Pranam Care Centre

Pranam Care Centre is a residential care home for older people and younger adults with mental health support needs. The care home accommodates up to 50 people in two joined buildings over two floors. It is owned by the provider Woodhouse Care Homes Limited. At the time of our inspection 44 people were living at the service.

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

Sometimes staff supported people in an unsafe way when they were walking and this placed them at risk.

Staff were not always respectful towards people.

The provider's systems and processes for monitoring risk and quality had not always identified where improvements were needed.

People using the service were happy with their care and support. They told us their needs were met and they were able to make choices about their care. People felt they were well treated by staff and had good relationships with them.

Care was appropriately planned, and staff followed care plans, working with other professionals to review and monitor people's health and wellbeing. The staff also assessed risks to people's safety and wellbeing and planned care in the least restrictive way.

People received their medicines safety and as prescribed.

People had opportunities to take part in a range of different social and leisure activities.

The provider investigated and responded to adverse events, such as accidents, incidents and complaints. The provider undertook a range of audits and checks. They planned ways to improve the service.

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 requires improvement (published 18 August 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 some found improvements had been made but the provider remained in breach of regulations.

This service has been rated requires improvement or inadequate at all inspections since registration in June 2015. In 2020, we imposed additional conditions on the service requiring the provider to send us information each month. These conditions remain in force and we will use this information to help monitor the service and to check they are making the required improvements. We will also ask them for an additional action plan relating to the new concerns we have identified.

Why we inspected

We carried out an unannounced inspection of this service on 15 July 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We found improvements had been made to areas where there were previous concerns. However, we found there was a concern with some of the interactions between staff and the people being cared for, so we widened the scope of the inspection to include the key question of caring.

This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led.

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 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 Pranam Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, dignity and respect 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 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.

Pranam Care Centre is a residential care home, which at the time of the inspection was providing personal care to 50 older people and younger adults with mental health support needs. The care home accommodates up to 50 people in two joined buildings over two floors. It is owned by the provider Woodhouse Care Homes Limited.

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

People’s care needs were not always met in a person centred way and their care plans did not always reflect their individual needs.

The provider did not always have quality assurance systems that were effective enough to enable them to appropriately monitor, assess and improve the quality and safety of the service.

People’s medicines were administered as prescribed. However, improvements were required in relation to locating equipment and guidance on when medicines which were prescribed to be administered as and when required. We have made a recommendation about the management of some medicines.

People had a range of risk assessments and risk management plans but there was not always guidance on how to mitigate risks. Following the inspection, the provider took prompt action to ensure risk management plans were in place for identified risks.

The provider had processes to monitor and investigate incidents and accidents, safeguarding alerts and complaints. There were appropriate processes for the recruitment of staff. The provider had infection control processes, and these were followed by staff.

People were supported to eat a balanced, healthy varied diet which reflected their dietary needs and cultural preferences.

People’s care plans identified if they had any hearing or visual impairments, their preferred language or any other issue which would impact their ability to communicate.

People told us they were happy living in the home and said if they had any concerns they could speak with the managers.

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 14 January 2020) and there was one breach of regulation for good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and sustained and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to infection control, staffing, person centred care, management of risk, dignity and respect and nutrition. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. We reviewed nutrition as part of the inspection but we have not rated the key question of effective as we only looked at the part of the key question we were specifically concerned about. The rating of this key question has not changed and remain good.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for the key questions of effective and caring 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 responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pranam Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to person centred care 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 meet with the provider and request an action plan 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.

Pranam Care Centre is a care home providing personal care and accommodation to younger and older adults some of whom have disabilities, sensory impairments and require mental health support. Some people are living with dementia. This adapted house is situated in a residential area and can accommodate up to 50 people. At the time of inspection there were 42 people using the service. The care home is owned by Woodhouse Care Homes Limited.

We found the following examples of good practice.

• In the reception area, there was information provided to visitors explaining the homes COVID 19 measures. This information was accessible as it was made available in five different languages currently used at the home.

•Staff explained the infection control protocol to visitors and took their temperature prior to agreeing access. Track and trace or written contact details were obtained from all visitors entering the home.

