Pondsmead Care Home

Pondsmead Care Home is a residential care home providing nursing and residential care. The home is registered to provide care and support to up to 76 people. At the time of the inspection there were 51 people living at the home, 28 people required nursing care support and 23 people had personal care needs. The home specialises in the care of older people.

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

People were cared for by adequate numbers of staff to keep them safe and meet their needs.

People told us staff were responsive to their need for assistance and answered call bells promptly.

People appeared comfortable and relaxed with the staff who supported them.

People received their prescribed medicines safely. Staff who administered medicines had received specific training and had their competency in this area assessed.

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

Rating at last inspection

The last rating for this service was good (published 7 November 2018)

Why we inspected

The inspection was prompted by concerns received about medicines management and staffing. A decision was made for us to inspect and examine those risks.

We undertook this targeted inspection to follow up those concerns. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

We found the following examples of good practice.

The care home had effectively sectioned up parts of the home to minimise the spread of COVID-19. During the inspection the manager increased this by creating a section of the home for COVID-19 positive people.

Staff had worked hard to minimise the impact of low staffing levels to the residents. This was because many staff had been isolating due to COVID-19. The management worked hard to find agency staff to support the permanent staff. Agency staff used were not working in other services for the period of time they worked at the home.

The manager had cohorted staff to work in specific areas of the home to minimise transmission of infections. When there was staff shortages named staff were the only ones moving between different areas in the home to meet the needs of the people. All staff were following good hand hygiene and understood the importance of it.

Systems were in place to support staff and residents with the emotional impact of the outbreak. Staff told us they felt supported by the manager and could speak to them if they were struggling. They all knew the importance of providing wellbeing opportunities for people when they had time. Staff told us they prioritised people’s safety first.

Staff knew how to correctly put on and take off personal protective equipment (PPE) which was in line with government guidance. There were adequate supplies at the home and the manager knew where to access more. Enough PPE stations were situated around the home for staff to access when supporting people including those who were COVID-19 positive.

Pondsmead Care Home was last inspected in July 2017 and was rated requires improvement. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

At the last inspection we found there were insufficient staff to meet people’s needs in a safe and timely manner. We also found that following an independent review of fire precautions some work needed to bring the fire precautions to the recommended standard had been completed. However, there remained areas, including one which had been identified by the review as "significant", which had not been completed. We also found records had not always been completed accurately to reflect how and when care had been provided to people in the home. The systems in place to monitor the quality of the service provided had not identified the shortfalls found in the inspection. The provider sent us an action plan setting out how and when they would be compliant.

At this inspection we found there had been an improvement in all areas of care and support provided in the home. However, there was still work needed to maintain the improvements consistently. We found that there was an inconsistency with the recording in care plans between the residential unit and the nursing unit. The residential unit care plans were person centred with sufficient guidance for staff to follow. However, the care plans on the nursing unit were more generalised and less person centred. Staff on the nursing unit had failed to record interventions in the correct forms. These shortfalls had been identified by the registered manager and training and one to one supervision had been put into place. This meant the systems in place to identify shortfalls and drive improvement were more robust and had been used effectively.

There were sufficient staff to support people in a safe and timely manner a reorganisation of the home so that people with non-nursing needs were cared for on one floor meant staff were deployed more effectively. Staff spoken to said they had more time to spend with people and less “running up and down stairs.”

The first day of the inspection was carried out by one adult social care inspector, a specialist nurse advisor (this is a person who provides specialist advise during the inspection on general nursing) and an expert by experience and was unannounced. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The second day was carried out by one adult social care inspector and a specialist nurse advisor and two assistant inspectors and was announced.

Pondsmead Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

All the work required to bring the fire precautions up to the recommended standard had been completed and fire precautions in place in the home were found to be safe.

The administration of medicines was managed safely however it was noted that one person’s pain management care plans had not been developed following their initial assessment. The registered manager had identified that staff were recording pain management in daily records and not the specific form. training had been arranged for all staff in the correct way to use the electronic system.

