Pilgrim Wood Residential Home

Pilgrim Wood Residential Home is a care home without nursing for up to 35 older people, including people living with dementia. There were 24 people living at the home at the time of our inspection.

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

People felt safe at the home and when staff provided their care. People said staff were always available when they needed them and knew how they preferred their care to be provided.

People received consistent care from a stable staff team who knew their needs well. Staff retention at the home was good and staff supported one another well to ensure people received the care they needed. The staff team had demonstrated admirable commitment during the coronavirus pandemic. Many of the team had moved into the home to minimise the risk of the virus entering the service.

Staff received safeguarding training and knew how to report any concerns they had about people’s safety or wellbeing. The provider’s recruitment procedures helped ensure only suitable staff were employed.

Standards of fire safety had been improved since our last inspection. When accidents or incidents happened, these were reviewed to identify any actions that could be taken to reduce the risk of harm to people. Medicines were managed safely. Staff maintained appropriate standards of infection prevention and control.

The quality of documentation had improved since our last inspection. This included people’s care plans, which were person-centred and contained detailed information for staff about how people’s care should be provided.

People were involved in decisions that affected them and staff encouraged people to make choices about their day-to-day lives. People who lived at the home and their relatives had opportunities to give their views at regular meetings.

The registered manager and provider had improved the governance and management oversight of the service. Two deputy managers had recently been recruited to strengthen the home’s management team.

Staff received good support to do their jobs and felt valued for the work they did. Staff said the registered manager and the provider were supportive and cared about their welfare. Team meetings took place regularly and staff were encouraged to speak up if they had ideas or concerns.

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 12 December 2019) and there were two 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

We carried out an unannounced comprehensive inspection of this service on 10 October 2019. Breaches of legal requirements were 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 and good governance.

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 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 changed from Requires Improvement to Good. 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 Pilgrim Wood Residential Home on our website at www.cqc.org.uk

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.

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:

Although some aspects of the home’s management had improved since our last inspection, we identified other areas which required improvement. Quality monitoring systems were not effective in ensuring action was taken when shortfalls were identified. Some records were disorganised and information was held in a number of places, which made it difficult to locate accurate, up-to-date information.

The provider had not acted to ensure that risks were managed effectively. A fire risk assessment carried out in April 2019 had identified actions required to improve fire safety. These actions had not been carried out at the time of our inspection. Following our inspection, the provider confirmed they had scheduled this work to be completed. Although accidents and incidents were recorded, these events were not reviewed by the management team to identify action that could be taken to prevent a similar incident happening again.

Other aspects of health and safety were managed safely. Regular checks were made on equipment used in people’s care and the call bell system and staff carried out in-house fire checks. A personal emergency evacuation plan had been developed for each person and the provider had a business continuity plan to ensure people would continue to receive their care in the event of an emergency. Medicines were managed safely and staff maintained appropriate standards of hygiene and infection control.

People told us they felt safe at the home and when staff provided their care. They said staff were always available when they needed them. People were protected from the risk of abuse because staff understood their role in safeguarding people and knew how to recognise and report concerns. The provider’s recruitment procedures helped ensure that only suitable staff were employed.

A new registered manager had joined the home since our last inspection. Relatives told us communication with them had improved since the new registered manager took up their post and staff said they received good support from the registered manager and senior staff. Residents’ and relatives’ meetings took place and team meetings were used to ensure staff provided people’s care in a consistent way. Staff received appropriate training for their roles and shared information about people’s needs effectively.

People received their care from staff who knew their needs and preferences about their support. Staff were kind and caring and treated people with respect. Friends and families could visit whenever they wished and were encouraged to be involved in the life of the home. Relatives told us the home had a friendly atmosphere which their family members enjoyed.

People were supported to maintain good health and to access healthcare services when they needed them. Staff monitored people’s health effectively and reported any concerns promptly. Staff kept relatives well-informed and up-to-date about their family members’ health and well-being.

