All inspections: Penberthy Residential Care Home

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.

We carried out an unannounced comprehensive inspection of Penberthy on 16 June 2016. The previous comprehensive inspection in April 2015 found there were breaches of regulations. This was because of the excessive use of pressure mats to monitor people’s movement without people’s mental capacity being assessed to justify there use. Not all information was in place to ensure the ‘fitness’ of the staff member prior to commencing work in the service. At this inspection we found improvements had been made in these areas and the service was now meeting the relevant requirements’.

Penberthy is a care home which provides care and support to older people some of whom have been diagnosed with a form of dementia. The service does not provide nursing care. The service can accommodate up to 35 people. There were 31 people living at the service at the time of this inspection. Penberthy is a detached building overlooking the town of Newquay. It has three floors served by a passenger lift. The service had been refurbished throughout since the previous inspection, with work continuing to develop in an area of the first floor to create new rooms but will not affect the current occupancy level.

The service is required to have a registered manager and at the time of our inspection a manager was progressing through the registration process. 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.

The previous inspection identified extensive use of pressure mats to monitor people’s movement, specifically during the night time period. This inspection showed reviews and taken place resulting in a reduction of the number of pressure mats being used to monitor people’s movement. Where pressure mats were required there was evidence mental capacity assessments and best interest meetings had taken place. This was to ensure they were being used within the requirements of the law.

Recruitment practices had been reviewed and changes made to ensure the applicant was safe to work at the service. Records showed checks had been made and verified prior to staff commencing work in the service.

Staff were familiar with the services medicine management system. Medicines were stored safely including those which required stricter controls. However, a member of staff had been disturbed when administering medicines and some medicines had been recorded as administered but had remained in the packaging. A medicine delivered to the service had not been recorded as received. This was discussed with the member of staff and management team and acted upon immediately.

Staff were supported by a system of induction training and supervision. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were opportunities for ongoing training and support and development.

There was a calm and relaxed atmosphere in the service and staff interacted with people in a kind and sensitive manner. Staff had time to support people and call bells were answered promptly. People told us, “They are good at answering the intercom. They will tell me if I have to wait” and “I like to do crosswords and they [staff] often take the time to pop in and help me”.

The service was staffed in accordance with the needs of people living there. Staff understood the needs of people they supported, so they could respond to them effectively. We observed care being provided and spoke with some people who lived at the service and visiting families. All spoke positively about the staff and the manager and felt they were meeting their needs. Comments included, “(Persons name) has settled very well. We are very happy with Penberthy.” and “Been here a long time. I get on very well with all the staff and couldn’t ask for more.”

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either the lounge, dining room or in their bedroom. People were seen to enjoy their meals on the day of our visit. One person said, “I enjoy my meals very much and there is a choice”.

People told us they knew how to complain and would be happy to speak with the registered manager if they had any concerns.

There were a variety of methods in use to assess and monitor the quality of the service. These included a satisfaction surveys for people using the service and their relatives as well as the staff team. Overall satisfaction with the service was seen to be positive and results of the most recent survey were available for people to view at various entry points to the service.

This inspection took place on 7 April 2015 and was unannounced.

Penberthy is a care home which provides care and support to older people some of whom have been diagnosed with a form of dementia. The home does not provide nursing care. The home can accommodate up to 35 people. There were 24 people living at the home at the time of the inspection.

The home had 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 and associated Regulations about how the service is run.

The previous comprehensive inspection at Penberthy was carried out on 5 and 7 January 2015. The service was judged to be inadequate. We found breaches of legal requirements in respect of infection control, maintenance and safety of the environment, assessing and monitoring the quality of the service, staff support, activities and, complaints.

We took enforcement action and issued three warning notices to the registered provider instructing them to meet breaches of regulation by putting measures in place to address cleanliness and infection control, improve safety and suitability of premises and improve the way the service assesses and monitors the quality of service provision.

The provider responded by sending the Care Quality Commission (CQC) an action plan of how they had addressed the breaches. We found the improvements the provider told us they had made were continuing to be developed during this inspection.

