that there was always information for staff to refer to when providing care for people. People’s choices and decisions were respected and staff enabled people to retain their independence.

The provider had implemented satisfactory systems to recruit and train staff in a way that ensured relevant checks and references were carried out and staff were competent to undertake the tasks required of them. The number of staff employed at The Potteries, and the skills they had, were sufficient to meet the needs of the people they supported and keep them safe.

People were protected from harm and abuse wherever possible. There were systems in place to reduce and manage identified risks and to ensure medicines were managed and administered safely. Staff understood how to protect people from possible abuse and how to whistle blow. People knew how to raise concerns and complaints and records showed that these were investigated and responded to.

Observations and feedback from staff, relatives and professionals showed us that the home had an open and positive culture.

There was a clear management structure in place. People and staff said was the manager was approachable and supportive. There were systems in place to monitor the safety and quality of the service. This included the use of audits and surveying the people who used the service and their representatives.

During the inspection we found that the home and local authority were in the process of transferring residents from a nearby care home that was closing. This meant that many residents had only recently come to live in the home.

This was an unannounced inspection which was undertaken by one inspector over the course of one day. The acting manager and regional director of the home assisted us throughout the inspection.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

There were 48 people living at The Potteries on the day of our inspection. We spoke with eight people, three relatives, the acting manager and five members of staff.

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

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

This is a summary of what we found:

Is the service safe?

People we spoke with during the inspection generally had no concerns or complaints about the care and support they received, however some people told us that they did have to wait for assistance when staff were busy. One person told us, "Well, I think it's very good. The food is brilliant." Another person told us "I think it's good, however when they took residents from [other care home] things have not been quite the same. Once I rang my bell and I waited 10 minutes for staff to come and tell me that they are helping someone else and that they will be back in another 10 minutes." A third person told us "Now we are full it's a bit hectic at times and I have to wait around for things to be done, I think the longest I have had to wait is 10 minutes or so."

We spoke with five members of staff who told us that they felt the ground floor of the home had been understaffed; some staff felt that the provider had not listened to them when they had initially raised concerns about this. However, all of the staff we spoke to told us that the provider had recently increased staffing levels on the ground floor, and whilst it was still extremely busy, current levels enabled them to deliver care safely. One member of staff told us "Things have improved, but it could still be better." Another member of staff told us, "Sometimes we struggle to assist people to get up in the mornings in good time. I don't think it's all about staff numbers though, some of it is about how we are organised."

During the day, we observed two incidents that did not protect people at risk of harm, as they did not receive appropriate support to ensure their safety.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and report on what we find. The provider sought consent from people and or their relatives in relation to their care and was reviewing procedures under the Mental Capacity Act. The acting manager was aware of what constituted a deprivation of liberty. During the inspection we discussed the new Supreme Court ruling with the provider who told us that they would start assessing people living in the home and submit the necessary DoLS applications to the appropriate authority.

Is the service effective?

People received care and support in accordance with their care plans. Care was planned to meet people's needs. Where a need was identified a plan was in place to meet this. For example, one person's care record stated that they required assistance to change position. This plan detailed the frequency of position changes, the equipment required and the number of staff required.

We noted that records relating to people who use the service were appropriately stored in a secure area. We found that whilst records were generally up to date, they did not always reflect the care and treatment provided to people.

Is the service caring?

We found the service was caring as people were treated with dignity and respect.

People spoke positively about the care they received and that staff were kind, caring and compassionate. One person told us, "The staff are very good and kind, I've not had a problem with any of them" A visiting relative told us "The staff are lovely, and they have kept the staff from [the other home] which is good as they know my husband's needs well."

People's privacy and dignity was always maintained. This was because staff respected people's privacy by respecting their private spaces and maintaining their dignity during personal care.

We saw that staff were kind and caring in their approach with people. There was information about people's personal preferences, life history and lifestyle choices. This meant that staff had information to be able to care for and support people as individuals.

Is the service responsive?

People's care needs were reviewed and their plans updated to ensure they received a service that met their current needs. Staff worked with and followed the advice of other professionals who were involved in people's care. For example, one person was identified as having difficulty in swallowing. We saw that the provider had contacted the SALT (speech and language therapist) to complete an assessment to promote the person's safety and welfare.

People accessed the services of healthcare professionals as required. Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, district nurses, opticians and GPs were documented.

Is the service well led?

The home had systems in place for monitoring the quality of service provided to make sure that the home was run safely. Accidents and incidents were audited so that remedial action could be taken to prevent further occurrences.

People were able to comment on the service provided via questionnaires and meetings.

The Potteries is a purpose built home which opened in October 2013. There were 21 people living in the home on the day of our unannounced inspection. The Registered Manager was not available but suitable arrangements had been made by the registered provider, Care UK, to ensure that an acting manager was in place to oversee the running of the home.

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

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

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was well designed, suitably furnished and equipped, clean and hygienic. There were enough staff on duty to meet the needs of the people living in the home. All of the people we spoke with confirmed this, as did the staff who were on duty during the inspection.

Risk assessments had been carried out both with regard to people's care needs and to other aspects of the running of the home such as the use of moving and handling equipment and the prevention of infections. Those staff whom we spoke with were aware of people's needs and how to ensure that they were met safely.

CQC monitors the Deprivation of Liberty Safeguards which applies to care homes and nursing homes. The acting manager confirmed that they were aware of recent changes to the use of this legislation and had appropriate policies and procedures in place. Relevant staff had been trained to understand when an application should be made and how to submit one. The acting manager advised us that they were discussing the need to make an application for one person with relevant health professionals.

Is the service effective?

People told us that they were happy with the care they received and felt their needs were well met. It was clear from what we saw and from speaking with staff that they understood people's needs, likes and dislikes and knew them well. One of the visitors that we spoke with told us 'I'm very happy with the care. XX (the person living in the home) can be very difficult but the staff are very patient and good." We found that there were systems in place to monitor the quality of the service provided and staff had received training to ensure that they could meet people's needs.

Is the service caring?

Throughout our inspection we observed that staff were kind and caring and in some instances were able to anticipate people's needs. One of the people living in the home had recently passed away. The home had provided space and refreshments to enable the family to hold the wake at the home on the day of the inspection. People told us they were able to choose what they did and were not rushed when they needed support.

Is the service responsive?

We found that people's needs had been assessed before they moved into the home to enable staff to ensure that they had the required skills and equipment to meet their needs. Once admitted to the home, people's needs were regularly reviewed and any changes were responded to as necessary either by consultations with other health professionals, changes to the way their care was provided or provision of equipment.

People living in the home confirmed that staff always took care to protect their privacy when providing personal care.

Is the service well-led?

The home had a registered manager with many of years experience. They were unavailable at the time of the inspection and the registered provider , Care UK, had taken steps to ensure the continued smooth running of the home by transferring a manager from another service to an acting manager's role until the registered manager could return. The acting manager told us that she felt the home was being well supported by regional managers.

Staff had a good understanding of the ethos of the home. People living in the home told us that they felt listened to and we found records reflected that complaints were taken seriously and always responded to.