About the service: Pranam Care Centre is a care home which is registered to provide personal care and accommodation for up to 50 older people and younger adults with a disability. It is owned by the provider Woodhouse Care Homes Limited. At the time of our inspection 35 people were living at the home.

People’s experience of using this service:

• At our last inspection we found a breach of the regulations relating to safe care and treatment. This was because some aspects of the environment were not kept in a safe manner. At this inspection we found safety in those areas that previously had been a cause for concern had been improved. However, at this inspection we found that the call system that people used to attract staff attention should they require urgent help or support had been switched off. This meant that people’s call bells were not audible unless a person was in or directly outside the person’s bedroom. In addition, two call bells tested in people’s bedrooms were not working.

• The provider had introduced an electronic care planning system and the care plans were still in the process of being transferred. This meant the care plans were not yet person- centred as they lacked relevant information and in some instances guidance for staff was inconsistent and contradictory.

• The provider had carried out checks and audits but had not identified the shortfalls we found during the inspection, as described above.

• At our last inspection we had found a breach of the regulation in relation to safeguarding adults from abuse and improper treatment. This was because we found that injuries to people were not always identified and responded to in a timely manner. At this inspection we found that staff reported concerns and the registered manager had systems in place to check people’s wellbeing and reported concerns in an appropriate manner.

• The registered manager had applied for Deprivation of Liberty Safeguards (DoLS) authorisations appropriately when a person might have been deprived of their liberty and lacked the mental capacity to consent to their care and treatment. We noted that care plans on the system were not signed by people to show their consent but were informed by the registered manager that these plans were, ‘work in progress.’

• At our last inspection we found that there was a breach of the regulation in relation to dignity and respect. At this inspection we found staff interactions with people to be respectful and responsive. People spoke well of staff describing them, as kind and caring.

• During our inspection agency staff had been put on shift to cover whilst staff received training. All staff spoken with told us there were adequate staff on duty and we observed that staff responded to people in a timely manner.

• Staff had received supervision and training to equip them to undertake their role. Staff spoke positively about the registered manager and provider and felt well supported by them.

• Staff who administered medicines used an electronic records system. We found that medicine administration records were completed without error. The provider worked in partnership with health care professionals to support people with their healthcare conditions.

• It was a strength of the service that staff had a good understanding of Asian cultures for example some staff spoke Punjabi and Hindi. The provider had undertaken work to ensure people knew how to complain and report any safeguarding adult’s concerns by translating the procedures into approximately five or six languages used by people in the home.

• Refurbishment had taken place to relocate the registered managers office to the reception area so it was more visible and the reception had been made welcoming for people to sit in and relax.

Rating at last inspection: We previously inspected Pranam Care Centre on the 21 and 22 June 2018 and rated the service requires improvement overall. This report was published on 10 September 2018.

Why we

This inspection took place on the 21 and 22 June 2018 and was unannounced.

Pranam Care Centre 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.

Pranam Care Centre can accommodate up to 50 older people some of whom are living with dementia in one adapted building. At the time of our inspection 31 people were living at the service. The home is owned by the provider Woodhouse Care Homes Limited.

There was a manager in post who registered with the Care Quality Commission in April 2018. 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 last inspection of the service was on 5 and 7 September 2017 when we rated the service requires improvement. Following this inspection, we asked the provider to complete an action plan to show what they would do. They provided us with an action plan that stated they would address concerns by the 31 December 2017 to improve the key questions Safe, Responsive and Well- Led to at least good. At the inspection of 21 and 22 June 2018, we found the provider had addressed some of the concerns we found at our last inspection but we found other concerns that meant all the key questions were now requires improvement.

At this inspection we found there were some hazards in the service that had not been identified and addressed through checks and audits. These included a fire exit which was partially obstructed by stored items, and an unlocked electric equipment room that contained flammable stored items. The outside areas of the home were not well maintained. There were cigarette ends that had not been picked up and litter that had not been cleared and which could have attracted pests. This made the outside areas unsuitable for people’s recreational use. The registered manager addressed these concerns when we pointed these to them.

We saw one person had a swollen and bruised hand. This had not been noted by the care staff. We brought this to the attention of the registered manager who arranged for the person to receive medical attention. Following our inspection, we requested this was reported as safeguarding adults to the local authority as it was an unexplained injury and the registered manager ensured it was reported as required.

