Pratt House

Pratt House is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

Pratt House accommodates people in one adapted building. People are accommodated on the ground and first floor, with communal areas such as the lounge and dining room on the ground floor. The second floor is for staff use only and consists of a training room and a storage area.

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

People and their relatives told us they were happy with the care and support provided. Relatives commented, “Pratt House is exceptionally warm, friendly and professional. I honestly don’t think they could do more than they do. Thank you to all Pratt House staff, your care and commitment for your residents is outstanding, exemplary and we couldn’t do without you all, ” and “I feel that the home offers a high standard of care and residents are kept clean, comfortable and entertained/engaged. I have only seen the staff acting kindly. “

All of the relatives were very grateful and complimentary of the registered manager and her team for the measures in place to mitigate a COVID-19 outbreak. Whilst they had an outbreak it was very quickly contained. Relatives commented, “They were very successful in preventing or limiting any significant infections throughout the outbreak,” and “Proactive response to the pandemic and done a fantastic job of keeping people safe.”

Some risks to people were identified but not always mitigated. Other risks had not been considered.

The registered manager was open and transparent but did not work to the duty of candour policy by sending people and their relatives a letter of apology after an incident. A recommendation has been made to address this.

People were safeguarded from abuse and systems were in place to promote safe medicine practices.

The service was clean and hygienic, areas of the service had been updated, refurbished and redecorated. Plans were in place to further improve the environment.

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’s health and nutritional needs were met, and person-centred care was promoted. People were provided with in-house, group and one to one activities and they were supported to maintain contact with families during times where the service was closed to visitors.

People were provided with information in an accessible format to promote their choices and independence. Systems were in place to deal with complaints. People and their relatives knew how to raise concerns.

Staff were suitably recruited, inducted, trained and supported in their roles. They had positive relationships with the people they supported and their relatives. Sufficient staffing levels were maintained, and people were supported by a consistent staff team. Systems were in place to promote good communication and staff worked well as a team.

Systems were in place to audit the service, although those audits had not identified that some risks to people were not mitigated. The registered manager and deputy manager had developed in their roles. They worked well together to improve the service. Staff, people who used the service and relatives were all complimentary of the management team whom they described as accessible, approachable, friendly, supportive, personable, professional and proactive.

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 30 July 2019) and there were four 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 9, 17 and 19 of the Health and Social Health Act 2008 (Regulated Activities) Regulations 2014, however, there was a continued breach of regulation 12.

Why we inspected

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, effective, responsive 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 remained the same. 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 Pratt House on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Pratt House is a residential care home providing personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 29 people. Pratt House accommodates people in one adapted building. People are accommodated on the ground and first floors, with communal areas such as the lounge and dining room on the ground floor. The second floor is for staff use only and consists of a training room and a storage area.

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

People were happy with their care and had positive relationships with staff. They described staff as “Wonderful, kind, caring, pleasant and helpful”. They confirmed their nutritional and health needs were met. They were supported by a consistent staff team but felt the current staff vacancies meant staff were more stretched than usual. They had access to activities and felt able to raise concerns.

People and staff were happy with the way the service was managed. However, records were not suitably maintained, and the provider had failed to monitor and audit the service to satisfy themselves that people got safe care. People's medicines were not appropriately managed, the home was not suitably clean and risks to people were not mitigated which had the potential to put people at risk. The required documentation was not available to evidence staff were suitably recruited. Person centred care was not consistently provided and the Accessible Information Standard (AIS) was not met.

People felt safe and systems were in place to safeguard people. The service had a consistent staff team but had three staff vacancies that they were covering, without the use of agency staff. This resulted in people feeling that staff were not available to them when their assistance was required. The registered manager was addressing this, and new staff had been appointed.

The service was not suitably maintained and fit for purpose. The provider had a total refurbishment plan in place and they confirmed after the inspection the work had commenced. We have made a recommendation about improving the environment to ensure it is safe and suitable for people. 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 assessed prior to admission to the service. Their health and nutritional needs were identified and met. Staff were trained and supported in their roles.

People confirmed staff were kind and caring. Their privacy and independence were promoted. People had access to activities. Their end of life preferences were identified. Systems were in place to deal with concerns and complaints which enabled people to raise concerns about their care if they needed to.

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 good (published 5 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. The provider confirmed they had taken action after the inspection to address our findings and mitigate risks.

The overall rating for the service has changed from good to requires improvement. 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 Pratt House on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to the management of risks, medicine administration, recruitment of staff, person centred care, records and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our most recent inspection in May 2014 we found the service was meeting the requirements of the regulations in place at the time.

Pratt House is registered to provide care for up to twenty nine older people. Twenty one people were being cared for at the time of our visit.

The service 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.

We received mostly positive feedback on the quality of the service from people who lived in Pratt House and their relatives. Health care professionals we contacted were also positive about the standard of care they observed and the communication and co-ordination that existed between Pratt House and themselves.

There were safeguarding procedures in place and staff received training on safeguarding vulnerable people. This meant staff had the skills and knowledge to recognise and respond to any safeguarding concerns. The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood that where people lacked capacity a mental capacity assessment needed to be completed and best interest decisions made in line with the MCA. Staff had a good understanding about giving people choice on a day to day basis.

