Penerley Lodge Care Centre provides personal care and nursing care to older people and those living with dementia. The service can accommodate up to 29 people. At the time of our inspection 19 people were using the service.

At the previous comprehensive inspection of Penerley Lodge Care Centre on 27 February and 4 March 2016, we found three breaches of regulations relating to the management of risks to people’s health and safety, staffing levels, and the way people’s care was planned and delivered. Due to our concerns and the breaches of regulations, we issued a warning notice at the time. You can read the full report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Penerley Lodge Care Centre’ on our website at www.cqc.org.uk.

We undertook a focused inspection on 4 August 2016 in relation to the breaches of regulation we identified at our previous inspection of 27 February and 4 March 2016. We found that the service had followed their action plan and had met the conditions of the warning notice we issued. We could not however change the rating for the five key questions and the overall rating of the service because to do so required a record of consistent good practice over time.

We undertook an unannounced comprehensive inspection on 11July 2017. At this inspection we found that the service had sustained the improvements put in place following our previous inspections of 27 February and 4 March 2016 and August 2016 and met the legal requirements.

There was no registered manager. The manager in post was new and was still in the process of completing their application to become the registered manager with CQC. 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’s medicines were managed in a safe way. This included administration, recording, storage, and disposal of unused medicines. Risks to people were adequately managed. Risk assessments were carried out and management plans were in place to keep people safe from avoidable harm. Recruitment procedures were safe to ensure only suitable personnel worked with vulnerable people. Sufficient levels of staffing were deployed to meet the needs of people. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse.

Staff understood their responsibilities within the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People consented to their care and support. Staff were supported through induction, supervision; appraisal and training to enable them to effectively meet people’s needs. People were supported to eat and drink appropriately and to meet their dietary and nutritional requirements. Relevant professionals were involved to ensure people received appropriate support and care that met their needs.

People told us staff treated them with kindness and respected their dignity. Staff knew people well and understood their needs and preferences and told us they were cared for as they wanted. People using the service and their relatives were involved in their care planning and these were reviewed and updated regularly to reflect people’s current needs and circumstances. Staff encouraged and supported people to maintain the relationships which mattered to them.

Staff encouraged and enabled people to do what they could for themselves to keep them active and maintain their independence. People were engaged in activities they enjoyed to occupy them and enable them to relax and socialise.

People knew how to complain if they were unhappy with the service. The manager investigated and responded to complaints and concerns appropriately. Regular spot checks and audits took place to identify any shortfalls in the serv

We carried out an unannounced comprehensive inspection of Penerley Lodge Care Centre on 27 February and 4 March 2016 at which we found three breaches of regulation. At this inspection, we found people had not always received safe and appropriate care. Risks to people’s health and safety were not always identified. There was insufficient guidance for staff to ensure they understood how to meet people’s needs safely. The provider had not ensured there were sufficient and suitable staff deployed to cover both emergency and routine work of the service. The provider had not ensured they had information about the quality of the service and any necessary improvements required.

Due to our concerns and the breaches of regulations, we issued a warning notice which the provider was required to comply with by 30 July 2016. The provider sent us a plan that described how they would meet the regulations.

We undertook a focused inspection on 4 August 2016 to check that the service now met the legal requirements. This report only covers our findings in relation to this. You can read the full report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Penerley Lodge Care Centre’ on our website at www.cqc.org.uk.

Penerley Lodge Care Centre provides personal care and nursing care to older people and those living with dementia. The service can accommodate up to 29 people. At the time of our inspection 28 people were using the service.

At this inspection, we found the manager and provider had followed their action plan and met the legal requirements in relation to managing staffing. We saw staffing levels had been reviewed and increased to ensure there were sufficient staff to meet people’s needs safely. Staff responded to people’s requests promptly and spent time engaging them in conversation and activities. The provider had a plan in place to manage staff shortages during a time of emergency.

The service identified risks to people and had up to date plans in place to keep them as safe as possible. Staff had received additional training and had the right skills and knowledge to provide people with safe care and treatment. Staff followed guidance in place to manage risks to people. The manager assessed people’s needs and care plans were in to ensure a person centred approach to care.

