Archived: Pellon Care Centre

We found the following examples of good practice.

Professional visitors and relatives were tested for COVID-19 at the service. Visiting professionals and staff provided evidence of their vaccination status before entering the service.

Risks relating to COVID-19 had been assessed and mitigated for individual people, staff and visitors.

A machine for measuring the level of sanitisation on common touch points was used daily. Reports of results of this identified where more thorough cleaning was needed.

The manager addressed issues relating to organisation of furniture to support social distancing and general hygiene practices on one unit immediately.

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

Staff were not always available to meet people’s needs.

We have recommended the provider reviews staffing arrangements to make sure people’s needs are met appropriately.

People felt they, or their relatives were safe. Risks assessments were in place, but, on Pellon Manor, these were not used effectively by staff and were not always up to date. Systems were in place to safeguard people from the risk of abuse. Senior managers had analysed recent events in the home and reported these appropriately. People received their medication as prescribed by staff who had been appropriately trained. Systems were followed to make sure staff were recruited safely.

Infection prevention and control (IPC) practices needed some improvement to minimise the risk of spread of infection.

Most of the people we spoke with were complimentary of the care provided. However, some gave us examples of people’s dignity needs not always being met. Our observations during our visit also identified issues in relation to maintaining people’s dignity.

There was not a manager in post at the time of the inspection. Day to day management was being shared between three senior managers. Systems were in place for audit of quality and safety within the service. However, these systems continued to lack the robust approach needed to identify issues that would affect the quality of service people received.

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

Why we inspected

This inspection was prompted through our intelligence monitoring system and to follow up on previous breaches.

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.

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

Rating at last inspection

The last rating for this service was requires improvement (published April 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

We have found evidence that the provider needs to make improvement. Please see the safe, caring 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 Pellon 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection, not enough improvement had not been made and the provider was still in breach of regulation 10 (Dignity and respect) and regulation 17 (Good governance). Please see the action we have told the provider to take at the end of this report in relation to regulation 10.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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

The COVID 19 outbreak only affected the Brackenbed unit.

We found the following examples of good practice.

The home was clean and well ventilated, with regular regimes in place to prevent the spread of infection.

Clear signs were in place to reinforce infection control procedures.

Staff wore personal protective equipment (PPE) appropriately.

People on Brackenbed unit who had not tested positive for COVID 19 were having weekly rather than monthly tests due to the outbreak.

Staff were making daily shopping trips for people isolating in their rooms.

Further information is in the detailed findings below.

Pellon Care Centre is a residential care home providing personal and nursing care in two separate units, each of which have separate adapted facilities. Brackenbed unit provides nursing intermediate care for up to 33 people and has two places for people requiring long term nursing care. At the time of the inspection there were 33 people receiving intermediate care and one person receiving long term care. Pellon Manor provides personal care for up to 35 people. At the time of the inspection there were 32 people in residence on this unit. A third unit within the complex, Birkshall Mews, is closed.

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

A new manager had been appointed at the service since the last inspection. The manager followed the provider’s systems for audit of quality and safety within the service. However, these systems continued to lack the robust approach needed to identify issues that would affect the quality of service people received.

Some improvements had been made to the way medicines were managed. However, better audit of medicine management on Pellon Manor was needed to make sure safe systems were maintained.

On Pellon Manor, people were not always supported in a way which met their dignity needs.

Risks to people’s health and safety were assessed but, on Pellon Manor, actions needed to minimise the risk, as identified by the assessment, were not always followed. Accidents and incidents were monitored, and lessons were learned when things went wrong. The premises were well maintained and clean.

Recruitment practices were safe; all the required checks were done before new staff started work. Staff followed a programme of training and updates. Staff supporting people living with dementia would benefit from further training in this area. We have made a recommendation about this.

Staff told us they felt supported in their roles.

Staff on Pellon Manor were not always available to support people in the way they needed.

People living in Pellon Manor did not always receive personalised support and activities were not always planned in a person centred way.

People in Brackenbed View praised the support they received from staff.

Care records lacked evidence of people consenting to or being supported to make decisions about their care and support. People on Brackenbed View told us they were able to make choices about their daily routine.

The service worked with other agencies to ensure people’s health care needs were met. Staff on Pellon Manor were not always alert to people’s minor healthcare needs.

People were not complimentary about the food or the provision of drinks and snacks. Records of food intake for people nutritionally at risk were not always robust.

The manager had used issues that occurred in the service as learning opportunities to improve quality and safety in the service. Two days after the inspection the manager provided CQC with an action plan to address issues identified during the inspection.

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 21 February 2019). The service remains rated requires improvement.