People’s records we reviewed indicated that some people not been referred to the appropriate health care professionals when there had been a consistent weight loss and when they needed chiropodist treatment.

Records indicated people were not being supported to change their continence pads on a frequent enough basis. Daily recordings were not completed contemporaneously and were completed sometimes in advance which meant we could not be sure of their accuracy.

Most people said staff were “nice” and “good.” Whilst most care staff supported people in a friendly and kind manner their responses to people who were upset or restless were not always adequate as they did not take time to identify what was troubling the person so they could offer a meaningful solution.

One care staff undertook the duties of activities coordinator from 10am -12pm and 2pm-4pm each day and although there were some activities the sessions were short and people told us how they no longer went out and felt there were not enough activities to keep them occupied.

The interior of the home was kept clean. One area had a malodour and we brought this to the attention of the registered manager who agreed to address this.

The provider was employing staff in line with their assessed rota and using agency staff when they did

This inspection took place on the 5 and 7 September 2017 and was unannounced.

Pranam Care Centre is a care home that provides accommodation and personal care for up to 50 older people some of whom are living with dementia. At the time of our inspection there were 33 people living at the service.

There is 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.

At our last inspection in March 2017, we found seven breaches of the regulations. We issued a Warning Notice to the provider for regulations relating to safe care and treatment, need for consent, safeguarding service users from abuse and improper treatment, premises and equipment and good governance. We made a requirement that the provider address the breaches in person centred planning and receiving and acting on complaints.

After the inspection in March 2017 the provider sent us action plans to say what they would do to meet the legal requirements in relation to the breaches of regulations we found and the warning notice.

At this inspection, we found that improvement had been made in most areas but further improvements were still needed in a few areas.

At our last inspection, there had been concerns about the cleanliness of some areas of the service and the maintenance of some equipment had not taken place in a timely manner. We found that most of the service was now clean and well maintained. However, one kitchenette area in the main dining area was not being cleaned to an acceptable standard and both the cleaning staff and management team had overlooked this. Food in this area was not stored safely. The concerns were addressed when we raised these with the registered manager.

Previously we found that people did not sign care plans or their relatives and care staff were not aware of their content. People now had person centred plans that contained how they wanted their care to be delivered and staff could tell us about this. Staff had worked with people to produce a “Profile page” that told staff about what was important to the person. However, they were not kept in the care records for staff with the other documents. We also found some inaccurate information in one person’s record. People’s bedrooms were not personalised with familiar items to them, to make them feel at home.

Previously people and relatives had not been supported to complain and there was not a management oversight of complaints. We found that people and their relatives had been told how to complain and were encouraged to raise concerns that were logged appropriately. However, a relative told us they had made a complaint to the management team that had not been addressed as the provider’s complaints procedure stated. We brought this to the attention of the registered manager who took steps to investigate this matter.

During this inspection, we found that concerns with regard to the administration and storage of medicines had been addressed. Staff had received medicines administration training and the provider had worked with the supplying pharmacist and the local authority to identify concerns and had taken appropriate action.

Previously the provider had generic risk assessments that did not cover some people’s specific risks, such as risks about their health. During this inspection, we found that the provider had reviewed each person and had identified their individual risks and had put in place measures to mitigate those risks. Previously the staff moving and handling practices were sometimes unsafe. People now had moving and handling risk assessments. Staff had received refresher training in moving and handling and knew how to support people to mobilise in a safe manner.

Pre

This inspection took place on 1, 2 and 6 March 2017 and was unannounced.

Pranam Care Centre is a care home which provides accommodation and personal care for up to 50 older people. At the time of our inspection 28 people were living at the home. Some people were living with dementia.

The last inspection took place on 22 November 2016 when we found seven breaches of Regulation relating to safe care and treatment, meeting the requirements around Mental Capacity Act 2015, the environment, person centred care, dignity and respect, good governance, and recruitment.

Following the inspection in November 2016 we issued a warning notice for regulations relating to safe care and treatment and person centred care. We told the provider to make the necessary improvements by 31 January 2017.

After the inspection in November 2016, the provider provided us with action plans to say what they would do to meet legal requirements in relation to the breaches we found and the warning notice.

We undertook this comprehensive inspection to check that the provider had followed their plan and to confirm that they now met legal requirements.

