We undertook this comprehensive inspection on the 18 and 19 June 2018 it was unannounced.

Petersfield care home provides accommodation for up to 36 people who require personal care. The service is a residential care home for older people. At the time of our inspection there were 27 people living at the home.

Petersfield has 36 rooms set over two floors and has communal lounges and sitting rooms, staff room, training room, laundry room, hairdressing room, offices, a dining area, kitchen and gardens including outdoor seating area.

The service had 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.

People were supported to receive their medicines safely and when required although some records relating to medicines were not always accurately completed.

Staff did not have access to suitable handwashing facilities to minimise the risk of cross infection after helping people with personal care.

People felt the use of agency staff at times meant they were supported by staff who were not always familiar with their individual needs. Staff felt at times there was a lack of staff. However we found that enough staff were available to meet people’s needs.

People were supported by staff who had suitable checks in place prior to being employed by the service. Staff received supervision and training and the registered manager was planning any outstanding appraisals. However, staff were not always able to demonstrate who to raise safeguarding concerns with or how to support people’s individual diverse needs.

People had care and support plans that confirmed how they wished to be supported. People who had dietary requirements had a detailed information in place. People received food and drink to meet their needs, however there were limited options for people who were diabetic.

Not all people had risk assessments that identified their individual risks and how these were being managed.

The staff respected the rights of people who lacked capacity to make certain decisions in line with the Mental Capacity Act 2005.

People had access to a range of healthcare professionals to ensure their health needs were met, these included the GP, dentist, district nurse and the falls team.

People were supported by staff who were kind and caring and who encouraged people to be independent. Staff offered people choices. People received support by health care professionals when required.

People’s care plans contained important information relating to their life histories and people felt able to choose the care that was important to them.

People could participate in a variety of activities and were able to spend their time how they wanted within the home and within the community.

The service had quality assurance systems in place that identified shortfalls and there was a clear action plan for areas to improve upon.

People, staff and relatives all had their views sought so that feedback could improve the care provided.

We inspected this service on the 9 & 10 January 2017. This was an unannounced inspection.

Petersfield care home provides accommodation for up to 36 people who require personal care. The service is a residential care home for older people. At the time of our visit there were 36 people living at the home. Petersfield has 36 rooms; it is set over two floors and has four communal lounges, a smoking room, staff room, training room, laundry room, hairdressing room, management office, dining area, kitchen, garden and patio area.

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.

People lived in a clean home although water checks needed improving due to inconsistent water temperatures and checks not being undertaken in line with the home’s guidelines. People felt the environment was not always promoting their independence. For example, at times people relied on staff to turn taps and the toilet layout could be improved.

People had mixed views about their meals and choices. Meals were not always provided in line with people’s specific dietary requirements relating to their diabetes and risks of choking. People felt supported by staff who were kind and caring and staff demonstrated a caring approach.

People’s care plans were detailed and personalised and contained informative risk assessments. However people who had diabetes and modified diets had no support plans in place which gave staff clear guidelines to follow. People were supported to maintain relationships with friends and family. Staff gave people choice and control in their care and support.

People felt safe in the home and received support from staff who had appropriate checks in place prior to commencing their employment. People’s care plans confirmed if people were unable to make decisions relating to their care and treatment and the principles of The Mental Capacity Act 2005 were being followed. People were happy with the medicines they received although records were not always accurately completed relating to prescribed creams.

People were supported by adequate staffing levels and staff supported people in a kind and caring manner. Staff received regular supervision and training to ensure they were skilled to meet people’s individual care needs. Staff felt happy and supported by the management of the home.

People were supported by staff who gave people choice and control in their care and support. People had access to activities and social events that were important to them. Activities available included quizzes, cards, coffee mornings, reading newspapers and exercises to music.

People told us they felt able to make a complaint to the registered manager should they need to do so. People and relatives were involved in planning their care. Peoples’ views were sought so that improvements could be identified, feedback received was overall positive about the care provided and received.

The provider had quality assurance systems in place that identified most areas for improvement. However we found during the inspection some areas that had not been identified prior to our inspection. For example, shortfalls in recording medicines, water temperatures and people’s feedback relating to difficulty with using the taps and toilets. The registered daily walk around had also failed to identify where one person was receiving a diet that was not in line with their health care professionals advice.

At the time of our inspection there were 31 people living in Petersfield. During our inspection we spoke with people living in the home, members of staff and the team leader who was the senior member of staff on duty.

We examined the care records for people living in the home and observed how staff interacted and supported people in communal areas. We crossed referenced peoples care plans with the observations that we made. We found that people were being supported in line with their assessed needs.

Overall people's comments were positive about the service they received. Comments included: “I have no grumbles here other than sometimes it’s a bit quiet”; “We do have choice here and that is respected. I like my own company and spend time in my room”; and “the staff are lovely really they are”.

Staff told us “it’s a good home. We provide a high standard of care here” and “We are well supported by the management. I am very happy here”. Another member of staff said “at the end of the day we are a busy team. But we do have time to meet people’s needs”.

The provider had effective systems in place to monitor the effectiveness of the service that was provided and to gain the views of people that used the service.

Overall, we found that improvements had been made since our last inspection of the home.

People who used the service were more involved in planning and agreeing to the care that they received. The care records included better information about people’s individual needs and the support that they required from staff.