At this inspection we found some improvements had been made and the provider was no longer in breach of regulation 12 (Safe care and treatment). However, the provider was still in breach of Regulation 17 (Good governance)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified a breach in relation to dignity and respect and a continued breach of 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 following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in January 2018 we rated the service as ‘Requires Improvement’ but did not identify any breaches of regulation.

Pellon Care Centre is a care home. People living 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.

Pellon Care Centre accommodates up to 100 people across three separate units, each of which have separate adapted facilities. Brackenbed unit provides nursing intermediate care for up to 35 people and Pellon Manor provides personal care for up to 35 people. A third unit, Birkshall Mews, which accommodated up to 30 people has closed. There were 65 people using the service when we inspected.

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. There was a registered manager at the service.

Staff did not always recognise safeguarding issues and did not always display behaviour to demonstrate they understood professional boundaries. The registered manager took immediate action to address these issues and make sure people were safe at the time of the inspection.

Accidents and incidents were analysed monthly by the registered manager and lessons learnt were shared with staff.

Staffing levels needed to be kept under review on Pellon Manor to make sure there were always sufficient staff to meet people’s needs.

Safe recruitment processes were in place to ensure staff were suitable to work in the care service.

Staff received the training and support they needed to carry out their roles and to meet people's needs effectively.

People told us staff were caring and described them as ‘lovely.’ However, people’s dignity needs were not always met.

Medicines were managed safely in Brackenbed View. People in Pellon Manor did not always have access to their prescribed medicines.

Risks were generally well managed, although risk assessments on Pellon Manor did not always accurately reflect the level of risk.

There were effective infection control systems in place. The home was clean and nicely presented.

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.

Staff supported people to access healthcare services. People were involved in planning their care and support which was delivered to meet their needs and preferences.

Complaints were managed well with thorough investigations and timely responses.

People told us they enjoyed the food, however, we saw people were not always supported effectively to make choices. Food and fluid charts were not always completed appropriately.

The activities organiser was enthusiastic about their role and we saw activities were organised both in the home and local community.

The registered manager demonstrated commitment to continuous improvement of the service. They, and senior members of the management team responded quickly and efficiently to issues identified during the inspection. However, these issues had not been identified through the systems in place at the service for auditing quality and safety which meant the systems were not effective.

We identified two breaches in regulations. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

At our last inspection on 16 and 18 May 2017 we rated the service ‘Inadequate’ and the service was placed in ‘Special Measures’. We identified seven breaches which related to staffing, safe care and treatment, nutrition, person-centred care, dignity and respect, consent and good governance.

Pellon Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Pellon Care Centre accommodates up to 100 people across three separate units, each of which have separate adapted facilities. Brackenbed unit provides nursing intermediate care for up to 35 people and Pellon Manor provides personal care for up to 35 people. A third unit, Birkshall Mews, which accommodated up to 30 people, has closed since the last inspection. There were 63 people using the service when we inspected.

The manager who was in post at the previous inspection has left. A new manager is in post who has applied for registration with the CQC. We have referred to this manager as the home manager throughout the report. A registered manager is a person who has registered with the CQC 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 saw there were enough staff to meet people’s needs and this was confirmed in our discussions with people, staff and relatives. However, two people raised concerns about night staffing levels on Brackenbed unit and the time they had to get up in the morning. The home manager told us they would look into this matter.

Safe recruitment processes helped to ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

Medicines were managed safely and people received their medicines when they needed them. Risks were generally well managed, although we saw two instances where staff assisted people using inappropriate moving and handling practices. This was addressed by the home manager straightaway. The home was clean and staff followed safe infection control practices.

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.

Staff understood safeguarding procedures and how to report any concerns. Accidents and incidents were analysed monthly by the home manager and lessons learnt shared with staff.

Staff supported people to access healthcare services. People were involved in planning their care and support which was delivered to meet their needs and preferences. There were systems in place to manage complaints.

We saw the quality, quantity and choice of food had improved significantly and people told us how much they enjoyed their meals.

People and relatives praised the staff who they described as lovely, kind and caring, which was what we observed during the inspection. Staff clearly knew people well and took every opportunity to engage with them.

Activity staff organised a range of activities and events both in the home and local community, however these occurred predominately on Pellon Manor. There were plans in place to increase activity provision on Brackenbed unit.

The management team had worked hard to make improvements and addressed all the regulatory breaches identified at the last inspection. Effective quality audit systems were in place. We found an open, inclusive culture and saw the home manager and unit managers worked well together and were committed to improving the service. Staff and relatives said the management team were visible, approachable, open and listened and acted on any issues they raised.

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.

