Peony Court

Peony Court is a residential care home providing personal care to up to 34 people. The service specialises in providing support to older people. At the time of our inspection there were 27 people using the service.

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

People were safe at the service. Staff understood how to safeguard people from abuse and knew when and how to report safeguarding concerns to the relevant agencies. Staff understood how to manage identified risks to people’s safety, to help keep them safe.

There were enough suitably skilled and experienced staff to support people and meet their needs. Staff were available to support people when their assistance was needed. Recruitment and criminal records checks were undertaken on staff to make sure they were suitable to support people.

Health and safety checks were carried out of the premises and equipment to make sure they were safe. The service was clean and hygienic. Staff followed current infection control and hygiene practice, to reduce the risk of infection. Medicines were managed safely and people took their medicines as prescribed.

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.

People were happy with the care and support they received from the service. They told us staff treated them well and they were kind and caring. Staff enjoyed working at the service. They were well supported and encouraged to put people’s needs and wishes at the heart of everything they did.

People’s relatives and friends were able to visit without any unnecessary restrictions and were warmly welcomed at the service.

The service was managed well. The registered manager was suitably experienced and understood how people’s needs should be met. They had good oversight of the service and undertook audits and checks to monitor and review the safety and quality of the service. The provider undertook their own checks of the service to make sure the service was providing safe, high quality care to people. People’s views were sought about how the service could improve and the service acted on these.

There were arrangements in place to make sure accidents, incidents and complaints were fully investigated, with people involved and informed of the outcome. Lessons learnt were shared with staff to help them improve the safety and quality of care and support provided.

Proactive working relationships had been developed with healthcare professionals involved in people’s care. The service acted on their recommendations to deliver care and support that met people’s needs.

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 good (published 15 August 2018). The service at that time was known as Thackeray House. The provider closed Thackeray House in February 2020 to refurbish the service. They reopened the service in September 2021 as Peony Court. Although the name of the service has changed, the provider retained their previous regulatory history at this location.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good, based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in March 2017 the service was rated requires improvement overall. We rated the key question ‘Safe’ Requires Improvement because people’s medicines were not always managed safely and there was an insufficient number of staff to meet people’s needs. We also found that the provider’s systems to assess and monitor the quality of care people received were not effective. After the inspection the provider sent us an action plan detailing how and when the required improvements would be made. These actions have been completed.

The home had 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 2008 and associated Regulations about how the service is run. The registered manager had many years’ experience working in adult social care and knew what was necessary to provide good quality care.

People felt safe living in the home. The design and layout of the home was appropriate for the needs of people living there. Records confirmed that staff had received safeguarding training. They knew how to recognise abuse and report any concerns. Senior staff conducted risk assessments and devised care plans which guided staff on how to manage the risks identified. The provider recorded and monitored accidents and incidents in order to identify trends, and put systems in place in order to minimise recurrence.

The home was well-maintained and was in the process of being refurbished during our inspection. We have made a recommendation that the provider improves the environment in a way which assists people living with dementia. The home remained clean and free of unpleasant odours. People were protected from the risk and spread of infection. Equipment used to support people was clean, in a good state of repair and was regularly serviced.

The provider had appropriate arrangements in place to help ensure people received their medicines safely. People received their medicines as prescribed. Staff supported people to maintain good health; people were appropriately referred to external healthcare professionals. People had sufficient to eat and drink and people who required support at mealtimes had the support they required.

Appropriate recruitment checks were conducted before staff were allowed to work with people alone. The provider supported staff through induction, supervision, training and appraisal. Staff had the knowledge and skills required to meet people’s needs; they knew people well and understood how to meet their needs. Staff were caring and treated people with respect.

People’s rights were protected. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People had been consulted about their care and support needs which were assessed before they moved into the home. Care plans and risk assessments included information and guidance for staff about how people’s needs should be met.

Staff supported people to maintain their independence There were organised activities inside and outside the home for people to participate in if they wished to do so. People were enabled to maintain relationships with their family and friends; visitors were made to feel welcome.

The provider recognised the importance of monitoring the quality of the service. They sought the views of people using the service, their relatives and friends through residents’ meetings and satisfaction surveys. The provider had a variety of systems in place to assess and monitor the quality of care people received. The provider had a complaints procedure in place and people said they were confident their complaints would be listened to and acted on.

Thackeray House Nursing Home is registered to provide nursing and personal care for up to 39 adults. At the time of our inspection there were 29 elderly adults living in the home.

We previously inspected Thackeray Nursing Home in November 2015 and found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to there being an insufficient number of staff to meet people’s needs, the lack of consistency with staff supervision and appraisal, failure to follow the provisions of the Mental Capacity Act 2005 and the lack of effective systems to assess and monitor the quality of care people received. The provider sent us an action plan setting out when the required improvements would be made. Some of these actions have been completed.

The home had a registered manager. 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. The registered manager had many years experience working in adult social care.

People felt safe from abuse living at Thackeray House. Staff treated them with kindness and respect. Staff had been trained in protecting adults from abuse and had good knowledge of how to recognise abuse and report any concerns. Assessments completed by the service identified any risks to each person and gave guidance to staff on how to manage those risks.

We found there was an insufficient number of staff to meet people's needs, particularly people who required assistance with their mobility.

Staff were appropriately supported by the provider to provide effective care through an induction, relevant training, supervision and appraisal. People received care and support from a consistent group of staff who knew them well and understood their needs and preferences.

Each person had an individualised support plan to help staff understand the support they required. People were supported to have choice and control of their lives and staff supported people in a way and at a pace that suited people. People were satisfied with the range of activities available to them. However, three of the people we spoke to felt that more could be done to support people to participate in activities outside the home.

People were supported to maintain their health and access external healthcare providers. There were appropriate arrangements in place for ordering, storing and disposing of medicines. However, people did not always receive their medicines safely and the systems in place to monitor this were not always effective.

People’s independence and privacy were respected. Visitors were made to feel welcome and staff enabled people to maintain relationships with their families and friends. There was a choice of nutritious food which took into account people’s cultural and personal preferences. People were satisfied with the quality and amount of food they received.

The provider's policies and procedures were up do date and regularly reviewed. People's records were appropriately stored and well organised. The home was clean and free of unpleasant odours. There were appropriate arrangements in place to help ensure people were protected from the risk and spread of infection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to there being an insufficient number of staff to meet people’s needs, because people did not always receive their medicines safely and the lack of effective systems to assess and monitor the quality of care people received. You can see what action we told the provider to take at the back of the full version of the report.

We found that people were asked for their consent before they received any care or treatment and staff acted in accordance with their wishes. There were procedures in place to assess where people did not have the capacity to consent and the provider acted in accordance with legal requirements. A staff member told us "I always ask the person if it is alright to do something for them such as lifting or turning them."

We found that people were protected from the risks associated with the unsafe use and management of medicines as appropriate arrangements were in place for obtaining, storing, recording, administering and disposal of medicines.

We saw there were effective recruitment and selection procedures in place which ensured that people's individual needs and wishes were met by suitably skilled, trained and experienced staff.

People's personal records, staff records and other records related to the management of the service were in most respect accurate, up to date and fit for purpose. We found that staff were aware of the requirements to keep people's information confidential and the principles of the Data Protection Act 1998.