The inspection took place on 6 February 2018 and was unannounced. On 22 February 2016, we inspected the service and rated it Good but identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines. We inspected the service again on 5 July 2017 and found a repeated breach of Regulation 12, Safe Care and Treatment in relation to medicines management. As a result, we issued the provider with a warning notice telling them they must make the required improvements by 15 August 2017.

We undertook a comprehensive inspection on 29 and 30 August 2017 to check if the provider had made the necessary improvements. We found that the provider had not met the requirements of the warning notice and in addition was breaching other aspects of the regulation in regards to Safe Care and Treatment. As a result we rated Safe as Inadequate and issued the provider with two warning notices for a repeated breach of Regulation 12, Safe Care and Treatment and Regulation 17, Good Governance, telling them they must make the required improvements by 2 October 2017. We also found a breach of regulation in relation to Person-centred care.

At this inspection on 6 February 2018, we found that the provider had made the necessary improvements, had met the requirements of the warning notices and was meeting the Regulations they previously breached.

142 Petts Hill 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.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people with mental health needs. At the time of our inspection, three people were living in the home, two of whom had been living there for over 25 years.

The home was owned by a group of family members. There was a registered manager at the service at the time of our 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.

Staff followed the procedure for recording and the safe administration of medicines. There were systems in place to monitor the management of medicines. All staff had received medicines training and had their competencies regularly assessed.

The provider carried out regular health and safety audits. There were systems in place to protect people from the risk of infection and the environment was clean and free of hazards.

Risks to people's wellbeing and safety had been assessed, and where risks had been identified, the provider had taken appropriate action to mitigate these. Risk assessments were regularly reviewed and updated.

The provider had processes in place for the recording and investigation of incidents and accidents. Risks to people’s safety were identified and managed appropriately.

There were enough staff on duty to meet people’s needs in a timely manner.

People felt safe when staff were providing support. Staff had received training in safeguarding adults and demonstrated a good knowledge of this and what they would do if they thought someone was being abused.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were reviewed and updated monthly or more often if necessary and included instructions for staff to follow to ensure people’s needs were met. Care plans contained information about people’s daily routines and preferences.

The provider had a number of systems in place to monitor the quality of the service and put action plans in place where concerns were identified.

Staff had received

This unannounced inspection took place on 29 and 30 August 2017. The last comprehensive inspection of the service took place on 22 February 2016, when we rated the service as Good but identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines. We inspected the service on 5 July 2017 to check if the provider had made the necessary improvements and found a repeated breach of Regulation 12, Safe care and treatment in relation to medicines management. As a result, we issued the provider with a warning notice telling them they must make the required improvements by 15 August 2017.

At the inspection of 29 and 30 August 2017, we checked if the provider had made the necessary improvements with regards to the management of medicines. We found the provider had not met the requirements of the warning notice and in addition was breaching other aspects of the regulation in regards to safe care and treatment.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people who have mental health needs. At the time of our inspection three people were living in the home, two of whom had been living there for over 25 years.

The home was owned by a group of family members. There was a registered manager in post at the service at the time of our 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.

Medicines management remained unsafe. The registered manager had not put systems in place to monitor the management of medicines therefore had not identified recording errors and discrepancies in stock. This resulted in people being at risk of not having their medicines properly administered.

The provider had not undertaken recent health and safety audits. Some areas of the home were cluttered and there were trip hazards in communal areas. Some cleaning products and chemicals had not been locked away safely and were found in a toilet.

Risks assessments were carried out but these were general and did not always reflect the specific risks for each individual. Risks had not always been reviewed when people’s needs changed.

The care plans contained assessments of people’s needs and information on how care was to be provided. However, these were not always reviewed and updated and did not always contain up to date information. Visits by health care professionals were recorded.

The provider did not have robust systems in place to monitor the quality of the service and had not identified shortfalls in relation to the management of medicines, health and safety and care planning.

The staff team supported each other. Formal staff supervision was taking place but nobody had received an annual appraisal in recent years.

People’s capacity to make decisions about their care and treatment had been assessed. At the time of our inspection, nobody was being deprived of their liberty unlawfully.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

The provider had processes in place for the recording and investigation of incidents and accidents.

All staff working at the service had a Disclosure and Barring Service (DBS) check carried out.

There were enough staff on duty to meet people’s needs in a timely manner, and bank staff were available to provide cover in the event of staff shortage.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care and support. Relatives and external professionals we spoke with confirmed this.

There w

This unannounced inspection took place on 5 July 2017. The last inspection of the service took place on 22 February 2016, when we rated the service as ‘Good’ overall but ‘Requires Improvement’ in the key question, ‘Is the service safe?’ and identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines.

At the inspection of 05 July 2017, we checked if the provider had put in place adequate systems to make the necessary improvements. We found the provider had not made the necessary improvements in the way they managed people’s medicines, therefore risks to people’s health and safety remained.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Petts Hill Care Home’ on our website at www.cqc.org.uk.

Petts Hill Care Home provides accommodation, support and care for up to three people who have mental health needs. At the time of our inspection, there were three people living at the service.

The home is family owned through a partnership. There was a registered manager in post at the time of our 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.

Medicines management remained unsafe. The provider had improved the way in which medicines were stored. However, records still did not ensure that a clear audit trail was provided to confirm people received their medicines as prescribed. The provider had still not put adequate systems in place to monitor the management of medicines. This resulted in people being at risk of not having their medicines properly administered.

