We carried out a review of the data available to us about Puddavine Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Puddavine Court, you can give feedback on this service.
Puddavine Court is a residential care home, providing personal and nursing care for up to 45 people aged 65 and over who may also be living with dementia or a physical disability. 39 people were living at the home at the time of the inspection. Accommodation is provided over three floors with passenger lifts giving access to the first and second floors.
People’s experience of using this service and what we found
Without exception all the people and relatives we spoke with praised the home. People 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 and their relatives well.
There were sufficient numbers of staff employed to ensure people’s needs were met. We saw staff had time to sit and engage people in conversation and to support people’s involvement in social activities. 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 management plans were in place to ensure risks were mitigated as much as possible. Staff were aware of their responsibilities to safeguard people.
People’s care plans contained personalised information detailing how people wanted their care to be delivered. People and their relatives were involved in making decisions about their care.
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.
Staff were keen to ensure people’s rights were respected including those related to disability, gender, ethnicity, faith and sexual orientation.
People received their medicines safely and as prescribed. Medicine management practices were safe.
The home was spacious and well furnished. The environment was safe and equipment regularly serviced to ensure it remained in safe working order.
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.
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 (report published 13 February 2017)
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Puddavine Court 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.
Puddavine Court is a residential home in Totnes, Devon providing accommodation and care for up to forty five people. People living at the home are older people, some of whom were living with dementia or a physical disability. On the day of the inspection, thirty three people were living at the home.
The home had a new registered manager who had been in their post since August 2016. 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 and associated Regulations about how the service is run.
People told us they were happy living at Puddavine Court and the staff were described as “lovely” and the home as “wonderful”. One person said, "The staff are lovely, they look after us very well". Throughout the inspection we observed staff interacting with people in a friendly, caring manner.
People told us they felt safe, and we found that the registered provider had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in relation to safeguarding adults. Staff were knowledgeable about how to recognise and report abuse. There were risk assessments in place regarding risks associated with people's care. These explained how people's care should be delivered in a safe way and how to reduce any risks involved.
Risks associated with nutrition and hydration had not always been identified or actions taken to mitigate those risks. For example, we found that staff did not consistently complete food and fluid monitoring records or provide details of the amounts people at risk had eaten and drunk. The registered manager did not monitor these charts to ensure staff were completing these records. Whilst staff and the registered manager were convinced these people were eating and drinking sufficiently well, records did not always support this. In the absence of these records, staff could not determine that people were eating and drinking sufficiently well, and that the risk to their health and welfare was being managed. We have made a recommendation about the management of risks associated with providing adequate nutrition and hydration.
Other risks were managed well. Each person had detailed risk assessments, which covered a range of issues in relation to people’s needs. For example, risks in relation to nutrition, falls, pressure area care and moving and handling were assessed and plans put in place to minimise the risks.
The registered manager and registered provider used a variety of quality management systems to monitor the services provided at Puddavine Court, which included a range of audits and spot checks. Although these systems had not been effective in identifying the issues we found in relation to providing people with adequate nutrition and hydration, in general they were comprehensive. We made a recommendation that the provider ensures governance systems are robust.
On the day of the inspection there were sufficient staff available to meet people's needs. We observed staff were attentive to people and people received care and support in a calm, patient and relaxed way. However, we received mixed views from people about the staffing levels. Some people reported having to wait for help with their care needs. We discussed this with the registered manager who told us they were not aware of any complaints about staffing levels. Staffing levels were determined according to people’s needs and adjusted accordingly. Rotas showed that the home’s staffing levels were consistent. We have recommended the registered manager keeps this under review and speaks with people about their experience. Staff understood people's care needs and how to support them effectively. They were provided with training to ensure they had the skills and knowledge to effectively meet these needs.
Safe recruitment systems were in place to ensure staff were suitable to work at the home. People told us and we observed that staff were kind and compassionate in the way they supported and cared for people. People said that staff respected their privacy and dignity. People had developed positive relationships with staff and were confident that they would address any concerns or complaint they might have.
Staff understood people's individual preferences, likes and dislikes. These were clearly documented within people's plans of care so that staff knew what action to take to deliver care focused on individual need. Care records were reviewed with people, regularly. People were supported to maintain their independence, take part in activities that were of interest to them and to get out and about.
People were given support to make their own decisions about their individual care and support needs. Staff understood how to ensure people's human rights were protected and people were continually offered choice throughout their day. They worked within the principles of the Mental Capacity Act (2005) to ensure people's capacity was assessed and monitored. Where people lacked capacity, any decisions were considered with people who were important to the person as part of a best interests decision. Staff were able to describe how they gained people's consent and how they worked in a way to ensure people were offered choice in their everyday lives.
People told us they enjoyed the food, had enough to eat and drink and received a healthy balanced diet. People were assisted with an appropriate diet to suit their needs. Snacks and drinks were also available throughout the day.
People received their medicines at the right times. There were safe systems in place to store, manage and administer medicines. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people's health.
Staff had mixed views about the management of the service. Some said they did not always feel able to raise issues with the registered manager or the higher management team. Other’s felt the registered manager and management team supported them well.
People and relative’s spoke positively about the registered manager and the improvements they had made. One relative said “it’s improved since [manager’s name] been here”. However, some people and their relative’s felt unsettled by the recent changes in the management team.
People had opportunities to express their views about the home, as did their relatives and staff. There were meetings to ensure information was shared with them about any developments in the home, as well as to ask what they would like to see happening within it. There was also a system for receiving and investigating concerns or complaints in a formal way so that people could have these addressed.
Puddavine Court is registered to provide personal care and accommodation for up to 45 people who are living with dementia and /or a physical disability. Nursing care is provided by the local community nursing team.
