Archived: Pennine Lodge Care Home

At our last inspection on 29 March 2017 we rated the service as ‘Requires Improvement’ and identified three breaches which related to safe care and treatment, person-centred care and good governance. The service remained in 'special measures' as the well-led domain was rated 'Inadequate' which it had been at our previous inspection in October 2016. If any key question is rated ‘Inadequate’ over two consecutive comprehensive inspections the service is placed in special measures. We have now rated these key questions and the service overall as ‘Good’.

Pennine Lodge 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. Pennine Lodge provides personal care for up to 40 older people living with dementia. The home is split into three separate units each with their own communal areas. Harrison unit has 14 places, Ryland and Williams units each have 13 places. There were 39 people using the service when we visited.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found the provider, registered manager and staff had worked hard to sustain and build on the improvements we had found at the last inspection. The increase in staffing levels had been maintained and was kept under review. The registered manager recognised additional staff were required at mealtimes and recruitment was on-going. We saw staff team worked well together as a team in meeting people’s needs.

Staff understood safeguarding procedures and knew how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the CQC. Risks to people were assessed and managed to ensure people’s safety and well-being.

Medicines were managed safely. Robust recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

The home was clean, bright and well maintained. Many areas had been redecorated and refurbished and this was on-going. People had been involved in these discussions for example choosing their own bed linen and murals to go round their bedroom doors.

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 plans were more personalised and the home was implementing an electronic care record system. People had access to healthcare services such as GPs, district nurse, dentist and chiropodist.

The mealtime experience for people had improved. Lunchtime was a pleasant, sociable occasion and we saw people were offered choices and given the support they required from staff. People's weights were monitored to ensure they received enough to eat and drink.

People told us they liked the staff and described them as kind and caring. People told us they were treated with respect and this was confirmed in our observations. People looked clean, comfortable and well groomed. We saw people enjoyed a wide range of activities both in the home and out in the wider community.

People and relatives knew how to make a complaint. Records showed complaints received had been dealt with appropriately and the outcome communicated to the complainant.

People, relatives and staff praised the improvements that had been made since the last inspection. Everyone spoke highly of the registered manager who they described as someone who listened and was approachable and supportive. Effective quality assurance systems were in place and we saw actions had been taken when issues had been identified.

At the last inspection on 5 and 12 October 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We found seven regulatory breaches which related to medicines, staffing, nutrition, safeguarding, dignity and respect, premises and quality assurance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Pennine Lodge is a care home which provides personal care for up to 40 older people living with dementia. Accommodation is provided over two floors with passenger lift access. There are 36 single bedrooms and two shared bedrooms. The home is split into three separate units each with their own communal areas. Harrison unit has 14 places, Ryland and Williams units each have 13 places. There are secure garden areas at the front and rear of the home. There were 40 people using the service when we visited.

The home had appointed a new manager who had been in post five weeks when we carried out this inspection. The manager is in the process of registering 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.

Overall we found some improvements had been made in the home since our last inspection, although there were still areas where further improvement was required.

Staffing levels had increased and staff were now allocated to work on specific units which helped ensure people had regular staff who they could relate to and who knew them well. Staff worked well together as a team to ensure people’s needs were met in a timely manner.

Staff understood how to identify abuse and were aware of the action to take if abuse was suspected or reported. We saw safeguarding procedures had been followed when incidents had occurred and most had been notified to the Care Quality Commission.

We found improvements in the way people’s medicines were managed which meant people received their medicines when they needed them. However, record keeping needed to improve in relation to prescribed creams and other medicines.

Risks to people were not always assessed and managed to ensure people’s safety and well-being. For example, fire safety and the recording and monitoring of people’s nutritional needs. We also found recruitment checks were not always thorough as references had not been sought from the applicant’s last employer. We made a recommendation about recruitment procedures.

The home was clean, comfortable, bright and well maintained. Many areas of the home had been refurbished and redecorated and this was ongoing. People had been involved in choosing colour schemes and a start had been made on making the environment more dementia friendly with the use of pictures, tactile objects and memory aids.

Some staff training had taken place since the last inspection and dates for further training had been booked.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had access to healthcare services such as GPs, district nurse, dentist and chiropodist. Healthcare professionals we met during the inspection said the home were receptive to advice they gave and were working with them to make improvements.

The mealtime experience for people had improved. Lunchtime was a pleasant, sociable occasion and we saw people were offered choices and given the support they required from staff.

People and relatives praised the staff who they described as 'good’ and 'caring'. We saw staff treated people with respect and ensured their privacy and dignity was maintained. However, relatives told us there were still problems with the laundry service.

People benefitted from a wide range of activities which include group and individual sessions as well as trips out. Individualised activity plans showed people’s interests and hobbies.

People’s care records had not improved. Care plans were not person-centred, up-to-date or accurate which meant people were at risk of receiving inconsistent and inappropriate care.

The handling of complaints had improved and records showed how these were investigated and the response made to the complainant.

Although the manager had only been in post for a short period of time relatives and staff spoke positively of the changes the manager had made. The manager was described by staff as supportive and approachable. Relatives we spoke with were happy with the care provided.

Quality assurance systems were in place however these were not yet fully effective in ensuring continuous service improvement. The provider, operations manager and manager had worked hard in implementing many positive changes and acknowledged further improvements were required. They recognised the scale of the task and were committed to ensuring the improvements made were sustained and developed further to make sure people consistently received high quality care.

We found continued shortfalls in the care and service provided to people. We identified three breaches in regulations – safe care and treatment, person-centred care and good governance. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection on 18 and 21 August 2014 we found three regulatory breaches which related to medicines, person-centred care and quality assurance.

