- Care home
Ponsandane
All Inspections
13 October 2020
During an inspection looking at part of the service
• The service continued to enable people to have visitors, and to facilitate this in a way which ensured this was done in a safe way. Staff had also helped people to stay in touch with family and friends through phone calls, and through the internet.
• The service was providing a range of social activities for people to help to keep them entertained and occupied. For example the service had arranged some minibus trips so people could go out.
• Staff had received suitable training and guidance regarding infection control, and how to respond to the Covid 19 pandemic.
• The service was very clean, and had effective cleaning routines to ensure risks were minimised and people were kept safe.
• Where people came to live at the service, there was a robust admissions policy to ensure people moved in and settled safely.
6 February 2018
During a routine inspection
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
On the day of the inspection there was a relaxed and friendly atmosphere in the service. People and staff welcomed us into the service and were keen to share their views with us. People told us they were happy with the care they received and believed it was a safe environment. Comments from people and their relatives included; “They never neglect what they need to do”, “Yes, 110% safe” and “Yes, I am very happy here; I couldn’t have any better; nothing is too much trouble for them.” Staff knew how to recognise and report the signs of abuse.
Throughout the day we saw numerous examples of staff and people laughing and chatting together in a light-hearted and friendly way. Staff continually checked on people’s well-being and were respectful in their approach.
Improvements were being made to the environment and the dining room was being redecorated at the time of the inspection. Carpets were being replaced in some areas of the building. Bedrooms were personalised to reflect people’s individual tastes.
Arrangements for the storing and administration of people’s medicines were robust. Medicine Administration Records (MARS) were completed appropriately and there were no gaps in the records.
There was a system of induction, training, one-to-one supervision and appraisals in place. Staff all told us they were very well supported. Throughout the day we heard staff refer to ‘team’ working and it was clear staff felt part of a supportive and nurturing team. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge.
Care plans were well organised and contained personalised information about individual’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.
People were able to take part in a range of group and individual activities. Two full time activity coordinators were in post who arranged regular events for people. These included gentle exercise sessions, arts and crafts, visits by external entertainers and trips out.
Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately. Staff assumed people had capacity and were keen to find ways to help ensure people’s views were heard. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Comments from staff included, “The manager is very supportive” and “The best manager I’ve ever had, she’s constantly flitting around.”
There were regular meetings for people and their families, which meant they could share their views about the running of the service. People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.
Further information is in the detailed findings below.
9 November 2015
During a routine inspection
We inspected Ponsandane on the 9 November 2015, the inspection was unannounced.
Ponsandane is part of the Swallowcourt group and is a registered nursing home for up to 58 older people. At the time of the inspection 40 people were living at the home some of whom were living with dementia. Ponsandane is required to have 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. At the time of the inspection there was no registered manager in post. However the manager was in the process of applying for the position.
At the last inspection in May 2015, we asked the provider to take action to make improvements to systems for the recording and administration of medicines and people’s care and treatment. At this inspection we saw this action has been completed.
People and relatives told us they considered Ponsandane to be a safe environment and that staff were skilled and competent. The premises were in a state of good repair, clean and odour free. There was a lack of signage around the building to support people to move around independently.
Pre-employment checks such as disclosure and barring system (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people’s needs.
People were supported and encouraged to take part in a wide range of activities organised in the service. There were two full time activity co-ordinators employed and they worked with groups of people and with individuals. People were asked about their interests and hobbies in order to identify activities that were meaningful for them.
Systems were in place to monitor people’s health and well-being regularly and effectively. When there were changes in people’s health this was quickly identified and action taken to address the issue. Staff were confident there were effective systems in place to keep them up to date with people’s changing needs
Staff were caring and considerate in their approach to supporting people in day to day routines. We saw positive interactions between people and staff with staff checking frequently on people’s well-being. People were supported to make decisions about how and where they spent their time and maintain their independence. When people chose to spend most of their time in their rooms staff checked on their well-being regularly. The activity co-ordinators spent one to one time with people to protect them from becoming socially isolated.
Relatives and external health care professionals told us they found the service to be welcoming and open. Management were described as friendly and approachable and the staff team; “Brilliant.”
There were systems in place to assess and monitor the quality of the service which involved all stakeholders. These included regular audits of all aspects of the service, care reviews, staff meetings and meetings for residents and relatives. Swallowcourt were working to make links with the local communities.