•In the warmer months the staff had supervised socially distanced garden or car park visits. Currently, because COVID 19 risk levels in the community had risen, relatives and friends were asked not to visit the home. Relatives were encouraged to communicate via telephone and video calls. In the event of an exceptional circumstance, such as end of life, the visit would be individually risk assessed and measures put in place to maintain, the person, visitors and others safety.

•There were adequate supplies of PPE and staff were observed using PPE in a safe manner, during the inspection. The registered manager had created a, “Safe” zone for the donning, doffing and disposal of PPE. There were PPE stations on each floor and wall mounted hand sanitizers throughout the home.

•Staff supported people to remain socially distanced. People who had the capacity to go out in the local community were reminded of the need to remain socially distanced at all times. They were provided with PPE and hand sanitizer and supported to remove PPE and wash their hands on their return to the home.

• A zone in the home had been identified for use should people become symptomatic or test positive for COVID19. Designated staff members would work exclusively in this area and would not move about the home.

•The registered manager had undertaken risk assessments for people and staff. They had reviewed factors which placed people at a higher risk and put in place measures to keep people safe from harm. They had worked with both health and social care professionals to identify measures to monitor people’s health and provide safe care.

Pranam Care Centre is a residential care home, which at the time of the inspection was providing personal care to 25 older people and younger adults with a disability. The care home accommodates up to 50 people in two joined buildings over two floors. It is owned by the provider Woodhouse Care Homes Limited.

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

During the inspection we found the provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, they were still in the process of addressing and improving some of the identified areas and needed to demonstrate they could sustain the improvements. Areas they were still addressing included diabetic care plans, more detailed information in care plans and developing activities for everyone.

We recommended the provider ensure there are a range of activities that meet the needs of all people using the service.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were in place and there were enough staff to meet people’s needs. Staff followed appropriate infection control practices to prevent cross infection.

Supervisions, appraisals and competency testing provided staff with the support they required to undertake their job effectively and safely. People were supported to maintain health and access healthcare services appropriately. People were also 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.

Staff were kind and provided support in a respectful manner. People were involved in making decisions about their day to day care. Staff respected dignity and promoted independence for people.

Families were welcomed to the service. There was a complaints procedure in place and people knew how to raise complaints with the manager.

People, relatives and staff reported the manager was making improvements and promoted an open work environment.

Rating at last inspection

The last rating for this service was inadequate (published 1 October 2019) and there were multiple 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 enough improvement had not been made/ sustained and the provider was still in breach of regulations. This service has been rated requires improvement or inadequate for the last nine consecutive inspections.

This service has been in Special Measures since October 2019. 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 safe, responsive and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pranam Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to 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 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.

Pranam Care Centre is a residential care home, which at the time of the inspection was providing personal care to 39 older people and younger adults with a disability. The care home accommodates up to 50 people in two joined buildings over two floors. It is owned by the provider Woodhouse Care Homes Limited.

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

Some of the provider’s practices were a risk to the people living in the home. The environment was not always maintained safely and medicines were not always managed safely. Incidents and accidents were not investigated consistently and did not always demonstrate learning outcomes to prevent future incidents.

Supervisions and appraisals were not carried out regularly, which meant staff may not have been getting the support they required to undertake their job effectively and safely.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

Activity provision was not person centred, therefore people’s individual interests were not always met.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people but these were not always effective and did not identify issues raised at the inspection.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were in place.

People’s needs were assessed prior to moving to the home. People were supported to maintain healthier lives and access healthcare services appropriately.

Staff were kind and provided support in a respectful manner.

There was a complaints procedure in place and the provider knew how to respond to complaints appropriately. People and staff reported the registered manager was approachable.

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 24 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations. This service has been rated requires improvement or inadequate for the last eight consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about a significant number safeguarding concerns raised at the provider concerns meeting with the local authority. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to people being cared for safely, consenting to their care, receiving person centred care, staff being appropriately supported to undertake their roles effectively and leadership 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 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.

Special Measures

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.

People’s experience of using this service:

• At our last inspection we found a breach of the regulations relating to safe care and treatment. This was because some aspects of the environment were not kept in a safe manner. At this inspection we found safety in those areas that previously had been a cause for concern had been improved. However, at this inspection we found that the call system that people used to attract staff attention should they require urgent help or support had been switched off. This meant that people’s call bells were not audible unless a person was in or directly outside the person’s bedroom. In addition, two call bells tested in people’s bedrooms were not working.