A responsive follow up inspection took place on 15 February 2015 to look at what action had been taken by the registered provider to manage and monitor standards of hygiene and cleanliness. We found the provider had taken effective action to meet the breach of legal requirements to maintain standards of hygiene.

During the inspection of 5 and 7 January 2015, we found the standard of maintenance was poor. During this inspection we found the service had taken action to improve environmental standards within the service. The way in which maintenance requests were managed had been revised, which meant they were being actioned and audited to ensure work was being carried out based upon the level of risk. This demonstrated, effective measures were in place to ensure the environment was being properly maintained.

The inspection of 5 and 7 January 2015 identified limited action had taken place to address issues identified in a report from the fire service. The registered person provided us with an action plan to inform us of what action was being taken including a timescale for completion in order to comply with the fire service. This demonstrated the registered person had acted on fire service requirements to improve the systems and ensuring service users health and safety.

During the inspection of 5 and 7 January 2015 we found the service was not recording how they were supporting staff. Staff were not being provided with the level of supervision in line with Cornwall Cares’ contractual agreement with staff. The registered manager provided us with an action plan showing what action they were taking to address this breach of legal requirement. A revised policy had been implemented which was designed to show evidence based good practice. Performance issues were being addressed separately to ensure issues were acted upon immediately. This showed the registered person was meeting the legal requirements of this breach.

During the inspection of 5 and 7 January 2015 we saw there were few meaningful activities taking place other than staff making time to play some board games and providing hand massages and manicures. There were no trips out of the home and people told us they were bored. People with dementia conditions did not receive activities which would stimulate and support them. The registered person provided us with an action plan to address this breach of legal requirement. During this inspection we saw how the service had put in place an activities diary so people could see what was taking place and when. Activities were varied and included trips out of the home at least once a month. A relative told us, “It has got better and there are more things to do. Especially going out like today but it could happen more often”. This showed the registered person was meeting the legal requirements of this breach.

During the inspection of 5 and 7January 2015 we found there was no process in place to record how complaints had been investigated and what the outcome was. The registered person provided us with an action plan to address this breach of legal requirement. During this inspection we saw the registered manager was recording individual complaints raised with the service. For informal complaints, notes were taken showing what the issues were and what action had been taken as part of the investigation. In addition more serious concerns or complaints were dealt with at a senior level where further investigation was required.

During the inspection of 5 and 7January 2015 we found the registered person had a limited system to gain the views of people using the service. The registered person provided us with an action plan to address this breach of legal requirement. The registered manager was now able to demonstrate that the views of people who used the service and other stakeholders were encouraged and welcomed. We saw a number of examples of changes and developments within the service, which had been made as a result of a review of how the views of others were taken into account and acted upon.

Recruitment procedures did not provide a full employment history or a written explanation for any gaps. Medical questionnaires were incomplete and did not provide satisfactory evidence of the person’s level of physical or mental health to carry out their role. This showed not all information had been in place to ensure the ‘fitness’ of the staff member prior to commencing work in the service.

Some people with alarmed mats did not have mental capacity assessments or records of ‘best interest’ meetings in place. This meant the registered persons was not meeting the requirements of the Mental Capacity Act 2005.

The organisation provided training and support to help staff effectively respond to people when their mental capacity was reduced. However some staff we spoke with were not as clear about their understanding of Deprivation of Liberty Safeguards (DoLs). This might affect how staff supported and respected the rights of people without capacity to make meaningful decisions about the care and support they require.

Medicine procedures were generally safe. Staff were trained in how to administer and record medication safely.

Procedures and systems were in place to safeguard people against abuse. People who lived at the service and relatives told us they felt safe and secure at the home. One relative said, “I know (my relative) is safe, secure and protected here, it has made my life very different”.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we have told the provider to take at the end of the full version of the report

Penberthy is a care home which provides care and support to older people most of whom are living with dementia. The service does not provide nursing care. The home can accommodate up to 35 people. There were 26 people living at the home at the time of the focused inspection.

The service had 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 and associated Regulations about how the service is run.

We carried out a comprehensive inspection on 05 & 07 January 2015. Breaches of legal requirements were found. As a result we undertook a focused inspection on 18 February 2015 to follow up on whether action had been taken to deal with the breach relating to the standards of cleanliness and hygiene.

