Promenade Care Home

Promenade Care Home is a residential care home providing personal care to 46 people at the time of the inspection. The home can accommodate up to 49 people and supports older people and people living with Dementia. Promenade Care Home is situated in Southport town centre. Accommodation is provided across 3 floors and people had access to a large lounge, dining area and rear garden.

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

People were at an increased risk of harm as records did not always demonstrate risks to their health, safety and welfare were routinely assessed. Risk assessments were either not completed or not detailed enough to guide staff on how to safely support people. Accident and incident processes were not always effective. Some incident records were poorly completed, and themes and trends were not analysed reliably.

The registered manager did not have oversight of all safeguarding incidents and therefore, appropriate investigation and referral to the safeguarding authority had not always taken place.

People received their medicines as prescribed. However, medicines administration records (MAR) were not always completed in line with best practice guidance, and we found missing signatures on multiple records.

Records relating to food and drink intake were not always reflective of people's needs. This increased the risk of people not being supported effectively in this area.

Monitoring systems had failed to identify all shortfalls found during the inspection process with risk management, accident and incident processes and safeguarding. This meant opportunities to drive improvements to quality and safety were missed.

The provider and manager were receptive to the concerns found during the inspection and took immediate and robust action to reduce the risk of harm to people living at the home. We were assured that enough action had been taken reduce the likelihood of harm before the inspection process concluded.

People told us they felt safe living at the home. Relatives also felt their loved ones were kept safe. The home was clean and hygienic throughout. People and their relatives spoke positively about the cleanliness of the environment.

Our observations found that staff were deployed in sufficient numbers to meet people’s needs. Staff were recruited safely and had the necessary pre-employment checks completed before they started work.

Staff received an induction and completed mandatory training to enable them to carry out their job roles effectively. It was clear from our conversations with staff that they were skilled and knew people well.

There were effective systems in place for staff to escalate any concerns they had about people's health. People and their relatives told us staff were attentive and could pick up very quickly on changes in relation to their health.

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.

Systems were in place to gather feedback from people, relatives and staff and the registered manager understood the importance of using this feedback to improve the home. The registered manager was approachable, consistent, and visible. As a result, staff felt respected, valued and supported.

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 5 December 2017).

Why we inspected

We received concerns in relation to the management of a person's skin condition. As a result, we undertook a focused inspection to review the key questions of Safe, Effective 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 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 Safe, Effective and Eell-led sections of this full report.

The registered manager and the provider were responsive to the concerns we shared and took immediate action to reduce the risk to people living at the home.

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

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

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding and good governance at this inspection.

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.

Located in Southport town centre, the Promenade Care Home provides accommodation and personal care for up to 49 people. Shared areas include a large dining room and lounge on the ground floor. A lift is available for access to the upper floors and lower ground floor. There is a large enclosed garden to the rear of the building. Both front and rear entrances have disabled access. A call system with an alarm facility operates throughout the home.

A registered manager was 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’.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

We looked at the care plans for four people receiving support at the service. Each record contained person-centred information which included physical and social information, life history, risks to people’s safety and reference to people’s choices and preferences. People told us they were involved with the care needs assessment and their plan of care. A person said, “I am more than happy with the help I receive from the staff, they are so nice.” The registered manager and staff were aware of how to support people from different cultures and backgrounds and this was recorded appropriately.

Staff were able to explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

We saw people’s dietary needs were managed with reference to individual preferences and choice.

People were supported to follow various social activities; these were arranged on a daily and very much appreciated by people living at Promenade Care Home. There was a relaxed friendly atmosphere in the home with plenty of chatter and laughter. A person said, “It’s so nice, we have lots of fun, I am never lonely here.”

Staff received safeguarding training and staff interviews confirmed their knowledge around reporting procedures to the local authority and other external agencies. A staff member said, “I would always speak up for the residents.”

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The registered manager had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

The service had complaints’ policy and procedure which was clearly displayed for people and their visitors to the home to view. Complaints logged had been investigated and responded to in accordance with this documentation.

We saw recruitment checks had been undertake to ensure staff were ‘fit’ to work with vulnerable people.

Medicines were stored and administered safely to people living at the service. People were encouraged to administer their own medicines where appropriate.

Staff were trained in a range of subjects appropriate to the needs of people receiving support. This training was provided regularly, along with specialist training, for example, end of life care and formal qualifications in care to improve staff’s skill and expertise.

The service was well managed and people using the service, relatives and staff were complimentary regarding the registered manager’s leadership. A person told us, “ A very good home to live in.”

Systems and processes were in place to help assure and improve the overall quality of the service. The registered manager completed regular audits (checks) on how the service was operating. Any required actions were completed promptly and lessons learned shared with the staff to improve practice.

The registered manager sent out satisfaction questionnaires to people using the service and relatives; meetings were also arranged for them and for the staff. The information from satisfaction questionnaires and meetings was used to make positive changes and these had been acted on promptly to help improve the service. We saw changes had been made to the menus, shift patterns and the key worker role for staff. It was evident that the registered manager and staff listened to what people had to say.

The ratings from the previous inspection were displayed as required in the care home and on the provider’s (owner’s) website.

People told us staff were respectful of their choices. One person said, 'I think it is very nice here, you don't get told to do this or do that. They [staff] ask you what you want to do.' The people we spent time with were aware of their care needs and said staff explained things to them.

People told us there was always plenty of staff about and staff responded quickly if a person needed something. One person said, 'The staff are excellent. Some of them have been around for years. There are always plenty of staff to help us.'

Care records informed us that individualised assessments and care plans had been developed for each person and these were reviewed consistently each month.

Arrangements were established for ensuring the environment was clean, safe and well maintained. We found that effective staff recruitment processes were in place.