Archived: Pinglenook Residential Home

Pinglenook Residential Home is a residential care home providing accommodation and personal care to up to 16 people. The service provides support to people aged 65 and over who may also be living with dementia. At the time of our inspection there were 12 people using the service.

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

People were not kept safe from known risks. Where risks were identified there was not always guidance to inform staff how to support people safely and consistently. Medicines were not managed safely which exposed people to the risk of harm. Infection prevention and control measures were not robust, and people were placed at risk of Legionella. The provider did not ensure recruitment checks were carried out in line with the regulations.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People's care was not always personalised. The home environment did not reflect dementia friendly best practice to best meet people's needs.

Systems and processes to ensure good oversight of the service were ineffective. People were at risk of receiving care that did not meet their needs or wishes. Records were either inaccurate or lacked detail to provide staff with guidance on how to support people appropriately. A robust system was not in place to ensure accidents and incidents were appropriately recorded and responded to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 6 June 2023). This service has been rated inadequate for the last 4 consecutive inspections. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection. This focused inspection was initially carried out to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

Enforcement and Recommendations

We have identified breaches in relation to consent, safe care and treatment, protecting people from abuse, staff recruitment, person-centred care and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Pinglenook Residential Home is a care home providing accommodation and personal care for up to 16 people aged 65 and over who may also be living with dementia. At the time of the inspection 10 people were using the service. Accommodation is provided over the ground and first floor with communal lounges and dining areas.

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

Governance systems and processes had failed to make improvements to the quality and safety of the service since the last inspection.

People were not kept safe from known risks. Action had not been taken to reduce fire risks. Quality monitoring systems were not in place to reduce risks to people following incidents.

People were not protected from abuse. A person was unlawfully deprived of their liberty, and this had caused them distress. Staff did not always know how to spot the signs of abuse.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care was not person-centred. Care plans were not always reflective of people’s needs. Staff did not always engage people or respond to people’s preferences. People’s and relatives’ input was not used to improve the care provided.

People were not always administered medicines safely. People were not always supported to eat enough and were not always offered food they preferred. Staff were not recruited safely, and staffing levels were not calculated safely. Up to date staff training was not always in place.

Some improvement had been made to the service environment since the last inspection and work was ongoing. People were protected from the risk of infection. Staff supported people with their mobility safely. Some people were happy with staff and felt safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (13 December 2022). The service remains rated inadequate. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection. This focused inspection was initially carried out to review the key questions of safe and well-led only. However, due to concerns found with consent and deprivation of people’s liberty, this inspection was also opened to the key question of effective.

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.

Enforcement

We have identified breaches in relation to people’s health and safety, protecting people from abuse, consent, staff recruitment, person-centred care and governance at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Pinglenook Residential Home is a care home providing accommodation and personal care for up to 16 people aged 65 and over who may also be living with dementia. At the time of the inspection 11 people were using the service. Accommodation is provided over the ground and first floor with communal lounges and dining areas.

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

People were not safe because risk was not managed effectively. There were a number of hazards in the environment. The provider’s systems and processes had failed to identify or manage these risks. The approach to the building and decoration works being carried out was haphazard. This caused significant disruption and unnecessary risk to people and staff.

Care plans were not always reflective of people’s needs. Staff did not always identify when people required medical attention in a timely manner. Although some improvements were noted to food and fluid monitoring, gaps remained in daily totals. There was no evidence of staff offering alternative meals, snacks and drinks.

Infection prevention and control requirements were not always met. Some areas of the premises were not clean. Staff did not always follow safe infection prevention and control guidance. Deficiencies identified by the fire service and by the local authority had not been fully addressed.

Some people told us they were bored and did not have enough to do.

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.

People received their medicines in a safe way. Staff were mostly kind and caring and had developed positive relationships with people. Staff were recruited in a safe way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 19 July 2022). The service remains rated inadequate. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement

We have identified breaches in relation to safety and leadership at this inspection.

We have taken enforcement action and cancelled the provider's registration.

Pinglenook Residential home is a care home providing accommodation and personal care for up to 16 people aged 65 and over who may also be living with dementia. At the time of the inspection thirteen people were using the service. Accommodation is provided over the ground and first floor with communal lounges and dining areas.

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

People were not safe because risk was not managed effectively. Care plans and risk assessments did not provide enough information about what staff should do to meet people’s needs and keep them safe. Staff did not always identify when people at risk of malnutrition and dehydration had not had enough to eat or drink and did not take action when this was the case.

Leadership and governance was not effective and did not identify risk, drive sustainable improvement or seek and act on feedback from people and staff. There were ongoing issues with the environment requiring general maintenance and redecoration. Deficiencies identified by the fire service and by the local authority had not been addressed.

The majority of the service's environment was clean and fresh and staff followed infection prevention and control and government guidance about the control of COVID-19.

There were enough staff on duty to meet people’s needs and staff were recruited in a safe way. Staff were kind and caring and had developed positive relationships with people.

