Our inspection took place on 8 and 10 January 2019 and was unannounced.

At our last inspection in January 2018 we rated the service as ‘Requires Improvement’ but did not identify any breaches of regulation.

Pellon Care Centre is a care home. People living 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.

Pellon Care Centre accommodates up to 100 people across three separate units, each of which have separate adapted facilities. Brackenbed unit provides nursing intermediate care for up to 35 people and Pellon Manor provides personal care for up to 35 people. A third unit, Birkshall Mews, which accommodated up to 30 people has closed. There were 65 people using the service when we inspected.

The service is required to 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. There was a registered manager at the service.

Staff did not always recognise safeguarding issues and did not always display behaviour to demonstrate they understood professional boundaries. The registered manager took immediate action to address these issues and make sure people were safe at the time of the inspection.

Accidents and incidents were analysed monthly by the registered manager and lessons learnt were shared with staff.

Staffing levels needed to be kept under review on Pellon Manor to make sure there were always sufficient staff to meet people’s needs.

Safe recruitment processes were in place to ensure staff were suitable to work in the care service.

Staff received the training and support they needed to carry out their roles and to meet people's needs effectively.

People told us staff were caring and described them as ‘lovely.’ However, people’s dignity needs were not always met.

Medicines were managed safely in Brackenbed View. People in Pellon Manor did not always have access to their prescribed medicines.

Risks were generally well managed, although risk assessments on Pellon Manor did not always accurately reflect the level of risk.

There were effective infection control systems in place. The home was clean and nicely presented.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people to access healthcare services. People were involved in planning their care and support which was delivered to meet their needs and preferences.

Complaints were managed well with thorough investigations and timely responses.

People told us they enjoyed the food, however, we saw people were not always supported effectively to make choices. Food and fluid charts were not always completed appropriately.

The activities organiser was enthusiastic about their role and we saw activities were organised both in the home and local community.

The registered manager demonstrated commitment to continuous improvement of the service. They, and senior members of the management team responded quickly and efficiently to issues identified during the inspection. However, these issues had not been identified through the systems in place at the service for auditing quality and safety which meant the systems were not effective.

We identified two breaches in regulations. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 7 and 8 December 2017. The first day was unannounced; the second day was announced.

At our last inspection on 16 and 18 May 2017 we rated the service ‘Inadequate’ and the service was placed in ‘Special Measures’. We identified seven breaches which related to staffing, safe care and treatment, nutrition, person-centred care, dignity and respect, consent and good governance.

Pellon Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Pellon Care Centre accommodates up to 100 people across three separate units, each of which have separate adapted facilities. Brackenbed unit provides nursing intermediate care for up to 35 people and Pellon Manor provides personal care for up to 35 people. A third unit, Birkshall Mews, which accommodated up to 30 people, has closed since the last inspection. There were 63 people using the service when we inspected.

The manager who was in post at the previous inspection has left. A new manager is in post who has applied for registration with the CQC. We have referred to this manager as the home manager throughout the report. A registered manager is a person who has registered with the 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.

We saw there were enough staff to meet people’s needs and this was confirmed in our discussions with people, staff and relatives. However, two people raised concerns about night staffing levels on Brackenbed unit and the time they had to get up in the morning. The home manager told us they would look into this matter.

Safe recruitment processes helped to ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

Medicines were managed safely and people received their medicines when they needed them. Risks were generally well managed, although we saw two instances where staff assisted people using inappropriate moving and handling practices. This was addressed by the home manager straightaway. The home was clean and staff followed safe infection control practices.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood safeguarding procedures and how to report any concerns. Accidents and incidents were analysed monthly by the home manager and lessons learnt shared with staff.

Staff supported people to access healthcare services. People were involved in planning their care and support which was delivered to meet their needs and preferences. There were systems in place to manage complaints.

We saw the quality, quantity and choice of food had improved significantly and people told us how much they enjoyed their meals.

People and relatives praised the staff who they described as lovely, kind and caring, which was what we observed during the inspection. Staff clearly knew people well and took every opportunity to engage with them.

Activity staff organised a range of activities and events both in the home and local community, however these occurred predominately on Pellon Manor. There were plans in place to increase activity provision on Brackenbed unit.

The management team had worked hard to make improvements and addressed all the regulatory breaches identified at the last inspection. Effective quality audit systems were in place. We found an open, inclusive culture and saw the home manager and unit managers worked well together and we

This inspection took place on 16 and 18 May 2017. The first day was unannounced; the second day the provider knew we were returning.