Care was provided in accordance with the Mental Capacity Act 2005. 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 had access to a range of activities and staff had established links with groups within the local community. People enjoyed the food at the home and any specific dietary needs were recorded and known by catering staff.

People and relatives knew how to complain and told us they would feel confident in doing so. The provider or registered manager had responded to any complaints received.

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 13 November 2018). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

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 in some areas but the provider remained in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence 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.

Pilgrim Wood 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 can accommodate a maximum of 35 people, some of whom may be living with dementia or have mobility and health needs. There were 29 people living at the home at the time of our inspection.

There was a registered manager in post at the time of our inspection. 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 had not been sufficiently protected from abuse. Following a disclosure by a member of staff in May 2018, an investigation took place into the actions of a member of staff. The investigation identified that six people had been affected by verbal abuse. The member of staff responsible for the abuse was dismissed.

The registered manager acted appropriately following the disclosure, notifying the police, the local authority and the Care Quality Commission (CQC). The registered manager also took appropriate action regarding the member of staff who had abused people. However, the member of staff making the disclosure had not reported the abuse as soon as they became aware of it, which had extended the time during which people were at risk of abuse.

Following these incidents, the registered manager had informed people and their relatives of the events that had occurred and the action that had been taken as a result. The registered manager had also reminded staff at a team meeting of their responsibility to report any concerns they had about abuse immediately.

Medicines were managed safely but some documentation relating to medicines management could not be located on the day. We have made a recommendation about this.

People’s care was not always provided in line with the Mental Capacity Act (2005). Assessments had not been carried out to determine whether people had the capacity to make decisions about their care. Where decisions had been made by others about people’s care, there was no evidence that an appropriate process had been followed to ensure decisions had been made in people’s best interests.

The provider and management did not always communicate effectively or maintain an adequate oversight of the service. Some relatives were dissatisfied with the provider’s communication with them about administrative issues, such as invoicing. Staff and relatives told us the registered manager was available if they needed to speak with them but said the registered manager did not spend much time ‘on the floor’.

The feedback we received indicated that there had been issues between the management and some staff in recent months. We were told that some staff had displayed negative attitudes in their work which affected people’s experience of care. Although these staff had left and been replaced by staff with a positive approach, the registered manager had not monitored improvements by observing how staff engaged with people and how they interacted with colleagues.

Quality monitoring checks were carried out but were not always up-to-date or effective in identifying shortfalls. Monthly audits of falls, medicines and infection control were overdue. Previous medicines audits had failed to identify that there were no protocols in place regarding medicines prescribed ‘as required’ (PRN) or that staff had not followed best practice guidance when transcribing verbal instructions.

There were enough staff on each shift to meet people’s needs. People told us they did not have to wait for care when they needed it. Relatives confirmed that there were enough staff to keep people safe when they visited. Staffing numbers were calculated based on people’s needs and this calculation was reviewed regularly. The provider operated appropriate recruitment procedures.

Risks to people’s safety had been assessed and action had been taken to minimise risks where these were identified. Accidents and incidents were recorded and reviewed. The home was clean and hygienic and staff maintained appropriate standards of infection control. Staff carried out regular checks to maintain the safety of the building and the provider maintained appropriate standards of fire safety. The provider had a business contingency plan to ensure people would continue to receive care in the event of an emergency.

Staff had the induction, training and support they needed to perform their roles. All aspects of mandatory training were included in the induction and refresher training was provided regularly. Staff had the opportunity to meet with their line managers to discuss their performance and development needs. People’s needs were assessed before they moved into the home to ensure staff had the knowledge and skills to meet their needs.

People enjoyed the food provided and told us they always had a choice of meals. Relatives said the quality of food was good and told us they were able to join their family members for meals if they wished. People were supported to maintain adequate nutrition and hydration. Their needs in these areas were assessed on admission and kept under review. People who had specific dietary needs had been assessed by a speech and language therapist and a care plan put in place.