• The provider had introduced an electronic care planning system and the care plans were still in the process of being transferred. This meant the care plans were not yet person- centred as they lacked relevant information and in some instances guidance for staff was inconsistent and contradictory.

• The provider had carried out checks and audits but had not identified the shortfalls we found during the inspection, as described above.

• At our last inspection we had found a breach of the regulation in relation to safeguarding adults from abuse and improper treatment. This was because we found that injuries to people were not always identified and responded to in a timely manner. At this inspection we found that staff reported concerns and the registered manager had systems in place to check people’s wellbeing and reported concerns in an appropriate manner.

• The registered manager had applied for Deprivation of Liberty Safeguards (DoLS) authorisations appropriately when a person might have been deprived of their liberty and lacked the mental capacity to consent to their care and treatment. We noted that care plans on the system were not signed by people to show their consent but were informed by the registered manager that these plans were, ‘work in progress.’

• At our last inspection we found that there was a breach of the regulation in relation to dignity and respect. At this inspection we found staff interactions with people to be respectful and responsive. People spoke well of staff describing them, as kind and caring.

• During our inspection agency staff had been put on shift to cover whilst staff received training. All staff spoken with told us there were adequate staff on duty and we observed that staff responded to people in a timely manner.

• Staff had received supervision and training to equip them to undertake their role. Staff spoke positively about the registered manager and provider and felt well supported by them.

• Staff who administered medicines used an electronic records system. We found that medicine administration records were completed without error. The provider worked in partnership with health care professionals to support people with their healthcare conditions.

• It was a strength of the service that staff had a good understanding of Asian cultures for example some staff spoke Punjabi and Hindi. The provider had undertaken work to ensure people knew how to complain and report any safeguarding adult’s concerns by translating the procedures into approximately five or six languages used by people in the home.

• Refurbishment had taken place to relocate the registered managers office to the reception area so it was more visible and the reception had been made welcoming for people to sit in and relax.

Rating at last inspection: We previously inspected Pranam Care Centre on the 21 and 22 June 2018 and rated the service requires improvement overall. This report was published on 10 September 2018.

Why we inspected: We inspected the service within six months of the last inspection based on its previous rating and because the key question ‘is the service well-led?’ was rated inadequate.

Action we told the provider to take:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will ask an action plan from the provider to address the areas where improvement is required. We will continue to monitor the service and will re-inspect based on the rating of requires improvement. We may re-inspect earlier if we receive concerns about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Pranam Care Centre 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.

Pranam Care Centre can accommodate up to 50 older people some of whom are living with dementia in one adapted building. At the time of our inspection 31 people were living at the service. The home is owned by the provider Woodhouse Care Homes Limited.

There was a manager in post who registered with the Care Quality Commission in April 2018. 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 last inspection of the service was on 5 and 7 September 2017 when we rated the service requires improvement. Following this inspection, we asked the provider to complete an action plan to show what they would do. They provided us with an action plan that stated they would address concerns by the 31 December 2017 to improve the key questions Safe, Responsive and Well- Led to at least good. At the inspection of 21 and 22 June 2018, we found the provider had addressed some of the concerns we found at our last inspection but we found other concerns that meant all the key questions were now requires improvement.

At this inspection we found there were some hazards in the service that had not been identified and addressed through checks and audits. These included a fire exit which was partially obstructed by stored items, and an unlocked electric equipment room that contained flammable stored items. The outside areas of the home were not well maintained. There were cigarette ends that had not been picked up and litter that had not been cleared and which could have attracted pests. This made the outside areas unsuitable for people’s recreational use. The registered manager addressed these concerns when we pointed these to them.

We saw one person had a swollen and bruised hand. This had not been noted by the care staff. We brought this to the attention of the registered manager who arranged for the person to receive medical attention. Following our inspection, we requested this was reported as safeguarding adults to the local authority as it was an unexplained injury and the registered manager ensured it was reported as required.

People’s records we reviewed indicated that some people not been referred to the appropriate health care professionals when there had been a consistent weight loss and when they needed chiropodist treatment.