Staff received the support they required through regular one to one supervision and appraisal to enhance their knowledge and competence to meet people’s needs effectively.

The quality of the service was now subject to regular checks. The provider had put systems in place to monitor the quality of the service. The manager monitored the quality of care planning and risk assessments. The registered manager had taken appropriate action to address the concerns and develop the service.

This unannounced inspection took place on 27 February and 4 March 2016. Penerley Lodge Care Centre provides personal care to older people and those living with dementia. The service can accommodate up to 29 people. At the time of our inspection 27 people were using the service.

The service did not have 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.

At the last inspection in September 2014, the service was meeting the regulations we inspected.

We identified that the provider was not meeting regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection, we found the service had not always provided people with safe and appropriate care. Staff had identified risks to people’s health but had not always managed these appropriately. The provider had not ensured staff fully understood the risks posed by people’s health conditions and how they considered this when delivering their care and support. Staff did not have sufficient information and guidance about safely managing risks to people. People’s food and fluid intake was not always monitored as required. The provider had not taken sufficient action to mitigate risks to people’s health and well-being.

The provider did not have robust audit systems in place to monitor the quality of the service. There were no systems to monitor the quality of care planning and risk assessments.

The provider had not ensured there was always sufficient staff on duty to meet people’s needs in case of an emergency. Staff had not always received regular one to one supervision and appraisal, which meant the service, could not ascertain staff knowledge and competence to meet people’s needs effectively.

Staff managed people’s medicines appropriately and administered them safely as prescribed. The manager had assessed staff’s competency to manage and administer people’s medicines.

People told us staff were kind and caring and treated them with respect. Staff respected people’s privacy and dignity. Staff supported people to communicate their views about how they wanted to receive their care and support. People had nutritious food which they liked.

People were asked for their consent to the support and care they received. The service complied with the principles of the Mental Capacity Act (MCA) 2005 and the legal requirements of the Deprivation of Liberty Safeguards (DoLS).

People took part in activities of their choice. Staff knew people’s end of life wishes and delivered their care in line with this.

Staff involved people and their relatives in planning for their care. Staff had assessed people’s needs and put support plans in place on how they were to deliver their care and support. People received support as planned and in line with preferences and choices. People had access to healthcare services they required. Staff asked people for their views about the service and used their feedback to improve their support delivery.

The service responded to complaints people made and resolved them to their satisfaction. Staff felt supported in their role by the manager and had received regular training and refresher courses.

The provider had recruited a manager who was yet to submit a registered manager’s application to CQC. The service had submitted notifications to CQC as required.

This inspection was carried out to check that the provider had made the required improvements following our last inspection on 13 June 2014 where we found that people were not protected from the risks of malnutrition and dehydration.

We answered the questions: Is the service effective? Is the service caring? Is the service responsive?

We spoke with three people who used the service and reviewed four people’s care records.

Below is a summary of what we found.

Is the service effective?

People’s nutritional needs were included in their care plans and risks were assessed and management actions put in place. A dietician and the person’s GP were involved where there were concerns about a person's nutrition to ensure they received the appropriate care, treatment and support. People's weight was monitored as required.

Is the service caring?

Staff understood the needs of the people they supported. Staff listened to people and offered them choices of what to eat and drink. People told us staff were kind and caring.

Is the service responsive?

People's changing needs were responded to promptly and appropriate actions were taken. People were supported to eat and drink as required.

This inspection was carried out by an inspector who gathered evidence to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and staff supporting them and from looking at records. We spoke to three of the of 29 people using the service , two relatives of people using the service, two health professionals and five members of staff.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained to support people safely. There was a safeguarding policy in place and staff understood the types of abuse that could happen and how to report any concerns they had. Risks were assessed for people; however actions were not always taken to address any risk promptly. Staffing levels were adequate and staff were trained and competent in their roles. There was a plan for how staff should respond to unforeseeable emergencies. Medication was handled safely. The service was covered by care staff 24 hours a day and people told us they felt safe living at the service. Incidents and accidents were recorded and reviewed and lessons learned were discussed with staff at handover meetings. Appropriate equipment were provided for people who had mobility needs and staff had received training in using these.

Is the service effective?

