This inspection took place on 16 July 2018 and was unannounced. Penbownder House is a ‘care home’. 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. The service was previously inspected on 20 June 2016 when it was found to be fully compliant with the regulations and good in all areas.

Penbownder House accommodates up to 29 people who do not require nursing care. It is an old country house with extensive gardens. The accommodation is split into two units. The older persons unit is located in the main house with accommodation over three floors accessible by passenger lift. At the time of the inspection 14 people were living in this unit. The mental health unit is located in an annex attached to the main house. Nine people were living there at the time of the inspection.

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 service had a full time registered manager in post who worked alongside the director. The director lives in the grounds of Penbownder and was fully involved in the running of the service.

The roles and responsibilities of the registered manager and director were well defined and understood by staff. Staff told us they were well supported by the service’s leadership team and commented, “[The director and registered manager] are approachable you can go to them with any issues” and “You can always go and talk to management if you need to.” Records showed staff had received regular supervision and there were appropriate on call management arrangements in place to enable staff to access support outside of office hours if required.

People were relaxed and comfortable at Penbownder House and told us, “I am happy. I am all right, they are looking after me”, “I get on well with staff here” and “I am looked after well here.”

Staff had received safeguarding training and understood their responsibilities in relation to protecting people from abuse and harm. Issues in relation to a recent safeguarding investigation were discussed with the director. They told us they would update their policies and procedures to help ensure people were fully protected from risk if similar events reoccurred in the future.

Risks to individuals had been assessed. Care plans were sufficiently detailed and provided staff with guidance on how to manage identified risks to ensure people’s safety. When accident and incidents occurred, these were recorded and investigated by the registered manager to identify any changes to procedures that could be made to prevent similar incidents reoccurring.

The well-established staff team were sufficiently skilled to meet people’s care and support needs. Training was regularly refreshed and there were appropriate systems in place for the induction of new members of staff. Staff told us, “I’ve done loads of training” and “They remind you if you are due to refresh anything.”

Records showed planned staffing levels had been routinely achieved and staff told us, “There are enough staff.” Recruitment processes for new members of staff were robust and all necessary pre-employment checks had been completed.

People got on well with their care staff who responded to requests for support without hesitation and provided assistance at a relaxed pace. People told us, “The staff are wonderful, I can speak to them about anything” and “I get on well with staff here, they encourage me to get up and I can always talk to staff if I have any problems.”

People’s medicines were generally managed safely. However, we identified some instances where people were n

This inspection took place on 15 and 20 June 2016 was unannounced.

Penbownder House provides personal care and support for up to 29 people. There were 27 people living at the home at the time of the inspection. It is not a nursing home. People with the condition of dementia reside in part of the service and people with enduring mental health illness reside in a separate part of the service.

The service had a registered manager 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.

Throughout the inspection there was a calm, friendly and homely atmosphere. People appeared relaxed and happy. People, who were able, spoke highly about the care and support provided.

People were supported to maintain a healthy balanced diet. People told us they enjoyed their meals and did not feel rushed. One person said, “I like the food and there is always lots of it!”

Care records were detailed and recorded people’s preferences. People’s communication methods and preferences were taken into account and respected by staff. People’s risks were considered, managed and regularly reviewed to help keep people safe. Where possible, people had choice and control over their lives and were supported to engage in activities within the home and in the community. .

People were protected by safe recruitment procedures. Staff put people at the heart of their work. We observed the staff were kind, compassionate and gentle in their interactions with people. Good relationships had been developed and practice was people focused, not task led. The service had an open door policy, relatives and friends were welcomed and people were supported to maintain relationships with people who mattered to them.

People who were able to, said they felt there were sufficient staff on duty. People told us “There are always staff here to help me.” Staff were supported with an induction and ongoing training programme to develop their skills and their competency was assessed. A staff member commented; “[…] and […] (the registered manager and registered provider) are always available to help if we are busy.”

The registered provider, registered manager and staff had sought and acted on advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Applications were made and advice sought to help safeguard people and respect their human rights. Staff had undertaken safeguarding training, they displayed good knowledge of how to report concerns and were able to describe the action they would take to protect people against harm. Staff were confident any incidents or allegations would be fully investigated. People told us they felt safe.

Some people knew who to contact and how to raise concerns and make complaints. People told us they had not needed to make a complaint but the management team were visible and approachable and would deal with any concerns promptly.

People and staff described the management as very supportive and approachable. Staff talked positively about their jobs and took pride in their work. People told us “It’s really, really lovely here” and “I am very happy here.” A staff member confirmed “I left but liked it so much I came back!”

The service had an open and transparent culture. The provider had set values that were respected and adhered to by staff. Staff felt listened to and were encouraged to share any concerns they had so issues could be promptly dealt with. The staff worked closely with external agencies such as the local authority to raise issues and seek advice promptly when required.

People’s opinions were sought formally and informally. Audits were conducted to ensure any concerns with the qual

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them and observing care practices.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Penbownder alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Penbownder had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them where possible and in some cases with the input from relatives. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

The quality of recording seen was of a good standard enabling care staff to use the information correctly.

Is the service caring?

We spoke with five people and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “wonderful” and “Staff are very friendly” and “Very considerate carers”. When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences and interests had been recorded and basic life histories were evident.

Penbownder had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

Many people who lived at Penbownder had complex health and care needs and were either not able, or chose not to join in group activities. The care records showed evidence of the lifestyle of these people and we observed that staff spent one-to-one time with people throughout the day.