We are proposing to take further action against the provider for the breach of regulation in regards to safe care and treatment. We will add full information about CQC’s regulatory response at the back of the full version of the report after any representations and appeals have been concluded.

The inspection took place on 22 February 2016 and was unannounced. The service was last inspected on 16 July 2014 and at the time we found that improvements were required with regards to the provider’s compliance with the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). At this inspection, we found the provider had made the necessary improvements.

142 Petts Hill Care Home is a care home without nursing that provides accommodation, support and care for up to three people who have mental health needs. At the time of our inspection three people were living in the home, two of whom had been living there for over 25 years.

The home was owned by a group of family members. There was a registered manager in post at the service at the time of our 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.

Medicines management was unsafe. Medicines were not stored securely and records did not ensure that a clear audit trail was provided. The manager did not have systems in place to monitor the management of medicines. This resulted in people being at risk of not having their medicines properly administered.

Staff told us they felt supported by their manager. Formal staff supervision had taken place in the past but had not been carried out since 2013. Staff had not received an annual appraisal since 2013. The manager told us that they carried out informal supervision but those meetings were not recorded.

People’s capacity to make decisions about their care and treatment had been assessed.

Staff had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service.

People’s needs were assessed and care and treatment were planned and delivered in line with their individual care plan. The care plans contained assessments of people’s needs and information on how care was to be provided. The care plans contained information about people’s daily routines and preferences. Visits by health care professionals were recorded.

Care plans were reviewed and updated regularly and signed by people (where they were able) or by their representatives. Individual risk assessments were carried out, so that people were cared for safely.

The provider had processes in place for the recording and investigation of incidents and accidents.

Health and safety audits were undertaken which indicated that all areas of the home were checked for safety and any areas requiring maintenance were identified.

All staff working at the service had a Disclosure and Barring Service (DBS) check carried out.

There were enough staff on duty to meet people’s needs in a timely manner, and bank staff were available to cover in the event of staff shortage.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care and support. Relatives we spoke with confirmed this.

There was a complaints procedure in place and people told us they knew who to complain to if they had a problem. Relatives were sent quality questionnaires to gain their feedback on the quality of the care provided.

People said they liked living at 142 Petts Hill Care Home. One person said, “It’s paradise here.” People were complimentary about the approach of the staff and managers. We observed a calm and friendly interaction between staff and people living at the service. People were supported to undertake activities of their choice, and those were recorded in their care records.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines. You can

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

At our last inspection in November 2013 when we found the service was meeting all of the standards we inspected.

This inspection was unannounced.

142 Petts Hill is a care home without nursing that provides accommodation, support and care for up to three people who have mental health needs. When we inspected, three people were living in the home. The registered manager told us the service provided a ‘home for life’ if this was what people using the service wanted. Two of the three people using the service told us they had chosen to live there for 25 years.

The home is owned by a partnership. One of the partners has also been the registered manager with the Care Quality Commission since 2010 and she holds a recognised management qualification. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People were treated with dignity and respect and there was a good atmosphere during our inspection. People spoke highly of the staff and told us they were kind and caring.

Although staff had received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS), we found staff were not always meeting the requirements of the DoLS with respect to the care of one person using the service. This meant restrictions were placed on the person’s liberty without authorisation.

People’s care plans considered their health and personal care needs. Care plans were reviewed annually or more regularly if the person’s needs changed.

Staff said their training had included issues of dignity and respect and they were able to tell us how they included this in the way they worked with people using the service.

People were involved in making decisions about their care wherever possible. If people could not contribute to their care plan, staff worked with their relatives and other professionals to agree the care and support they needed.

We spoke with two of the three people who live at 142 Petts Hill and one relative. We asked their opinion of the care received by their relative and they made the comment, “The staff invite me to give feedback, I have no complaints.”

We were informed by one person using the service, “Staff always ask me before they do anything; the people are very good they tell me everything up front.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We observed that people’s needs were assessed appropriately and care plans were individualised and person centred.

People who used 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. One person using the service informed us, “I feel safe, not in danger in any way.”

There were enough qualified, skilled and experienced staff to meet people’s needs. People received effective and safe care from suitably skilled staff who understood their individual needs. We saw records of a very extensive programme of training that all care staff had taken part in.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We observed that all records were stored securely and all records were up to date.

We carried out this inspection to check progress on work that we told the provider was needed when we last visited in May 2012.

We found the provider had completed all of the required work to improve the premises for people using the service. This included refurbishing and redecorating the kitchen, improving fire safety measures, updating staff training and ensuring that checks were carried out on staff before they started work in the home.

We spoke with one person using the service. They said "I've lived here a long time, it's looking good now, they've done a lot of work".

We spoke with two of the three people using the service. They told us they were happy living in the home and one person said “I can go out when I want to as long as I let staff know where I am going”. One person said staff were supportive and they felt able to talk with them about their care. One person told us the staff asked them for their views about the home.

However, other evidence did not support this as we found the provider had not taken steps to assess and monitor the welfare and safety of the people living in the home. Audits and checks for example on people’s medication and on the maintenance of the premises were infrequent or did not take place. Staff had not attended regular training on subjects such as mental health and fire awareness.