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.

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 requires improvement (28 May 2021).

Why we inspected

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.

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in regulations in relation to safe care and treatment and leadership and quality monitoring.

We have taken enforcement action and cancelled the provider's registration.

We found the following examples of good practice

• The registered manager made weekly telephone calls to people’s relatives to keep them up to date with COVID-19 government guidance and to arrange visiting appointments in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors.

• Risk assessments took into account people's individual communication needs and additional support they required to stay safe during COVID 19 outbreaks.

• Cleaning schedules and checklists had been developed to improve infection prevention and control. Where areas for improvement had been identified, the registered manager had developed an action plan and was checking staff were working to this and following government guidance.

Pinglenook Residential home is a care home providing accommodation and personal care for up to 16 people aged 65 and over who may also be living with dementia. At the time of the inspection seven people were using the service. Accommodation is provided over the ground and first floor with communal lounges and dining areas.

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

The service needed further improvement to ensure it was managed effectively.

A concern over staffing levels, and some pieces of equipment that could pose risk of cross contamination were addressed at the inspection.

People’s care needs were assessed by trained staff. People received compassionate care from staff who were recruited safely.

People felt safe living at the service. Staff knew how to recognise abuse and how to report it.

People were supported to access healthcare services when required. People had access to their medication when they needed it, and medicines were managed safely.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 21 January 2021). The service has been in Special Measures since 21 January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 20 September 2020. Breaches of legal requirements were found, and the service was placed in special measures. We imposed conditions on the providers registration. A director completed an action plan after the last inspection to show what they would do and by when to bring about the improvements needed.

This inspection was prompted in part due to concerns received about care and support provided to people. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Pinglenook Residential home is a care home, providing personal care for up to 16 people aged 65 and over who may also be living with dementia. At the time of the inspection 13 people were using the service. Accommodation is provided over the ground and first floors with communal lounges and dining areas.

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

Risk was not identified or managed. Care plans and risk assessments were not always reflective of people’s needs or risks. This exposed people to risk of significant harm.

Staffing numbers were not sufficient to meet people’s needs or keep them safe. Staff did not always have time to spend with people or to monitor people when they displayed risky behaviours.

People were not protected from the risk of avoidable harm. There were a number of unwitnessed falls and opportunities to learn from accidents and incidents were missed.

Quality assurance systems and processes failed to identify concerns relating to safe care. Opportunities for people to follow their hobbies and interests were very limited and some staff were not aware of people’s unique life and social histories. This information is important when supporting people with communication difficulties.

Infection prevention and control procedures mostly followed expected government guidance and requirements.

People received their prescribed medicines at the right time. Medicine administration records were accurate and up to date.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Good (Published 15 July 2020). The rating for the service has deteriorated to Inadequate. This is based on the findings at this inspection.

Why we inspected

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 coronavirus and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about care and support provided to people at Pinglenook Residential Home. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led. We reviewed all the information we held about the service.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pinglenook Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is 'inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time-frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Pinglenook is a residential care home, providing personal care for up to 16 people aged 65 and over who may also be living with dementia. At the time of the inspection 12 people were using the service. Accommodation is provided over the ground and first floors with communal facilities.

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

People at the home felt safe and well cared for. People's preferences were respected, and staff were sensitive and attentive to people's needs. Staff were seen to be kind, caring and friendly and it was clear staff knew people well.

Recruitment practices were safe and staff received the training they required for their role.

Risks to people's health, safety and well-being were assessed and care plans were in place to ensure risks were mitigated as much as possible.

Staff were aware of their responsibilities to safeguard people and the home had procedures in place.

People's care plans contained personalised information detailing how people wanted their care to be delivered.

Staff were keen to ensure people's rights were respected including those related ethnicity and dietary requirements.

People received their medicines safely and as prescribed. Medicine management practices were safe.

The service was provided in a homely and clean environment.

Consideration was given to providing a variety of leisure and social activities for people to enjoy.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided.

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.

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 requires improvement (report published 22nd March 2019).

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

•Whilst people received their medicines in a safe way and as prescribed by their GP, the staff team did not always follow the providers process of dealing with refused medicines. The staff team were appropriately trained in the management of medicines and their competency was assessed.

•On the day of our visit, door wedges were used in some people’s bedrooms due to them not liking their door shut. We questioned this practice and were informed following our visit that this practice had ceased. The provider was in the process of obtaining automatic closers.

•There were on the whole, appropriate numbers of staff available to meet people’s needs though we recommended the provider re visit the deployment of staff to ensure suitable numbers were available to meet people’s ever-changing needs.

•People felt safe living at the service. They told us the staff team were kind and caring and this was observed during our visit. People were treated with dignity and respect and were involved in decisions about their care and support.

•Appropriate recruitment procedures had been followed and the staff team had received appropriate training, guidance and support. We recommended the provider re visited the dementia training offered to staff to ensure it was suitable and effective.

