We carried out an unannounced inspection of the service on 21 and 23 May 2018. Pennine Care is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Pennine Care is registered to provide residential care for up to 64 people in one building. Some of these people were living with dementia and mental health issues. At the time of the inspection 42 people were using the service. The service was divided into two distinctive areas Pennine and Moorland with Moorland being a male provision.

The service does not have a registered manager. 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. However a manager was in post and had applied for registration with CQC.

During the home’s previous inspections in May 2015 and April 2017, we rated the home overall as Requires improvement. At this inspection we continued to find areas of concern. The overall rating continues to be ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

People felt safe living at the home. Staff understood the processes for protecting people from avoidable harm. However some staff did not always put the protection of people first. People’s medicines were generally managed safely however they were not always stored in a manner that ensured they were safe to use.

The risks to people’s safety had been assessed and care plans were in place to support people safely. There were enough staff to keep people safe. Although staff were trained to deliver person centred care, this did not always happen and some care was task led. This could place people at risk of poor care. Accidents and incidents were regularly reviewed, assessed and investigated by the registered manager. The home was clean and fresh.

People’s physical, mental health and social needs were not always assessed and provided in line with current legislation and best practice guidelines. People were supported by trained staff who had their performance regularly assessed. People did not always speak highly about the food. People were not always assisted to eat in a manner that promoted their dignity.

The manager had built effective relationships with external health and social care organisations and people’s health was regularly monitored. The environment had been adapted to ensure people who had mental or physical disabilities were able, where possible to move freely. There was directional signage to support people living with dementia to orientate themselves independently around the home.

Staff mostly treated people with dignity and respected their privacy, however we saw occasions where people did not have their dignity supported. Some people felt able to make decisions about their care and felt the staff respected those decisions. People were encouraged to lead as independent a life as possible and some were prepared for a more independent life back in the community. People were provided with access to an independent advocate if they needed one.

People’s care records were person centred and guidance was provided for staff on how each person would like to be cared for.

People did not have their social care needs recognised and met. Group activities were available but these were not suitable to everyone. People were not always encouraged to attend these and were planned a year in advance. They did not always include activities that were important to individuals. People felt able to make a complaint and were confident it would be dealt with appropriately. The service r

This inspection took place on 4 and 11 April 2017. The service was last inspected on 5 and 6 May 2015. At the last inspection the outcome was Requires Improvement in all five key lines of enquiry. Three breaches in regulations were identified. At this inspection the required standards had been met in all but Regulation 12 People were not protected from the risk of infection and medicines were not managed safely.

Pennine Care Centre comprises of two units, Moorland Suite and Pennine Suite. It provides nursing and personal care for up to sixty four people, some of whom are living with dementia. On the day of our first inspection visit there were 46 people living there.

There was not a registered manager in post. The service was being managed by a peripatetic manager employed by the provider. The provider was taking active steps to recruit to a new 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Effective infection controls and measures were not sufficiently robust to ensure people were kept safe from the risk of infection. Medicines were not always managed safely and signatures were missing from medication administration records (MAR) charts.

People felt safe living at Pennine Care Centre. Staff we spoke with had a good understanding of different types of abuse and understood their roles and responsibilities in recognising and reporting any potential abuse. Care plans contained information about how to minimise risk for people. There were sufficient staff to keep people safe but not enough to spend adequate one to one time with people on their hobbies and interests.

Pre-employment checks had been carried out on staff to help ensure people were kept safe. New staff participated in an induction which included shadowing an experienced member of staff.

Staff had received the required training to help keep people safe and meet their wishes and needs. Training had been undertaken in areas including safeguarding and infection control. Staff received supervision and induction to help meet people’s needs.

The manager and staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. People’s consent was sought before care was provided.

People had sufficient to eat and drink and special diets were catered for. People were supported to access health and social care when this was required.

Staff knew people and were aware of the importance of treating them with dignity and respect. Staff were kind and caring and people were involved in the planning of their care.

People weren’t always supported to take part in daily activities and they were not always supported to follow their interests. However, the manager had introduced a scheme whereby all people living in the home were being supported to express their interests and wishes and staff were working towards meeting those.

Information regarding how to make a complaint was available and people knew how to raise concerns and complaints.

The manager and deputy manager were aware of their responsibilities and improvements that were required in the home. They were open and approachable in their work.

At this inspection we found a breaches 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 inspected Pennine Care Centre in response to concerns we had received about aspects of the care provided at the home. The home provides care for older people, some of whom have dementia and other disabilities. As part of our inspection we spoke with eleven people receiving care and four of their relatives, the registered manager, a regional manager and staff working at the home. We also examined records relating to the service provided.

Below is a summary of what we found.

Is the service safe?

People we spoke with were mostly happy with their care and support. One person receiving care told us, "It's okay for me."

The provider was not fully ensuring risks to peoples’ welfare and safety were identified and managed. Risks were not always identified promptly and appropriate action was not taken for planning and delivering safe care. This included where incidents of behaviours that challenge (for example verbal or physical aggression) had occurred between people receiving care, or between people who used the service and staff.

