Peacock Manor Nursing Home

Peacock Manor Nursing Home is a residential care home providing personal and nursing care to up to 49 people. The service provides support to older people, some of which may be living with dementia, physical disabilities or have mental health conditions. At the time of our inspection there were 43 people using the service.

Peacock Manor nursing home offers accommodation to people over two wings, ‘The Hall’ and ‘The Cottage’. Both wings have communal dining and lounge areas and there is a large garden which people can access throughout the day.

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

People were supported by staff who knew them, who listened to their opinions and acted on them. Care plans helped aide in their care however some details in these needed reviews to ensure they were consistently accurate, and person centred. We have made a recommendation about this.

People told us their rooms were kept clean and tidy however on the day of the inspection we found that areas of the home were not cleaned to a good standard and renovation was needed in many areas to help improve the environment. This did not seem to affect the people in the service and an extensive renovation plan was in place by the provider. We have made a recommendation about this.

The dining experience had been improved and people enjoyed the variety of meals offered, telling us they had a choice and staff supported them to maintain a healthy diet. People were offered plenty of drinks and snacks throughout the day and staff were seen to be attentive to those who were nursed in bed.

Effort had been made by the provider to ensure a more consistent staffing team. People and relatives were complimentary about the staff and found them to be helpful, caring and respectful. One relative told us, “They talk to [Relative] all the time, the people are lovely, very patient.” and one resident told us, “Staff are wonderful.”

Systems were in place to monitor the quality and safety of the service to help ensure people received good care. Staff felt supported in their roles and the registered manager was proactive in responding to any feedback to improve the service. One staff member told us, “Management is very supportive and there is a nice team.”

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 requires improvement (published 22 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. Breaches in regulation were found at the last inspection so we also undertook this inspection to review their action plan and confirm they now met legal requirements.

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. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Peacock Manor Nursing Home is a residential care home providing personal and nursing care to 34 people aged 65 and over at the time of the inspection. The service can support up to 49 people. The service is split into two wings, ‘The Hall’ and ‘The Cottage’. Both wings are serviced by a lift and there are communal toileting and bathing facilities. Each wing has a main lounge and dining area.

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

People were exposed to risks associated with COVID-19. Staff did not wear the correct personal protective equipment (PPE) or change their PPE in line with guidelines. Staff did not always screen visitors for the risk of COVID-19 and some staff worked at different care settings, such as in a hospital and in a care home, against COVID-19 guidelines.

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. Staff did not always give people choice at mealtimes.

The provider had not always safely recruited staff. In some cases, pre-employment checks had not been completed.

The provider's audits did not identify poor care practices. There was not a robust system to consistently monitor patterns and trends of incidents to learn lessons and improve the safety and quality of the service. Further development was needed to promote a positive culture within the service.

Staff managed people’s medicines safely and worked with health and social care professionals to make sure people’s health and wellbeing was promoted. There were enough staff with the right skills and experience to safely care for people.

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 March 2020). The service remains rated requires improvement and there was a breach of regulation. The service has been rated requires improvement or inadequate for the last four consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of the service on 3 and 4 February 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 not changed from requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Peacock Manor Nursing 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 infection prevention and control and management oversight 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tancred Hall Nursing Home provides residential and nursing care for younger adults and older people who may be living with a physical disability, sensory impairment, mental health needs or dementia. The service is split into two areas. The 'Hall' provides residential and nursing care for people who may also be living with dementia. The 'Cottage' provides support for people with more advanced dementia or complex mental health needs. The service is registered to support up to 49 people, and 28 people were using the service when we inspected.

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

People benefited from a more welcoming and homely environment, but further improvements were needed to make sure all areas of the service were thoroughly and regularly cleaned.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. We made a recommendation about record keeping in relation to the Mental Capacity Act 2005.

People’s care plans were being reviewed and updated to make sure they consistently contained person-centred information about their needs, preferences and any risks to their safety.

People were supported to eat and drink enough, but their dietary requirements were not always clearly recorded to guide staff and help make sure they received consistent support. We spoke with the manager about the importance of reviewing records to make sure actions were recorded and handed over where people had not had a lot to drink.

