Partridge House Nursing and Residential Care Home

Partridge House Nursing and Residential Care Home is a residential care home providing nursing care and support for up to 38 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia or other mental health needs. 36 people were living at the service on the day of our inspection.

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

We saw the required improvements had been made since the last inspection in respect to the deployment of staff, the design and adaptation of the premises, treating people with dignity and respect, the provision of meaningful activities and person centred care and culture and staff morale. The provider had systems in place to monitor and improve the quality of the service. However, we were unable at this inspection to determine whether the current service provision could be sustained over time. Many of the systems and processes put in place to improve the service have not yet been fully embedded and assessed to ensure they maintain continuous improvement. The service would need to demonstrate appropriate systems and processes and care delivery over a period, to ensure the sustainability of good care could be achieved for people. We also identified an area of practice that needs improvement in relation to the provision of activities for people who chose to stay in their rooms.

People told us they felt safe and they received care that met their needs. It was clear from the feedback we received from people, relatives and staff that significant improvements had been made by the provider since the last inspection. A relative told us, “Things had really slipped in this home, but they’re definitely going in the right direction now.” A member of staff added, “The home is so much better now. A lot of work had gone in from all of us and the managers. The residents are getting good care and I enjoy working here.”

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.

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 inadequate (published 22 June 2022) and there were breaches of regulation. 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 regulation.

This service has been in Special Measures since 22 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the Responsive and Well Led sections of this full report.

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 Partridge House Nursing and Residential Care Home on our website at www.cqc.org.uk.

Follow up

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

Partridge House Nursing and Residential Care Home is purpose built. The home provides nursing and residential care, across three units, for up to 38 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care was provided. There were 37 people living at the service at the time of the inspection. There were assisted bathrooms on each floor, with dining rooms and lounge areas on each floor.

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

People had not always received personalised care and support specific to their needs and preferences. People’s dignity and independence was not always promoted. On the day of our Inspection there were sufficient staff to support people. However, the provider relied heavily on agency staff and this had impacted on people’s experience of the care they received.

People were not always protected from the risks of harm, abuse or discrimination. The service relied heavily on agency staff to support people and it was clear the induction given to agency staff to familiarise themselves with the service and the people living there was not robust.

Improvements were required to the mealtime experience for people and the environment of the service. Many of the systems and processes put in place to improve the service had not been fully embedded and assessed and people did not receive care that met their needs.

People and relatives were not always happy with the care provided. A relative told us, “I do worry about [my relative] being here. I hope things improve.” The culture of the service and support for staff required improvement. People's feedback was mixed in respect to feeling the service was well managed. They did not feel routinely involved in their care, or feel their feedback was acted upon.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People received their medicines safely, when they needed them. Staff were recruited in line with safe recruitment practices. Complaints were managed and responded to appropriately and people had access to healthcare as required. People’s wishes at the end of their life had been recorded.

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 22 July 2021). 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 the provider remained in breach of regulations. This service had been rated requires improvement for the last two consecutive inspections. After this inspection, the rating for this service has changed to Inadequate.

At our last inspection we recommended the provider sought support and guidance locally and nationally to improve the environment of the service in order to make it more dementia friendly. At this inspection we found that improvements had not been made.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and care delivery. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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 Partridge House Nursing and Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person centred care, dignity and respect, premises and equipment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

The service had appropriate procedures in place for visiting, including checking of COVID-19 passports for visiting professionals.

The registered manager has facilitated visits for people safely and regularly during the pandemic.

The service was clean and tidy throughout. There were robust cleaning schedules inclusive of high touch point areas, to promote safe infection control practices.

Staff had received all appropriate infection prevention and control training. This included the correct use of personal protective equipment (PPE), and donning and doffing safely. Staff were observed to be wearing PPE correctly.

Managers had managed risks to people from outbreaks through appropriate isolation and separation of areas within the service.

Partridge House is a care home with nursing registered to provide accommodation for up to 38 people with various health conditions, including dementia, frailty and sensory impairment. There were 29 people living at the service on the day of our inspection.

People’s experience of using this service

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. Through the use of these systems, the provider had identified areas of practice that needed to be improved. Our own observations supported this. We saw that some areas of record keeping and analysis of data to prevent the reoccurrence of issues and drive improvement needed to be fully implemented and developed further.

We were shown an action plan for improvement developed by the provider that was robust and achievable, and managers were committed to driving up the quality of care. Changes had begun to be implemented and improvements had been made. However, these new systems and processes developed by the provider were not fully in place and needed time to embed and be effective.

People and relatives were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them. Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “I am very happy with the home for my [relative]. I visited yesterday and I asked my [relative] how she feels. She said the staff are all very caring and from what I have seen the staff are brilliant. Security is very good. [My relative] feels safe as she has people to look after her all the time. The staffing levels appear good. She uses a mobility frame to get around. They give her medication, which has been given correctly. All the COVID-19 regulations are in place, her room is clean and immaculate. I have no concerns. [My relative] is very well looked after as she is well presented.”

