Pen Inney House

Pen Inney is a residential care home providing personal care to up to 20 people. The service provides support to older people. At the time of our inspection there were 18 people using the service.

The service is on 2 floors with access to the upper floor via stairs or a stair lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include a lounge, dining room, garden and patio seating area.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were gaps in monitoring systems. For example, some people living at Pen Inney House were unable to make decisions in relation to their care and support due to their health. Restrictions had been put in place to keep people safe. Records to demonstrate the restrictions were in line with legislation had been archived and the restrictive practices were not being monitored. The manager assured us they would audit the restrictive practices in place and take steps to ensure these were reasonable, proportionate and in people’s best interest.

Checks on fire equipment were carried out, however, the records to evidence these checks had taken place were not always completed. The records indicated a fault in equipment had been identified. It was not clear if any action had been taken to rectify this.

There were no systems in place for gathering feedback from people living at Pen Inney House, or their families.

Other audits had been completed, for example medicine administration records and accident and incident forms were checked regularly to identify any areas for improvement.

Risks were identified and recorded. Risk assessments and guidance for staff on how to minimise risks were not always available and we have made a recommendation about this in the report.

People told us they felt safe living at the service and they trusted staff and considered them skilled and competent. Training records showed staff training was up to date.

Pen Inney House was located in a rural village and there were strong links with the local community. Areas of the building were in need of updating and this was being planned. People’s bedrooms were spacious. When identified as necessary, alterations had been made to ensure the environment met people’s needs.

Staff told us they were well supported. They received regular supervision and the manager frequently worked alongside staff which allowed them to monitor staff skills and values. Staff told us morale was good and they had a shared set of values. They knew people well and understood their needs and 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 24 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the effective and well-led sections of this full report.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the oversight of the service

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. 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.

Different entrances to the home had been allocated for different reasons. For example, there was an entrance for visitors to the home, but staff had been allocated a separate entrance. Each entrance held the relevant supplies visitors or staff would need before entering the home, such as lateral flow tests and PPE (personal protective equipment such as gloves, masks and aprons).

Staff understood what information to collect from any visitors or professionals entering the home, and what PPE to ask them to wear. This helped protect people from cross infection.

Staff understood the importance of enabling people who wanted to, to go out into the community

as often as possible to help maintain their wellbeing.

A relative told us they were very grateful to the staff for keeping their relative safe throughout the pandemic.

Staff told us they had worked well as a team, supporting each other’s wellbeing however possible.

There was a registered manager in post who was responsible for the day-to-day running of 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 2008 and associated Regulations about how the service is run.

At this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 15 February 2017. In February 2017 we found gaps in people’s medicines records and inconsistent guidance for staff about when people might need ‘as required’ medicines. Risks in relation to some people’s skin care and nutrition were not managed effectively. People’s confidential information was not adequately protected because their personal records were not always kept securely. Systems to monitor the quality of the service provided were not effective. Concerns about the effectiveness of the auditing systems and risk management had also been raised at a previous inspection in January 2016.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection.

Safe arrangements were in place for the storing and administration of medicines. Medicine administration records (MARs) were clear and there were no gaps. Where people were prescribed medicines to take ‘as required’ (PRN) clear protocols had been put in place for staff to follow when administering these medicines. This helped ensure a consistent approach to the use of PRN.

Since the last inspection a new risk assessment format had been introduced. Risks were clearly identified in the new assessments and included guidance for staff on the actions they should take to minimise any risk of harm. In particular risks in relation people’s skin care and nutrition were being effectively monitored.

At previous inspections we found systems to monitor and check the quality of the service and to identify areas for improvement were not robust or consistently carried out. At this inspection we found there were effective quality assurance systems in place and audits were routinely completed. This meant that areas for improvement were identified and addressed to help drive improvement.

After the last inspection a locked cupboard was purchased and was now used to securely store people’s care files and other personal information about people. This meant people’s confidential information was protected appropriately in accordance with data protection guidelines.