Records indicated people were not being supported to change their continence pads on a frequent enough basis. Daily recordings were not completed contemporaneously and were completed sometimes in advance which meant we could not be sure of their accuracy.

Most people said staff were “nice” and “good.” Whilst most care staff supported people in a friendly and kind manner their responses to people who were upset or restless were not always adequate as they did not take time to identify what was troubling the person so they could offer a meaningful solution.

One care staff undertook the duties of activities coordinator from 10am -12pm and 2pm-4pm each day and although there were some activities the sessions were short and people told us how they no longer went out and felt there were not enough activities to keep them occupied.

The interior of the home was kept clean. One area had a malodour and we brought this to the attention of the registered manager who agreed to address this.

The provider was employing staff in line with their assessed rota and using agency staff when they did not have sufficient permanent staff.

The provider met with people to assess their needs before they moved to the service. The assessments were used to create person centred care plans that stated people's preferences and support needs. Where a risk to the person was identified, a risk assessment was completed with measures for staff to take to minimise the risks.

Medicines were administered and stored in an appropriate manner.

The provider worked in line with the Mental Capacity Act 2005 and applied for authorisations under the Deprivation of Liberty Safeguards(DoLS) in an appropriate and timely manner. People’s care plans gave guidance for staff about how they made decisions.

The provider encouraged people and their relatives to raise concerns. The registered manager responded to complaints and had an oversight of complaints and safeguarding concerns to recognise trends in the service. The registered manager demonstrated they learnt from mistakes made in the home sharing learning with care staff and taking actions to prevent a reoccurrence.

The director who was also the responsible individual had been in both roles for two months had a clear vision and ethos for the development of the service to meet the needs of the local community

We found five breaches of regulations in relation to, person-centred care, dignity and respect, safe care and treatment, safeguarding adults from abuse and improper treatment, and good governance.

Full information about CQC regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on the 5 and 7 September 2017 and was unannounced.

Pranam Care Centre is a care home that provides accommodation and personal care for up to 50 older people some of whom are living with dementia. At the time of our inspection there were 33 people living at the service.

There is 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.

At our last inspection in March 2017, we found seven breaches of the regulations. We issued a Warning Notice to the provider for regulations relating to safe care and treatment, need for consent, safeguarding service users from abuse and improper treatment, premises and equipment and good governance. We made a requirement that the provider address the breaches in person centred planning and receiving and acting on complaints.

After the inspection in March 2017 the provider sent us action plans to say what they would do to meet the legal requirements in relation to the breaches of regulations we found and the warning notice.

At this inspection, we found that improvement had been made in most areas but further improvements were still needed in a few areas.

At our last inspection, there had been concerns about the cleanliness of some areas of the service and the maintenance of some equipment had not taken place in a timely manner. We found that most of the service was now clean and well maintained. However, one kitchenette area in the main dining area was not being cleaned to an acceptable standard and both the cleaning staff and management team had overlooked this. Food in this area was not stored safely. The concerns were addressed when we raised these with the registered manager.

Previously we found that people did not sign care plans or their relatives and care staff were not aware of their content. People now had person centred plans that contained how they wanted their care to be delivered and staff could tell us about this. Staff had worked with people to produce a “Profile page” that told staff about what was important to the person. However, they were not kept in the care records for staff with the other documents. We also found some inaccurate information in one person’s record. People’s bedrooms were not personalised with familiar items to them, to make them feel at home.

Previously people and relatives had not been supported to complain and there was not a management oversight of complaints. We found that people and their relatives had been told how to complain and were encouraged to raise concerns that were logged appropriately. However, a relative told us they had made a complaint to the management team that had not been addressed as the provider’s complaints procedure stated. We brought this to the attention of the registered manager who took steps to investigate this matter.

During this inspection, we found that concerns with regard to the administration and storage of medicines had been addressed. Staff had received medicines administration training and the provider had worked with the supplying pharmacist and the local authority to identify concerns and had taken appropriate action.

Previously the provider had generic risk assessments that did not cover some people’s specific risks, such as risks about their health. During this inspection, we found that the provider had reviewed each person and had identified their individual risks and had put in place measures to mitigate those risks. Previously the staff moving and handling practices were sometimes unsafe. People now had moving and handling risk assessments. Staff had received refresher training in moving and handling and knew how to support people to mobilise in a safe manner.

