We carried out an unannounced inspection of Pen Inney House on 4 April 2018. Pen Inney House is a ‘care home’ that provides care for a maximum of 20 adults. People 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. At the time of the inspection there were 15 people living at the service. The service is on two floors with access to the upper floor via stairs or a stair lift. Some rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas included one lounge, a dining room, garden and patio seating area.

There was a registered manager in post who was responsible for the day-to-day running of the 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.

At this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 15 February 2017. In February 2017 we found gaps in people’s medicines records and inconsistent guidance for staff about when people might need ‘as required’ medicines. Risks in relation to some people’s skin care and nutrition were not managed effectively. People’s confidential information was not adequately protected because their personal records were not always kept securely. Systems to monitor the quality of the service provided were not effective. Concerns about the effectiveness of the auditing systems and risk management had also been raised at a previous inspection in January 2016.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection.

Safe arrangements were in place for the storing and administration of medicines. Medicine administration records (MARs) were clear and there were no gaps. Where people were prescribed medicines to take ‘as required’ (PRN) clear protocols had been put in place for staff to follow when administering these medicines. This helped ensure a consistent approach to the use of PRN.

Since the last inspection a new risk assessment format had been introduced. Risks were clearly identified in the new assessments and included guidance for staff on the actions they should take to minimise any risk of harm. In particular risks in relation people’s skin care and nutrition were being effectively monitored.

At previous inspections we found systems to monitor and check the quality of the service and to identify areas for improvement were not robust or consistently carried out. At this inspection we found there were effective quality assurance systems in place and audits were routinely completed. This meant that areas for improvement were identified and addressed to help drive improvement.

After the last inspection a locked cupboard was purchased and was now used to securely store people’s care files and other personal information about people. This meant people’s confidential information was protected appropriately in accordance with data protection guidelines.

On the day of the inspection there was a calm and relaxed atmosphere at the service. We observed that staff interacted with people in a caring and compassionate manner. People told us they were happy with the care they received and believed it was a safe environment. Comments included, “The staff are nice people and very caring”, “Someone always comes when I need help” and “I am happy living here.”

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People had

The inspection took place on 15 February 2017 and was unannounced.

Pen Inney House provides care and accommodation for up to 20 older people who are living with dementia or who may have physical or mental health needs. The provider also offers a day care facility. On the day of the inspection 12 people were living at the service. Pen Inney House is owned and operated by Mr and Mrs L Difford. Mr and Mrs L Difford also have three other care homes and a domiciliary care agency in Cornwall.

The home was on two floors with access to the upper floor via stairs or a stair lift. Some rooms had en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included one lounge, a dining room, and garden and patio seating area.

The service had a manager in place but they were not registered with the Commission. We spoke with the provider’s representative (Nominated Individual) about this and requested that an application was made. 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 our last inspection on 20 January 2016 we asked the provider to make improvements to ensure people were involved in their care, supported in line with their wishes and preferences, and that people’s care records were accurate. We also asked the provider to ensure people’s human rights were protected, people’s complaints were handled effectively and that infection control practices were reviewed. As well as ensuring there were sufficient numbers of care staff employed and that staff received training and support enabling them to meet people’s individual needs. The provider sent us an action plan telling us how they intended to meet the associated regulations. During this inspection we looked to see if improvements had been made. We found action had been taken and that the provider also had future plans in place to help maintain a high quality service for people.

People told us they felt safe living at the service. Staff had received training to recognise signs of potential abuse and knew what action to take to raise a safeguarding concern.

People’s freedom and independence was respected. There were sufficient numbers of staff and staffing was flexible to meet people’s changing needs. Some risks, associated with people’s care such as skin care and nutrition were not always managed effectively, meaning professional guidance was not always followed and documentation was not always competed accurately.

People were protected by infection control practices and lived in an environment which was free from odour; it was also assessed to ensure it was safe.

People were not always supported by staff who had received training to enable them to meet people’s individual needs. The local authority service improvement team also told us, training in some areas had been slow. People told us they thought the staff had the correct skills and knowledge to care for them and did not raise any concerns about staffs competence. New staff received an induction when they joined, introducing them to day to day practices and to policies and procedures. The manager and the Nominated Individual (NI) gave us assurances that immediate action would be taken regarding training, by providing us with an action plan following our inspection.

People’s consent to their care and treatment was sought in line with legislation; ensuring their human rights were protected. People did not always receive their medicines as prescribed and documentation was not always accurate.

People enjoyed the meals and had a variety of choices to choose. The catering staff were knowledgeable about people’s individual needs. People were offered drinks and snacks throughout the day.

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We carried out an unannounced comprehensive inspection of this service on 20 January 2016.

