Peel Gardens is a residential service which provides accommodation and support for up to 45 people who require nursing or personal care. At the time of our inspection there were 34 people living at the home.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

We found that staff had been recruited safely and were aware of how to safeguard vulnerable adults living at the home from abusive practice. There were safe processes in place for the management and administration of medicines.

Concerns were expressed about staffing levels. We addressed this with the acting manager and the regional manager and shortly after our inspection staffing levels were increased at the home. This helped to ensure that people’s needs were met in a timely way and they received safe care.

Staff received appropriate training and had the knowledge and skills to meet people’s needs. People received appropriate support with eating and drinking and their healthcare needs were met at the home.

People living at the home were encouraged to be independent and staff respected their privacy and dignity. We observed staff at the home communicating with people in a kind and caring way. People looked relaxed and comfortable in the home environment.

We saw evidence that people received individualised care that reflected their needs and preferences. We received positive feedback from most relatives and staff about activities at the home.

The service did not have a registered manager in post. The previous registered manager had left two weeks before our inspection. An acting manager had been in post for just over two weeks and had been recruited to provide leadership and short term support to staff at the home while a permanent manager was being recruited.

Feedback had been sought from relatives who expressed a high level of satisfaction with many areas of the service. Where improvements had been suggested, we found evidence that action had been taken. Relatives and staff were happy with the management of the service.

We found that audits and checks of the service were completed regularly and were effective in ensuring that appropriate levels of quality and safety were maintained at the home.

Further information is in the detailed findings below.

Prior to our inspection we received some concerning information from members of the public, staff and other agencies. We considered this information and brought forward our scheduled inspection. We considered the evidence we had gathered under the outcomes we inspected. We spoke with three people using the service, four relatives and six members of staff. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found:

Is the service safe?

We noted the medicine ‘rounds’ were still in progress until late morning. This meant there could be a risk that medicines were not being given to people at the correct time. We also found gaps in the medication records which could mean people had not been given medication as per their prescription, or that it had been given but not recorded. We were told a member of staff had recently been given responsibility for monitoring staff practice and ensuring people’s medicines were managed safely. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found a number of areas in the home were in need of repair or upgrade, or were difficult to clean or untidy. We were shown a plan for improvement of the home and found evidence that some improvements were underway. However, the plan was incomplete and timescales for action were unclear. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The home had been reliant on both nursing and care agency staff since late 2013, which had impacted on all areas of the day to day running of the home. The service continued to be staffed, to some extent, with agency staff. However, in the past six weeks, new staff had been appointed and the use of agency staff had significantly reduced. Staff told us, “It is good to have some experienced staff”. A visitor said, “It is what this place needs to make sure people are looked after properly”. However despite an increase in staffing numbers we observed there were still times where people were not given the assistance they needed. We were told working patterns and routines were under review to ensure people received the attention they needed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found some of the records were not up to date or accurate. This meant people may be at risk of unsafe or inappropriate care and treatment. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

The staff team had undertaken training to help them to understand their responsibilities when making decisions for people who were unable to consent to care and treatment.

People’s views varied about whether people's needs were being met. Most of the comments could be linked to the lack of stable management in the home and a high reliance on agency staff. Comments from visitors included, “Mum is looked after and always looks very nice but it's just basic care; we expect much more”, “There hasn’t been very much for people to do, they get bored and angry” and “They (agency staff) are very nice but they don’t know how to look after my mum properly”.

Staff told us, “Things are improving now we have some experienced staff of our own” and “We have done our best but it has been difficult to look after everyone properly. The home is getting better and we are changing the way we do things”.

The home had recently employed an activities coordinator. We observed some positive interactions between him and some of the people living in the home.

A number of serious concerns had been raised about this service which meant the management of the home and the systems to monitor the quality of the service had been ineffective. However, we found a range of internal and external audits had recently been introduced. Improvement plans were in place with clear timescales for action. This should help to protect people from poor care standards and to identify any areas of non-compliance.