The registered manager was aware of the correct procedures to prevent and respond to allegations of abuse. However, staff were not aware of how to record and respond if concerns arose about possible abuse or neglect.

We notified social services and the police about our findings at a meeting on 6 August 2014. This meeting had been arranged to discuss concerns previously reported the local authority and CQC.

Is the service effective?

People's needs were assessed and some information was provided for staff about their care needs. However, records did not contain information about any diagnosed health conditions or disabilities. Some risks that could affect people had not been adequately assessed and managed as part of the care planning process, including where people had dementia. This meant that care delivered did not fully meet people’s individual needs.

Is the service caring?

We observed that people were not always cared for in a way that met their needs. Some people were not provided with adequate support to eat their meals, or with personal hygiene and continence.

We saw the provider did not always ensure people with sensory disabilities, for example hearing loss, were properly supported to use and look after their hearing aids. This meant people's needs were not being fully met.

Care planning did not always take account of people’s wishes, preferences and routines to ensure staff could provide personalised care that met their needs.

Is the service responsive?

Systems were in place for obtaining people’s views about the service provided and information was collated and results produced. The provider had a complaints procedure and relatives of four people receiving care told us they felt any concerns would be responded to appropriately.

We saw action was not always taken when needed in response to people’s care needs. This included where incidents of aggression had occurred and where people need help with their mobility.

Is the service well-led?

Some checks of care practice were completed by the registered manager. Systems were not adequate for analysing incidents that could cause harm. The registered manager did not have an effective system for identifying and managing risks or a full overview of current concerns or areas for development at the home.

On the day of our visit to Pennine Care Centre there were 47 people living at the care home.

We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us observing in the dining room for an hour over the lunch period. This enabled us to see how the staff spoke with people, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff spoke with people in a polite and professional manner. We saw staff offering support and encouragement in a way that met people’s needs. We saw staff making good eye contact, and bending down to speak to people on their level.

We spoke with two people who live at Pennine Care Centre. The first person said: “I’m all right. I’ve got everything I need, and the staff are OK.” A second person said: “I can’t grumble, the staff are nice, and I’ve got my own bedroom which is very nice.”

We saw that since our last inspection visit in August 2012 there had been a number of improvements at the care home, particularly in relation to the environment and infection control.

On the day of our visit to Pennine Care Centre there were 53 people living at the care home. The home is divided into two units: Moorland where 26 people were living and Pennine where 27 people were living.

We spoke with two people who live at Pennine Care Centre. We asked if they were happy living at the care home and we were told: “I’m very happy here, the staff are very good, they are very kind, and help me a lot.” A second person said: “I think the staff are wonderful, and I am very happy.”

We spoke with people specifically about their care, and they said they thought they were well cared for. One person said: “I think they do a good job, the staff, and yes I do think I’m well cared for.” A second person said: “I think they (the staff) look after me very well.”

People said that staff talked to them about their care plans. They also said that they were happy that staff controlled their medicines for them as they had memory problems.

The inspection of Pennine Care Centre took place on 5 and 6 May 2015. It was unannounced. The home provides care and support for up to 64 older people, including people living with dementia. On the day that we visited forty nine people were living there. The home was divided into two units, Pennine Unit and Moorland Unit . People in both units have access to communal areas and gardens.

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.

We spoke with six people who used the service, two visiting relatives and a visiting professional. We also spoke with members of care staff. We observed care and support in communal areas, spoke to people in private and looked at care and management records.

Our last inspection on 5 August 2014 found three breaches in legal requirements. These were in relation to care and welfare of people who use services, safeguarding people from abuse and assessing and monitoring the quality of service provision. We found the service had made improvements in their safeguarding procedures but the requirements of the other regulations had not been met.

We found that the provider had still not fully ensured that the planning and delivery of care met people’s individual needs. Quality assurance systems were in place but they were ineffective as risks to people had not been monitored or responded to. People had not been fully protected from the risk of cross-infection because areas of the home were unclean and the provider’s infection control policy was not being followed. Medicines were stored and administered safely. However, failures in ordering systems meant that some people had not received their prescribed medicines.

Staff had been recruited safely and received training. However, staff did not always put their training into practice, particularly with regard to meeting people’s dementia care needs. There were sufficient numbers of staff to meet people’s personal care needs, but staff did not always have time to speak with people on an individual basis

People had individual care plans in place but these were not always based on how people would like their care to be delivered. People were not always involved in decisions about their care and how the home was run. Activities took place at the home but some people told us they were bored. There was limited evidence that staff supported people to engage in meaningful activities and interests.

Staff understood how to safeguard people from the risk of abuse. We saw that mostly, people were treated with compassion and respect from the care staff. However, on a few occasions we observed care practices that fell short of this.

People had a choice of meals and vegetarians in the home were catered for. People’s health needs were monitored but some people had not received dental care in a timely manner.

Requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards were met.

We found three breaches of the Health and Social Care Act and you can see what actions we told the provider to take at the back of the full version of this report.