On the day of the inspection there was a calm and relaxed atmosphere at the service. We observed that staff interacted with people in a caring and compassionate manner. People told us they were happy with the care they received and believed it was a safe environment. Comments included, “The staff are nice people and very caring”, “Someone always comes when I need help” and “I am happy living here.”

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People had their capacity assessed appropriately. The service knew who had appointed lasting powers of attorney for either finances or health and these people were asked to consent on behalf of the person if they lacked the capacity to do this for themselves. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

There were enough suitably qualified staff on duty and additional staff were allocated if peoples’ needs increased, such as when someone was unwell. Staff were supported by a system of induction training, one-to-one supervision and appraisals. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People had access to healthcare services such as occupational therapists, GPs, chiropodists, community nurses and dentists. Relatives told us staff always kept them informed if their relative was unwell or a doctor was called.

People had personalised care plans that provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff.

People had a choice of meals and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told us they enjoyed their meals. “The food is good and family visitors can eat a meal if they want, which some often do” and “I don’t eat so much now, and don’t have a great appetite, but the Staff encourage me to eat enough and make sure I have enough to drink during the day.”

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

People were able to take part in activities facilitated by staff and external entertainers. These included, singing sessions, music entertainers, exercises, pamper sessions and church services.

The environment was clean and there were no unpleasant odours. Some areas of the premises were in need of re-furbishment, particularly the carpets in the downstairs corridors and shared living areas. New carpets had been ordered and there was a plan to re-decorate these areas in the next two to three weeks. There was an on-going programme to re-decorate people’s rooms and all the unoccupied bedrooms were in the process of being decorated and the bathroom facilities upgraded. Appropriate safety checks were completed to help ensure the building and utilities were safe.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. People and their families were all complimentary about the way the service was run and described the management as open and approachable. The service regularly asked people for their views about the quality of the service they received. People and their families were given information about how to complain.

Pen Inney House provides care and accommodation for up to 20 older people who are living with dementia or who may have physical or mental health needs. The provider also offers a day care facility. On the day of the inspection 12 people were living at the service. Pen Inney House is owned and operated by Mr and Mrs L Difford. Mr and Mrs L Difford also have three other care homes and a domiciliary care agency in Cornwall.

The home was on two floors with access to the upper floor via stairs or a stair lift. Some rooms had en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included one lounge, a dining room, and garden and patio seating area.

The service had a manager in place but they were not registered with the Commission. We spoke with the provider’s representative (Nominated Individual) about this and requested that an application was made. 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 our last inspection on 20 January 2016 we asked the provider to make improvements to ensure people were involved in their care, supported in line with their wishes and preferences, and that people’s care records were accurate. We also asked the provider to ensure people’s human rights were protected, people’s complaints were handled effectively and that infection control practices were reviewed. As well as ensuring there were sufficient numbers of care staff employed and that staff received training and support enabling them to meet people’s individual needs. The provider sent us an action plan telling us how they intended to meet the associated regulations. During this inspection we looked to see if improvements had been made. We found action had been taken and that the provider also had future plans in place to help maintain a high quality service for people.

People told us they felt safe living at the service. Staff had received training to recognise signs of potential abuse and knew what action to take to raise a safeguarding concern.

People’s freedom and independence was respected. There were sufficient numbers of staff and staffing was flexible to meet people’s changing needs. Some risks, associated with people’s care such as skin care and nutrition were not always managed effectively, meaning professional guidance was not always followed and documentation was not always competed accurately.

People were protected by infection control practices and lived in an environment which was free from odour; it was also assessed to ensure it was safe.

People were not always supported by staff who had received training to enable them to meet people’s individual needs. The local authority service improvement team also told us, training in some areas had been slow. People told us they thought the staff had the correct skills and knowledge to care for them and did not raise any concerns about staffs competence. New staff received an induction when they joined, introducing them to day to day practices and to policies and procedures. The manager and the Nominated Individual (NI) gave us assurances that immediate action would be taken regarding training, by providing us with an action plan following our inspection.

People’s consent to their care and treatment was sought in line with legislation; ensuring their human rights were protected. People did not always receive their medicines as prescribed and documentation was not always accurate.

