Archived: Peel Gardens Residential and Nursing Home

Peel Gardens Residential and Nursing Home is a purpose-built residential care home providing personal and nursing care for 45 people. Within this number, the service also provides care and support for people living with a dementia.

Accommodation is provided over two floors. The home is situated in a quiet residential area of Colne near to local amenities. There is adequate parking.

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

People were very happy about the care and support they received and with the way the home was managed. They made positive comments about the manager and the staff team and were happy with the recent improvements made. The manager considered people’s views about the quality of care provided and used the feedback to make improvements to the service. All aspects of the quality of the service were monitored and appropriate action was taken to improve the service when needed. Lessons learned were discussed at management and staff meetings.

People felt safe and described staff as kind, patient, friendly and caring and described the care as excellent. Staff had access to safeguarding adults' procedures and understood how to protect people from abuse. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. Some people, and their relatives, told us they were concerned about the risks associated with other people’s behaviours. We observed staff responding to difficult situations in a calm and patient manner and records showed appropriate action had been taken to respond to any incidents. People were protected from the risks associated with the spread of infection.

Recruitment processes ensured new staff were suitable to work in the home and there were enough staff to meet people's needs and ensure their safety. People received their medicines when they needed them from nursing staff who had been trained and had their competency checked.

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. People's care needs were assessed prior to them living in the home.

Staff received induction training and ongoing training, supervision and support. Staff felt valued and supported. People enjoyed the meals and were supported to eat a nutritionally balanced diet. They had access to various healthcare professionals, when needed. People were happy with their bedrooms and with the communal areas. A development plan was in place to ensure ongoing refurbishment and redecoration.

Staff treated people with dignity, respect care and kindness and knew people well. We observed positive, caring and warm interactions between staff and people who lived in the home. Staff spoke with people in a friendly and patient manner and we overheard laughter and friendly banter. Staff knew about people’s routines and preferences and people told us they received the care they needed and wanted. People or their relatives, where appropriate, had been consulted about care needs.

People enjoyed a range of appropriate activities and entertainments and links with local community groups had been developed to enhance people’s lives. People were supported to maintain contact with their friends and family and friendships had developed within the service. People could raise any complaints or concerns if they needed to and had access to a complaint’s procedure.

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 Good (published 17 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

We found that staff had been recruited safely and were aware of how to safeguard vulnerable adults living at the home from abusive practice. There were safe processes in place for the management and administration of medicines.

Concerns were expressed about staffing levels. We addressed this with the acting manager and the regional manager and shortly after our inspection staffing levels were increased at the home. This helped to ensure that people’s needs were met in a timely way and they received safe care.

Staff received appropriate training and had the knowledge and skills to meet people’s needs. People received appropriate support with eating and drinking and their healthcare needs were met at the home.

People living at the home were encouraged to be independent and staff respected their privacy and dignity. We observed staff at the home communicating with people in a kind and caring way. People looked relaxed and comfortable in the home environment.

We saw evidence that people received individualised care that reflected their needs and preferences. We received positive feedback from most relatives and staff about activities at the home.

The service did not have a registered manager in post. The previous registered manager had left two weeks before our inspection. An acting manager had been in post for just over two weeks and had been recruited to provide leadership and short term support to staff at the home while a permanent manager was being recruited.

Feedback had been sought from relatives who expressed a high level of satisfaction with many areas of the service. Where improvements had been suggested, we found evidence that action had been taken. Relatives and staff were happy with the management of the service.

We found that audits and checks of the service were completed regularly and were effective in ensuring that appropriate levels of quality and safety were maintained at the home.