5 May 2015
During an inspection looking at part of the service
We carried out an unannounced comprehensive inspection of this service on 3 and 5 of January 2015 and found breaches of legal requirements. This was because systems for recording the administration and recording of medicines were not robust. Risk assessments did not guide staff on how to minimise identified risks.
After the comprehensive inspection the registered manager wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook this focused inspection on 5 May 2015 to check they had followed their plan and to confirm they now met legal requirements.
We saw that daily medicine audits were carried out to identify any errors quickly and ensure actions could be taken to address them. We saw there were new systems in place to record risks which included information on what action staff should take to reduce the risk of avoidable harm.
Following the comprehensive inspection of 3 and 5 January 2015 we received information about concerns in relation to the service. As a result we also looked into these concerns during our focused inspection. The concerns were about how the service identified and responded to people’s changing needs.
This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ponsandane on our website at www.cqc.org.uk.
Ponsandane is a registered nursing home for up to 58 older people. At the time of the inspection 41 people were living at the service some of whom were living with dementia. The service is required to have 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. At the time of the inspection there was no registered manager in post. The manager had been employed at the service for four weeks and they were planning to apply to be registered.
At our focused inspection we identified some errors in the recording of the administration of medicines. However we found improvements had been made since the previous inspection. Regular audits were being carried out but these had not eliminated all errors. Following the inspection the Head of Elder Care for the provider, contacted us to tell us about additional safeguards they had introduced to protect people from any risk.
Where people had been identified as at risk from poor nutrition and/or hydration they were weighed regularly and food and fluid charts were usually kept to record how much they were eating and drinking each day. The charts did not advise staff as to how much people should be consuming. Following the inspection we received a copy of a revised chart which was being introduced which would record this information.
We looked at records for two people who had been admitted to hospital while at Ponsandane. The records showed people’s needs had not been responded to in a timely manner.
We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The actions we have asked the provider to take are detailed at the back of the full version of the report.
4 & 6 February 2015
During a routine inspection
We inspected Ponsandane on the 3 and 5 January 2015, the inspection was unannounced.
Ponsandane is a registered nursing home for up to 58 older people. At the time of the inspection 44 people were living at the home some of whom had dementia related problems. 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 2008 and associated Regulations about how the service is run.
Arrangements for the recording of the administration of medicines was not robust and we saw gaps in the Medicine Administration Records (MAR).
A dependency tool was used to calculate the numbers of staff required and these staffing levels were adhered to. However the tool was task orientated and did not take into account people’s social needs. We have made a recommendation about having sufficient numbers of staff to meet all of people’s needs. We will follow up recommendations at the next inspection.
Care plans for people living at Ponsandane were in the process of being updated to a more individualised format. However the information contained in plans was inconsistent and unreliable. Information could be duplicated or contradictory and was difficult to locate. Some care plans did not include risk assessments. Where there were risk assessments these only identified risk and did not highlight when the risk was increased or guide staff on how they could minimise risk.
People’s consent to the care they received was not consistently documented. Some people had Allow Natural Death Orders (ANDOs) in their care plans. These were not filled in correctly and it was not always possible to establish if people were in agreement with them. We have made a recommendation about gaining and recording people’s consent to care.
Staff received an induction before they started work at the home. They were supported by a system of training and supervision. Staff told us they felt supported by the registered manager who they described as “easy to talk to” and “approachable.” However staff said they were not supported by the provider and felt disassociated and “segregated” from the higher organisation. They were unaware of the higher management structure and could not explain the various roles or lines of responsibility to us.
People told us staff were kind and caring. We observed staff supporting people when it was requested. There were a range of activities available for people and these had been planned taking people’s interests and preferences into account.
Regular audits took place within the home. This included audits in respect of the maintenance of the home such as fire checks and daily checks to identify any trip hazards. Audits in respect of care planning had not identified the problems we found in the care plans.
We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The actions we have asked the provider to take are detailed at the end of the full version of the report.
21 July 2014
During an inspection in response to concerns
Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
During our inspection of Ponsandane we saw evidence to support a judgement that this service was safe.
People were asked for their consent prior to the delivery of care and treatment. During our inspection we spoke with five people living in the home and one visiting relative. People told us they liked living in the home and everyone we spoke with told us they felt safe. One person told us 'They're marvellous'.
Care plans were personalised to the individual and gave clear guidance for staff to follow to meet people's needs. This included how staff should provide care to people who had complex needs and were not always orientated to their surroundings.
We saw staff at Ponsandane understood the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.
