About the service:

Penhill is a residential care home that was providing personal care and accommodation to 16 people at the time of our inspection.

People’s experience of using this service:

People experienced good care and support at Penhill. People told us they received good care and got on well with staff. People had opportunity to go out on trips and enjoy entertainment in the home if they wished. Care was person centred in nature, taking account of individual needs and wishes.

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 knew and understood people’s needs well. Staff received good training and support to enable them to carry out their roles effectively. Supervision took place every few weeks as a means of supporting staff with their performance and development.

People experienced a safe service. There were sufficient numbers of staff to meet people’s needs and keep them safe. Changes to medicine administration had recently taken place to improve the process. There was an open and transparent culture where the registered manager encouraged staff to raise any issues or concerns.

Staff worked with health and social care professionals to ensure people’s health needs were met. We received positive feedback from health care professionals working with the service. People were positive about the food at the home. There were options available and people were able to contribute their ideas about what they wanted on the menu. People’s weights were monitored and discussed with the GP if there was any cause for concern.

The service was well led. Staff felt well supported and told us morale was good. Checks and audits took place to ensure the service was running well.

Rating at last inspection: At our last inspection, the service was rated as Good. The last report was published 24 September 2016.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: ongoing monitoring.

We undertook an unannounced inspection of Penhill Residential Home on 26 July 2016. When the home was last inspected in June 2014 no breaches of the legal requirements were identified.

Penhill Residential Home provides personal care and accommodation for up to 19 older people. At the time of our inspection there were 19 people living at the home.

A registered manager was 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 home is run.

The home was not consistently effective because training had not always ensured staff had the correct skills and knowledge to support people effectively. People’s healthcare needs were not always met as additional information was required within people’s assessment in regards to medical conditions.

Medicines were managed and administered safely by staff. Regular audits of the medicines system and administration ensured people were kept safe. Risk assessments promoted people’s independence and people told us staff were there to support them as needed. Accident and incidents were fully reported. Audits ensured that subsequent action taken had been effective in reducing reoccurrence.

Thorough recruitment processes were in place, which made sure staff suitable for the role were employed. Staffing levels were safe and people told us there was always staff available to support them safely. A comprehensive and supportive induction procedure enabled staff to be introduced to the family ethos of the home. Staff received regular supervision. Staff told us the registered manager and senior staff members were supportive and accessible.

The registered manager was aware of their responsibilities in regards to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm. The registered manager kept clear records of the steps taken in the DoLS process. When a person lacked the capacity to make a particular decision, it was recorded how this had been established. When a best interest decision was needed, this was fully documented with the involvement of family and health or social care professionals. Staff were not always confident in their knowledge of DoLS and the Mental Capacity Act 2005.

Comments made by people and relatives were consistently positive about the care and support at Penhill Residential Home. People told us that staff were kind, caring and respectful. Staff knew people well. Support was given as people preferred and people’s privacy and dignity was always maintained. The home had received many compliments and reviews which commented on high quality care provided to people. Visitors were welcomed within the home. The home had good relationships with people’s family and friends and provided opportunities for them to be involved in the home.

Care was person centred. People were supported to maintain their hobbies, interests and networks. The home engaged with people, relatives and professionals to gain feedback through a variety of methods. The home was fully receptive and responsive to feedback and ensured changes were made. The complaints procedure was made available to people and the home considered different ways to make people aware of it.

The home was well run and managed. We received positive feedback about the registered manager. Staff felt valued and supported. A range of systems were in place to enable the quality of the care and support to be monitored. Regular meetings took place and staff fully participated. The home had good links within the local community and ensured these were maintained and developed. The home provided good

This inspection was undertaken by two Adult Social Care Inspectors. We looked at five standards during this inspection and set out to answer these key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our visit to the home, speaking with people who used the service, our observations and discussions with staff. Please read the full report if you want to see the evidence supporting our summary.

Is the service caring?

We made observations of positive relationships between staff and people who used the service. When one person became anxious, a member of staff held their hand and offered verbal reassurance. At the lunch time meal we saw that people who needed the support of staff, were offered this in a way that met their individual needs. The lunch time meal was served in pleasant surroundings.

People that we spoke with gave positive comments about the support and care that they received. One person told us "staff treat me like a person, not a patient". Another person told us "staff are excellent".

People in the home benefitted from a programme of activities on offer. On the day of our inspection, we saw that people were engaged in a sing along activity. We also heard about various trips outside of the home that people had been able to take part in.