People said the standard of food in the home was good, one relative said they were happy to see their loved one eating a healthy well-balanced diet. There were choices available on a seasonal menu and people could request an alternative if they did not like the food on the menu for the day. The dining experience for people was relaxed and a social occasion. However, we saw the dining room was laid up to a high standard during the morning but when meals were served people did not have the benefit of the tablecloths and cotton napkins which were removed. We discussed this with the registered manager who told us this did not usually happen and people usually had the benefit of a napkin and tablecloth. We saw the routine had changed on the second day of the inspection with the tablecloths remaining on the table and condiments provided. One person spoken with said, “The new owner likes it to look like that during the day.”

People told us they felt safe living in the home. One person said, “I feel very safe living here.” A relative said, “I am happy [the person] is safe. They were falling over at home and they haven’t fallen once since they have been here.”

There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. All staff spoken with were confident action would be taken by the registered manager and provider to address any issues they may raise.

People received effective care from staff who were well trained and understood their needs, likes and dislikes. People told us they felt staff were well trained and that they knew their care needs, likes and dislikes.

People said they received care and support from caring and kind staff. Comments included, “They [the staff] are all really nice and friendly.” And, “They [the staff] are all lovely.” And “There is always a cheerful and happy group of staff.”

People told us they could talk with staff and the manager if they wished to raise a concern. One person said, “He [the registered manager] is always about the home and takes the time to listen to you.”

People were supported at the end of their life to have a comfortable pain free death. Care plans showed people’s advance decisions were taken into consideration and acted upon. The staff also supported the bereaved with compassion understanding.

There was a clear drive to improve the service and the quality of care provided. This could be seen at all levels of staff who told us they were proud of the changes they had made and the plans for the future development of the home.

Pondsmead Nursing Home provides accommodation and personal care for up to 76 older people. At the time of our inspection there were 48 people living in the home of whom 23 needed nursing care. The home is arranged over three floors each floor having a communal living room and dining area. On the ground floor there is a recently refurbished dining room which is also occasionally used for activities. There are extensive grounds and garden with access from the dining area and lower ground floor.

There is a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Records had not always been completed accurately to reflect how and when care had been provided to people in the home.

People told us there was not sufficient staff to respond to their needs in a safe and timely manner. Since the inspection the provider told us they had increased the care staff numbers on both morning and afternoon shifts. We have made a recommendation about staffing arrangements.

There had been an independent review of the fire precautions. The provider had put in place an action plan to address areas for improvement to ensure the fire prevention arrangements were safe and adequate. Whilst some of the work needed to bring the fire precautions to the recommended standard had been completed there remained areas, including one which had been identified by the review as "significant", which had not been identified in the action plan or completed.

People were confident about staff having the necessary skills however there were some staff who had not completed refresher or updating training in line with the provider's policy. We have made a recommendation related to staff training.

Whilst a system of quality monitoring was in place this had not always been effective in identifying shortfalls and ensuring improvements had been made in how the quality of service was maintained.

People told us they felt safe living at Pondsmead Nursing Home and staff understood their responsibilities in reporting any concerns about the welfare of people. As part of the recruitment process all potential employees were vetted to ensure they were fit to work with vulnerable people.

The arrangements for managing and administering medicines were safe and protected the health and wellbeing of people. However, there needed to be improved arrangements where people were administering their own medicines.

People had mixed feeling about the meals provided in the home. Some said there was not enough variety whilst others were satisfied with the menu and meals. Changes had been made to the menu and a questionnaire given to people had resulted in some positive comments and noted improvements. However it was recognised continued improvements needed to be made.

People described staff as caring and kind. One person told us that being caring "Was a strength" of staff. Another said, "They treat me with respect and are so caring. They always ask if I am ok just thinking about me." Staff were observed supporting people in a caring and sensitive way.