Is the service caring?

During our visit we observed staff treating people in a friendly and respectful way. We observed people being offered choices and being supported in a way that respected their privacy and dignity and encouraged their independence. People living in the home told us, “They do their best and look after me but they are always very busy” and "Staff are good to me; I am well looked after”.

Is the service responsive?

We found that people's needs were assessed and care plans were in place. However, the plans were not up to date and did not accurately reflect any risks to people, people’s care and support needs or the care that was being given. This could result in people not having their needs met. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found appropriate advice and support had been sought in response to changes in people’s condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Is the service well led?

The service had not had a stable management team in place to support staff. This had impacted on all aspects of the day to day running of the home, which had resulted in people's needs not being met and a number of safeguarding alerts being made. A new management team was in place including a regional manager (from November 2013), a registered manager (from March 2014) and a deputy manager (from April 2014).

Management and staff at the home told us they were working hard to address non-compliance to ensure people were receiving appropriate care in a safe environment. The service was working with a number of agencies, led by the local authority, to ensure improved standards for the people who were living in the home.

People had been asked to express their views and opinions of the service during recent meetings and during day to day discussions with staff and management. People told us they were being kept up to date with the changes about how the service was run. One visitor said, “Let’s hope it makes a difference; we will wait and see”.

During our visit we spoke with seven people living in the home, six visitors and five staff.

We found people's needs were assessed and care, treatment and support was planned and delivered in line with their individual care plan. We observed staff treating people in a patient, kind and respectful way. However, we also noted that people in the lounges were left unsupervised for short periods of time. People living in the home and their visitors told us they were happy with the care and support provided. Comments included, “I get the help that I need, when I need it” and "I'm confident my relative is looked after properly".

People told us there were opportunities for involvement in suitable activities and entertainments. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were encouraged to express their views and opinions of the service. People said their views were listened to and used to develop the service.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People made positive comments about the staff team. Comments included, "The staff are very good" and "Staff are polite, respectful and friendly".

Regular checks were undertaken by the manager and regional manager and appropriate action taken when any shortfalls had been identified. This helped to identify any risks of non compliance.

At our last inspection visits we had concerns the home was not adequately maintained which impacted on the dignity and well-being of people living at the home. Following our visit the provider sent us an action plan to indicate how and when they would achieve compliance with the regulations.

During this visit we found there had been a number of improvements made and there was a plan for ongoing improvements.

We spoke to people using this service but their feedback did not relate to this standard. We gathered evidence of people's experiences of the service by reviewing the providers' records and by undertaking a tour of the premises.

People told us they were able to make choices and decisions about how they spent their day. One person said, "I can do what I want, within reason, it's my choice". Another said, "I choose what I want to wear; I like to look nice".

People told us they were happy with the care and support they received. Comments included, "I can't fault the care", "I'm treated really well", "I like it here" and "I'm looked after properly". A visitor told us they were kept up to date and involved with any changes to their relatives' care. They said, "You can't fault the care".

People told us they were treated with respect and treated well. People were happy with the staff team. They told us, "There are enough staff", "The staff are lovely" and "The staff are nice and friendly". A visitor said, "The staff are very good" and "They do a good job".

People who we spoke with told us the home was clean. However they also said, "It's a bit scruffy in places but I'm comfortable", "It is not in a good state of repair", "The way the home looks is very disappointing" and "It's a bit shabby". We were concerned about the standard of the environment and the length of time it took to get repairs done as this affected people's dignity and wellbeing. We were also concerned that some of the issues raised at the last inspection visit had still not been addressed despite reassurances from the provider.

People told us they were given choices about how they spend their day.

One person said "staff listen to me" and another said " I can choose what I want to do and can make my own mind up".

Visitors told us they were kept up to date and involved in decisions about care; one said "it is like being part of an extended family".

People told us they were able to express their views and opinions and could influence the way that the home was run.

One person said "our opinions are valued and help to change things for the better".