Summary of the findings of the comprehensive inspection 05 & 07 January 2015

The home did not have suitable procedures to ensure the maintenance of cleanliness and hygiene standards. Carpets had not been cleaned sufficiently. There were severe incontinence odours evident throughout the home.

The number of bathing facilities in the home was inadequate to meet the needs of people living at Penberthy. Of the four bathrooms one was not used as it was not appropriate to meet the needs of the people that lived in the home. A first floor bathroom with assisted hoist was not working. Two remaining bathrooms were being used to meet the bathing needs of up to thirty five people, many of whom had continence management needs. There were no showers available to people which staff said would have made bathing easier for some people.

Following our inspection of 05 & 07 January 2015 the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Summary of the findings of the focused inspection 18 February 2015

We observed the service to be clean and tidy when we visited. A carpet cleaner was available to staff to clean and maintain carpets following spillages. Records were in place to show when areas had been cleaned in order to monitor cleaning activity.

Cleaning schedules were in place in all bathrooms, toilets and sluices to monitor the standards of cleanliness and hygiene.

The service was actively recruiting a housekeeping lead to take responsibility for the monitoring and maintenance of standards of cleanliness and hygiene within the service. In the interim period the homes registered manager and deputy manager were carrying out this role.

A review of quality audits, policies and procedures in relation to the management of cleanliness and hygiene was being undertaken by members of the senior management team. This process was still underway at the time of this inspection.

Three bathrooms were operating in the home. One on each floor which improved access to people living at the service. In addition, work was progressing to equip a ‘wet room’. This will improve the range of bathing facilities for people living at the service.

The service had met the breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Cleanliness and Infection control.

A breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Safety and suitability of premises remain in the domain of safe. Therefore the rating of Inadequate will remain for the comprehensive inspection which took place on 05 & 07 January 2015.

This inspection took place on 05 and 07 January 2015 and was unannounced.

The inspection was triggered following information of concern being brought to the attention of the Care Quality Commission (CQC). Areas of concern related to the poor environmental standards within the home. This included poor availability of bathing facilities and ineffective continence management in the home. It was alleged carpets within the home were in a poor condition, peoples rooms were sparse, with damp on the walls with wallpaper peeling away, maintainence of fire systems were incomplete and a lack of activities for people living at the home. Our inspection found these allegations were true.

Penberthy is a care home which provides care and support to older people some of whom have been diagnosed with a form of dementia. The home does not provide nursing care. The home can accommodate up to 35 people. There were 31 people living at the home at the time of the inspection.

The home had 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 and associated Regulations about how the service is run.

The home did not have suitable procedures to ensure the maintenance of cleanliness and hygiene standards. Carpets had not been cleaned sufficiently. There were severe incontinence odours evident throughout the home.

We found the standard of maintenance was poor. There was poor maintenance of windows resulting in draughts in people’s rooms, and the residue of damp on the walls of some people’s rooms. Rooms had not been decorated following the repair of a roof leak. The service had not repaired a door with a faulty closure resulting in a staff member receiving an injury. This put people at risk of harm. Maintenance requests were not always being actioned resulting in people living in an environment which was not of a satisfactory standard.

The service development plan showing what action would be taken to comply with the noncompliance requirements of the fire service was incomplete. Significant internal work was required but this had not begun at the time of our inspection.

The number of bathing facilities in the home was inadequate to meet the needs of people living at Penberthy. Of the four bathrooms one was not used as it was not appropriate to meet the needs of the people that lived in the home. A first floor bathroom with assisted hoist was not working. Two remaining bathrooms were being used to meet the bathing needs of up to thirty five people, many of whom had continence management needs. There were no showers available to people which staff said would have made bathing easier for some people.

Supervision of staff was taking place but there was little record of these meetings and some supervision sessions were very brief. Cornwall Care supervision policy committed to providing staff with twelve hours of care supervision annually. Staff were not receiving supervision in line with its own contractual agreement with staff.

There were no meaningful activities taking place other than staff making time to play some board games and providing hand massages and manicures. There were no trips out of the home. People told us they were bored. People with dementia conditions did not receive activities which would stimulate and support them.