Previously the provider was not meeting the requirements of the Mental Capacity Act 2005 (MCA). Staff were not obtaining people’s consent before offering support and care and the provider was not applying for Deprivation of Liberty Safeguards (DoLS) appropriately. We found that staff had received training in MCA and understood the need to get people’s permission before supporting them. The registered manager had applied for DoLS authorisations appropriately and was following up requests when there was a delay.

At the last inspection, a recommendation was made with regard to the provision of social and leisure activities. The staff were now undertaking both group and individual activities with people.

A second recommendation was made to ensure staff supported people to express their views about their care and treatment. The staff had started to arrange one to one meetings with people and residents meetings had been held.

Staff had received safeguarding adults training and could demonstrate how they would report concerns appropriately.

The registered manager used a dependency tool to assess the number of staff required to meet people’s needs. This was reviewed to reflect people’s changing support needs.

There was safe recruitment of staff who received an induction and training to undertake their role. Staff received supervision and they confirmed they found this supportive.

People were being supported to eat healthily and remain hydrated. Staff supported people to access the appropriate health care.

People told us staff were caring and respected their privacy and dignity. People received support to attend their place of worship and staff prepared traditional food that people liked from their culture. People’s cultural and religious festivals were celebrated.

People spoke well of the registered manager and found him approachable. However, some relatives did not feel they had been listened to when they had raised concerns.

The provider, registered manager, and deputy manager undertook regular checks and audits to ensure the quality of the service provided. However, our findings during this inspection show that whilst there has been an improvement in the provider’s governance arrangements, these were not always effective because of the areas for improvements that we found during the inspection, that the provider had not identified. This was a breach of the Regulation in relation to Good Governance. You can see what action we have asked the provider to take at the back of this report.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Pranam Care Centre is a care home which provides accommodation and personal care for up to 50 older people. At the time of our inspection 28 people were living at the home. Some people were living with dementia.

The last inspection took place on 22 November 2016 when we found seven breaches of Regulation relating to safe care and treatment, meeting the requirements around Mental Capacity Act 2015, the environment, person centred care, dignity and respect, good governance, and recruitment.

Following the inspection in November 2016 we issued a warning notice for regulations relating to safe care and treatment and person centred care. We told the provider to make the necessary improvements by 31 January 2017.

After the inspection in November 2016, the provider provided us with action plans to say what they would do to meet legal requirements in relation to the breaches we found and the warning notice.

We undertook this comprehensive inspection to check that the provider had followed their plan and to confirm that they now met legal requirements.

At this inspection, we found that improvements had been made in some areas but further improvements were still needed.

The provider was registered with the Care Quality Commission in June 2015.

The previous registered manager had left in January 2017 and there was a new manager in post who confirmed an application had been made to the Care Quality Commission (CQC) to become the registered manager which was being processed. 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.

Some staff member’s practice was unsafe and put people at risk as they used an incorrect technique when moving and handling people.

Some parts of the environment were not safe, not clean and unhygienic and could cause harm to people’s health and wellbeing.

The provider did not always assess risks to people’s health and wellbeing. Available risk assessments were generic and did not identify specific risks to each individual. There were no risk management plans in place to guide staff on how to support people and how to minimise these risks.

Staff did not always manage medicines administration correctly. There were issues with recording of medicines administration, lack of clarity around verifying a dosage of prescribed medicines and the process by which medicines were administered.

The provider did not always seek people’s consent to their care and treatment and did not always work within the principles of the MCA, therefore there was increased risk of people’s rights not being protected.

The information on people’s dietary needs was not always clear and consistent.

Staff did not always treat people with dignity and respect and did not always act in accordance with people’s wishes and preferences.

People’s care plans varied in details and they not always reflected changes in peoples care and support needs. Staff did not always read people’s care plans, therefore, they did not always know them.

People and their family members were not always involved in care planning and reviewing processes.

The provider had a procedure for complaints and this was displayed, however people using the service and their relatives did not know of it.

The provider did not always maintain accurate, complete and detailed records relating to various aspects of providing the regulated activity.