The manager had made significant and widespread improvements to the quality and safety of the service. Whilst this work was ongoing and further improvements were needed in some areas, they were aware of what was needed and work was ongoing to deliver the planned improvements. Systems had been put in place and were being embedded to help deliver sustained improvements. The provider had appointed a new nominated individual and arranged for audits to help monitor progress and support improvements.

Improvements had been made to the way medicines were managed and administered. People received safe support to take their prescribed medicines.

The provider had improved their recruitment process. Safe systems were in place to make sure enough suitable staff were deployed. People benefited from patient and unrushed support when they needed it.

People were supported to stay safe by staff trained to identify and report any safeguarding concerns. Risks relating to the environment and fire safety had been addressed and the provider continued to make significant improvements to the quality and safety of the service.

People benefited from a more comfortable, stimulating and homely environment. Work was ongoing to continue redecorating and renovating the service.

Improvements had been made to help make sure suitably trained and supervised staff were deployed. New staff received an induction to the service. Existing staff, including nurses, completed a range of training and received supervisions to monitor their performance and support them to develop in the role. Plans were in place to complete annual appraisals.

Staff worked with professionals to make sure people’s complex needs were met and they received medical attention if required.

Improvements had been made to the range of activities on offer. People benefited from more regular and meaningful activities to help avoid social isolation. There was a relaxed, happy and friendly atmosphere within the service and people shared friendly interactions with staff throughout our visit.

Staff were kind and caring. Interactions were more person-centred and less task orientated. People’s personal care needs were met and they were supported to have regular baths or showers. People were supported to maintain their privacy and dignity.

People felt able to speak with staff or management if they were unhappy or needed to complain. The manager was approachable and responsive to feedback. They took consistently positive steps to listen and respond to feedback to improve the service.

Staff and professionals praised the management of the service and the significant improvements being made.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was inadequate (report published 17 October 2019) and there were six breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since October 2019. During this inspection the provider demonstrated improvements have been made. The service is no longer rated inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection significant improvements had been made to meet five of the six breaches of regulation identified during our last inspection. However, further improvements were needed to meet the breach of regulation relating to the cleanliness of the environment. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tancred Hall Nursing Home provides residential and nursing care for younger adults and older people who may be living with a physical disability, sensory impairment, mental health needs or dementia. The service is split into two areas. The ‘Hall’ provides residential and nursing care for people who may also be living with dementia. The ‘Cottage’ provides support for people with more advanced dementia or complex mental health needs.

The service is registered to support up to 49 people, and 36 people were using the service when we inspected.

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

People received inconsistent care, which did not always meet their needs. The provider’s approach to managing the service put people at risk of avoidable harm as they had failed to adequately monitor the quality and safety of the service. Risks were not always identified or addressed in a timely way.

There were significant and widespread issues and concerns in relation to the decoration, maintenance and cleanliness of the environment. The environment did not promote people’s wellbeing and support the delivery of high-quality care. People had not been protected from risks associated with a fire occurring; North Yorkshire Fire Service were due to revisit the service to make sure appropriate action had been taken in response to these concerns.

People were put at risk of harm because the provider had not followed a robust process to make sure suitable staff were employed and deployed. There was a high use of agency staff and suitable checks had not always been completed before they worked at the service. Staff lacked organisation and leadership, particularly at mealtimes. There were gaps in staff’s training and supervisions and appraisals had not always been completed in line with the provider’s policy and procedures.

Improvements were needed to make sure medicines were managed safely. Care plans and risk assessments varied in quality and detail. They did not consistently provide enough information about people’s needs, risks and how to safely support them. People did not always benefit from the support of skilled and experienced staff when they became anxious or distressed. The provider had not developed an evidenced based approach to supporting people with mental health needs or dementia. Care plans did not support good practice and clear information was not recorded in relation to periods of anxiety and medicines used to reduce distress.

People told us staff were generally kind and friendly, but interactions were brief and often task focussed. There were limited activities and people spent long periods of time socially isolated or without meaningful stimulation.