At this inspection, we found that improvements had been made in some areas but further improvements were still needed.

The provider was registered with the Care Quality Commission in June 2015.

The previous registered manager had left in January 2017 and there was a new manager in post who confirmed an application had been made to the Care Quality Commission (CQC) to become the registered manager which was being processed. 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.

Some staff member’s practice was unsafe and put people at risk as they used an incorrect technique when moving and handling people.

Some parts of the environment were not safe, not clean and unhygienic and could cause harm to people’s health and wellbeing.

The provider did not always assess risks to people’s health and wellbeing. Available risk assessments were generic and did not identify specific risks to each individual. There were no risk management plans in place to guide staff on how to support people and how to minimise these risks.

Staff did not always manage medicines administration correctly. There were issues with recording of medicines administration, lack of clarity around verifying a dosage of prescribed medicines and the process by which medicines were administered.

The provider did not always seek people’s consent to their care and treatment and did not always work within the principles of the MCA, therefore there was increased risk of people’s rights not being protected.

The information on people’s dietary needs was not always clear and consistent.

Staff did not always treat people with dignity and respect and did not always act in accordance with people’s wishes and preferences.

People’s care plans varied in details and they not always reflected changes in peoples care and support needs. Staff did not always read people’s care plans, therefore, they did not always know them.

People and their family members were not always involved in care planning and reviewing processes.

The provider had a procedure for complaints and this was displayed, however people using the service and their relatives did not know of it.

The provider did not always maintain accurate, complete and detailed records relating to various aspects of providing the regulated activity.

There were some improvements in relation to leisure and social activities at the service, however, these were still limited and did not represent the interests of all people who used the service.

Improvements had been made in relation to the provider’s recruitment processes.

The inspection took place on 22 November 2016 and was unannounced.

The last inspection took place on 22 March 2016 when we found five breaches of Regulation relating to safe care and treatment, the environment, person centred care, display of Care Quality Commission rating and lack of a registered manager. At this inspection we found that improvements had been made in some areas but further improvements were needed.

Pranam Care Centre is a care home which provides accommodation and personal care for up to 50 older people. Some people were living with dementia. At the time of our inspection 33 people were living at the home. The service was registered with the Care Quality Commission in June 2015. The service was managed by Woodhouse Care Homes Limited, a private organisation. Although Pranam Care Centre was the only service operated by the provider, the company directors also managed other organisations providing residential and domiciliary care services in England.

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 and associated Regulations about how the service is run.

People were not always safe because some of the practices at the service put them at risk. The environment was not always safe or clean. Procedures for managing medicines were not always followed safely. Risk assessments did not always identify how staff should manage the risk and keep people safe.

People's leisure and social needs were not always met in a way which reflected their preferences.

The provider did not always have all the required documentation in place for the staff employed at the service.

The provider had not always acted in accordance with the Mental Capacity Act 2005 because information about people's capacity and their consent to care was not always clearly recorded. In addition the staff did not understand the principles of the Mental Capacity Act 2005 or their responsibilities under this.

Not all staff treated people with dignity and respect.

Records were not always well organised or clear.

The provider had made improvements in some areas but these were not enough and people were still placed at risk because the service was not always well-led.

We found 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The environment was not designed in a way to support people who had dementia and help them to orientate themselves. We have made a recommendation in respect of this.

Not all staff had good English language skills and this meant there was a risk they would not understand or meet the needs of people who lived at the service. We have made a recommendation in respect of this.

People's personal care, health and nutritional needs were being met.

Some of the staff were kind, caring and treated people with compassion.

The inspection took place on 22 March 2016 and was unannounced.

The last inspection of the service was on 7 and 8 January 2016 when we found breaches in five Regulations relating to safe care and treatment, consent to care and treatment, person centred care, recruitment and selection of staff and good governance. At this inspection we found some improvements had been made. However, there were other areas which required improvements. For example, risks associated with people's care and treatment, the cleanliness of the environment and meeting people's health care and leisure needs.

Pranam Care Centre is a nursing home which provides accommodation, nursing and personal care for up to 50 older people. Some people were living with dementia. At the time of our inspection 17 people were living at the home. The service was registered with the Care Quality Commission in June 2015. The service was managed by Woodhouse Care Homes Limited, a private organisation. Although Pranam Care Centre was the only service operated by the provider, the company directors also managed other organisations providing residential and domiciliary care services in England.