Pellon Care Centre is divided up into three units and has a total of 100 places. Pellon Manor has 35 places and provides residential care for people living with dementia. Birkshall Mews has 30 places and provides nursing care for people living with dementia. Brackenbed View also has 35 places and provides nursing and intermediate care. At the time of the inspection there were 77 people using the service.

A new manager had been appointed to the service in December 2016. At the time of the inspection they had not completed the process to achieve registered manager status. 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 manager was present on both days of this inspection.

At our last inspection in November 2016 we identified five breaches of regulation and issued warning notices to the provider in respect of two of these breaches. These breaches were in relation to person centred care, dignity and respect, staffing, safe care and treatment and good governance.

We found variations in the quality of care within the home with an overall higher quality of care experienced on the Brackenbed View and Pellon Manor units.

Staffing levels were not appropriate to meet the needs and maintain the safety of people on the Brackenbed View and Pellon Manor units.

Safe recruitment procedures were in place which helped ensure staff were suitable to work in the care service.

Staff had not received the received the training they needed to carry out their roles and meet people’s needs.

Medicines management systems were not always safe.

Not all staff were clear about what constituted abuse. Where safeguarding concerns had been raised these had been reported appropriately.

Individual risks to people were not clearly assessed and there was out of date and inaccurate information in care records.

In some areas improvements were needed to make sure the environment was clean. Checks on the safety of the environment were in place and up to date.

People were not provided with appetising and nutritious meals appropriate to their needs and some people experienced a poor dining experience. There was a lack of overview of records relating to people’s diet and fluid intake.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Appropriate Deprivation of Liberty Safeguards (DoLS) had been made by the service; however conditions applied to DoLS had not been met. Best interest processes where decisions needed to be made for people who lacked capacity, had not been followed in line with the Mental Capacity Act (MCA).

Staff appeared caring, and people told us staff were kind and attentive. However we found people’s privacy and dignity needs were not always met.

People and relatives told us they felt able to raise any issues or concerns and were confident these would be dealt with appropriately. Records showed complaints received had been investigated although we were made aware of one complaint that had not been recorded.

We found care was not planned with a person centred approach and we found care records to be inaccurate and out of date.

People did not have access to appropriate and meaningful activities.

Systems to assess and monitor the service were in place but these were not sufficiently robust as they had failed to achieve compliance with breaches of regulation identified at the last inspection or identify the issues we found during this inspection.

People

Pellon Care Centre is divided up into three units and has a total of 100 places. Pellon Manor has 35 places and provides residential care for people living with dementia. Birkshall Mews has 30 places and provides nursing care for people living with dementia. Brackenbed View also has 35 places and provides nursing and intermediate care.

The inspection took place on 2 and 3 November 2016 and was unannounced. On the first day of the inspection 93 people were living in the home. At the last inspection in July 2015 the service was found to be compliant with our regulations and given a rating of ‘Good.’

A registered manager was in place. ‘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.

We found variations in the quality of care within the home with an overall higher quality of care experienced on the Brackenbed View and Pellon Manor units, where established unit managers were in place supported by stable and well organised staff teams. On Birkshall Mews we identified a number of care quality issues and lack of organisation of the staff team. A service improvement plan was in place to help drive improvement in this area. However we were concerned that the provider was unable to demonstrate a sustained, high quality service over time. During the inspection of February 2015 we identified five breaches of regulation, with improvements made during a follow up inspection in July 2015. At this inspection we found further risks demonstrating that the provider was unable to sustain this improvement.

Overall people and relatives provided positive feedback about the home. They said that people were safe, well looked after and that staff treated them well, with kindness and respect.

We observed some good medicines practice, although a number of inconsistencies meant medicines were not always managed in a safe or proper way, for example the management of topical creams.

In most cases, we saw risks to people’s health and safety were assessed and plans of care put in place for staff to follow. However we had some concerns over the way behaviours that challenge were managed on the Birkshall Mews unit.

Staffing levels were suitable and sufficient on Brackenbed View and Pellon Manor however we concluded staffing was not always sufficient on the ground floor of Birkshall Mews to ensure people’s safety. There was also a lack of nursing staff available at times to ensure robust oversight of people’s nursing needs.

Recruitment procedures were appropriate to ensure that people were of sufficient character to work with vulnerable people.

The premises was generally managed in a safe way although there were some areas which required attention.

We found appropriate Deprivation of Liberty Safeguards (DoLS) had been made by the service, although two people’s DoLS conditions had not been met by the service, demonstrating a lack of appropriate care. Where important decisions needed to be made for people who lacked capacity, best interest processes were followed in line with the Mental Capacity Act (MCA).