The home had recently employed an activity enabler. During our visit we observed people being taken out for a walk in the extensive grounds. We observed staff spending quality time with people during the afternoon of our visit.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

We saw minutes of regular meetings held with the staff. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We carried out an unannounced inspection on 13 May 2013. We spoke with five members of staff and twelve of the people living at the home.

People told us, "...wouldn't want to be anywhere else." People told us they were treated kindly and with care. They told us they were very happy living at Penbownder and that they were treated with consideration and respect. We saw people being encouraged to be independent where possible and supported where this was needed. Detailed care plans enabled staff to meet people's needs. People told us about activities they engaged in and we saw staff interacting with people in a person centred manner.

The staff we spoke with understood how to protect people and how to raise concerns if they had any. Staff had an induction period, they were trained in safeguarding and understood that some people needed support to make decisions about their care and welfare. Staff received comprehensive training in a variety of physical and mental health areas. This enabled them to provide the care people needed. They told us they felt supported by their colleagues and the management. We saw staff caring for people confidently and in a calm, unhurried manner explaining what they were doing and why.

The Nominated Individual had a system in place for monitoring the quality of the service to ensure the standards of care remained high. We saw evidence of good practice guidance being implemented in the dementia unit.

We conducted an unannounced visit to Penbownder House on 26 June 2012 as part of a programme of scheduled inspections.

We met the majority of people who used the service. One told us, “It’s very nice. You more or less do what you want here”. Where people were unable to talk to us about their experience of being at the home we spent time observing what it was like for them.

We looked closely at the care of two people, one with a dementia and one with enduring mental illness. This involved meeting them, looking at records and asking support workers about their care. The provider and unregistered manager also provided information and we spoke with a health care professional with knowledge of the home.

We saw that support workers had a good understanding of people’s individual needs and they were kind and respectful. They took time to work at people’s own pace. They gave us examples of how they had worked to give people a good quality of life. For example, people were taken into the town shopping when they wanted. One person talked about his friends and told us he felt safe at the home.

People were supported to make decisions about their lives and be as independent as possible. We saw that people’s care records described their needs and how those needs were to be met. A support worker told us how one person’s plan had been discussed with them on a regular basis. Those records confirmed what we had been told.

People’s emotional and physical needs were promoted. A health care professional said she had no concerns about the home and that staff had been proactive in reducing the possibility of a person becoming distressed.

People were safeguarded from abuse through the arrangements at the home to protect them, such as staff training. Skilled and knowledgeable staff were provided in sufficient numbers and the quality of the service people received was being regularly reviewed.

We inspected Penbownder House on 7 & 10 July 2015, the inspection was unannounced. The service was last inspected in April 2014, we had no concerns at that time.

Penbownder House is a registered care home for up to 29 people. The service comprises of two units. In one care is provided for older people some of whom are living with dementia. People with a mental health condition are supported in the second smaller unit. At the time of the inspection 29 people were living at the service, 19 older people and ten people with a mental health illness. There was a registered manager in post. 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 also a director at the service who was fully involved with the day to day running of the organisation.

Penbownder House is an old manor house set in rural surroundings on the outskirts of Launceston. The building has been adapted to meet the needs of the people living there. In the unit which accommodates older people the décor had been planned with regard to people’s dementia needs. There were signs to assist people to move around the building independently and bedroom doors were personalised. The unit where people with a mental health condition were supported was in a separate adjacent building. This was converted to two flatlets and eight en suite bedrooms in 2014. Prior to this time all residents had lived in the same building on different floors. The new accommodation had been planned to help ensure the differing needs of the two client groups could be met.

People and their relatives told us they felt safe living at Penbownder House. People approached staff for assistance and to talk with them. They did this without hesitation or any sign of reluctance. Staff were friendly in their response to people. When it was necessary to refuse people’s requests in line with their plan of care this was done with patience and humour. People were offered reassurance and explanations were given as to why their request had been turned down and when it could be met.

Risk assessments were in place and offered staff clear guidance on how to keep people safe while enabling them to take part in meaningful occupation. Staff and management spoke about the importance of ensuring people were supported to maintain their independence. The registered manager told us; “You look at the person and you look at their needs. You try and maintain their independence in every aspect of their life….personal care, choosing clothes, everything.”

Pre-employment checks such as disclosure and barring system (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Not all staff had completed refresher training in order to maintain their skills and knowledge base. We have made a recommendation about this in the report.

The director and registered manager had a comprehensive understanding of the requirements laid down in the Mental Capacity Act (2008) (MCA) and associated Deprivation of Liberty Standards (DoLS). DoLS applications were made appropriately and in accordance with the legislation.

People were able to make choices about how and where they spent their time. Some people chose to get up very early. Staff told us they tried to encourage people to stay in bed but that if people really wanted to get up that was; “their choice.”

Staff respected people’s individual communication styles and preferences. One member of staff told us; “I always talk to people and try and encourage a conversation.” Throughout the inspection we heard staff chatting with people on a variety of subjects.

Care plans were well organised and contained information specific to the needs of the individual. Staff told us they found them to be logical and useful. The information was up to date and reflected people’s current needs. There were systems in place to help ensure staff were aware of any change in people’s needs or well-being. There was no record of people’s personal backgrounds or histories in the care plans. Management and staff acknowledged the importance of this information.

There were clear lines of accountability and responsibility within the service. Staff told us management were supportive and approachable. Both the director and registered manager were fully involved with the day to day running of the service and people knew them well. During the inspection people frequently came to the office to speak with them. Relatives told us they considered the service to be “homely” and management communicated well with them.