The people we spoke with commented favourably about the care and support they received. One person, for example, told us “if you are ill you are well attended”; somebody else said there was “never a problem with getting the doctor out”.

People also spoke positively about the staff team; one person, for example, commented “you can’t fault any of them and the night staff are just as nice”. Action was being taken to ensure that people were cared for by staff who were well supported and had received the training that they needed.

People had been asked for their views about the home; as a result, changes had been made to the meal arrangements. A programme of audits had continued as a means of identifying any improvements in standards that may be needed.

People did not comment directly on the standard of record keeping. We had found at the last inspection that some people’s records did not include the information that was needed to ensure they were protected against the risk of receiving unsafe or inappropriate care. In particular, not everybody had a care plan, or their care plan had only been completed in part. After the inspection, the provider produced a plan to ensure that they were compliant with regulation 20, which concerns record keeping.

When we returned to the home on 24 October 2012, we found that changes had been made. We saw for example that people’s needs had been reviewed and new care plans had been written with the people who used the service. Overall we found that this aspect of record keeping had improved significantly since our last inspection.

People said that they were able to maintain some independence in the home. Some people told us that they liked to spend time in their own rooms and there was a choice of sitting areas for people who preferred to use the communal rooms.

On the day we visited, several people enjoyed an ‘exercise to music’ session that was held in the dining room. The staff member running the session said they tried to arrange activities that helped to keep people fit and moving, whilst also being fun.

One person told us that they liked to do as much as could for themselves, but they appreciated the help that they received with showers. Another person commented about the staff “I don’t need that much help, but when I do they’re around”. Other people we met with were more dependent on staff, for example because of their mobility and the risk of falling.

Some people told us that they were not aware of having a care plan; we found that people’s views were not well reflected in their individual care plans and there were some significant omissions in the care records. The lack of information meant that there was a risk of people receiving unsafe or inappropriate care.

People told us that they knew who to speak to if they had any concerns. We heard about some improvements that would benefit people in the home. We found that although there were systems in place for carrying out audits and reviews of the service, these were not effective in ensuring that improvements were being made when needed.

People we spoke with when we visited told us that they were included in decisions about their care. For example, one person said “I am asked what I would like for dinner. As long as I am fed I don’t mind what the meal is”. Another person told us that they can choose what time they get up in the mornings. We were told “the staff arranged a meeting with my family and my social worker and we all talked about the care I needed and how this was to be given”. One person who had not been living at the home for very long told us that information about the service was given to them to help them make up their minds about living at Petersfield.

People told us that they were well cared for. “I am very happy living here. I have lots of friends and all the help I need”, “I could not be any better looked after” and “I was unsure about coming to live in a home but have been pleasantly surprised. I am enjoying the company of others and am looking forward to knowing what activities are arranged during the day”.

People we spoke with during our visit told us that they were given their medicines when they needed them. “They bring me my tablets, I don’t have to worry about forgetting them now”, “they come round when we are having our meals and give us our tablets” and “they always ask me if I need my pain killers”.

People we spoke with were able to tell us that the staff were “very good”, “are very caring and know what they are doing” and “work well together as a team”.

People we spoke with when we visited were unable to tell us about how the provider monitors the quality of the service they are provided with, but were able to make some short comments. “We have residents meetings and are asked our opinions about the meals, and activities”, “everyone is always interested to know if we are happy” and “we have had forms to fill out in the past asking questions about the food, the home and the staff”.

This inspection was unannounced and took place on 9 and 14 October 2015. At our last inspection in October 2013 no concerns were identified.

Petersfield care home provides accommodation for up to 36 people who require personal care. The service is a residential care home for older people. At the time of our visit there were 33 people living at the home. Petersfield has 36 rooms, it is set over two floors and has four communal lounges, a smoking room, staff room, training room, laundry room, management office, dining area, kitchen, garden and patio area.

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.

People could be at risk of unsafe care due to not having referrals or actions taken when there were safeguarding concerns. People’s support plans and risk assessments did not always adequately detail what support staff might provide although staff demonstrated they knew people well. Staff did not always ensure they washed their hands or use personal protective equipment when administering medicines. People who were living with dementia were supported by staff who had not received training or that had a clear understanding of what action should be taken if people did not have capacity.

People and relatives felt supported by staff who demonstrated a kind and caring approach. There was a high use of agency and at times people were supported by staff who were unfamiliar with their care needs. People and staff were happy in the home, and people felt able to receive visitors and walk into the local community should they wish. There was a safe system in place for the recruitment of new staff. Staff demonstrated they respected people privacy and knocked before entering people rooms. People were generally satisfied with the meals in the home although some people found using packs of condiments and sauces difficult. The area manager confirmed they would review this and see what improvements could be made.

People had access to activities and there was an activities co-ordinator who supported people with activities and health appointments. People accessed to the local community and church and there were also opportunities within the home to attend communion. Rooms were individual to people and had personal possessions such as pictures, plants and furniture.

There was a complaints and compliments policy in place. People and relatives felt able to raise concerns should they need to. There were resident meetings that gave people opportunities to give feedback but there was no system to seek, relatives, staff or others who were in contact with the home. Audits were failing to identifying areas of concern such as window restrictors that were unsafe, missing mental capacity assessments and inadequate personal protective equipment whist administering medicines.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.