Further information is in the detailed findings below.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

We noted the medicine 'rounds' were still in progress until late morning. This meant there could be a risk that medicines were not being given to people at the correct time. We also found gaps in the medication records which could mean people had not been given medication as per their prescription, or that it had been given but not recorded. We were told a member of staff had recently been given responsibility for monitoring staff practice and ensuring people's medicines were managed safely. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found a number of areas in the home were in need of repair or upgrade, or were difficult to clean or untidy. We were shown a plan for improvement of the home and found evidence that some improvements were underway. However, the plan was incomplete and timescales for action were unclear. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The home had been reliant on both nursing and care agency staff since late 2013, which had impacted on all areas of the day to day running of the home. The service continued to be staffed, to some extent, with agency staff. However, in the past six weeks, new staff had been appointed and the use of agency staff had significantly reduced. Staff told us, 'It is good to have some experienced staff'. A visitor said, 'It is what this place needs to make sure people are looked after properly'. However despite an increase in staffing numbers we observed there were still times where people were not given the assistance they needed. We were told working patterns and routines were under review to ensure people received the attention they needed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found some of the records were not up to date or accurate. This meant people may be at risk of unsafe or inappropriate care and treatment. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

The staff team had undertaken training to help them to understand their responsibilities when making decisions for people who were unable to consent to care and treatment.

People's views varied about whether people's needs were being met. Most of the comments could be linked to the lack of stable management in the home and a high reliance on agency staff. Comments from visitors included, 'Mum is looked after and always looks very nice but it's just basic care; we expect much more', 'There hasn't been very much for people to do, they get bored and angry' and 'They (agency staff) are very nice but they don't know how to look after my mum properly'.

Staff told us, 'Things are improving now we have some experienced staff of our own' and 'We have done our best but it has been difficult to look after everyone properly. The home is getting better and we are changing the way we do things'.

The home had recently employed an activities coordinator. We observed some positive interactions between him and some of the people living in the home.

A number of serious concerns had been raised about this service which meant the management of the home and the systems to monitor the quality of the service had been ineffective. However, we found a range of internal and external audits had recently been introduced. Improvement plans were in place with clear timescales for action. This should help to protect people from poor care standards and to identify any areas of non-compliance.

Is the service caring?

During our visit we observed staff treating people in a friendly and respectful way. We observed people being offered choices and being supported in a way that respected their privacy and dignity and encouraged their independence. People living in the home told us, 'They do their best and look after me but they are always very busy' and "Staff are good to me; I am well looked after'.

Is the service responsive?

We found that people's needs were assessed and care plans were in place. However, the plans were not up to date and did not accurately reflect any risks to people, people's care and support needs or the care that was being given. This could result in people not having their needs met. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found appropriate advice and support had been sought in response to changes in people's condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Is the service well led?

The service had not had a stable management team in place to support staff. This had impacted on all aspects of the day to day running of the home, which had resulted in people's needs not being met and a number of safeguarding alerts being made. A new management team was in place including a regional manager (from November 2013), a registered manager (from March 2014) and a deputy manager (from April 2014).

Management and staff at the home told us they were working hard to address non-compliance to ensure people were receiving appropriate care in a safe environment. The service was working with a number of agencies, led by the local authority, to ensure improved standards for the people who were living in the home.

People had been asked to express their views and opinions of the service during recent meetings and during day to day discussions with staff and management. People told us they were being kept up to date with the changes about how the service was run. One visitor said, 'Let's hope it makes a difference; we will wait and see'.

We found people's needs were assessed and care, treatment and support was planned and delivered in line with their individual care plan. We observed staff treating people in a patient, kind and respectful way. However, we also noted that people in the lounges were left unsupervised for short periods of time. People living in the home and their visitors told us they were happy with the care and support provided. Comments included, 'I get the help that I need, when I need it' and "I'm confident my relative is looked after properly".

People told us there were opportunities for involvement in suitable activities and entertainments. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were encouraged to express their views and opinions of the service. People said their views were listened to and used to develop the service.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People made positive comments about the staff team. Comments included, "The staff are very good" and "Staff are polite, respectful and friendly".

Regular checks were undertaken by the manager and regional manager and appropriate action taken when any shortfalls had been identified. This helped to identify any risks of non compliance.