About the service:

• Pinfold Home is residential care home that was providing personal care to 26 people with a mental health diagnosis at the time of the inspection.

People’s experience of using this service:

• The service was not consistently safe, with a lack of regular medication training and competency assessments to ensure staff knew how to administer medicines safely.

• Risk assessments and care plans were not always in place to manage specific conditions, namely diabetes. Smoking risk assessments were not always in place where people smoked within the premises.

• We were not assured that potential safeguarding allegations were always dealt with and investigated as necessary, to ensure that people’s concerns were taken seriously.

• Quality assurance processes required improvement to ensure that the registered manager had consistent oversight and review of care delivery and potential areas for improvement.

• People and relatives were pleased with the support that staff and management offered them, in an environment that was inclusive of people’s wishes.

• People felt well cared for and were supported to ensure that they accessed activities of their choosing, all the while feeling their dignity was respected.

• People were supported to make decisions in relation to their care, and relatives were involved where necessary to input into the review process.

Rating at last inspection:

• At our last inspection of 08 December 2017 the service was rated “requires improvement” (report published 24 February 2018). At that inspection we found improvements were needed to risk assessments and fire safety; and that there was no registered manager.

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

• We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the safe care and treatment. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Pinfold Home 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 is a staffed residential home for 26 people with mental health needs, some of whom may also have a learning disability. There were 24 people using the service at the time of this inspection.

This inspection took place on 8 December 2017 and 10 January 2018. Our first visit was unannounced.

At the last inspection in October 2016, we asked the provider to take action to make sure maintenance staff respected people's privacy. We found this action had been completed.

A registered manager was not in place. Since our last inspection the registered manager had left the service. A new manager was in post and they told us they would be applying to register with CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 felt safe living at Pinfold Home and spoke positively about the support provided to them. Staff told us that the service had improved in recent months with the new manager and changes being made in important areas such as medicines management and support planning.

We found some areas of the service required further improvement. Risk assessments required review to help ensure people’s safety by fully addressing all identified risks and the steps in place to reduce these. Documented fire safety checks were not taking place consistently.

Staff were aware of safeguarding procedures. Appropriate recruitment checks took place before staff started work.

Staff had received training which gave them the knowledge and skills to support people effectively. Refresher was being arranged at the time of this inspection. Staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People were asked for their consent to the care and support they received.

There was a system in place for dealing with people’s concerns and complaints. People told us they knew how to complain and felt confident to do so.

People were supported to have their health needs met. Staff worked with people to access the GP and other local health services as appropriate to help make sure their individual health needs were met.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection was carried out on 29 September and 05 October 2016 and was unannounced.

Pinfold Home is a residential care home, providing accommodation and personal care for up to 26 people. At the time of the inspection the service was providing support to 18 people.

The service has a registered manager in post 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.

Staff at Pinfold Home understood how to keep people safe. Staff received safeguarding training and knew what actions they needed to take if they thought a person was at risk of abuse. People’s risks were identified and managed reducing the possibility of avoidable harm. Staff were recruited through safe procedures and there were enough staff available to support people. People received their medicines safely and staff recorded medicines administration appropriately.

People received care and support from staff who were trained and supervised. Staff sought people’s consent before delivering support and people’s legal rights were upheld. People received healthy meals and had access to health and social care professionals as required.

The registered manager and staff at the service were caring, however the provider’s maintenance staff did not respect people’s privacy. People were supported to keep in contact with their families and to make decisions about how they received care.

People’s needs were assessed before they received a service and their needs were regularly reviewed. People were involved in developing the care plans. People’s views were sought and they were aware of the complaints procedure. People engaged in activities they chose, however health and social care professionals told us the activities provided did not support people to increase their independent living skills.

We recommend that the service seeks advice regarding skills teaching to promote people’s independence.

The service was led by an experienced and well qualified registered manager. The quality of the service people received was regularly audited. The service worked collaboratively with health and social care professionals.

People who use the service understood the care and treatment choices available to them. People we spoke with were happy and confident with the degree of choice and control they had. One person told us: “It’s up to me what I do and don’t do. If I need help staff will help me”. We saw that people's care and support needs had been written in to care plans and staff had discussed these plans with people and given them an opportunity to read the plans, add their own comments and sign the plans to show that they agreed to them.

Care staff supported people with ordinary day-to-day activities such as room cleaning, making snacks or more structured activities such as art, knitting and music. Care staff spoke positively about their work and told us that they liked to work as a team.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. A safeguarding policy and procedure was in place for staff reference along with the local authority guidelines.

We spoke with four members of staff and all said that they felt supported in their roles. They were able to describe the training and supervision they received. Some members of staff were developing their skills further by participating in further study via the Qualifications and Credit Framework (QCF) in subjects such as Leadership and Dementia.

We saw that the manager ensured that service users were protected against the risks of unsafe or inappropriate care and treatment by ensuring that records were up to date and regularly reviewed. Staff records were also held securely and confidentially with access allowed only by the manager or the employee concerned.

We found that the people we spoke with were satisfied with the care provided at Pinfold Home.

We spoke with seven of the 26 people using the service and their comments about the service at Pinfold House included, "staff do a wonderful job here. I get fantastic care and am making steady progress. This is the place that I want to stay at. The new manager is really helpful. I feel safe here. This place has done a lot for me; I would recommend it to anyone. The staff motivate me and that does me good."

"The staff love and cherish us and they help me to get up in the morning."

"The service is wonderful and so is the food."

"This place has saved my life. The staff care a lot about me."

We contacted three mental health professionals involved in the care of some of the people using the service and they were satisfied with the care and support that people received. Their comments to us included, "The staff are helpful and they have kept me up to date with what is going on for people. They have worked very well with one person whose mental health had deteriorated and this had prevented them from being readmitted to hospital."