Pennine Lodge provides personal care for up to 40 older people living with dementia. Accommodation is provided over two floors with passenger lift access. There are 36 single bedrooms and two shared bedrooms. The home is split into three separate units each with their own communal areas. Harrison unit has 14 places, Ryland and Williams units each have 13 places. There are secure garden areas at the front and rear of the home. There were 40 people using the service when we visited.

The home has a registered manager who has been in post for four years. 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.

We found marked differences in the three units we visited which impacted on the outcomes people experienced. For example, Harrison unit has a spacious layout and large communal areas, the other two units are more confined and have small communal areas at opposite ends of a corridor. The registered manager told us people could be admitted to any of the units as there was no specific admission criteria for each unit.

Although the registered manager had looked at people’s dependencies and used a staffing tool which showed the home was over-staffed, we found there were insufficient staff deployed to meet people’s needs. For example, we observed two people did not get up until late morning, not through choice but because there were not enough staff to assist them. We saw delays in people receiving help they needed from staff at mealtimes and occasions when there was only one care staff member available to support 13 people.

We found inconsistencies in how individual and environmental risks were managed. We saw some areas of good practice, yet others where risks had not been assessed or mitigated. For example, two people had detailed risk assessments and care plans in place to manage challenging behaviour and we saw staff put this into practice. However, there was a lack of assessment and guidance for staff in relation to another person who displayed similar behaviours. Similarly, most upstairs windows had openings restricted in line with Health and Safety Executive (HSE) guidance to keep people safe, yet we found two windows opened to three times the limit recommended by the HSE.

Medicines management was not safe and we found some issues we identified at our last inspection in August 2014 had not been addressed.

Staff were aware of the different types of abuse and knew the reporting systems. Records showed that incidents reported to the registered manager were dealt with appropriately and referred to the local safeguarding team. However, we found the reporting systems were not always effective as we found two safeguarding incidents had occurred which the registered manager was unaware of as these had not been reported to them and they had not been dealt with.

We found overall standards of cleanliness were maintained, however there were isolated areas which were not clean, we also found continence pads had not been bagged before being placed in the clinical waste bins and there were odours. Although the Statement of Purpose stated the home provides specialist dementia care we found a lack of aids, adaptations and use of colour in the environment meant it was not easy for people living with dementia to find their way around the home.

Robust recruitment procedures were in place which ensured staff were suitable to work in the care service. Staff received the induction, training and support they required to fulfil their roles and meet people’s needs.

People told us they liked the food but we found people’s nutritional needs were not always being met. We found there were not effective systems in place to ensure that people who were nutritionally at risk were receiving sufficient to eat and drink. We found people’s mealtime experiences differed depending on which area of the home they lived in and people did not always receive the assistance they required with eating and drinking in a timely way.

The registered manager had a good understanding of their responsibilities under the Mental Capacity Act 2005. However, we found conditions stated in one person’s deprivation of liberty safeguards (DoLS) authorisation had not been met.

Relatives were satisfied with the care provided. We observed some kind, caring and sensitive interactions between staff and people who used the service. However, we found examples which showed a lack of respect for people and compromised their dignity. Activities were provided which we saw people enjoyed, yet there was little to occupy and interest people in some areas of the home.

There was a complaints procedure displayed. The registered manager told us they had received no complaints.

We found there was a lack of effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved and any improvements made were not sustained.

We found shortfalls in the care and service provided to people. We identified seven breaches in regulations – regulation 18 (staffing), regulation 14 (nutrition), regulation 12 (safe care and treatment), regulation 10 (dignity and respect), regulation 13 (safeguarding), regulation 15 (premises) and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People living at the home, relatives and staff were satisfied with the standards of care at the home. They felt people were well cared for. They said, 'The staff are wonderful', 'The home is fantastic', 'It's a good home', 'Residents are well looked after' and 'One of the best homes I have worked in.' One of the visitors we spoke with said they were always kept informed about any changes in their relatives care needs and said, 'The home is very good at sorting out any concerns.'

We found people who lived at the home, or their relatives had been asked to give their consent to care and treatment. Where people did not have the capacity to consent, the Provider acted in accordance with legal requirements.

Effective procedures were in place to ensure people received their medication appropriately. Medicines were properly stored, administered and when necessary disposed of correctly.

Staff received appropriate professional development and opportunities to study for further qualifications. Staff told us they worked well as a team when delivering care. They felt well supported by the Registered Manager. They said the Registered Manager was 'Brilliant' and 'An excellent manager'. They said they could seek advice at any time and were confident the Registered Manager would deal with any concerns.

The Provider had carried surveys of the views of relatives and visiting professionals. The responses were all positive and standards were graded as excellent or good. However, the Provider had not surveyed or otherwise sought the views of staff. We found that there were significantly differing perceptions between the Provider and some staff about relationships in the home and this was not conducive to the long term maintenance of good standards of care.

During our visit we spoke to two people who lived at the home and relatives who were visiting another person who was not able to give us feedback. One of the relatives we spoke with told us they felt the staff were very good. They also told us they felt very well informed about their relative's progress and there was only one occasion in the 18 months since their relative had lived at the home when they had not been updated about a change in their health. Another relative told us there had been an improvement since October 2012 in how her mother was dressed. This related to difficulties in the laundering of clothes and her mother not wearing her own clothes.

We spoke with one visitor who told us that they are very satisfied and had been involved in their relatives care plan and that staff always let them know what was going on.

However other evidence did not support this. We saw that people did not look well cared for and were not treated with dignity and respect. There were areas of the home that were not clean and not well maintained. We also didn't think there were enough staff on duty to meet people's needs.