Complaints were being addressed by the manager when raised at a local level. However, there was no record kept of the complaint, investigation or outcome. This meant they could not be audited and specific trends identified and acted upon.

There were a limited number of surveys taking place to gain the views of people using the service including service users and staff. This showed people did not have the opportunity to contribute and provide feedback to improve the service.

Staffing levels were suitable to meet the needs of people using the service. In order for staff to have the time to gain updates on each shift there was an overlap between shifts. This ensured staff were informed of any changes in peoples care and support needs and could respond effectively.

Staff had access to regular training in areas of care and support to meet the needs of people using the service. This included how to protect people from abuse. Our discussions with staff demonstrated they understood how to safeguard people against abuse. Staff we spoke with said they would have no hesitation in reporting abuse. They were able to describe the action they would take if they became aware of abuse. This showed us they had the necessary knowledge and information to understand about safeguarding people.

The registered manager demonstrated an understanding of the legislation as laid down by the Mental Capacity Act (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

We found a number of Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the end of the full version of the report.

We did not speak with people who lived at Penberthy as this was a follow-up inspection to check compliance with record keeping only. Care plans had been reviewed and rewritten. We saw three examples where drink and food intake was monitored, and saw that the information recorded was consistently monitored, interpreted and communicated so that action could be taken where necessary.

We did not speak with people who lived at Penberthy as this was a follow-up inspection to check compliance with record keeping only. Care plans were being reviewed and rewritten at the time of the inspection. We saw only one example where drink and food intake was monitored, and could not ascertain if the information recorded was consistently monitored, interpreted and communicated so that action could be taken where necessary.

Some of the people we spoke with were not able to comment about the service they received because of their health care needs. We did speak with a visitor and two people who lived at Penberthy, the manager and deputy manager. We saw people talked with staff during personal care and when being assisted. We saw people's privacy and dignity being respected and staff being helpful. We saw that people were spoken with in an adult, attentive, respectful, and caring way. We saw and heard staff talk with people to ascertain their wishes, for example their choice of food at breakfast. We saw and heard staff greeting people in passing, for example whilst going through a communal area carrying out a task.

We found that people did get the care they needed, and people's consent was sought.

People were protected by the home's management of medicines.

People were protected because the home operated a robust recruitment procedure.

There was enough staff on duty to provide personalised care that met people's preferences.

We were told, and records confirmed, that training was provided, and also that staff numbers were sufficient, though some days were busier than others. Supervision was provided, although this was not scheduled as a regular occurrence. Staff said that they enjoyed working at Penberthy.

Records were not always up to date or accurate. Records were stored securely.

We used our SOFI (Short Observational Framework for Inspection) tool for approximately one and a half hours in the dining area. The SOFI tool allowed us to spend time watching what was going on and helped us record how people spent their time, the type of support they got and whether they had positive experiences.

Some of the people who used the service were not able to comment in detail about the service they receive due to their healthcare needs. We saw people's privacy and dignity being respected and staff being helpful.

We saw that people were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw and heard staff talk with people to ascertain their wishes, for example their choice of food at breakfast. We saw and heard staff greeting people in passing, for example whilst going through a communal area carrying out a task.

Staff told us that training was provided, and also that staff numbers were sufficient, though some days were busier than others. Staff told us that supervision was provided and also confirmed that they had good training opportunities. Staff said that they enjoyed working at Penberthy.

People told us that the staff were kind and always did their best. A visitor told us that they had no misgivings about their relative moving into the care home, and they could only speak well of the staff and the care provided.

Staff told us that training was provided, that they enjoyed working at Penberthy, and that they felt they could approach the manager and senior staff if they needed to.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Penberthy Residential Care Home

All Inspections

3 November 2018

During a routine inspection

16 June 2016

During a routine inspection

7April 2015

During a routine inspection

18 February 2015

During an inspection looking at part of the service

5 and 7 January 2015

During a routine inspection

10 March 2014

During an inspection looking at part of the service

13 February 2014

During an inspection looking at part of the service

25 November 2013

During a routine inspection

29 September 2012

During a routine inspection

6 December 2011

During a routine inspection

Reports under our old system of regulation