We found there was enough qualified, skilled and experienced staff to meet people's needs. All the people we spoke with thought there was sufficient staff. The service regularly monitored people's needs and adjusted staffing levels to meet people's needs if they changed.
Is the service effective?
During our inspection of Ponsandane we saw evidence to support a judgement that this service was effective.
People's health and care needs were assessed and mobility and equipment needs had been identified in care plans where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.
People were asked for their consent for any care or treatment and the home acted in accordance with their wishes. Where the home assessed people did not have the capacity to consent, they acted in accordance with legal requirements.
Is the service caring?
During our inspection of Ponsandane we saw evidence to support a judgement that this service was caring.
People's individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. Where people were unable to be communicate their choices the home had worked with people's families to write details of their known daily routines on their behalf.
The people we spoke with told us they were happy living in the home and the staff were caring and attentive to their needs. People told us 'they [staff] are very good' and 'staff look after you'. We observed staff responded to people in a kind and sensitive manner.
Is the service responsive?
During our inspection of Ponsandane we saw evidence to support a judgement that this service was responsive.
People were able to take part in a range of group and individual activities such as singing, bingo and painting.
Ponsandane gave clear information to people about how to complain. We saw the home responded appropriately when complaints were made and took prompt action to resolve the concerns raised.
Is the service well-led?
During our inspection of Ponsandane we saw evidence to support a judgement that this service was well-led.
The home worked with other services to ensure people's health needs were met. This included professionals such as GPs, dieticians, tissue viability nurses and district nurses.
The home had a registered manager, a deputy manager and administrative support.
23 April 2014
During a routine inspection
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.
Is the service safe? People told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.
People were protected from unnecessary risk because of the safe medication administration procedures.
Ponsandane alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Ponsandane had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people's needs were met.
Is the service effective? People's health and care needs were assessed with them, although people were not involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.
Specialist dietary needs had been identified where required. Care plans were up-to-date.
We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.
Is the service caring? We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'I am happy here, the staff are very kind to me' and 'Some carers are exceptionally good, they go over the mark'.
Ponsandane had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.
Is the service responsive? Many people who lived at Ponsandane had complex health needs and were either not able, or chose not to join in group activities. More could be done to show the lifestyle of these people, or show that they were routinely offered one-to-one time or group activities.
The service worked well with other agencies and services to make sure people received care in a coherent way.
Is the service well-led? Ponsandane had a registered manager, who was not available at this inspection, but the provider's compliance manager attended and assisted with the inspection.
We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.
The service had a quality assurance system, and staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.
15 November 2013
During an inspection looking at part of the service
People were protected because there were sufficient numbers of staff to fully meet their needs.
9 September 2013
During an inspection in response to concerns
People were protected by the home's adherence to safeguarding procedures.
People were not protected because there were insufficient numbers of staff to fully meet their needs.
Records inspected were accurate, up to date and stored securely, which meant staff could be guided by correct information.
22 April 2013
During a routine inspection
People were protected from infection because there was sufficient hand washing facilities around the home and staff could easily access personal protective equipment. Infection control guidance had been followed.
The premises were effectively maintained, and the provider monitored the development and maintenance of the property.
People were protected because the home operated a robust recruitment procedure.
People were protected because there was sufficient numbers of staff to meet their needs.
Staff told us training was provided, and also confirmed staff supervision occurred. Records seen supported this.
Records in use were not always accurate or up to date, which meant staff could be guided by incorrect information.
17 July 2012
During an inspection looking at part of the service
Some of the people using the service were not able to comment in detail about the service they receive. One person said that the home and the staff were 'wonderful'. We saw people's privacy and dignity being respected and staff being helpful.
We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw and heard one staff member take the time to explain what would happen next for a person waiting for some test results.
Staff told us that training and supervision was provided, and also that staff numbers had improved since the last inspection.
We spoke to the home's business manager at the start of the inspection, but the majority of the inspection and its findings were discussed with the nominated individual for the provider and/or other staff.
21 January 2012
During an inspection in response to concerns
Some of the people using the service were not able to comment in detail about the service they receive. One person said that the home and the staff were 'wonderful'. We saw people's privacy and dignity being respected and staff being helpful.
We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw and heard one staff member take the time to explain what would happen next for a person waiting for some test results.
Staff told us that training was provided, and also confirmed that staff supervision took place. Staff told us they thought the home was understaffed, and one staff member she was working on their day-off to increase the numbers. Staff told us that approximately 85% of people at Ponsandane needed two staff to assist them with their care, and that this continued through the night as well.