There was a range of activities available and people spoke positively of the activities. However, there were difficulties in ensuring everyone was supported to take part in activities. We have made a recommendation about activities.

There was a welcoming environment where people were able to maintain their relationships with family and friends. People and relatives told us there were no restrictions on visiting.

People felt able to voice their views or concerns about the service. There were opportunities for people living in the home to give feedback about the quality of care provided in the home.

People spoke of a registered manager and staff who were approachable and promoted an environment where people felt listened to and able to voice their views.

We have recommended staffing arrangements are kept under review, staff refresher training system is improved to monitor arrangements for such training and the arrangements for the providing of activities are reviewed.

We have identified one breach 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.

At the time of our inspection there was no 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. The regional manager of Avon Care Homes was acting as manager of the home and was present throughout our inspection.

Improvements were needed in the management and administration of topical (eye ointments and skin creams) medicines. There were no arrangements to monitor they were being used correctly and as prescribed. Safe systems were in place for the administering and management of other prescribed medicines including those which required additional security.

We looked at arrangements for the use of equipment such as bed rails and pressure mats. These are used for the monitoring of people’s movements and can be viewed as restrictive. There was no evidence that the decision for use of this equipment had been made with the consent of the person or where a person lacked capacity a best interest decision had been made.

There was a failure to ensure records were consistent in identifying people’s care needs and completing assessments and care planning. There was differing information about people’s ability to make decisions. In one instance an assessment had been completed which indicated a high risk of skin breakdown but no care plan had been put in place to address this risk.

Staff demonstrated a knowledge and understanding of adult abuse and their responsibility to protect people from harm. They told us how they would report any concerns about possible abuse and were aware of their right to report any concerns to an outside organisations such as social services or the police.People told us they felt safe living in the home because they trusted staff. One person told us “I feel safe here because staff are here to care for us and they do.”

People told us how staff responded promptly when they used the call bell to request help. One person told us “The staff are there when you need them.” However people and relatives told us staff were not always available to “Just sit and have a chat.” This was something people told us they would have liked to happen more frequently.

Staff demonstrated an understanding of the importance of involving people in making decisions about their daily lives and those which affected their health and welfare. This was confirmed by people who told us “Staff always ask me what I want to do and where I want to be. It is my choice.” Another person said “What I do is up to me and staff always make sure it is my choice what I do.”

At our previous inspection there was a lack of training for staff. Staff told us training had improved and this was confirmed by training records. There was an ongoing training programme in place as well as a “learning topic of the month.”

People had access to healthcare services such as podiatrist and nutritionist. This also included more specialist support such as speech and language therapist. One person told us “If I want to see the doctor I just tell staff and they arrange it no questions.”

People told us they enjoyed the meals though some said they would have liked to have seen more “Traditional” meals. The menu did show some meals which could be seen as “Traditional” had been provided. The chef told us they had made changes to the menu in response to suggestions from people.

People told us they found staff “Caring and kind”. They told us how they were treated with respect and their dignity and privacy respected. Staff responded to people in a caring and sensitive manner. Staff were able to respond to people who were upset in a calming manner preventing further upset or distress.

Relatives and other visitors told us they could visit at any time and found the home friendly and welcoming. One person told us “Whenever my friend visits the staff are always welcoming. It is never a problem having family and friends coming to see me.” Staff had an understanding of people differing needs and diversity. Staff understood how they needed to approach people in differing ways because of physical disability. They told us about one person whose hearing was impaired and they had used writing boards to help the person tell staff what they needed.

Staff demonstrated knowledge of specific needs of people and their routines. They understood the importance of recognising people as individuals and providing care which reflected the individual.

A range of activities were provided on a daily basis. However they were focused on activities in a group setting. There was limited number of people who felt able to take part in these group activities. There was some opportunity for people to have one to one time as part of the activities arranged.

People spoke of not being informed about the management arrangements in the home and the changes that had taken place over the past year. Staff also felt they had not always been kept informed about what was happening regarding the management of the home.

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 this report