People enjoyed the meals and had a variety of choices to choose. The catering staff were knowledgeable about people’s individual needs. People were offered drinks and snacks throughout the day.

People told us the staff, were kind and cared for them with compassion. Staff showed a genuine love and care for people. The atmosphere within the service was calm, people were supported at their own pace and staff took time to stop and chat with people.

People were supported to be actively involved in decisions relating to their care and about how they chose to live their life. People’s personal histories were obtained so staff could get to know people and have meaningful conversations. People had the choice to participate in social activities and people’s religious needs were respected.

People's privacy and dignity were promoted. Staff knocked on people's doors and spoke in private about people's health and social care needs.

People's confidential information was not always protected because their personal care records were not always locked away. At the time of our inspection we asked the manager and Nominated Individual (NI) to take immediate action to rectify this.

People, prior to moving into the service had a pre-assessment review to establish what their needs were and to help ensure they could be met by the staff. People had care plans in place which provided guidance and direction for staff about how to meet people's individualised needs. Care plans were reviewed and updated when changes to people's care occurred, this helped to ensure they were consistent and reflective of their needs. People were supported to maintain good health and had access to external healthcare services.

People received personalised and responsive care. People's changing care needs were not always effectively communicated to ensure people received continuity of care. We spoke with the manager about this who told us she would address the quality of the handover to ensure important information was not missed, and that people’s changing care needs were fully understood by staff.

People's relatives were welcome to visit at any time. Relatives told us they were kept informed and were involved in decision making about their loved ones care.

People’s complaints were spoken positively of, and used to help improve the service. The manager and Nominated Individual (NI) were in the process of looking at a better way to share the complaints procedure with people.

Checks and audits were in place to help monitor the quality of the service and to help identify if improvements were needed, this included a weekly visit carried out by another manager. However, these had not always been effective in identifying when improvements were needed. We raised our concerns with the Nominated Individual (NI) about this, as the Commission had previously taken enforcement action during March 2016 in relation to this. They told us that auditing processes would be reviewed.

The registered manager had not always notified the Commission of significant events which had occurred in line with their legal obligations. For example, a safeguarding concern had been raised in December 2016 but the Commission had not been made aware.

People and staff were being encouraged to feedback and to be involved in developing the service and the manager and the Nominated Individual (NI) also spoke about developing a residents committee which would help to ensure “people’s voices” were heard.

People spoke positively of the manager. Staff told us they felt supported and that the manager was “hands on”. The manager, who was new to the role, told us she had a support network and a mentor who visited the service on a weekly basis.

There was an open and transparent culture. The provider had organisational policies and procedures which set out what was expected of staff. A whistleblowing policy was also in place to protect staff should they wish to raise concerns about poor practices.

The provider was investing in the service to help improve the environment; new carpets were planned to be laid throughout and new doors were being fitted. New flooring had been laid in the kitchen.

We recommend that the provider ensures people’s personal information is handled in line with the Data Protection Act 1998.

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 the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

Breaches of legal requirements were found and enforcement action was taken. This was because people were not protected from risks associated with their care and people were not protected by infection control procedures. People were also at risk of not receiving their medicines as prescribed because documentation relating to medicines was inaccurate and there were no monitoring systems in place. We also found, people's feedback was not always respected or listened to and the systems in place to monitor and improve the quality of service people received were not effective.

We undertook this focused inspection on 8 June 2016 to check improvements had been made. 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 Pen Inney House on our website at www.cqc.org.uk.

Pen Inney House is owned and operated by Mr and Mrs L Difford. Mr and Mrs L Difford also have two other residential care homes in Cornwall. The service provides care and accommodation for up to 20 older people who are living with dementia or who may have physical or mental health needs. The provider also offers a day care facility. On the day of the inspection 13 people were living at the care home.

The home was on two floors with access to the upper floor via stairs or a stair lift. Some rooms had en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included one lounge, a dining room, and garden and patio seating area.