People’s personal care needs had not always been met and their dignity had been compromised by issues with the cleanliness and care shown in maintaining a welcoming and homely environment.

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 were not always offered choices or appropriately supported to make decisions. A lack of management oversight had led to delays seeking applications to deprive people of their liberty; mental capacity assessments and best interest decisions were not always recorded.

Records did not support staff to appropriately monitor and make sure people’s needs were met. The new manager had begun working more closely with professionals and reviewing people’s needs to ensure the support provided was appropriate and based on up-to-date clinical advice.

People generally told us they felt able to speak with management if they had any issues or concerns. One complaint had been recorded, but the provider had not followed their complaints procedure in responding to this concern.

The new manager had been responsive to feedback and worked with the provider to make changes and improvements. Whilst management had taken positive steps to improve the environment and reduce risks, and positive feedback had been received from visiting professionals about the improvements being made, this was reactive management. We were concerned that adequate systems had not been put in place to monitor the service and prevent the significant and widespread issues and concerns we found.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was requires improvement (report published 9 March 2019). At this inspection the service remained requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

Why we inspected

The inspection was prompted by concerns received about the environment, infection control practices, staffing and the quality of the care provided. We inspected the service to examine those risks.

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

Enforcement

We have identified breaches of regulation in relation to safety, the quality of the person-centred care, the premises, staffing, recruitment practices and the governance of the service at this inspection. 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 six 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.

People’s experience of using this service: The provider and registered manager had made significant improvements since our last inspection. The environment was cleaner and more welcoming. Staff were more attentive and engaged, and there were more effective systems to monitor and make sure people’s needs were met. The provider was now compliant with all legal requirements.

Although there had been significant improvements, progress was needed to show improvements could be sustained. Work was ongoing in other areas to develop and improve the service. For example, a more robust system was needed to make sure agency staff were suitably trained; progress was needed to develop a fully dementia friendly environment, and to maintain consistently high standards of cleanliness. The range of activities on offer had improved, but further improvements were needed as people were not always meaningfully engaged.

We recommend opportunities for regular, meaningful stimulation should be further explored and developed.

We recommend the provider implement a business continuity plan to help keep people safe in an emergency.

Staff were safely recruited and enough staff were deployed to meet people’s needs. Staff had been trained to respond to safeguarding concerns. The registered manager was proactive investigating and responding to concerns to keep people safe.

People received care from staff who were kind and caring. Staff worked closely with healthcare professionals and sought their advice, guidance and support on how to best meet people’s needs. Staff had completed a range of training. The registered manager was looking to source and deliver more comprehensive training for staff working with people with mental health needs and behaviours that may challenge.

People were supported to meet their personal care needs and dress according to their personal preferences. Staff supported people when needed to make sure they ate and drank enough.

People gave very positive feedback about the new registered manager and deputy manager (who was also the clinical lead) and the changes and improvements they had made. The registered manager was approachable, responsive to feedback and clearly dedicated to developing and improving the service. They used a range of audits to check quality and safety. They put in place action plans to make sure improvements were made when needed.

More information is in the Detailed Findings section below. For more details, please see the full report which is on the Care Quality Commission's (CQC) website at www.cqc.org.uk.

Rating at last inspection: At the last inspection service was rated Inadequate (report published 11 July 2018). This is the second consecutive time the service has not achieved a Good rating overall.

Why we inspected: At the last inspection, there were seven breaches of regulation. Following the inspection, we asked the provider to take action to make improvements. They sent us a plan to show what they would do and by when to improve the service. This inspection was planned to check the provider had acted to improve the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider, local authority and clinical commissioning group to monitor progress. If any concerning information is received we may inspect sooner.

This service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in one adapted building separated into two areas. The ‘Hall’ supports people with nursing needs who may also be living with dementia. The ‘Cottage’ supports people with nursing needs, mental health needs and people living with dementia.

We inspected the service on 26 March, 5 April and 25 April 2018. The first day of our inspection was unannounced. At the time of our inspection, 32 older people with nursing needs, dementia and mental health needs were using the service.

