This inspection took place on 23 November 2017 and was unannounced. This meant the registered provider did not know we would be visiting. Peterlee Care Home was last inspected by the Care Quality Commission (CQC) on 20 and 21 July 2016 and was rated Requires Improvement overall and in two areas, Safe and Responsive. We informed the provider they were in breach of regulation 12 regarding the safe management of medicines and the management of risk assessments and regulation 9 regarding not having person centre activities which met people's individual needs.
Whilst completing this visit we reviewed the action the provider had taken to address the above breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had ensured improvements were made in these areas and this had led the home to meeting the above regulations.
Peterlee Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Peterlee care home provides nursing and personal care for up to 44 people. At the time of our inspection there were 41 people living at the home, some of whom were living with dementia.
There was a registered manager in place. 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 we found that the service didn’t have appropriate arrangements in place for the safe handling of medicines. This was in regard to topical medicines that were found to be not dated on opening and no guidance in place for staff to administer them correctly. As Topical medicines such as creams or ointments have a short shelf life such as 28 days once opened. At this inspection we found that improvements had been made to the storage and management of topical medicines and improved directions and recording were in place.
At the last inspection we found the service didn’t offer a varied range of activities for people that were individualised to their needs, wishes and preferences. At this inspection we saw that this had been improved and a wider range of activities were provided that were more meaningful and we saw people taking part and feedback was positive.
At the last inspection we found risk assessments were not managed appropriately. At this inspection we found that risks to people were assessed and improved. These risk assessments were up to date individualised. These were in place to ensure people could take risks as part of everyday life and minimise any potential harm by mitigating risks.
Accidents and incidents were monitored by the registered manager to highlight any trends and to ensure appropriate referrals to other healthcare professionals were made if needed.
The premises and people’s rooms were clean and tidy and throughout the inspection we saw staff cleaning communal areas. Staff had access to plenty of personal protective equipment.
People who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.
Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.
Staff were supported to maintain and develop their skills through training and development opportunities.
Staff had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further training needs
People’s health was monitored and referrals were made to other health care professionals where necessary, for example, their GP.
People were treated with equality, dignity and respect.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.
Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the Mental Capacity Act to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.
Consent to care and treatment records were signed by people where they were able.
People were supported to maintain a healthy diet, and where needed records to support this were detailed.
People enjoyed their dining experience and we received positive feedback regarding the food and the choices on offer.
Throughout the day we saw that people who used the service, relatives and staff were comfortable, relaxed and had a positive rapport with the registered manager and also with each other.
The service supported people to access advocacy services. Procedures were in place to provide people with appropriate end of life care.
People’s needs were assessed before they moved into the service. Care plans were then developed to meet people’s daily needs on the basis of their assessed preferences. Plans were improved and included more person centred details regarding people’s preferences and were updated regularly.
An experienced registered manager was in place and understood the importance of monitoring the quality of the service and reviewing systems to identify any lessons learnt. The service regularly consulted with people, relatives and staff to capture their views about the service.