All the people that we spoke to told us they were happy with the care and support they received. Comments from the people who lived at the home included said "I get the care and support that I need and they always ask if I am happy" and "I see the GP when I need and get my medicines on time" .

A visitor told us they were satisfied with the care and said "you can't fault it" and "It's a good place, everyone is looked after".

People told us they were looked after properly and that staff treated them well. Comments included "I feel safe" and "I like it here, everyone is so nice to me".

People told us "my room is very nice and always clean", "I have a nice room, it has been redecorated and having an en suite is a great help", "the home is always clean & tidy, there are no smells", "the environment is not fantastic" and "the home needs upgrading as some areas are a bit shabby".

People who used the service told us they were happy with the staff team. Comments included "the staff are very caring and helpful", "there are enough staff; they work very hard" and "there are enough staff, they are lovely".

Peel Gardens is a two storey purpose built home situated in a quiet residential area of Colne near to local amenities. There are three comfortable lounges, a number of quiet seating areas and a dining room. All bed rooms have en-suite facilities and there is lift access to both floors. There is adequate parking. At the time of the inspection there were 35 people accommodated in the home.

At the last inspection on 17 April 2014, we found the provider was not meeting the relevant legal requirements relating to how care and treatment was planned and delivered, how people’s medicines were managed and the suitability and safety of premises. We also found there were insufficient skilled and experienced permanent staff and accurate and appropriate records were not maintained. We asked the provider to take action to make improvements. During this inspection visit we found action had been taken and further improvements were ongoing in respect of the premises and people’s care records.

There was a registered manager in day to day charge of the home. 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 registered manager had been in post since March 2014. People made positive comments about how the home had improved. A visitor said, “Everything has improved; the home is much better”. Staff told us, “The home has improved; the manager is very good”, “We have a good manager who is clear about what needs doing” and “There are still things to do but we are in a much better place than we were. Things have improved.”

During the inspection we did not observe anything to give us cause for concern about people’s wellbeing and safety. People living in the home, and their visitors, told us they did not have any concerns about the way they were cared for. We observed staff interacting with people in a kind, warm and caring manner. 

Staff told us they were confident to take action if they witnessed or suspected any abusive or neglectful practice and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care.

We found accurate records and appropriate processes were in place for the ordering, receipt, administration and disposal of medicines and people received their medicines on time.

There were sufficient numbers of permanent staff to support people and keep them safe. We noted people’s requests for assistance were responded to in a timely way and staff were available in all areas of the home. One person said, “The staff are very good; there is always someone on hand to help.” We found appropriate checks had been completed on new staff before they began working for the service and staff had received a range of training to give them the necessary skills and knowledge to help them look after people properly.

During our visit we observed staff responding to people with care and compassion. We observed staff talking gently and calmly to people to try to resolve difficult situations. People told us they were happy with the approach taken by staff. Comments included, “Staff are very good with me” and “Everyone is very nice.”

Each person had a care plan containing information about their likes and dislikes as well as their care and support needs. They had been updated on a monthly basis in line with any changing needs and showed people had been consulted about their care.

People told us they enjoyed their meals. We observed people being given the support and encouragement they needed and being offered choices of meals.

Meaningful activities were provided for small groups of people or mainly on a one to one basis. People had been involved in discussions about the activities they would prefer and we were given examples of how people’s individual social needs were met. Visitors told us they were able to visit at any time and were made to feel welcome.

People were able to discuss their concerns and share their views about the running of the home during regular meetings, during day to day discussions with staff and management and also as part of the annual survey. Visitors spoken with said they knew how to make a complaint and were confident to do so. One visitor said, “I have complained. They were very apologetic and dealt with the problem.” The information was used to monitor people’s satisfaction with the service provided and to make improvements.

Improvements to all areas of the home were ongoing. There was a detailed plan for improvements with clear timescales for action. People were happy with their rooms. There were improved systems in place to regularly assess and monitor the quality of the service with evidence these systems had identified any shortfalls and that improvements had been made.