This inspection took place on 10 and 15 June, and 2 July 2015 and was unannounced. There were 32 people living in the home at the time of the inspection. The service was last inspected on 27 June 2013 when it met the regulations we looked at.
Since our inspection, the manager has registered with the Care Quality Commission. 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.
People were pleased with the service provided. Their comments included “The staff are marvellous, really kind” and “The staff are as good as anyone can hope for”. Staff treated people with respect and kindness. Staff spent time speaking with each person individually. People enjoyed the conversations and visibly brightened whilst chatting.
People were happy and relaxed during our inspection visit. People felt safe and comfortable in their home. People said “I know I am safe here” and “The staff always make sure I’m ok”. Staff understood the signs of abuse, and how to report concerns. Appropriate staff recruitment checks had been undertaken to ensure staff were suitable to work with vulnerable people.
People received support from skilled, trained, and experienced staff who knew them well. Staff said “The training is very good and there is lots of it”. Staff knew the people they supported. They were able to tell us about people’s preferences and personal histories.
There were enough staff to meet people’s needs. Staff were patient when supporting people, allowing them time without rushing them. Staff spoke with people, explained what they were doing, and reassured them when supporting them with their care needs. Staff did not seem rushed and remained calm and attentive to people’s needs. One person told us “They’ve always got time to do what you need”. Two relatives said they were concerned about staff cover overnight. The manager confirmed they were recruiting new staff and planned to increase the number of staff on duty. In the meantime, extra cover had been put in place.
People’s needs had been assessed and care plans developed to ensure people’s individual care needs were met. People’s care plans were updated when these needs changed. People were supported to access health care services. Visiting healthcare professionals said staff were excellent at keeping on top of people’s health needs and always rang as soon as concerns were identified. They felt people were well looked after and benefited from staff who knew them well and were quick to act.
People were supported to follow their interests and take part in social activities. For example, staff gave one person a jigsaw puzzle as they enjoyed them. The staff member encouraged them to put the jigsaw together and see what the animal was. Some people had taken opportunities to take part in the day to day running of the service. For example, one person delivered people’s newspapers and fed the cat. Another person enjoyed folding napkins. There was a memory room and shop window for reminiscence. This was full of items for people to pick up and use. This type of stimulation can improve mood, encourage people to talk with others and take part in daily activities. Group activities were also offered. For example, a knitting club, outings, musical entertainment, exercises, and art club. One relative said they would like to see more activities. Two people told us they would like to have more walks in the garden. The manager told us they planned to look at individual plans for meaningful activities to ensure people always had activities to promote their wellbeing.
Staff had a good knowledge of the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. Staff sought consent from people before carrying out care. For example, staff explained to a person what they were going to do. They asked the person for consent and this was given. A number of people had been assessed as not having capacity to consent to care and treatment. When people were assessed as not having the capacity to make a decision, a best interest decision was made involving people who knew the person well and other professionals, where relevant. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This includes decisions about depriving people of their liberty so they get the care and treatment they need, where there is no less restrictive way of achieving this. The manager had made the appropriate DoLS applications to the local authority. The front door was locked to keep people safe whilst the DoLS applications were in progress. One application had been authorised and there was evidence the person’s best interests had been properly considered.
People’s medicines were managed safely. Records relating to medicines were completed correctly. The service could evidence that people had received their medicines as they had been prescribed by their doctor to promote good health.
Risk assessments were completed for each person. For example, people were protected against the risks associated with behaviour that may put themselves or others at risk. Staff knew how to manage each person’s behaviour according to their individual assessment. One person invaded another person’s personal space and this could cause upset. Staff were mindful of this and spent time ensuring this person had meaningful occupation. This prevented incidents from taking place and meant the risk was minimised.
People benefited from a service that was well-led. People spoke highly of the manager. Comments included “It’s so much better now that they’re in post” and “They’re so efficient and kind – it’s a breath of fresh air”. A relative told us “The manager is exceptional”. People and staff told us they found the manager approachable and could discuss issues with them at any time.
The provider had systems in place to assess and monitor the quality of care. The director and management team were keen to develop and improve the service. They accessed resources to learn about research and current best practice.
People who lived at the home, their families and visitors were all pleased with the care and treatment they received. One person said 'Oh yes dear, they treat me very well and we get along very well.' People told us they were treated with respect and had choice and control over their lives. Where people were not able to make decisions about their care, processes were in place to make sure decisions were made in the person's best interests.
People felt safe living at the home and were able to make any concerns known to the staff. We saw that complaints and concerns were handled well. One visitor said 'the manager almost wants us to make complaints and she is very keen to sort things out.'
Staff at the home cooperated well with other health care professionals and feedback from the visiting professionals about communication was positive. There was mutual respect shared between people and staff. People spoke highly of the staff and said 'The staff are very good here', and 'The carers are very nice and the deputy manager is so helpful'.
The home was decorated to a very high standard and well maintained. Communal facilities were of a high standard. For example the home had a memory room for people with dementia, a designated hairdressing salon, a computer room and several bedrooms with additional living space.
The day of our visit coincided with the first day of employment for the new manager. We learnt that she had previously been registered with us. She told us that she intended to apply to register with us in due course.
We saw from our inspection of files that people's care and welfare were considered and managed well. People were asked how they want to be treated and staff were aware of individual's preferences.
Some people lacked capacity to make their own decisions. We saw from the files that the proper steps had been taken. Where families were in contact decisions were taken in consultation with them on a Best Interests basis. The home had in place proper procedures to ensure that people's welfare was safeguarded. We heard evidence that showed that these procedures had worked.
People who live at Puddavine Court told us "It's clean, it's comfortable. Staff are nice. It's about as good as it gets really" and "It's lovely - I've just said it is very good." One member of staff told us "I'd put my Mum in here, no problem."