People provided mixed feedback about the quality of the food. We saw issues with the catering providers had been identified and action was being taken to address. The mealtime experience varied, with some good positive support observed, however breakfast and lunchtime lacked organisation on Birkshall Mews and some people did not receive appropriate support.

People’s healthcare needs were assessed and we saw some good examples of how people were supported to maintain good health. People had access to a range of healthcare professionals.

In most cases, staff supported people in a positive manner and treated them with dignity and respect. Staff de

We carried out an unannounced comprehensive inspection of this service on 17 February 2015. We found the provider was in breach of Regulation 9 (person centred care), Regulation 12 (safe care and treatment), Regulation 13 (safeguarding people from abuse), Regulation 17 (good governance) and Regulation 18 (staffing). After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified.

We undertook this focused inspection on 29 July 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. This inspection was unannounced. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pellon Care on our website at www.cqc.org.uk

We found the service employed sufficient staff to respond to people’s needs in a timely fashion. New staff had been recruited leaving agency staff usage being lowered. People told us they had their needs met. We looked at the staffing rota and saw minimum staffing levels had been met during the previous four weeks.

People received their medicines in line with their prescription. We observed medicines being administrated. Staff were patient with people and explained what they were doing. Medication Administration Records had been completed by nurses. As and when required medicines were stored separately to daily medicines. These medicines were easily checked for quantity so stock control could take place. Regular medicine audits had taken place.

The service had identified people who had been deprived of their liberty and referred them to the Deprivation of Liberty Safeguards team. We looked at the documentation and saw people had authorisations granted to lawfully deprive them of their liberty. The service had identified further people who were being deprived of their liberty and referred them for assessment. The service was acting in accordance with the Mental Capacity Act 2005.

People’s care records had been reviewed within the previous two months. We saw when peoples support needs changed, this was reflected in their care records. We observed support being provided according to people’s wishes and in line with their care plan. However we saw people that were supported with pressure care equipment, did not have recorded an appropriate setting in which their equipment should be set at.

The service now had a registered manager in place. 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 registered manager ensured a robust programme of quality assurance was in place. We saw the service introduced a new audit system from the provider. This system produced a report that allowed the registered manager to identify and action issues and concerns within the service at an earlier stage.

We inspected Pellon Care Centre on 17 February 2015. The visit was unannounced.

Pellon Care Centre is divided up into three units and has a total of 100 places. Pellon Manor has 30 beds and provides residential care for people living with dementia. Birkshall Mews has 35 beds and provides nursing care for people living with dementia. Brackenbed View also has 35 beds and provides nursing care and intermediate care. On the day of inspection, Pellon Manor was following infection control guidance following illness so we had limited access to this unit.

No manager had been registered with the Care Quality Commission (CQC) since December 2014. A registered manager is a person who has registered with the 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. A new manager had been recruited and told us they were in the process of registering for the position.

We saw personalised risk assessments were in place. One person’s care plan stated they had been found to be at significant risk of sustaining injury through falls. The initial assessment identified a need for physiotherapy and occupational therapy assessments. The professional assessments produced a detailed care plan explaining how the person had to be supported in all moving and handling situations. This showed us health professionals were involved with care planning where appropriate.

Medicines were not always safely managed. Systems were in place to ensure medicines including controlled drugs were stored safely and appropriately. However we found people had their medicines in a mixture of loose boxes and blister packs which could create confusion and increased the risk of errors happening. We also saw some people did not have a photograph attached to their medication documentation. Some people’s medicines to be administered as and when required were not always robustly documented.

People told us they enjoyed the food and they could choose what they wanted. We observed a person who was not happy with the choice of food sent up on the food trolley. Further suggestions were made and it was decided the kitchen would make them an omelette and chips. This showed us other options aside from the menu were available.

Staffing levels were not sufficient to protect people from harm. We found communal areas were not adequately supervised and people experienced delays when they requested assistance. People told us staff were very busy and in mornings could be left waiting.

The Care Quality Commission (CQC) monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes. We saw restrictions on people’s liberty which could constitute a deprivation of their liberty. The home had referred two people for urgent authorisation for DoLS, both of which expired 29 January 2015. We spoke with the manager and deputy about this. They said they had an understanding of the legal framework in which the home had to operate but agreed no further action had been taken.