The registered manager for the service had recently resigned. 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 resignation of the registered manager, an acting manager supported by an assistant manager had been appointed. They told us there had been positive improvements and that they felt supported by the Nominated Individual, who visited most weeks and was always available by telephone. Systems had and were continuing to be devised and implemented to help ensure the quality of the service people received was effective and met their needs. Auditing systems now helped to highlight areas which required action and drive continuous improvement across the service.

People had been asked for their feedback about the service, but the acting manager told us further work was required to help ensure people’s views were being effectively used to ensure the ongoing quality and continued development of the service.

People were protected from risks associated with their care. However, risk assessments in place to monitor people’s weight loss were not always followed, which meant people’s needs may not be met. The acting manager told us immediate action would be taken to rectify this.

People’s individual mobility needs were now being met by staff who had received training, to help minimise moving and handling risks associated with people’s care. Staffing was being managed effectively to help ensure the correct skill mix of staff was on duty to meet people’s needs.

People were protected by infection control procedures and a cleaner had been recruited to help ensure the environment was clean and free from odour and people told us they had seen an improvement.

People’s medicines were managed safely, staff had received training and had had their competence reviewed to help ensure there were administering people’s medicines correctly. New auditing systems helped to protect people and highlight areas which required improvement.

Pen Inney House provides care and accommodation for up to 20 older people who are living with dementia or who may have physical or mental health needs. The provider also offers a day care facility. On the day of the inspection 17 people were living at the care home. Pen Inney House is owned and operated by Mr and Mrs L Difford. Mr and Mrs L Difford also have three other care homes and a domiciliary care agency in Cornwall.

The home was on two floors with access to the upper floor via stairs or a stair lift. Some rooms had en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included one lounge, a dining room, and garden and patio seating area.

The home had 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.

People and staff told us there were not always enough staff to meet their needs. There were care staff vacancies at the service and the registered manager had been covering shifts which had impacted negatively on the management of the service. People told us staff were usually kind and caring but their attitude could change when the service was short staffed. People were cared for by staff who had not received training and supervision to carry out their role. Staff did not feel supported.

People were supported to maintain a balanced diet. Comments about the quality of the meals were varied. Some people told us the meals were nice, whilst others felt improvements could be made. People’s care plans provided details to staff about how to meet people’s individual nutritional needs. However, the system in place to monitor people’s weight was not effective in ensuring prompt action was taken when concerns had been identified.

People felt safe, but did not always feel “secure”, because staff spoke with them about difficulties they were experiencing regarding the management of the service. The registered manager and staff had not undertaken training in safeguarding procedures, which meant staff may not always make safeguarding alerts when they were concerned people may be subject to abuse or mistreatment. Staff did not feel confident about whistleblowing.

People were not always protected from risks associated with their care needs because staff did not have the correct guidance and direction available about the risks or how to mitigate them. Accidents and incidents were recorded. A new process was being implemented to analyse incidents to help prevent them from occurring again. People had personal evacuation plans in place, which meant people could be effectively supported in an emergency. People’s specialist equipment was serviced to ensure it was working correctly.

People were not protected from the spread of infection, because staff did not follow infection control practices and had not received training. People told us they did not always feel the environment was kept clean.

People's consent to care and support was not always sought in line with legislation and guidance. The registered manager and staff had a limited understanding of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). This meant decisions being made by staff may not always be in people’s best interests. People’s privacy and dignity were promoted, staff knocked on people’s bedroom doors and their health and social care needs were discussed in private.

People did not always have care plans in place to address their individual health and social care needs. People’s care plans were not always reflective of the care being delivered. People were not involved in the creation or review of their care plan. Social activities were not always promoted which meant some people did not have much to occupy themselves. People had access to health care services, such as GPs, district nursing staff and opticians. People did not receive their medicines safely and documentation relating to medicines was inaccurate.

People were not confident their complaints would be listened to and acted upon. People and staff were not encouraged to feedback or involved in developing the service. For example, there were no residents meetings, staff meetings or quality surveys.

People and staff did not feel the service was well led. An external health professional told us they did not feel the staff team had leadership and direction. The registered manager and provider did not have effective systems and processes in place to ensure people received a high quality of care which met people’s needs. The Commission was notified appropriately, for example in the event of a person dying.

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 the report.