Is the service responsive?

People's support was reviewed on a regular basis and a summary was written by the individual keyworkers each month. This enabled staff to identify any changes or concerns and adapt the support provided accordingly.

Any accidents or incidents experienced by people who lived in the home were recorded. We discussed the ways in which these would be responded to if they identified any recurring issues. For example, a person might be referred to a specialist team if they were experiencing a number of falls.

Is the service safe?

People were supported safely with their medication. Medications were stored safely so that they were only accessible to those authorised to do so. There were appropriate systems in place to manage the return of unused medications to the pharmacy.

Risk assessments were in place to help ensure that people were cared for in a safe way. These included assessments, for example that identified people who were at risk nutritionally or at risk of developing pressure damage to the skin.

Clear records were kept to show that people's individual health needs were met. For example, we saw that one person required regular blood tests; these were carried out and records kept of them. This would allow staff to seek advice from other professionals if the blood tests indicated there was a concern.

Staffing levels were sufficient to ensure that people's individual needs could be met. This was confirmed by our observation on the day of our inspection and feedback from people who used the service and staff. We viewed copied of staff rotas that showed that staffing levels were maintained at the required levels consistently.

Is the service well led?

At the time of our inspection there was not a registered manager in place; however, a new manager had been appointed and they were intending to register with the Commission.

There were systems in place to monitor the quality and safety of the service. This included gathering feedback from people who used the service, their relatives and other professionals who visited the home.

We spoke to 12 people who used the service. Comments were positive about the care and support they were receiving.

One person told us “the home allows me to live here in the way I want to”. Another person told us “the people are very nice” and someone else who lived there told us “I like to do my own dusting which keeps me active”. This meant people felt happy and supported in the home.

One person told us that “I would not have been here 7 years if I did not like it, and we have a bit of a laugh”. Another person told us that “the staff are most cheerful which is very important”

People we spoke with told us that the food was good and there was plenty of choice. One person told us “ I think I am over-eating here”. People told us that the menu choice was good and that if they did not like what was on the menu they could always have something else. One person told us “there is always enough to eat from the time you get up in the morning until the time you go to bed”

People told us that they felt safe. One person told us “I feel I am being taken care of,. all the staff are kind here but if I had concerns I know they will sort it quickly”. We were also told, “I like living here it is home from home, the staff are kind and friendly”.

We spoke with four people receiving a service and a relative. Comments were positive about the care and support they were receiving.

One person told us “the staff cannot do enough, it is like home from home and it could not get any better”.

People told us they had access to their care records and the manager had sat with them to talk through what was recorded to ensure they were happy.

A relative confirmed they were involved and had been asked their opinion of the care plans that were in place. They also told us they were always made to feel welcome and the staff listened and kept them informed of any changes. People using the service had signed their care documentation and where relevant a family representative.

People confirmed that the service listened and acted appropriately to most requests. One person said “the staff go the extra mile to ensure we are happy and nothing is too much trouble”.

People told us that there were daily activities organised by the staff in the home. These included both in house activities and community based outings. People told us they had been to the theatre in Weston Super Mare and the local village hall for a local theatre group. Other activities included bingo, quizzes, keep fit, cross words and sing-a-longs.

People told us the local church visited the home and provided a service twice a month, and if they wanted staff would support them to attend the local church.

People told us the staff treated them with respect and were very caring. We observed staff knocking prior to entering bedrooms and bathrooms.

People using the service confirmed they had information to enable them to make a decision on whether to move to the home, including a statement of purpose and a service user guide. This information was available in the entrance hall of the home.

People were registered with a local GP, dentist and opticians. The manager told us that some people had their own dentist and opticians and these links were maintained.

A relative told us “this is an excellent home and would highly recommend it. The staff are really kind and caring and we are always made to feel welcome”.

People commented positively about the food and the choice that they could have. One person said “the food is really good and if you do not like something they will prepare you an alternative”.

People seen during the visit looked well cared for, staff were observed interacting with individuals and enquiring whether they were warm enough and if they had enough to eat and drink.

People told us they knew how to complain and that the staff and the manager would act appropriately to any concerns raised. One person said “I am not sure if I have been given the complaints procedure but there again I have no concerns about the care, I would highly recommend this home”. A visiting relative confirmed they had received the complaints procedure and there was a copy in the main hall of the home.

People told us the service regular obtains their views through weekly meetings, care reviews and annual surveys.