Our Inspector gathered evidence to help answer five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?Below is a summary of what we found based on the evidence gathered during our inspection carried out on 22 April 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.
The detailed evidence that supports our findings can be read in the full report.
Is the service safe?
We saw that risk assessments had been completed and regularly reviewed in relation to a range of issues relevant to people's care needs. These included assessments relating to the management of medicines, nutrition and hydration, mobility, physical and mental health.
However, we saw that not everybody who lived at the home appeared to have received care and support at a time that best suited them or their individual needs and personal circumstances. Many people remained in bed throughout the morning of our inspection as they required the support of two members of staff to help them get up and complete their personal care.
One member of staff said, 'We are still getting people up and its past lunchtime so dinner will be pushed back. We don't have time to chat [with people] or do one to one work or activities. We do eventually meet people's needs but mostly it's late and not necessarily when they need it'
A range of policies had been put in place that gave staff guidance, information and advice about infection control practices and procedures. We also looked at records which showed that most staff employed at the home had received infection control training. Members of staff confirmed they had received training appropriate to their role and were knowledgeable about the infection control procedures used at the home.
However, during our inspection we toured the home and checked people's bedrooms, including their en-suite facilities, toilets, bathrooms and communal areas. We found that in some areas the required standards of cleanliness and hygiene had not been met. For example, the carpets and toilet bowls in some bedrooms were dirty and heavily stained.
We saw that effective recruitment policies and procedures were in place to ensure that staff employed at the home were of good character and appropriately skilled to meet people's needs. This included carrying out appropriate checks before staff began work.
Most of the people we spoke with during our inspection expressed concerns that staffing levels had not always been sufficient. A relative of a person who lived at the home said, 'They [the provider] need more staff. Often I need assistance but can't find anyone because they are all too busy."
Is the service effective?
During our inspection we saw that staff explained to people what was happening by using a range of both verbal and non-verbal communication methods. They made efforts to establish people's wishes and obtain their consent before care and support was provided.
However, we looked at the 'Do Not Attempt Cardio Pulmonary Resuscitation' (DNACPR) records in respect of five people who lived at the home. In all cases we found it unclear as to whether or not valid consent about the decision not to resuscitate had been properly obtained in line with the provider's own policy, published guidance and the Mental Capacity Act (MCA) 2005.
We looked at care records relating to seven of the 24 people who lived at the home. We saw that people's individual care and treatment needs had been assessed, documented and reviewed on a regular basis. They were personalised and gave staff clear guidance about the care and support people needed in most cases.
However, some relatives expressed concerns about the length of time it had taken to get people up and the delays experienced in meeting their care and support needs. One relative commented, 'I often arrive late afternoon and they [staff] are still getting people up. They meet my [family member's] needs but are always late doing so.'
Is the service caring?
During our inspection of Potton House we saw that in most cases the people who lived at the home were supported in a kind and caring manner. We spoke with staff who demonstrated a good knowledge and understanding of people's individual welfare requirements, health needs and personal circumstances.
Most people who were able to communicate with us said they were happy at the home and had been well looked after. One person told us, 'I love it here. The staff are absolutely first class. They work wonders and I get looked after very well.' A relative commented, 'I think people are well looked after in general. They are very good at getting doctors in quickly if there is a problem and following up on medical issues. All of the staff are dedicated, caring and good.'
However, when we observed lunch being provided in the communal dining room we saw that staff were rushed and that people were not offered a choice of meal or drink.
Is the service responsive?
The provider had put a complaints policy and procedure in place. People told us they knew how to complain if the need arose and we saw that information and guidance about the process had been prominently displayed in communal areas.
Staff told us that some of the people who lived at the home frequently displayed challenging, aggressive and occasionally violent behaviour towards other people and staff. We looked at the care records relating to one person who had displayed such behaviour on a regular basis.
Most of the care plans made reference to behaviour that often resulted in the person acting aggressively or violently in a way that made both them and others vulnerable to injury. Some plans gave staff guidance on how to deal with challenging behaviour if it arose, for example through distraction or by encouraging the person to go elsewhere in the home. However, we saw that plans had not been put in place to help staff recognise potential triggers to aggression or effectively manage the the behaviour.
Is the service well led?
The provider had some arrangements in place to identify and manage risks to people who used the service and to monitor and assess the quality of care and support they provided.
However, we were told that some weeks prior to our inspection the manager had been given the additional responsibility of managing another care home which meant that the leadership and management at Potton House may not have been as consistent and effective as it could have been.
We found that some of the systems used had not always been effective at protecting people against the risks of inappropriate or unsafe care and treatment. For example, audits had been carried out in relation to the environment and infection control. However, we found that problems identified with poor cleanliness and hygiene had been been responded to or dealt with effectively.