This unannounced comprehensive inspection took place on the 12 November 2018. The last comprehensive inspection took place on the 21 April 2016. At that time the service was rated Good. At this inspection we found breaches of regulations and the service was rated Requires Improvement.

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.

Penlee is situated close to the centre of Penzance. The service IS registered to provide accommodation for up to 25 predominantly elderly people who need assistance with personal care, including those with a dementia related condition. At the time of the inspection there were 23 people living at the service. The service is situated over three floors which are served by a passenger lift and stair lift. Some floors have staggered landings meaning people using rooms close by require mobility to use a small flight of stairs. All but four rooms had en-suite facilities and there were enough assisted baths and showers to support people. A lounge and dining room were situated on the ground floor as well as two conservatory areas. The rear ground floor conservatory included an office area. There were a range of aids and adaptations to support people with limited mobility.

During the inspection of April 2016, we made a recommendation that the service improved how it monitored food storage. This was because we saw that stored food kept in the refrigerator was not dated and cold meat had been left out uncovered in preparation for lunch at least 45 minutes before it was served. At this inspection we found improvements had been made and the service was following current food management guidance.

At the previous inspection we found people who lacked capacity had the potential to be at risk because there was not a suitable locking system on the front door. During this inspection we found a key pad lock had been installed and this mitigated risks to people, but did not constrain people who were safe to come and go when they wanted to.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Guidance for staff in respect of managing risk were not always in place. There were portable heaters in several first and second floor rooms. However, there was no evidence of risk assessments in place to protect or mitigate any potential associated risks to people. This meant staff might not have the information they needed to support and keep people safe.

Most windows on upper floors had window restrictors to keep people safe. However, in one room one of the restrictors was broken and in another there were no restrictors in place on the sash window. This meant people using these rooms may have been at risk.

The environment was not being effectively maintained. For example, several radiators on the first and second floor were not working and people relied on portable heaters to keep warm. One room had a window which did not close properly and towels and paper had been used to try and stop the cold air coming into the room. There was a refurbishment programme in place and the dining room had recently been decorated.

Suitable equipment for monitoring peoples weight was not available. Seven people were physically unable to use the stand on scales. There were no other options available to monitor peoples weight which is an early indicator for a person’s change in health. We discussed this with the registered manager who had come to an agreement with the registered provider to purchase sit on scales. This would support people who had limited mobility.

Staff had been recruited safely, received relevant training relevant to their role and were supported by the registered manager. They had the skills, knowledge a

We inspected Penlee Residential Care Home on 21 and 22 April 2016, the inspection was unannounced. The service was last inspected in August 2013; we had no concerns at that time.

Penlee Residential Care Home is a family run residential home that can accommodate up to 23 older people. On the day of our inspection 23 people were living at the service. The service is required to have a registered manager and there was one 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.

The service operated an ‘open door policy’. This meant both the exterior and hallway door leading into the service were kept unlocked during the day. Some people who lived at Penlee Residential Care Home suffered from a degree of dementia and confusion. This meant some people were at risk if they left the service on their own. There had been incidences when one person, with dementia, had left the service without telling staff. This had resulted in the person being supported to return to the service. The provider acknowledged this posed a potential risk to people and told us they would put a key pad lock in place. This meant people who were at risk by leaving unaccompanied would be supported to go outside safely with an escort. The code number for the lock would be visible to other people with capacity so that they could use it easily and leave the building as they wished.

Care plans contained risk assessments which identified when people were at risk, for example from falls. Some risk assessments needed to be reviewed and updated to reflect the current situation for the people they were about. Guidance for staff did not always contain detailed information on the action staff could take to minimise risks.

Medicine Administration Records (MAR) were clear and accurate. This meant it was possible to establish how much medicine people were receiving and whether the amount of medicine in stock tallied with the amounts recorded.

The registered manager had oversight of the service and people, relatives and staff told us they were available and approachable. Management were supported by both providers who were actively involved in the running of Penlee Residential Care Home. Staff told us, “It starts from the providers. They are very supportive.” There was a system of senior carers and an effective staff team. In addition the staff team included kitchen staff, cleaning staff and a maintenance worker. There were clear lines of accountability and responsibility. There were sufficient numbers of staff to meet people's needs.

People and relatives told us they considered Penlee Residential Care Home to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service as having a 'family' feel and terms such as 'homely' and 'friendly' were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff.

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. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people's needs.

Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been made to the local authority appropriately. Training for the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) was included in the induction process and in the list of training that required regular updating. The registered manager and

We spoke with three people who used the service and spent time observing people and staff during the day. Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs.

We saw people’s privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff.

We observed staff had positive interactions with people. People told us staff answered their call bells promptly. One person told us the staff were “polite and friendly”. Another person said, ”I am very happy here, no complaints”. People told us the food was good and they were offered choices. We were told visitors were welcome. One person said “I can go to bed when I want, if I wanted to go out someone would take me”. Another person told us they were involved in the planning of their care.

We heard care staff ask people what they would like to do and they shared ideas if people could not make a choice.

We found each person had a care plan which was regularly reviewed. We saw evidence that people were involved in planning their care.

We found staff had received a positive level of training and were supported by management.

On the day of the inspection, we spoke with 14 of the people who lived at Penlee Residential Care Home. People were extremely positive about the care and support they received. For example one person said “There is a lovely family feel….staff are very thoughtful….they always help me and I feel at home”. Other people we spoke with all made similar remarks. People said the food was to a good standard, the home was always clean and they felt safe living there. Two people independently made a point, without being prompted by the inspector that they did not feel restricted by the staff. People said that staff were supportive and responsive to their needs.

When we inspected the home was clean and odour free. The home was furnished and decorated to a good standard. Health and safety standards were all maintained appropriately.

Staffing levels were to a good standard. Staff were observed as working professionally with the people living in the home. There was evidence that suitable recruitment checks were completed. Although there were some gaps, overall, staff training was to a satisfactory standard. Quality assurance systems were satisfactory.

We spoke with six people who live at Penlee and also with two people who were visiting the home. This was to seek their views of the service provided to them.

People who use the service told us that they are happy to live at Penlee and also with the way in which their care is delivered.

People who use the service told us that they think the staff are very helpful and kind. One person said that the staff at Penlee look after them well. A visitor that we were able to talk with during our inspection told us that the staff meet their relative’s needs fully. People told us that staff are kind and respectful to them. They also told us that if they had any concerns they would be able to speak with the staff or the registered providers.

One visitor to the home told us that their relative was always shown respect by the staff and that they were always welcome in the home. They told us that the staff kept them informed of any pertinent issues regarding their relative’s care, whilst supporting their relative with their daily needs.