People’s care was planned and delivered in a person centred way. The provider involved other healthcare professionals in the planning and coordination of people’s care and treatment. Staff responded to alarm calls promptly and flexibly to meet the needs of people. People were supported to take part in activities taking place at the service and outside the service.

Is the service caring?

Staff understood the needs of people they supported. People using the service told us that they were treated with dignity and respect. One person said, “Staff are nice and they look after me well.” A relative told us that “the staff do a good job and you cannot fault them.” We observed staff interacted and responded to people in an open and positive manner. Staff knocked on people’s doors before entering. Staff communicated with people in the way they understood.

Is the service responsive?

We saw that peoples changing needs were not always responded to promptly. People were not always supported to eat a sufficient amount of food and therefore, they could be at risk of malnutrition. People were encouraged to do as much as possible for themselves. Choices were not always offered at meal times. We saw staff attending to calls from people and responding to alarm bells. There were activities within the service which people participated in. The provider liaised effectively with other health and social care professionals to ensure the service responded to people’s needs.

Is the service well-led?

The provider worked well with other agencies in meeting the needs of people using the service. There were quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records of complaints and actions taken to address them. People using the service and their relatives told us that management take complaints and comments seriously and sort things out quickly.

During our last inspection of 11 June 2013 we found that improvements were needed to the way the service collated information from incidents and shared learning about ways to lessen the likelihood of reoccurrence. We found that standards of cleanliness were not consistently maintained. We returned for a follow-up inspection to check that action had been taken to address these shortcomings.

We found on our recent inspection that there had been improvements to the cleanliness of the premises and that there were effective systems in place to learn lessons from incidents.

We spoke with seven people using the service or their relatives. People spoke well of the staff in the home. Their comments included, "The staff are good. If you want something, you just have to ask”, "They’re very caring people" and “They’re absolutely brilliant. I can’t fault them. They have time for you.”

We found the interactions between staff and people using the service, and among people using the service, to be friendly, relaxed and cheerful.

People using the service we spoke with were complimentary about the food they were provided. They told us they enjoyed the food. People were supported to be able to eat and drink sufficient amounts to meet their needs.

Staff at Penerley Lodge Care Centre had access to appropriate training, support and development.

Our last inspection of 14 and 15 August 2012 found that the home's lounge and dining areas were not maintained to an appropriate standard of cleanliness and hygiene. During this inspection, we found that the situation had not been adequately addressed. The communal lounge and conservatory / dining areas had a strong unpleasant smell of urine, and the carpets were also dirty and stained.

Our last inspection of 14 and 15 August 2012 found that there were a high number of falls (on average 3 per week) recorded as being sustained by people using the service, without a wider review of such incidents being conducted. At this inspection, we found that improvements had been made, but further work was required.

We carried out inspections of Penerley Lodge Care Centre on the night of 14 August 2012 and during the day of 15 August 2012.

Residents and family members spoke well of the service and the staff team. The residents looked happy and at home. We saw warm and supportive interactions between staff members and the residents.

Suitable background checks were completed before people started working at Penerley Lodge Care Centre.

The staff team had access to suitable training and many people using the service commented on their good attitudes and how well they carried out their jobs.

Although the members of staff felt they had adequate staffing levels, they mentioned that the night time staffing levels could be inadequate during emergency situations.

The lounge and dining areas needed attention to bring them to a suitable standard of cleanliness and hygiene.

There had been a considerable number of falls in the home, and arrangements to identify, assess and manage risks of falls had not been implemented.

People who live in Penerley Lodge Care Centre said that they liked living there and felt at home. They said that the staff looked after them well and they came to them when they called for help. People liked said that they liked their bedrooms and were able to have their own things in their room. Relatives said that the home was homely and clean. They also said that if they raised a concern with staff it was usually dealt with immediately.

People who lived in the home were generally complimentary about the food. They also said that since the new manager had been appointed, the quality, availability and choice of food had improved. They also said that if they needed help to eat, the staff assisted them.

However, people who lived at the home and their relatives said that sometimes there were not enough staff on duty, particularly at night and weekends. They felt that staff were stretched and sometimes it took longer than ideal to provide personal care and help with meals.