Perran Bay Care Home

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 24 April 2017. In April 2017 we found some people did not have a current accurate accessible care plan or risk assessment in place to guide and direct staff on how to meet people’s needs. Some specific guidance in people’s care plans was not being followed by staff. Some people had been assessed as being at risk from pressure damage to their skin and the service had provided pressure relieving mattresses for them. However, the correct settings for these mattresses were not being effectively monitored. The risk associated with accidents and incidents were not robustly managed. The processes for managing medicines were not robust. The management team were not able to easily access electronically held information relating to people’s care needs. Quality assurance systems were not satisfactory. The service was not regularly auditing areas such as care plans and medicines management therefore had not identified the areas of concern found at this inspection.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good.

Since the last inspection the registered manager had ensured all care plans had been reviewed and reflected the current needs of people using the service. Risk assessments were regularly reviewed with evidence of changes in people’s needs and how staff should respond to them.

The electronic care planning system was fully operational and all staff were using this system effectively. Where people’s risks involved the need for pressure relieving mattresses they were being checked regularly to ensure they were accurate.

Auditing procedures took account of all areas of operation within the service to ensure systems were effective. Accidents and incidents were being reported and recorded as they occurred. These were audited to ensure any trends or patterns were evident and the service learned from them to make changes to mitigate risks to people.

Medicine procedures had been reviewed with changes made to some of the processes. For example, consent and risk assessment for people choosing to self-administer their medicines. Medicine audits were identifying where errors had occurred and stock control of medicines had been reviewed. There were no medicines or creams which were out of date. This meant the service was meeting the requirements of regulations.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, social workers, psychiatrists, general practitioners (GP) and speech and language therapists (SALT).

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. There was a wide range of training available to all staff which met the diverse needs of people being supported.

Staff were supported through formal and informal group supervision.

The atmosphere in the service on the day of the inspection was relaxed, friendly and calm. Staff responded promptly when people asked for help and support was provided at a relaxed pace. Throughout our inspection we observed staff providing support with respect and kindness. People told us they felt safe and comfortable living at Perran Bay Care Home. Comments included, “Overall the move to the care home has been a great success and the biggest thing is it’s a very safe place for them to be” and “All the staff are lovely. They check I’m okay and ask if I need help with anything. Nothing is too much trouble for them.”

People’s legal rights were protected because management understood the legal requirements of the Deprivation of Liberty Safeguards (DoLS). Nobody living at the service had any current restrictive practices or continuous supervisions required to protect them from the risk of harm and keep them safe. The registered manager was aware of the requirements for assessing people who would need their human rights protected. This was through an assessment process to decide if it was necessary to make a DoLS applications to the local authority, in order to seek the legally required authorisation to have these restrictions in place.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

The provider had systems in place to monitor the quality and safety of the service.

Perran Bay is a care home which provides care and support for up to 42 predominantly older people. At the time of this inspection there were 34 people living at the service.

The service had transferred people’s care plans from a paper based format on to an electronic system in July 2016. Staff had been provided with training on how to use the system. Some people did not have a current accurate accessible care plan or risk assessment in place to guide and direct staff on how to meet people’s needs. Some specific guidance in people’s care plans was not being followed by staff. However, we judged that staff had a good knowledge of people’s needs and that these needs were being met. Staff monitored people’s needs and reported any changes in a timely manner.

Some people had been assessed as being at risk from pressure damage to their skin and the service had provided pressure relieving mattresses for them. However, the correct settings for these mattresses were not being effectively monitored. The risk associated with accidents and incidents and the self administration of medicines were not robustly managed.

The processes for managing medicines were not robust. There had been a medicine error reported by the service in April 2017. Out of date medicines were found to be available for use. Handwritten entries on to the Medicine Administration Record were not always signed by two staff to help ensure the risk of errors was reduced. The service was not auditing their management of medicines.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. However, the service did not hold an accurate up to date DoLS policy. The service was not following its own policy as had not provided training in this legislation for all staff.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Staff monitored all food and drink taken by people who lived at the service.

The service was not regularly auditing areas such as care plans and medicines management therefore had not identified the areas of concern found at this inspection.

We walked around the service which was warm, comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect. People reported that the management team and staff, "Went the extra mile" when supporting people's individual needs and wishes. The management team were passionate about providing good care and helping people to live the life they chose. People were encouraged to be active both mentally and physically where possible.

Staff were supported by a system of induction training, supervision and appraisals. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. Staff meetings were held for all staff groups and allowed staff to air any concerns or suggestions they had regarding the running of the service.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

The premises were well maintained. The service had reduced the number of people living there in order to reduce the amount of disruption which may occur when the planned extension of the service begins soon. There was also a planned re-design of the décor of each floor/corridor to aid people’s orientation around the building. The service did not currently have any additional pictorial signage to aid people’s recognition of specific areas of the building such as toilets and bathrooms. People’s bedroom doors had their names and a number upon them. There were people who moved around the service independently as they chose, some of these people had a degree of cognitive impairment and may benefit from additional signage to aid their independence.

People had access to meaningful activities. An activity co ordinator was in post who arranged regular events for people. These included a range of activities such as quizzes, bingo, games and musical entertainment. Trips out in to the local area were arranged regularly. Volunteers from the local community and school children regularly visited the service to support activities such as art and craft. People and their relatives were positive about the care and support they received at Perran Bay. Comments included, “I love it here,” “If I could live anywhere I would chose to live here” and “I am delighted with the care (the person) gets here, it feels like a warm blanket wrapping you up when you come in.”

The registered manager was supported by an assistant manager, senior team leaders and a team of care staff. All the staff were positive about the support they received from the management team. The provider regularly spent time in the service talking with people who lived there and supporting the manager. Relatives were positive about the staff and management at the service.

We found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take in order to meet the requirements of the regulations at the end of this report.

The staff we spoke with were knowledgeable about the people who lived at the home. Staff told us they "love" working at Perran Bay Care Home. We spoke with the registered manager who told us that due to a number of factors the priority had been on the high quality of care provided daily and not on the paper work and assured us this would be addressed.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us they were satisfied with the care they received. We found that the care plan documentation did not identify that people's care needs were consistently met or that concerns raised by care staff were clearly addressed.

During our visit we saw that the home was clean, tidy and hygienic and the decor and furnishings were domestic in style.

The home is owned and managed by a charity. We were told the trustees of the charity were planning to build an extension to the home to provide additional bedrooms and communal areas. People who used the service had been consulted and involved in this planning and were keen to tell us about this venture.

From reviewing care records and associated documentation we found that the reporting of incidents or concerns had not been reported to the appropriate external organisations. For example to the primary care trust regarding medication.