Pellon Care Centre is divided up into three units and has a total of 100 places. Pellon Manor has 35 places and provides residential care for people living with dementia. Birkshall Mews has 30 places and provides nursing care for people living with dementia. Brackenbed View also has 35 places and provides nursing and intermediate care. At the time of the inspection there were 77 people using the service.

A new manager had been appointed to the service in December 2016. At the time of the inspection they had not completed the process to achieve registered manager status. 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 manager was present on both days of this inspection.

At our last inspection in November 2016 we identified five breaches of regulation and issued warning notices to the provider in respect of two of these breaches. These breaches were in relation to person centred care, dignity and respect, staffing, safe care and treatment and good governance.

We found variations in the quality of care within the home with an overall higher quality of care experienced on the Brackenbed View and Pellon Manor units.

Staffing levels were not appropriate to meet the needs and maintain the safety of people on the Brackenbed View and Pellon Manor units.

Safe recruitment procedures were in place which helped ensure staff were suitable to work in the care service.

Staff had not received the received the training they needed to carry out their roles and meet people’s needs.

Medicines management systems were not always safe.

Not all staff were clear about what constituted abuse. Where safeguarding concerns had been raised these had been reported appropriately.

Individual risks to people were not clearly assessed and there was out of date and inaccurate information in care records.

In some areas improvements were needed to make sure the environment was clean. Checks on the safety of the environment were in place and up to date.

People were not provided with appetising and nutritious meals appropriate to their needs and some people experienced a poor dining experience. There was a lack of overview of records relating to people’s diet and fluid intake.

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; the policies and systems in the service did not support this practice. Appropriate Deprivation of Liberty Safeguards (DoLS) had been made by the service; however conditions applied to DoLS had not been met. Best interest processes where decisions needed to be made for people who lacked capacity, had not been followed in line with the Mental Capacity Act (MCA).

Staff appeared caring, and people told us staff were kind and attentive. However we found people’s privacy and dignity needs were not always met.

People and relatives told us they felt able to raise any issues or concerns and were confident these would be dealt with appropriately. Records showed complaints received had been investigated although we were made aware of one complaint that had not been recorded.

We found care was not planned with a person centred approach and we found care records to be inaccurate and out of date.

People did not have access to appropriate and meaningful activities.

Systems to assess and monitor the service were in place but these were not sufficiently robust as they had failed to achieve compliance with breaches of regulation identified at the last inspection or identify the issues we found during this inspection.

People had confidence in the new manager and felt they were approachable and responsive. However we concluded the provider had failed to provide the manager with the support they needed in their new role.

We found the service had failed to take sufficient action to achieve compliance with the warning notices and requirements issued at our last inspection.

This meant we found continued breaches in relation to person centred care, dignity and respect, staffing, safe care and treatment and good governance. We identified further breaches in relation to need for consent and meeting nutritional and hydration needs.

The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. 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 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

The inspection took place on 2 and 3 November 2016 and was unannounced. On the first day of the inspection 93 people were living in the home. At the last inspection in July 2015 the service was found to be compliant with our regulations and given a rating of ‘Good.’

A registered manager was in place. ‘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 variations in the quality of care within the home with an overall higher quality of care experienced on the Brackenbed View and Pellon Manor units, where established unit managers were in place supported by stable and well organised staff teams. On Birkshall Mews we identified a number of care quality issues and lack of organisation of the staff team. A service improvement plan was in place to help drive improvement in this area. However we were concerned that the provider was unable to demonstrate a sustained, high quality service over time. During the inspection of February 2015 we identified five breaches of regulation, with improvements made during a follow up inspection in July 2015. At this inspection we found further risks demonstrating that the provider was unable to sustain this improvement.

Overall people and relatives provided positive feedback about the home. They said that people were safe, well looked after and that staff treated them well, with kindness and respect.

We observed some good medicines practice, although a number of inconsistencies meant medicines were not always managed in a safe or proper way, for example the management of topical creams.

In most cases, we saw risks to people’s health and safety were assessed and plans of care put in place for staff to follow. However we had some concerns over the way behaviours that challenge were managed on the Birkshall Mews unit.

Staffing levels were suitable and sufficient on Brackenbed View and Pellon Manor however we concluded staffing was not always sufficient on the ground floor of Birkshall Mews to ensure people’s safety. There was also a lack of nursing staff available at times to ensure robust oversight of people’s nursing needs.

Recruitment procedures were appropriate to ensure that people were of sufficient character to work with vulnerable people.

The premises was generally managed in a safe way although there were some areas which required attention.

We found appropriate Deprivation of Liberty Safeguards (DoLS) had been made by the service, although two people’s DoLS conditions had not been met by the service, demonstrating a lack of appropriate care. Where important decisions needed to be made for people who lacked capacity, best interest processes were followed in line with the Mental Capacity Act (MCA).