This was the first inspection of this location since it was taken over by Tancred Hall Care Centre Limited in July 2017. Before this, the service had been in administration.

During the inspection process CQC was notified of an incident in which a person using the service died. The inspection did not examine the specific circumstances of this incident. However, the information shared with the CQC indicated potential wider concerns about the care and support provided at Tancred Hall Nursing Home and about the management of risks including the risk of choking. The inspection examined those risks.

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 timeframe 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.

The service did not have a registered manager and had been without a registered manager since December 2017. A registered manager is a person who has registered with the CQC 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. On the first day of our inspection a manager was in post and applying to become the registered manager. However, they withdrew their application and left the service. On the second and third day of our inspection the service was being managed by a director, who was also the provider’s nominated individual, and a manager from another service. Following our inspection site visits, a new manager was appointed and started working at the service.

During this inspection, the provider had invested in the service and areas were being renovated. However, work had not been consistently managed in a person-centred way. People had been moved into a new area which was not yet ready and suitable for people with dementia or complex needs. This impacted on their wellbeing.

Areas of the service were unclean and staff did not always follow good infection prevention and control practices. Effective systems were not in place to ensure all areas of the service were regularly cleaned.

Health and safety risks in the home environment had not been adequately assessed and managed. People’s care plans and risk assessments did not always provide clear information to guide staff on the support required to keep the person safe.

The provider had not embedded a robust system to ensure all new staff received an induction, completed training and received regular supervision. Competency checks had not been documented to evidence new staff had the skills needed to provide safe and effective care. There were significant gaps in staff training records. Staff provided negative feedback and raised concerns about the lack of face to face training.

Daily records were not always completed appropriately. There were inconsistencies between the care assessed as needed and the support provided. For example, weights were not completed as often as people’s care plans and risk assessments identified as needed. People were not always repositioned as regularly as they had been assessed as needing. Records relating to people’s nutritional needs and support provided at mealtimes were not always available.

Applications to deprive people of their liberty had not been made in a timely manner. This meant people had been unlawfully deprived of their liberty.

The support provided was not always caring and dignified. Interactions were often task based. There were limited activities or opportunities for meaningful stimulation. The service did not have an activities coordinator after they left the service following the first day of our inspection. There was no activities schedule in place.

People raised concerns about the lack of communication. They told us they had not been informed of changes in management and did not know who was in charge.

The provider had not effectively monitored the quality and safety of the service. They had been too slow to recognise the extent of the concerns and not taken adequate steps in the eight months since taking over management of the service to ensure the quality and safety of the support provided. Following the first day of our inspection the provider had responded to our concerns and had taken significant steps to start addressing our concerns, but this was reactive not proactive management.

There were breaches of regulation relating to person-centred care, dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, the premises and equipment and staffing. The wide spread and outstanding issues and concerns showed the provider’s systems of governance were inadequate. You can see what action we told the provider to take at the back of the full version of the report.

People’s mental capacity had been assessed, but best interest decisions were not always recorded. We made a recommendation about documentation in relation the Mental Capacity Act 2005.

We made a recommendation about analysing accidents and incidents to identify patterns and trends.

Sufficient numbers of staff were deployed and staffing levels were safe, but records did not evidence appropriate checks had been completed on agency staff working at the service. We made a recommendation about records kept in relation to staff deployed to work at the service.

Despite these concerns, we received positive feedback about the provider and the positive changes they had made since taking over management of the service. The provider had positively invested in the service and showed us plans they had and work they were doing to address our concerns. A new manager was appointed following our visits and the provider and manager were sending weekly updates outlining the changes and improvements made in response to our feedback. This showed a commitment to continue investing in the service to improve the quality of the care and support provided.

Medicines were managed and administered safely. Staff supported people to ensure they ate and drank enough. Maintenance checks were completed to ensure utilities and any equipment used was safe.

We received positive feedback about the work being done to develop good working relationships with healthcare professionals.

A copy of the provider’s complaints procedure was displayed in the service, but we received mixed feedback about how issues, concerns and complaints were dealt.