This unannounced inspection took place on 4 June 2015.
Pendleton Court care home is located in Salford, Greater Manchester and is owned by HC-One Ltd. The home is registered with the Care Quality Commission (CQC) to provide care for up to 58 people. There are three separate units at the home, each providing care to people with residential, nursing and dementia care needs. Our last comprehensive inspection of the home was on 23 April 2014 where the home was judged to be non-compliant in relation to safe management of medication. We also conduced a follow up inspection on 16 October 2014 to see if improvements had been made in relation to the safe handling of medicines. However, we found the provider was still non-compliant in this area. This inspection focussed on what improvements had been made since our last visit.
During this inspection we found a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment with regards to medication.
There was a registered manager in post. 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 checked to see if medication was handled safely. During this inspection we looked at records about medicines for 14 people. We saw there was some good practice around medicines handling, however we still found concerns about medicines safety for all 14 people. This meant that overall people were still at risk because medicines were not being handled safely.
The people we spoke with and their relatives told us that they felt safe whilst living at the home. One person said to us; “I do feel very safe. If I ever feel unwell they are there straight away and do something about it”.
During the inspection we spoke with staff about their understanding of safeguarding vulnerable adults. Each member of staff was able to describe the process they would follow if they suspected abuse was taking place. One member of staff said; “Initially I would report my concerns to the manager or team leader to seek further advice on what to do. I would also check that it has been followed up and that something was being done about it”.
We looked to see whether there were enough staff in order to meet people’s care requirements. The nursing unit was staffed by four care assistants and a lead nurse for the unit. This was to provide care for 23 people. Both the residential and dementia unit were staffed by two care assistants and a team leader who seemed to work between both units. There were 22 people living on the residential unit and nine people living on the dementia unit. An additional member of staff was working on the residential unit during the inspection, who had worked at the home previously in a student placement role, but had not yet undertaken any formal training. Through speaking with staff they felt staffing levels were not adequate, particularly on the residential and dementia units. One member of staff said; “Staffing levels are very bad on here. With the team leader working between two floors, there are often only two of us down here. We are constantly playing catch up. Sometimes it can be absolutely chaotic”.
We found staffing levels at the home were defined by the number of people living on each unit and not by the levels of dependency. This meant that at times there were insufficient staffing levels to offer the care required. However these were not being brought together to inform staffing levels. This meant the service could not demonstrate that staffing levels reflected the needs of people who use the service.
Through our observations during the day, we felt there were insufficient staffing levels at the home, to meet people’s needs in a timely manner. These issues meant there had been a breach of regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Staffing.
We looked at staff personnel files to ensure that staff had been recruited safely, with appropriate checks undertaken. Each file we looked at contained application forms, CRB/DBS checks and evidence that at least two references had been sought from previous employers. CRB and DBS checks are used to establish if staff have any criminal convictions.
During the inspection we checked to see if the environment was suitable for people living with dementia and what adaptations had been made. We found these to be limited on the residential unit, where we were told approximately 20 people lived with dementia. For example, there was no signage around the unit, which would help people correctly locate where the dining room or lounge area was. Additionally, things such as hand rails and toilet seats were not bright in colour which again, would make them easier for people to locate. There were also no specific memory boxes or items people could touch or relate to as they walked around the unit. The corridors on the unit were long and at times we saw people appeared confused about finding different rooms on the unit and asked where they were.
We looked at what training staff had undertaken to support them in their role. Staff had a variety of training at their disposal including moving and handling, safeguarding, MCA/DoLS, infection control and dementia. The majority of training was done through eLearning and we saw that approximately five members of staff were not up to date in all of these topics and that the completion dates for these courses had now expired. We raised this with both the home manager and area manager who were aware of this and that a deadline of the 30th June had been given for completion before moving to disciplinary procedure. We found that training for the remaining staff was up to date.
We observed the lunch time meal served at the home, on each of the three units. We saw staff displayed a good understanding of people’s nutritional needs and offered choice where necessary. Some people required a ‘modified’ diet and we saw this was provided for them in order for them to consume their food safely. Some people chose to eat in their bedroom and we saw staff took people their meals on request.
We saw that staff received regular supervision as part of their ongoing development. This provided an opportunity to discuss their workload, any concerns and any training opportunities they may have. We saw appropriate records were maintained to show these had taken place.
The people we spoke with and their relatives told us they were happy with the care provided by the home. One person living at the home said to us; “In general, I’m quite happy with the care here”.
We saw that people were treated with dignity, respect and were allowed privacy at times they needed it. We saw people looked clean, were well presented and were able to choose how they spent their day which was respected by staff. We saw that when entering people’s bedrooms to provide personal care, staff closed the doors behind them to respect people’s privacy.
We found that complaints were responded to appropriately, with a policy and procedure in place for people to follow when they needed it. Additionally, we saw that a response had been provided to the complainant, letting them know of any action that had been taken. A full description of the homes complaints procedure could be found in the homes ‘service user guide’, although was not displayed anywhere in the home.
There were various systems in place to monitor the quality of service provided to people living at the home. These included regular audits and by gaining feedback from the service through surveys which were sent to relatives and people who lived at the home. This was usually done each year.
We saw that there were regular audits and checks made by senior management of the company, which covered different aspects of the service. The most recent medication audit was done on 1 June 2015 stating that there was safe medicines management in the home. The audit failed to pick up the concerns we found during our inspection visit. This meant that the homes auditing processes were not always robust enough to identify concerns.
The staff we spoke with were positive about the leadership of the home. One member of staff said; “I think the manager is very good. She is very approachable and fair. I feel I can also speak with her as a friend”.