Breaches of legal requirements were found and enforcement action was taken. This was because people were not protected from risks associated with their care and people were not protected by infection control procedures. People were also at risk of not receiving their medicines as prescribed because documentation relating to medicines was inaccurate and there were no monitoring systems in place. We also found, people's feedback was not always respected or listened to and the systems in place to monitor and improve the quality of service people received were not effective.

We undertook this focused inspection on 8 June 2016 to check improvements had been made. 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 Pen Inney House on our website at www.cqc.org.uk.

Pen Inney House is owned and operated by Mr and Mrs L Difford. Mr and Mrs L Difford also have two other residential care homes in Cornwall. The service provides care and accommodation for up to 20 older people who are living with dementia or who may have physical or mental health needs. The provider also offers a day care facility. On the day of the inspection 13 people were living at the care home.

The home was on two floors with access to the upper floor via stairs or a stair lift. Some rooms had en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included one lounge, a dining room, and garden and patio seating area.

The registered manager for the service had recently resigned. 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.

Following the resignation of the registered manager, an acting manager supported by an assistant manager had been appointed. They told us there had been positive improvements and that they felt supported by the Nominated Individual, who visited most weeks and was always available by telephone. Systems had and were continuing to be devised and implemented to help ensure the quality of the service people received was effective and met their needs. Auditing systems now helped to highlight areas which required action and drive continuous improvement across the service.

People had been asked for their feedback about the service, but the acting manager told us further work was required to help ensure people’s views were being effectively used to ensure the ongoing quality and continued development of the service.

People were protected from risks associated with their care. However, risk assessments in place to monitor people’s weight loss were not always followed, which meant people’s needs may not be met. The acting manager told us immediate action would be taken to rectify this.

People’s individual mobility needs were now being met by staff who had received training, to help minimise moving and handling risks associated with people’s care. Staffing was being managed effectively to help ensure the correct skill mix of staff was on duty to meet people’s needs.

People were protected by infection control procedures and a cleaner had been recruited to help ensure the environment was clean and free from odour and people told us they had seen an improvement.

People’s medicines were managed safely, staff had received training and had had their competence reviewed to help ensure there were administering people’s medicines correctly. New auditing systems helped to protect people and highlight areas which required improvement.

The inspection took place on 21 January 2016 and was unannounced.

Pen Inney House provides care and accommodation for up to 20 older people who are living with dementia or who may have physical or mental health needs. The provider also offers a day care facility. On the day of the inspection 17 people were living at the care home. Pen Inney House is owned and operated by Mr and Mrs L Difford. Mr and Mrs L Difford also have three other care homes and a domiciliary care agency in Cornwall.

The home was on two floors with access to the upper floor via stairs or a stair lift. Some rooms had en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included one lounge, a dining room, and garden and patio seating area.

The home had 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.

People and staff told us there were not always enough staff to meet their needs. There were care staff vacancies at the service and the registered manager had been covering shifts which had impacted negatively on the management of the service. People told us staff were usually kind and caring but their attitude could change when the service was short staffed. People were cared for by staff who had not received training and supervision to carry out their role. Staff did not feel supported.

People were supported to maintain a balanced diet. Comments about the quality of the meals were varied. Some people told us the meals were nice, whilst others felt improvements could be made. People’s care plans provided details to staff about how to meet people’s individual nutritional needs. However, the system in place to monitor people’s weight was not effective in ensuring prompt action was taken when concerns had been identified.

People felt safe, but did not always feel “secure”, because staff spoke with them about difficulties they were experiencing regarding the management of the service. The registered manager and staff had not undertaken training in safeguarding procedures, which meant staff may not always make safeguarding alerts when they were concerned people may be subject to abuse or mistreatment. Staff did not feel confident about whistleblowing.

People were not always protected from risks associated with their care needs because staff did not have the correct guidance and direction available about the risks or how to mitigate them. Accidents and incidents were recorded. A new process was being implemented to analyse incidents to help prevent them from occurring again. People had personal evacuation plans in place, which meant people could be effectively supported in an emergency. People’s specialist equipment was serviced to ensure it was working correctly.

People were not protected from the spread of infection, because staff did not follow infection control practices and had not received training. People told us they did not always feel the environment was kept clean.

People's consent to care and support was not always sought in line with legislation and guidance. The registered manager and staff had a limited understanding of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). This meant decisions being made by staff may not always be in people’s best interests. People’s privacy and dignity were promoted, staff knocked on people’s bedroom doors and their health and social care needs were discussed in private.

People did not always have care plans in place to address their individual health and social care needs. People’s care plans were not always reflective of the care being delivered. People were not involved in the creation or review of their care plan. Social