Pinhay House Residential Care Home

Updated 12 June 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Pinhay house is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Inspection team

Two inspectors visited the service. An Expert by Experience contacted relatives the day after the inspection to seek their feedback about the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We announced the inspection the day before we visited to discuss the safety of people, staff and inspectors with reference to the COVID 19 pandemic.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received from the provider and others since the last inspection such as monthly reports, safeguarding concerns and feedback from local professionals. We requested information about infection control policies and procedures and about the ongoing monitoring of safety and quality. We used all of this information to plan our inspection.

During the inspection

We met the 23 people who lived at the home and spoke in depth with four of them. We met with one relative at the home and spoke by telephone with 11 other relatives and three people’s representatives, to ask them about their experience of the care provided. We looked at four people's care records and at medicine records. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the nominated individual (the person responsible for supervising the management of the service on behalf of the provider), the registered manager, and with 12 other staff which included care staff, housekeeping, administrative, maintenance, kitchen and activity co-ordinator staff.

We looked at three staff files in relation to recruitment and at records of staff training and supervision. We reviewed quality monitoring records, such as checklists, audits, policies and procedures as well as servicing and maintenance records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We contacted health and social care professionals who regularly visited the service and received a response from three of them.

Updated 12 June 2021

About the service

Pinhay House is a residential care home registered to provide personal care to up to 25 people aged 65 and over. There were 23 people living there when we visited, most of whom were living with dementia. The home is a grade II listed Victorian building, overlooking the sea, just outside Lyme Regis. Accommodation is over two floors with stair lift access to most, but not all rooms on the upper floor. Three bedrooms are double rooms for shared occupancy, with the rest single room accommodation.

In September 2019, we inspected the service where we identified eight breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding, good governance, staffing and a failure to notify CQC of the absence of the registered manager. Following this inspection, the Care Quality Commission (CQC) took enforcement action by imposing a condition on the provider’s registration. This required the provider to provide CQC with a monthly report outlining actions and progress towards making the required improvements.

In August 2020, CQC carried out a further inspection where we reviewed the Safe and Well Led domains only. These were the areas where the highest risks were identified in our September 2019 inspection. We found improvements had been made in staffing, safeguarding and notifications. However, some care and treatment risks, related to choking and dehydration, were identified, which had not been identified or addressed by the provider’s quality monitoring systems. This meant the service remained in breach of safe care and treatment and good governance regulations. CQC asked the provider to continue to provide CQC with a monthly report outlining actions and progress towards making the required improvements.

This latest inspection was to follow up the remaining five breaches of regulations in safe care and treatment, consent, person centred care, dignity and respect and good governance. All five remaining breaches of regulations were met at this inspection.

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

People, relatives and staff all reported ongoing improvements since the last inspection. People said, “I couldn’t be better looked after.” Relatives said, “I am pleased with the home,” “I can’t fault them, I am kept informed” and “I don’t worry.” A staff member said, “People are safe here.”

People felt safe living at the service and relatives felt confident people were safely cared for. Further improvements had been made in managing people’s risks and care plans had detailed up to date information for staff on ways to reduce risks. The service had enough staff with the right skills to meet people’s needs.

Improvements in leadership and quality monitoring systems had continued, with evidence of improvement actions taken in response to risks, concerns and audits. The provider sent monthly reports to CQC, so we could monitor progress.

Staff knew people well and people's care was more personalised. However, we found some aspects of people’s care was based around routines. For example, getting certain people up and downstairs and carrying out regular day and night checks. The provider and registered manager have since confirmed they have reviewed this, to ensure they meet people’s individual needs and preferences.

People received effective care and were treated with dignity and respect. Staff skills and communication had improved through further training in dignity and respect and person-centred care.

Staff helped people keep in touch with their friends and relatives throughout the pandemic, which helped alleviate their worries. Limited indoor visiting had resumed with the appropriate testing and safeguards in place to prevent cross infection. There was a comfortable visiting area in the garden where people could see visitors in a safe way.

People's care plans were up to date and regularly reviewed, although daily records remained task focused. The provider had plans to replace the paper care record system with an electronic care record and was currently researching more person-centred options.

The home was clean. Staff had received training and were following up to date guidance in infection prevention and control, to minimise risks to people. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people.

Where people lacked capacity, improvements in seeking people’s consent and in documenting best interest decisions had been made. 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.

Some improvements to environment had been made but planned worked to improve disabled access to shower/bathroom facilities had been delayed due to the COVID 19 pandemic but was planned for September 2021. Further improvements in letter/symbol signage were still needed to help people find their way around the home more easily.

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 Requires Improvement (report published 4 August 2020) with two ongoing breaches of regulations. 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. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating. We followed up two ongoing breaches of Safe care and treatment and good governance found at the previous focused inspection. We also followed up three previous breaches of regulations Person centred care, Dignity and respect and Consent found at the September 2019 inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pinhay House Residential Care Home 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.