Staff monitored people’s healthcare needs and supported them to access medical treatment if they needed it. People told us they were able to see a doctor if they felt unwell and relatives said their family members’ health was monitored effectively. Healthcare professionals told us the home worked effectively with them. They said staff followed any guidance they put in place and that the registered manager responded appropriately if they raised concerns about people’s care.

People told us staff were kind and caring. They said there had been changes in the staff team in recent months but that the consistency of staffing had improved. Relatives told us that staff treated their family members with respect. They said the home had a friendly atmosphere that they valued. People’s families were encouraged to be involved in the life of the home and to attend events.

People had opportunities to take part in activities and to go out into their local community. People at risk of social isolation were protected against this risk because they were encouraged and supported to engage with others.

There were appropriate procedures for managing complaints and people told us they felt able to raise concerns. Team meetings took place each month and the registered manager had used these to remind staff of their duty to report any concerns they had about abuse or poor practice immediately. The registered manager had submitted statutory notifications to the CQC when required.

During the inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

Pilgrim Wood Residential Home provides accommodation and personal care for up to 35 older people, some of whom are living with dementia. There were 34 people living at the service at the time of our inspection.

There was a 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 and associated Regulations about how the service is run.

People were safe because there were enough staff on duty to meet their needs. Risks to people had been assessed and staff had taken action to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly and medicines were managed safely. The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the provider’s whistle-blowing policy.

People were supported by staff that had the skills and experience needed to provide effective care. Staff had induction training when they started work and ongoing refresher training in core areas. They had access to regular supervision, which provided opportunities to discuss their performance and training needs.

Staff knew the needs of the people they supported and provided care in a consistent way. Staff shared information effectively, which meant that any changes in people’s needs were responded to appropriately. People were supported to stay healthy and to obtain medical treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when decisions that affected them were made and applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People enjoyed the food provided and could have alternatives to the menu if they wished. People’s nutritional needs had been assessed when they moved into the service and were kept under review. Staff ensured that people who required assistance to eat and drink received this support.

Staff were kind and sensitive to people’s needs. People had positive relationships with the staff who supported them. Relatives said that staff provided compassionate care and were professional and caring. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity. Relatives told us they were made welcome when they visited. People had opportunities to take part in activities at the service and to go out to local places of interest.

People who lived at the service and their relatives told us their views were encouraged and listened to. Any complaints received had been managed appropriately.

The registered manager provided good leadership for the service. Relatives told us the service was well run and that the registered manager was open and approachable. They said the registered manager had always resolved any concerns they had. Staff told us the registered manager provided good leadership and promoted an open culture at work. They said they were encouraged to give their views about how the service could be improved.

The provider had an effective quality assurance system to ensure that key areas of the service were monitored effectively. Records relating to people’s care were accurate, up to date and stored appropriately.

This latest inspection on 9 May 2013 was carried out in order to check whether the provider had taken action to achieve compliance. We found the provider had taken the actions required to achieve compliance.

The home provides care for up to 35 people and we spoke with eight people using the service and two relatives who were visiting.

People who used the service told us the staff were kind and caring, they generally liked the food and were offered choices. The three people we asked with regards to the care plans said the staff had consulted them about their care and they had been asked their opinions. One person said "The staff are very kind; they keep me and my relative informed about my care and health; I can't speak more highly of it here."

People told us there had been a range of activities they had been able to choose to participate in.

The staff we spoke with told us they had been trained and supported to carry out their roles and the staff records we saw confirmed this.

They were complimentary about the food but several people said they would like more to do.

People who use the service told us that staff always respected their privacy and dignity but some people said they thought there were not enough staff to meet their needs.

Several comments received from people and a visitor to the home said 'I like to be waited on it is a nice place to live' and 'it's an amazing home and we are very pleased with it. Our relative is very happy here and well looked after.'

People told us that they didn't know anything about their care plans and one person commented that the communication in the service between staff should be improved.