There were some improvements in relation to leisure and social activities at the service, however, these were still limited and did not represent the interests of all people who used the service.

Improvements had been made in relation to the provider’s recruitment processes.

Staff were able to describe potential signs of abuse and were aware of the provider's safeguarding policies and procedures.

The provider had a process in place for the reporting of incidents and accidents and staff followed it.

There were adequate staffing numbers on each shift.

Staff received an induction and a variety of training as well as regular support and supervision.

There was a daily menu in place and each person could choose between different meal options.

Staff had referred people to appropriate professionals when they had concerns about their health and wellbeing.

People had communication, dignity and respect care plans in place describing what people’s preferred method of communication was and what name they would like to be referred to as.

We have made two recommendations relating to the provision of social and leisure activities and supporting people to express their views about the care and treatment they received at the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

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 last inspection took place on 22 March 2016 when we found five breaches of Regulation relating to safe care and treatment, the environment, person centred care, display of Care Quality Commission rating and lack of a registered manager. At this inspection we found that improvements had been made in some areas but further improvements were needed.

Pranam Care Centre is a care home which provides accommodation and personal care for up to 50 older people. Some people were living with dementia. At the time of our inspection 33 people were living at the home. The service was registered with the Care Quality Commission in June 2015. The service was managed by Woodhouse Care Homes Limited, a private organisation. Although Pranam Care Centre was the only service operated by the provider, the company directors also managed other organisations providing residential and domiciliary care services in England.

There was 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 and associated Regulations about how the service is run.

People were not always safe because some of the practices at the service put them at risk. The environment was not always safe or clean. Procedures for managing medicines were not always followed safely. Risk assessments did not always identify how staff should manage the risk and keep people safe.

People's leisure and social needs were not always met in a way which reflected their preferences.

The provider did not always have all the required documentation in place for the staff employed at the service.

The provider had not always acted in accordance with the Mental Capacity Act 2005 because information about people's capacity and their consent to care was not always clearly recorded. In addition the staff did not understand the principles of the Mental Capacity Act 2005 or their responsibilities under this.

Not all staff treated people with dignity and respect.

Records were not always well organised or clear.

The provider had made improvements in some areas but these were not enough and people were still placed at risk because the service was not always well-led.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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 environment was not designed in a way to support people who had dementia and help them to orientate themselves. We have made a recommendation in respect of this.

Not all staff had good English language skills and this meant there was a risk they would not understand or meet the needs of people who lived at the service. We have made a recommendation in respect of this.

People's personal care, health and nutritional needs were being met.

Some of the staff were kind, caring and treated people with compassion.

The last inspection of the service was on 7 and 8 January 2016 when we found breaches in five Regulations relating to safe care and treatment, consent to care and treatment, person centred care, recruitment and selection of staff and good governance. At this inspection we found some improvements had been made. However, there were other areas which required improvements. For example, risks associated with people's care and treatment, the cleanliness of the environment and meeting people's health care and leisure needs.

Pranam Care Centre is a nursing home which provides accommodation, nursing and personal care for up to 50 older people. Some people were living with dementia. At the time of our inspection 17 people were living at the home. The service was registered with the Care Quality Commission in June 2015. The service was managed by Woodhouse Care Homes Limited, a private organisation. Although Pranam Care Centre was the only service operated by the provider, the company directors also managed other organisations providing residential and domiciliary care services in England.

There was no manager in post. The last registered manager left the service on 28 August 2015. Another manager was appointed however they did not apply to be registered with the Care Quality Commission and left the service in January 2016. The provider told us that they were in the process of recruiting a new 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 and associated Regulations about how the service is run.

Some of the things people said about the service were, “They do their best to give people what they want”, It is absolutely brilliant. The residents are happy, I’m very happy” and ''I like it.” One visitor told us, “(My relative) says they look after her well. She gets good attention as there aren’t many people (living in the home).”

The environment was generally well maintained but had not always been cleaned.

People were sometimes placed at risk because of practices at the service.

People's healthcare needs were not always being met because the staff had made decisions about their health which were not based on best practice and without the consultation of relevant healthcare professionals.

People's individual social and leisure needs were not always met and did not reflect their preferences because there was limited organisation and support with social activities.