Risks to people were identified and managed well at the service so that people could be as independent as possible. A range of detailed risk assessments were in place to reduce the likelihood of injury or harm to people during the provision of their care.

We found staffing levels were adequate to meet people’s needs effectively. The staff team worked well together and were committed to ensure people were kept safe and their needs were met appropriately.

Staff had been subject to a robust recruitment process. This made sure people were supported by staff that were suitable to work with them.

Staff received appropriate support through induction and supervision. All the staff we spoke with said they felt able to speak with the registered manager or senior staff at any time they needed to. There were team meetings held to discuss issues and to support staff. Overall the staff we spoke with were positive about the newly appointed registered manager. People commented favourably on the ‘open door’ policy of the registered manager, who had a high profile throughout the service and who was readily available to staff, people who lived in Pratt House and their relatives.

We looked at summary records of training for all staff. We found there was an on-going training programme to ensure staff gained and maintained the skills they required to ensure safe ways of working.

Care plans were in place to document people's needs and their preferences for how they wished to be supported. These were subject to review to take account of changes in people's needs over time. We found the format for care plans was sufficiently comprehensive to ensure people were protected by accurate and up to date records of their care.

Medicines were administered in line with safe practice. Staff who assisted people with their medicines received appropriate training to enable them to do so safely. Problems with the storage temperature of medicines were addressed satisfactorily during the inspection.

The service was managed effectively. The registered manager was also responsible for the local Abbeyfield care at home service operated from a different address. In their absence, there was effective management and communication in place. The quality of care was regularly checked through audits and by giving people the opportunity to comment on the service they received and observed.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). We saw documentation in one person's file which showed correct procedures were followed. A referral to the Local Authority (as "Supervisory Body") had been made and approved. This showed the provider had identified the person could potentially be deprived of their liberty and understood when an application should be made and how to submit one.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. We viewed the staff training matrix which showed all staff were provided with safeguarding training. This ensured staff had the knowledge and skills to respond to any allegations of abuse appropriately. Appropriate measures were in place to ensure that people's money was managed safely.

Is the service effective?

People told us someone from the home had visited them to assess their health, care and social needs prior to them moving into the home. This enabled the home to access any necessary equipment prior to them moving in and to write an initial care plan with details of their preferences and wishes.

People received co-ordinated care. We saw evidence in people's care plans which demonstrated people had been visited by their GP and other health care professionals and appropriate advice sought when required

We found the care and support provided was reflective of their needs detailed in their care plans and were regularly updated where any changes in health were evident . Any accidents or incidents were recorded appropriately. They detailed the actions taken and risk assessments had been updated to document any further measures put into place to prevent a recurrence.

It was evident through discussions with people living in the home, our observations and speaking with staff that they had a good understanding of people's needs and knew them well.

Is the service responsive?

People knew how to make a complaint or raise any concerns if they were unhappy. We saw the complaints procedure displayed in the home which detailed who to direct any concern to and the timescales in which complaints would be responded to. The procedure was available in large print and braille to meet with people's individual needs.

People we spoke with told us they felt there were enough staff both during the day and night and they met their needs well. A survey sent to people using the service in September and October 2013 showed that 96% felt staff were available when needed.

Regular meetings were provided for people who used the service. Where any concerns were raised actions were put into place to resolve them and improve the outcomes for those who received a service.

Is the service caring?

The atmosphere within the home was calm and relaxed. We saw positive interactions between the staff and people using the service. We observed a meal time and saw discreet assistance from staff was available as needed. People were not seen to be rushed and were able to eat their meal in their own time in a relaxed manner.

Throughout our visit staff were attentive to people's needs, assisted people where help was required and interacted with people positively.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well.

Activities were provided for those who wished to take part. They included one to one activities and group sessions. They were tailored to people's likes and dislikes to ensure their social care needs were met appropriately.

The provider had not ensured there were enough qualified, skilled and experienced staff to meet people's needs during the night which had the potential to place people's health and welfare at risk.

People told us they were happy with the care and support they received. They said they were involved in the care planning and review process and their views taken into consideration. Comments included ''They look after me well...they do their very best I can't grumble at them at all.'' ''The staff are terrific, very good, I can't fault them.''

There was a complaints procedure in place to ensure people could raise any concerns they had. People told us they knew who to speak to if they had concerns.

Care plans addressed people's individual needs, were detailed, reviewed and updated regularly. People had access to healthcare professionals and specialist support to ensure they kept healthy and well.

We found people were treated with dignity and respect. We observed people in the dining room during lunch time. We saw staff offered people choice of food and people were not rushed and enabled to eat their lunch at their own pace.

Daily activities were provided to ensure people's social care needs were met.

The home was comfortable, clean and warm. Each person had their own bedroom which they had personalised to their own taste.

People told us they had no concerns about the care and support they received. They found the staff to be caring and polite. One person said "I have never had to complain, I can't imagine there would be a need they are all so nice. I feel the staff are knowledgeable and I can not find any fault in them." Another said "It is a friendly atmosphere here, I have never had to make a complaint. The girls are cheerful and will always do things for me...they always welcome my visitors...all in all I am as happy as can be expected."