This unannounced comprehensive inspection took place on the 12 November 2018. The last comprehensive inspection took place on the 21 April 2016. At that time the service was rated Good. At this inspection we found breaches of regulations and the service was rated Requires Improvement. 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.
Penlee is situated close to the centre of Penzance. The service IS registered to provide accommodation for up to 25 predominantly elderly people who need assistance with personal care, including those with a dementia related condition. At the time of the inspection there were 23 people living at the service. The service is situated over three floors which are served by a passenger lift and stair lift. Some floors have staggered landings meaning people using rooms close by require mobility to use a small flight of stairs. All but four rooms had en-suite facilities and there were enough assisted baths and showers to support people. A lounge and dining room were situated on the ground floor as well as two conservatory areas. The rear ground floor conservatory included an office area. There were a range of aids and adaptations to support people with limited mobility.
During the inspection of April 2016, we made a recommendation that the service improved how it monitored food storage. This was because we saw that stored food kept in the refrigerator was not dated and cold meat had been left out uncovered in preparation for lunch at least 45 minutes before it was served. At this inspection we found improvements had been made and the service was following current food management guidance.
At the previous inspection we found people who lacked capacity had the potential to be at risk because there was not a suitable locking system on the front door. During this inspection we found a key pad lock had been installed and this mitigated risks to people, but did not constrain people who were safe to come and go when they wanted to.
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.
Guidance for staff in respect of managing risk were not always in place. There were portable heaters in several first and second floor rooms. However, there was no evidence of risk assessments in place to protect or mitigate any potential associated risks to people. This meant staff might not have the information they needed to support and keep people safe.
Most windows on upper floors had window restrictors to keep people safe. However, in one room one of the restrictors was broken and in another there were no restrictors in place on the sash window. This meant people using these rooms may have been at risk.
The environment was not being effectively maintained. For example, several radiators on the first and second floor were not working and people relied on portable heaters to keep warm. One room had a window which did not close properly and towels and paper had been used to try and stop the cold air coming into the room. There was a refurbishment programme in place and the dining room had recently been decorated.
Suitable equipment for monitoring peoples weight was not available. Seven people were physically unable to use the stand on scales. There were no other options available to monitor peoples weight which is an early indicator for a person’s change in health. We discussed this with the registered manager who had come to an agreement with the registered provider to purchase sit on scales. This would support people who had limited mobility.
Staff had been recruited safely, received relevant training relevant to their role and were supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who lived at the home.
The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.
We observed staff providing support to people throughout our inspection visit. The staff were kind, patient and treated people with respect.
The registered manager used a variety of methods to assess and monitor the quality of the service. These included, staff meetings. In addition, resident and relative surveys were collected to seek people’s views about the service provided.
Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. However, pictorial menus would support people living with dementia more effectively. People told us the food was good. One person said, “The food here is of a good quality, and there’s always sufficient.”
Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. Supplies were available around the building for staff to use when they needed them.
There was a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.
The registered manager used a variety of methods to assess and monitor the quality of the service. However, they were not all effective. For example, not identifying potential environmental risks to people.
At this inspection we found the service to be in breach of regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.