We saw care plans indicated some people were using pressure relieving equipment with specified pressure settings for their mattress. We checked their mattresses and saw pressure settings that were different to that stated in their care plans. We asked staff how the pressure settings were calculated and they told us they did not know. We saw another person’s care plan indicated a recent drop in weight and they were to be weighed weekly. The staff told us they had not had weighing scales for about three weeks.

We found breaches of regulation 9, 13, 18, 17 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

We received information of concern about the care and support people were receiving, staff recruitment and staff training. We visited the home to look specifically at these issues. We found people had care plans in place which contained detailed information about the care and support they required. We also saw from the daily records and observation, staff were providing appropriate support to meet people’s needs.

We saw staff were being checked properly before they started working in the home to make sure they were suitable and safe to work with adults at risk. We also found staff were receiving appropriate training in order to be able to work safely.

We spoke with 12 people who were living in the home, three relatives, 17 staff, a visiting health care professional and a reviewing officer. These were some of the things they told us:

“It’s very nice here. The staff are very nice with you and have a bit of fun. Everyone is friendly.”

“The place is kept clean and tidy I am well looked after and have no complaints.”

“I like it here. I get the help I need and the food is alright.”

“The staff are very nice and helpful, I wouldn’t want to leave.”

“The staff are very good. I have a bell in my room if I need them (staff) to come to me.”

“I have only been here a few days. The staff are good and have made me feel welcome. The food is OK. I’m a vegetarian and they cater for me.”

“The staff are lovely but the food is poor. I’d like scrambled egg but I don’t get it.”

“There are no staff here that I dislike.”

“I get bored sometimes but they do arrange some activities for us.”

“I am very happy with the care and support my relative receives.”

“We have got some really, really good staff and we all muck in together.”

There are three separate units at the Pellon Lane Care Centre and we spent time on each one.

During our SOFI observation we found that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people. People also had positive interactions and communication with each other.

We spoke with ten people living at the home and two relatives. Their comments included:

“You can’t beat the staff here.”

“I’m the only one who has been to the kitchen to say thank you – they are really good.”

“It’s very nice here, the staff are lovely. I can get up and go back to bed when I want.”

“I am very happy with everything; the staff have a lot of patience and look after my relative well.”

We found that people or their representative were asked for their consent to care and treatment and the staff acted in accordance with their wishes.

During the inspection we spent time sitting with people and found that care and support was offered appropriately to people.

Our conversations with people, relatives and staff, together with observations on the day of our inspection evidenced that there were enough staff on duty. We also saw some good practice indicating staff who worked in the home were appropriately qualified to do their jobs.

The provider had appropriate systems in place for gathering and evaluating information about the quality of care the service provided. Records were up to date and stored safely.

When we visited the service in September 2012 we found that they were not compliant with the regulations relating to staffing (outcome 13) and told them they must become complaint by 1 October 2012. We went back on this visit to check that they had increased the staffing levels.

On this visit we spent time on Pellon Manor, the residential dementia unit and Birkshall Mews, the dementia nursing unit.

We spoke with 12 members of staff, they all confirmed that staffing levels had been increased and were being maintained. They were all very positive about recent changes that had been made and told us that they had time to spend with people living in the home and were working in a more person centred way.

We saw that staff were smiling and happy and were spending time with people. People themselves looked well cared for and were smiling and looked content. In one lounge a member of staff was engaging people in conversation about ‘The Wizard of Oz.’ In another lounge a carer was engaging one person in a ball game, which generated a lot of laughter. Furniture had been rearranged in the lounges and occasional tables, books and magazines put out. We saw people picking up the magazines and looking at them, one person we spoke with told us they used to enjoy horse riding and on the table in front of them there was a magazine about horses.

We spoke with six people who lived at the home who told us that they liked living there and liked the staff.

We spoke with four people living in the home, four relatives and nine members of staff. These are some of the things they told us about Birkshall Mews:

“I am well fed and looked after.”

“I can’t fault it, there is a new manager on Birkshall Mews who is very good, they have taken the time to explain about my relatives needs.”

“The cleanliness of the home has improved and the home is much fresher. Any spillages are dealt with quickly.”

“There are more permanent staff, but there aren’t enough of them.”

“I think they are short of staff, there should be three carers on duty with a nurse, but often there are only two carers and a nurse.”

“Some staff are really dedicated and very good. I know when one particular member of staff is on duty by the way my relatives’ personal appearance. It’s a shame this can’t be replicated on every shift.”

People living in the home told us that they like the staff as did the two relatives we spoke to. Relatives also told us that they didn’t think there were always enough staff on duty to meet people’s needs.