There had been no registered manager in post since August 2015 and no application to register a new manager with the Care Quality Commission had been received.

You can see what action we told the provider to take at the back of the full version of the report.

People received their medicines in a safe way.

There were enough staff on duty and they had been suitably recruited.

There were procedures designed to safeguard people from abuse and the staff were aware of these.

People had consented to their care and treatment.

The staff received the training and support they needed.

People had a choice of freshly prepared food.

People living at the service had positive relationships with the staff.

The staff were kind, caring, polite and considerate.

People's privacy and dignity was respected.

People's care needs had been recorded in care plans and these were regularly updated.

There was an appropriate complaints procedure and people knew how to make a complaint.

Records relating to the care and treatment of people who used the service, staff and other records were up to date, clear and accurate.

The provider had a system of audits and checks designed to monitor the service and to help plan improvements.

People living at the service and staff said there was a positive and inclusive atmosphere.

Pranam Care Centre is a nursing home which provides accommodation, nursing and personal care for up to 52 older people. Some people were living with dementia. At the time of our inspection 22 people were living at the home. The home is divided into three units over two floors. Each person had their own bedroom and could access the communal facilities such as a lounge, dining room, worship temple and garden.

There was a home manager in post who was not yet registered with the Care Quality Commission (CQC). They informed us that the application to become the registered manager had been made to CQC and was being processed. 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 five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some of the staff practices put people at risk of harm.

People’s medicines were not always managed safely because there were no mechanisms in place to ensure regular stock checks of medicines on premises were carried out.

People and their relatives told us they were happy with service they received. However, we observed that some of the principles of The Mental Capacity Act 2005 (MCA) were not always recognised. Staff received MCA 2005 training but their knowledge was not always consolidated.

Staff asked people living in the service for their consent to their care, however there was a lack of relevant documentation showing that decisions were made in people’s best interest.

People’s care needs were not always assessed accurately and the care received by people was not always personalised. Pre-admission documents were not always fully completed and not all people using the service had their care plans in place.

Not all staff files consisted of relevant recruitment or induction paperwork. Staff were aware of the existence of people’s individual care plans, however, they said they did not always read them. They told us that they knew people’s needs from their day-to-day interactions with them. However, their knowledge on people’s care needs was incomplete.

Family members told us they thought the service was well led. However, we observed this was not always the case. The home admitted nine new people even though they were not fully prepared and consequently people’s needs were not met. Therefore people may have been put at risk.

The service had a handover system implemented to ensure communication between staff on different shifts, but it was not always effective and not all information was passed on.

The communication with external professionals was not always prompt and responsive.

Not all people had risks to their health, safety and welfare assessed and management plans were not always put in place.

There were a limited amount of activities taking place at the home.

There was a system of audits in place to ensure the safe running of the service. However, some of these had not been completed since September 2015.

Medicines were stored in a lockable cabinet and medicines trollies and the staff had access to relevant medicines policies and procedures.

People were protected from harm and abuse as staff received safeguarding training and were aware of the provider’s safeguarding policies and procedures.

The service had recruitment procedures to ensure suitable staff were appointed to work with people who used the service.

There were sufficient staff numbers on each shift and specific duties were allocated to each staff on daily basis.

There were systems in place to ensure people lived in a safe environment. We saw evidence that weekly, monthly and yearly health and safety checks took place and staff received relevant training.

The Deprivation of Liberty Safeguards (DoLS) applications had been made correctly for 11 people living in the service.

There was an induction process in place that consisted of e-learning, classroom training and shadowing.

Staff received regular supervision in the form of one to one or group meetings and they could ask for additional support if needed.

People’s nutritional and dietary needs were assessed and people were encouraged to have a healthy and balanced diet. An experienced chef had prepared a mixture of Indian and Western food in accordance with people’s dietary and cultural needs and wishes.

Family members told us the service was caring and they were happy with the way staff approached their relatives. We observed staff reacted promptly to meet people’s changing needs. People’s privacy and dignity was respected.

The provider had a complaints policy and procedure and residents and relatives satisfaction survey procedure in place. Nevertheless, this relatives and staff were not aware of it and the residents and relative’s survey was only carried out once when the service was newly opened and there were only two people leaving there.