•People’s needs had been assessed and risks to people had been identified and managed. The staff team followed the providers infection control procedures and lessons were learned when things went wrong.

•People were supported to eat and drink well and support from relevant healthcare professionals was sought when required. People’s wishes at the end of their life had been sought and training had been provided to the staff team.

•The staff team worked in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

•Concerns and complaints were appropriately handled and people had a say on how the service was run.

•People were provided with a clean and tidy place to live. People’s likes and dislikes were observed and activities of choice were offered.

•Monitoring systems had been introduced enabling the provider and the registered manager to effectively assess the service being provided.

More information is in the full report.

Rating at last inspection: Inadequate - last report published 17 September 2018.

Why we inspected: At the last inspection in June 2018 we found six breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.The service was rated overall Inadequate with an Inadequate rating in the Safe and Well led domains and a Requires Improvement rating in the Effective, Caring and Responsive domains. A warning notice was served and the service was placed in special measures.

Following our inspection, the provider informed us what they would do to meet the regulations.

We carried out this comprehensive inspection to check their progress against the warning notice served and to check if they had now met the regulations. Our visit was unannounced. This meant the staff and the provider did not know we would be visiting. During this inspection we found the provider had implemented the necessary improvements, though some areas still needed addressing. At this visit we found evidence to demonstrate and support the overall rating of Requires Improvement. The service is no longer in special measures.

Follow up: We will continue to monitor the home in line with our regulatory powers.

More information is in the detailed findings below.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

During the first two days of inspection we found a number of areas of concern. After these visits we liaised with the police and local authority who had undertaken their own investigations and checks on the service. Following this liaison we returned for a third visit on 28 June 2018 to check whether any of the necessary improvements had been made since our initial two visits.

Pinglenook Residential Home is a ‘care home’. 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. The home provided care for a maximum of 16 older people. Thirteen people lived at the home at the time of our inspection. The home comprises of a communal lounge and dining area; and some bedrooms on the ground floor; with more bedrooms on the first floor along with the manager’s office. There is some outdoor space for people’s use at the rear of the home.

At the start of our inspection there was no 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. By the third visit a manager was in post although had not yet applied to be registered with the CQC.

People were not always safeguarded from harm. Safeguarding authorities had determined that some people in the home had been neglected and acts of omission had occurred.

People did not always receive timely referrals and reviews of their care when their needs changed. For example, peoples’ weights had not been monitored despite some people requiring nutritional supplements.

Accidents and incidents, such as falls, were not analysed and used to help identify how to reduce the likelihood and make improvements. Risks related to people’s care had not been updated since the registered manager left and staff had not always taken appropriate action to manage new and emerging risks.

Risks associated with the cleanliness of the premises were not effectively managed and dealt with appropriately. Some areas of the home had fallen into a state of disrepair as no monitoring had taken place or action taken in a timely manner.

Infection prevention and control practices did not protect people from the risks associated with infection.

The management of medicines did not follow best practice as set out by the Royal Pharmaceutical Society Guidance for Care Homes. Not all external creams or ointments had dates of opening recorded or body maps in place. Errors were not being identified or acted on when people missed their medicines that were due at set times.

Staff had not received all the training considered essential to provide safe and effective care. Management checks to determine whether staff were competent to carry out specific tasks had not taken place to assure them staff knew their responsibilities.

There were not enough staff employed or deployed to meet people’s needs in a timely manner, and to provide people with emotional support when they needed it. Following the concerns identified, the provider contacted an agency to provide staff cover, however, appropriate checks had not been completed by the provider to ensure they had the right skills and training to meet people’s needs.

Staff did check people’s consent to care before they provided it. However, appropriate assessments had not been reviewed on a regular basis and care had not always followed the Mental Capacity Act 2005 (MCA). Staff knowledge on the MCA and Deprivation of Liberty Safeguards (DoLS) varied and staff did not always understand how this legislation applied to the people they cared for. DoLS and any conditions in place had not been reviewed and some had expired nearly a year ago.

The CCTV in the communal areas had not had any review to ensure it was in the best interests of people within the home.

There was a lack of meaningful activities for people to enjoy and to provide purposeful lives. People’s personal care needs had not always been met in a personalised and responsive manner.

People enjoyed their food, however they did not always receive food that met their preferences.

People’s privacy and dignity was mostly respected but staff sometimes acted in a way which did not consider this. People and relatives were not always involved in the development and review of care plans.

Systems and processes designed to assess, monitor and improve the quality and safety of services, and reduce risks were not effective.

Following the first two days of our inspection we were informed that a new manager had been appointed and started working at the home on the 18 June 2018. A number of improvements have taken place in a short period of time. These have been reflected in the main findings of this report.

The provider did not have enough expertise and knowledge of the Regulations to manage the care home when a manager was not present. They had not provided sufficient staff support to ensure people's care and safety needs were met, and the premises and equipment were safe.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this time frame so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.