People provided mixed feedback about the quality of the food. We saw issues with the catering providers had been identified and action was being taken to address. The mealtime experience varied, with some good positive support observed, however breakfast and lunchtime lacked organisation on Birkshall Mews and some people did not receive appropriate support.

People’s healthcare needs were assessed and we saw some good examples of how people were supported to maintain good health. People had access to a range of healthcare professionals.

In most cases, staff supported people in a positive manner and treated them with dignity and respect. Staff demonstrated a good knowledge of the people they were caring for. However on Birkshall Mews , we found some staff were less familiar with people’s needs and requirements and observed some instances where people’s dignity and respect was not always maintained.

People’s views were listened to and wherever possible acted on to help improve the service.

People and relatives provided positive feedback about the quality of the care and said care needs were met. We saw some good examples of care and support being delivered in line with agreed plans of care. However on the Birkshall Mews unit there was not always a full assessment of people’s needs and we observed some examples of inappropriate or unresponsive care.

Some activities were available to people, however we concluded there was at times, a lack of well thought out and personalised activities provided to meet people’s individual needs.

People and relatives generally expressed a high level of satisfaction with the service. Complaints were logged, investigated and responded to. There was generally a low level of complaints with most recent concerns relating to Birkshall Mews.

We found an open and honest culture within the home. Staff on Brackenbed and Pellon Manor told us that morale was good and demonstrated these areas were well organised with staff having clear roles and responsibilities. This was less so on Birkshall Mews where we found the lack of unit manager had an impact on staff morale and the quality of care provided.

Systems to assess and monitor the service were in place but these were not sufficiently robust as they had not ensured a consistent high quality service across the three units or pro-actively identified all the issues we found during the inspection.

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

We saw staff were being checked properly before they started working in the home to make sure they were suitable and safe to work with adults at risk. We also found staff were receiving appropriate training in order to be able to work safely.

We spoke with 12 people who were living in the home, three relatives, 17 staff, a visiting health care professional and a reviewing officer. These were some of the things they told us:

'It's very nice here. The staff are very nice with you and have a bit of fun. Everyone is friendly.'

'The place is kept clean and tidy I am well looked after and have no complaints.'

'I like it here. I get the help I need and the food is alright.'

'The staff are very nice and helpful, I wouldn't want to leave.'

'The staff are very good. I have a bell in my room if I need them (staff) to come to me.'

'I have only been here a few days. The staff are good and have made me feel welcome. The food is OK. I'm a vegetarian and they cater for me.'

'The staff are lovely but the food is poor. I'd like scrambled egg but I don't get it.'

'There are no staff here that I dislike.'

'I get bored sometimes but they do arrange some activities for us.'

'I am very happy with the care and support my relative receives.'

'We have got some really, really good staff and we all muck in together.'

During our SOFI observation we found that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people. People also had positive interactions and communication with each other.

We spoke with ten people living at the home and two relatives. Their comments included:

'You can't beat the staff here.'

'I'm the only one who has been to the kitchen to say thank you ' they are really good.'

'It's very nice here, the staff are lovely. I can get up and go back to bed when I want.'

'I am very happy with everything; the staff have a lot of patience and look after my relative well.'

We found that people or their representative were asked for their consent to care and treatment and the staff acted in accordance with their wishes.

During the inspection we spent time sitting with people and found that care and support was offered appropriately to people.

Our conversations with people, relatives and staff, together with observations on the day of our inspection evidenced that there were enough staff on duty. We also saw some good practice indicating staff who worked in the home were appropriately qualified to do their jobs.

The provider had appropriate systems in place for gathering and evaluating information about the quality of care the service provided. Records were up to date and stored safely.

On this visit we spent time on Pellon Manor, the residential dementia unit and Birkshall Mews, the dementia nursing unit.

We spoke with 12 members of staff, they all confirmed that staffing levels had been increased and were being maintained. They were all very positive about recent changes that had been made and told us that they had time to spend with people living in the home and were working in a more person centred way.

We saw that staff were smiling and happy and were spending time with people. People themselves looked well cared for and were smiling and looked content. In one lounge a member of staff was engaging people in conversation about 'The Wizard of Oz.' In another lounge a carer was engaging one person in a ball game, which generated a lot of laughter. Furniture had been rearranged in the lounges and occasional tables, books and magazines put out. We saw people picking up the magazines and looking at them, one person we spoke with told us they used to enjoy horse riding and on the table in front of them there was a magazine about horses.

We spoke with six people who lived at the home who told us that they liked living there and liked the staff.