People and their relatives thought the service was well managed and they enjoyed living there. A relative told us, “I feel the home is well managed. I am impressed with the home. [My relative] hasn’t been there for a long time, but it is a calm home where staff are genuinely supportive and friendly. We made the right choice choosing this home”

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.

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 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 (published 1 November 2020).

We received concerns in relation to the care delivery at the service and the provider having robust systems and processes in place. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the key question of effective, caring and responsive. We therefore did not inspect these. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the well-led sections of this full report.

Follow up

We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement. If we receive any concerning information we may inspect sooner.

Partridge House Nursing and Residential Care Home is purpose built. The home provides nursing and residential care, across three units, for up to 38 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care was provided. There were 36 people living at the home at the time of the inspection. There were assisted bathrooms on each floor, with dining rooms and lounge areas on each floor. People had access to a large garden.

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

People living with dementia, were not always treated with dignity and respect. There was a lack of meaningful and stimulating interactions with staff to occupy people’s time. The environment and information had not always been adapted to meet people’s needs.

Whilst staff completed mandatory training online and there were opportunities to attend local authority training. There were no systems in place to check staff understanding and competency in key areas. People were supported to maintain a balanced diet; however, we found the lunch time experience was not a sociable occasion and staff approach was task focussed. People were not always supported to have maximum choice and control of their lives and there was a lack of staff understanding in this area.

People’s care plans were not always consistently completed to ensure staff had the relevant information to deliver person centred care. Quality assurance processes were not always effective at identifying issues and improving the quality of care people received. Audits and systems did not always identify areas for improvement.

Systems supported people to stay safe and reduce the risks to them. Staff knew how to recognise signs of abuse and what action to take to keep people safe. There was enough staff to support people safely and the provider had safe recruitment procedures and processes in place. One relative told us, “The staff have so much patience, they are amazing.”

We observed kind interactions between staff and people at the home. Staff were trained in administering medicines and people were protected by the prevention and control of infection.

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 on 02 May 2017). At this inspection we found the service had deteriorated to Requires Improvement.

Enforcement:

We have identified breaches of two regulations. These were in relation to Regulation 10 (Dignity and Respect) and Regulation 17 (Good Governance).

You can see what action we have asked the provider to take at the end of this full report.

Full information about The Care Quality Commission's (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

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.

Partridge House Nursing and Residential Care Home is purpose built, and was taken over in 2014 by Tradstir Limited. The service provides nursing and residential care, across three units, for up to 38 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care was provided. There were 36 people resident at the time of the inspection.

There was a registered manager for the service. 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.

At the last inspection of the service on 3 November 2015 the service was rated as requires improvement. This was because training records had not been kept up-to-date and it was not possible to fully evidence staff had completed essential training. Training opportunities for nursing staff to update their clinical skills was in the process of being sought. Not all the staff had received regular supervision. Auditing and monitoring processes were not fully in place and embedded in practice. There was no evidence of analysis of the information received and how this had been used to influence and improve the service delivery. At this inspection we found work had been undertaken to rectify this and address the issues highlighted. However, we found although the range of activities people could join in continued to be developed and were provided every day, there were significant numbers of people not engaged in meaningful activities. This is an area in need of improvement.

People lived in a safe and secure environment. We observed staff speaking with people in a kind and respectful manner and saw many examples of good natured but professional interaction. Staff were aware of the values of the service and understood the importance of respecting people’s privacy and dignity.

Medicines were stored correctly and there were systems to manage medicine safely. Regular audits and stock checks were completed to ensure people received their medicines as prescribed.

Senior staff monitored peoples dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. They told us there had been good access to training to ensure they had the skills to meet people’s care needs. The registered nurses could attend the essential training provided, and were being supported with training updates to ensure their clinical skills were kept up-to-date. Staff told us they felt well supported and had received regular supervision and support.

Safe recruitment policies and procedures were followed in the recruitment of new staff to work in the service.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff were aware of the appropriate action to arrange meetings to make a decision within their best interests.

People told us they had felt involved in making decisions about their care and treatment and felt listened to. People's individual care and support needs were assessed before they moved into the service. An electronic care planning system had been embedded into the service. There were good examples of personalised care plans, and these included detailed information about people’s personal histories and preferences, including details about their previous occupation, family, pets, hobbies, interests and food likes and dislikes. Staff spoke well of the new system and there were access points in the service which care staff could use to update the records. They told us this had led to the care plans being more up-to-date and accessible. Supporting risk assessments were in place to protect people. Where people had been assessed as being at risk of developing pressure sores, or from falling out of bed, the equipment identified to be used had been regularly checked to ensure it remained suitable for individual people’s use.

People’s nutritional needs were assessed and recorded. People told us they enjoyed the food provided.

Procedures were in place for people and their relatives/representatives to raise any concerns. No one we spoke with had raised any concerns, but they felt it was an environment where they could raise issues and they would be listened to.

Staff told us that communication throughout the service continued to be good and included comprehensive handovers at the beginning of each shift and staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable.