Penberthy Residential Care Home

Updated 7 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 3 November 2018. The inspection was carried out by an adult social care inspector and an expert by experience. An expert by experience is a person who has experience of using, or of caring for a person who has used this type of service.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR and other information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with eight people who were able to express their views of living at the service. Not everyone we met who was living at Penberthy was able to give us their verbal views of the care and support they received due to their health needs. We also spoke with a visitor, staff, the registered and deputy manager, Interim Operational Director and the Regional Manager. We used pathway tracking (reading people’s care plans, and other records kept about them), carried out a formal observation of care, and reviewed other records about how the service was managed. We looked around the premises and observed care practices on the day of our visit. Following the inspection, we spoke with more staff to gain their views of the service. Overall, we spoke with 14 care staff.

We looked at care documentation for four people living at the service, medicines records, two staff files, training records and other records relating to the management of the service.

Updated 7 December 2018

Penberthy is a ‘care home’ that provides accommodation for a maximum of 35 adults, of all ages with a range of health care needs and physical disabilities. At the time of the inspection there were 33 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Penberthy is situated in the town of Newquay. It is a purpose built three storey building with a range of aids and adaptations in place to meet the needs of people living there. There were people living at the service who were living with dementia and were independently mobile. On the ground floor there is a main lounge/dining area. There are smaller quieter areas for people to use if they wish. Bedrooms are located on the three floors, some have en suite facilities and others share bathroom facilities. Two bedrooms were being used for couples. There is a lift to allow people access throughout the home. There was a garden which people could use.

This unannounced comprehensive inspection took place on 3 November 2018. At the last inspection, in June 2016 the service was rated Good. The safe section of the report was rated Requires Improvement as there were concerns about the management of medicines. At this inspection we found medicines systems were safe. Therefore, the service has been rated Good in all areas with an overall rating of Good.

The management team at Penberthy had changed significantly in the last year with the recruitment of a registered, deputy and regional manager and administrator. The registered manager was also registered to manage the providers domiciliary care service, plus was providing temporary management support, for another care home. This meant that there was an impact on the amount of time she was able to spend at Penberthy. Staff told us they felt, “Staff morale is low”. However, they also told us they enjoyed working at the service and that, “Teamwork between the care staff is fantastic.” Staff felt there was a divide between the management team and staff. We received a mixed response from staff when we asked if they could approach the management team with suggestions or concerns. Some staff did not think the management team were approachable. The registered manager acknowledged the difficulties and stated they would meet with the team to look at how relationships could be improved.

The senior managers met regularly and had redesigned their performance management system in order to improve reflective practice, increase sharing and improve communication across the organisation. The management team were keen to implement changes that would improve the quality of people’s care and assist staff. For example, the décor of the home had been improved to make it feel more appealing for people.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in 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. We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect.

The service was comfortable and appeared clean. People’s bedrooms were personalised to reflect their individual tastes. Toilet facilities were not easily accessible for people who used a wheelchair independently. The registered manager had highlighted to the provider that a bath on the ground floor needed resituating as there was no room for a care worker to get to the side of the bath to help the person using it. We have made a recommendation about this in the report.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.

Accidents and incidents that took place in the service were recorded by staff in people’s records. Such events were audited by the manager. This meant that any patterns or trends would be recognised, addressed and the risk of re-occurrence was reduced.

Information about people’s care would be shared at daily handovers, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly.

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. People told us, “Food is nice here and we do get a choice. If I don’t like what they have they will give me something else”.

People commented the activities provided by the service were enjoyable but limited. The service had just employed an activity coordinator and it was hoped that the level of activities would increase. Staff ensured people kept in touch with family and friends.

Staff were supported by a system of induction training, supervision and appraisals. Staff were recruited in a safe way. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. The rota showed that agency staff were used regularly due to staffing vacancies in the service. They used the same agency staff to provide consistent support to people. The registered manager was actively recruiting to these posts.

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Audits were also in place to monitor the standards of the care provided. Audits were carried out regularly by both the manager and members of the senior management team.