CQC report explained · a nursing home
What the CQC found at Puttenham Hill House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found insufficient staff at times, delayed care, unsafe continence and repositioning practices, and weaknesses in managing risks to skin, nutrition, hydration and choking. Medicines, fire safety, safeguarding and infection control arrangements were positive.
- Effective?
- Requires improvement
- Care was not always effective because meals were sometimes cold or left without enough support, and agency staff did not always receive enough information before starting work. People did have access to healthcare professionals and staff received role-specific training.
- Caring?
- Good
- The report did not give a separate rating for Caring. People and relatives said staff were kind and caring, and inspectors saw examples of this.
- Responsive?
- Good
- The report did not give a separate rating for Responsive. People were given opportunities to say how they wanted their care delivered, and residents' meetings were used to gather feedback.
- Well-led?
- Requires improvement
- Staff said their concerns about staffing had not been properly addressed. Care records were sometimes inconsistent, and the provider and management team had not identified all the shortfalls found by inspectors.
What inspectors found, October 2021
Rated Requires Improvement; inspectors found kind care and safe medicines, but serious shortfalls in staffing, risk management and oversight.
This was an unannounced inspection on 23 August 2021. Inspectors spoke with people, staff and professionals, observed care, and checked care plans, daily notes, medicines records, training, policies, audits and meeting minutes.
The home was not always safe or effective. There were not enough staff at some times, which meant people waited for care, were left in wet continence pads and were not always repositioned as planned. Inspectors also found risks around skin damage, choking, nutrition and hydration that were not always managed properly.
People and relatives said staff were kind and caring. Medicines were given safely, people had access to healthcare professionals, and infection control arrangements were assessed as satisfactory. However, the provider's checks and management oversight had not identified or fixed important problems.
The overall rating was Requires Improvement. Safe, Effective and Well-led were all rated Requires Improvement. This was worse than the previous Good rating published in October 2018. The provider was asked to send an action plan and will be checked again.
Kind and caring staff
People and relatives described staff as kind and caring. Inspectors also saw examples of caring interactions.
“People and relatives told us that staff were kind and caring and we saw examples of this.” from the report
Medicines
People said they received their medicines when needed. Records included photographs and allergy information, and time-critical medicines were given at the appropriate time.
“Medicines were managed in a safe way and people told us that they received their medicines when needed.” from the report
Healthcare support
People had access to a range of healthcare professionals, including nurses, doctors and therapists.
“People had appropriate access to health care services in their ongoing care.” from the report
Infection control
Inspectors were assured about the home's arrangements for preventing and managing infection, including visits, testing and protective equipment.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Too few staff
seriousThere were not enough staff to meet people's needs safely. People waited for help, and some were left for prolonged periods without personal care.
“There were insufficient staff deployed to safely meet the needs of people.” from the report
Care risks not managed safely
seriousRisk assessments and records did not always reflect people's changing needs. Inspectors found concerns about pressure damage, continence care, choking, nutrition and hydration.
“The failure to not always manage risks associated with people's care in a safe way is a breach of regulation 12” from the report
Food and drink support
needs fixingMealtimes were rushed. Some meals were cold or left without enough prompting and encouragement, creating a risk that people would not eat or drink enough.
“Not enough staff to encourage people to eat. People are not eating warm food.” from the report
Weak management oversight
seriousThe provider and managers had not acted effectively on repeated staffing concerns or identified all the problems found during the inspection. Some care records also contained conflicting information.
“The provider and registered manager did not have sufficient oversight of the service and had not picked up on all of the shortfalls we had identified.” from the report
- 01What staffing levels are now in place at busy times and overnight, and how do you make sure call bells and personal care are not delayed?
- 02How do you now monitor repositioning, continence care and skin condition for people at risk of pressure sores?
- 03What checks make sure people at risk of choking are positioned safely and receive the right support with meals?
- 04How do you record and review people's food, fluid and weight accurately?
- 05What evidence can you show that the three breached regulations have been addressed since the August 2021 inspection?
This was an unannounced inspection prompted by concerns about staffing and reported ratings for Safe, Effective and Well-led; Caring and Responsive were not separately rated in this report. This explanation was written from the published report of 1 October 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2020
Inspected but not rated; inspectors were assured that infection prevention and control measures were being followed.
This was an announced, targeted inspection on 11 August 2020. It looked only at infection prevention and control measures during the coronavirus pandemic.
Inspectors found good arrangements for visits and contact with families. These included a booking system, outdoor visits with a clear screen, cleaning before and after visits, mobile phones and tablets for calls, and staff support with video calls.
Inspectors were assured about shielding, social distancing, admissions, personal protective equipment, testing, hygiene, outbreak management and the infection control policy. The service was inspected but not rated, so this report is not a full quality rating of the home.
Keeping families in touch
The home provided phones and tablets, and staff helped people use video calls while shielding.
“The provider supplied three mobile telephones to ensure people were able to stay in regular contact with friends and families whilst shielding.” from the report
Safer visits
There was a booking system and an outdoor visiting area with a clear screen and spaced chairs. Visitors were given protective items and surfaces were cleaned before and after visits.
“Visitors were provided with hand gel, mask and gloves for outdoor visits to reduce the risk of transmission and surfaces were cleaned before and after visits.” from the report
Working with health services
Staff worked with district nursing teams and local commissioning groups to follow current guidance on protective equipment and testing.
“Staff worked together with community district nursing teams and engaged with local Clinical Commissioning Groups (CCGs).” from the report
Inspectors raised no specific concerns in this report.
- 01How does the current visiting booking system work, and what arrangements are available for seeing relatives indoors or outdoors?
- 02How do you make sure people can keep in touch with family if they are shielding or unable to have visitors?
- 03How are staff and residents currently tested for infections?
- 04What personal protective equipment is used by staff and visitors, and how is it provided?
- 05What is the current plan for preventing and managing an infection outbreak?
This was a targeted inspection of infection prevention and control during the coronavirus pandemic; it was not a full inspection and the service was inspected but not rated. This explanation was written from the published report of 9 September 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Puttenham Hill House Care Home
5 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- October 2021Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Puttenham Hill House Care Home →
- September 2020Inspected but not ratedSafe: Inspected but not rated
Read what inspectors found at Puttenham Hill House Care Home →
- October 2018Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- October 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- December 2013
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 15 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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