There was no manager in post. The last registered manager left the service on 28 August 2015. Another manager was appointed however they did not apply to be registered with the Care Quality Commission and left the service in January 2016. The provider told us that they were in the process of recruiting a new 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 and associated Regulations about how the service is run.

Some of the things people said about the service were, “They do their best to give people what they want”, It is absolutely brilliant. The residents are happy, I’m very happy” and ''I like it.” One visitor told us, “(My relative) says they look after her well. She gets good attention as there aren’t many people (living in the home).”

The environment was generally well maintained but had not always been cleaned.

People were sometimes placed at risk because of practices at the service.

People's healthcare needs were not always being met because the staff had made decisions about their health which were not based on best practice and without the consultation of relevant healthcare professionals.

People's individual social and leisure needs were not always met and did not reflect their preferences because there was limited organisation and support with social activities.

There had been no registered manager in post since August 2015 and no application to register a new manager with the Care Quality Commission had been received.

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

People received their medicines in a safe way.

There were enough staff on duty and they had been suitably recruited.

There were procedures designed to safeguard people from abuse and the staff were aware of these.

People had consented to their care and treatment.

The staff received the training and support they needed.

People had a choice of freshly prepared food.

People living at the service had positive relationships with the staff.

The staff were kind, caring, polite and considerate.

People's privacy and dignity was respected.

People's care needs had been recorded in care plans and these were regularly updated.

There was an appropriate complaints procedure and people knew how to make a complaint.

Records relating to the care and treatment of people who used the service, staff and other records were up to date, clear and accurate.

The provider had a system of audits and checks designed to monitor the service and to help plan improvements.

People living at the service and staff said there was a positi

This inspection took place on 7 and 8 January 2016 and was unannounced. This was the first inspection of the service since it was registered in June 2015.

Pranam Care Centre is a nursing home which provides accommodation, nursing and personal care for up to 52 older people. Some people were living with dementia. At the time of our inspection 22 people were living at the home. The home is divided into three units over two floors. Each person had their own bedroom and could access the communal facilities such as a lounge, dining room, worship temple and garden.

There was a home manager in post who was not yet registered with the Care Quality Commission (CQC). They informed us that the application to become the registered manager had been made to CQC and was being processed. 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 five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some of the staff practices put people at risk of harm.

People’s medicines were not always managed safely because there were no mechanisms in place to ensure regular stock checks of medicines on premises were carried out.

People and their relatives told us they were happy with service they received. However, we observed that some of the principles of The Mental Capacity Act 2005 (MCA) were not always recognised. Staff received MCA 2005 training but their knowledge was not always consolidated.

Staff asked people living in the service for their consent to their care, however there was a lack of relevant documentation showing that decisions were made in people’s best interest.

People’s care needs were not always assessed accurately and the care received by people was not always personalised. Pre-admission documents were not always fully completed and not all people using the service had their care plans in place.

Not all staff files consisted of relevant recruitment or induction paperwork. Staff were aware of the existence of people’s individual care plans, however, they said they did not always read them. They told us that they knew people’s needs from their day-to-day interactions with them. However, their knowledge on people’s care needs was incomplete.

Family members told us they thought the service was well led. However, we observed this was not always the case. The home admitted nine new people even though they were not fully prepared and consequently people’s needs were not met. Therefore people may have been put at risk.

The service had a handover system implemented to ensure communication between staff on different shifts, but it was not always effective and not all information was passed on.

The communication with external professionals was not always prompt and responsive.

Not all people had risks to their health, safety and welfare assessed and management plans were not always put in place.

There were a limited amount of activities taking place at the home.

There was a system of audits in place to ensure the safe running of the service. However, some of these had not been completed since September 2015.

Medicines were stored in a lockable cabinet and medicines trollies and the staff had access to relevant medicines policies and procedures.

People were protected from harm and abuse as staff received safeguarding training and were aware of the provider’s safeguarding policies and procedures.

The service had recruitment procedures to ensure suitable staff were appointed to work with people who used the service.

There were sufficient staff numbers on each shift and specific duties were allocated to each staff on daily basis.

There were systems in place to ensure people lived in a safe environmen