Archived: Pemberton Fold

Pemberton Fold is a residential care home providing personal care for up to 60 people aged 65 and over. At the time of the inspection the service was supporting 55 people.

People’s experience of using this service and what we found

People and their relatives told us the home was a safe place to live. One person said, “The staff are brilliant, really good. I’d say it’s safe here.” Staff were knowledgeable about safeguarding vulnerable people and the home had effective systems in place to safeguard people from abuse. Staff were available when people needed support. One person told us, “The Staff are great. If I press my buzzer they are here in a minute.” The home was well-maintained, safe and clean.

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

People were supported to have enough to eat and drink and were offered regular drinks and snacks throughout the day. However, we received mixed feedback about the food and some dining tables were not as well-presented as others. We have made a recommendation regarding the provision of food and people’s mealtime experience. People and their relatives told us staff ensured they promptly accessed other healthcare services when needed.

People and their relatives gave us positive feedback about the staff at the home. One relative commented, “They [the staff] are a caring team and they pop in and check on [Relative] a lot.” Staff were friendly and familiar with people living at the home and people appeared happy and comfortable in the company of the staff. We observed many kind and caring interactions throughout our inspection.

People’s care plans were person-centred and gave staff the insight and guidance required to support people safely and effectively, along with getting to know them. There was a wide range of activities for people living at the home to take part in and staff had positively engaged with people living at the home, the local community and other organisations to assist with this. Staff also supported people to keep up with their religious preferences. For example, church ministers of different denominations regularly visited the home to carry out services.

There was a kind and caring culture amongst staff at the home. Managers, care workers and other staff all had similarly warm and friendly relationships with the people living at the home. People and their relatives told us staff were approachable and listened to them. One person said, “They always say to me, ‘if you’ve got any problems, tell us and we will get it sorted.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 3 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service sent us an action plan identifying the actions they intended to take to address the breaches of regulations identified. At this inspection we found improvements had been made and the service was now meeting all regulatory requirements.

There was 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.

People who used the service, their relatives and professionals we contacted, told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise highlighted risks. Safeguarding policies were in place and staff had an understanding of the types of abuse and procedures for reporting concerns.

The environment was effective for people living with dementia and provided stimulation. There was signage to aid people’s orientation and help them to be as independent as possible.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of DoLS and the MCA, the importance of consent to care and treatment and how to act in peoples best interests.

People who used the service and their relatives told us the staff were caring and kind. We observed care in the home throughout the day. Staff interacted with people who used the service in a kind and considerate manner, ensuring people’s dignity and privacy were respected.

Relationships between people who used the service and staff members were warm. Conversations were of a friendly nature and staff’s attitude to people was polite and respectful using their chosen names, to which people responded positively.

There was an appropriate complaints procedure in place. Complaints were followed up appropriately and people who used the service and their relatives knew how to make a complaint.

A number of audits were carried out by the service, issues were identified and action plans put into place. Medication policies were appropriate and medicines were administered, stored, ordered and disposed of safely.

People’s care plans showed evidence of effective partnership working and we saw information in peoples care files that showed the involvement of relatives where appropriate.

People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Care plans included appropriate personal and health information and were up to date.

We observed the lunchtime meal. There was a relaxed unrushed atmosphere and we saw that staff interacted with people in a respectful and dignified manner, recognising people as individuals’ and encouraging their engagement. There was a seasonal menu cycle in use which was nutritionally balanced and offered a varied selection.

The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose, which is a document that includes a specific set of information about a service.

The home had an End of Life Care Policy in place and people’s wishes regarding end of life were recorded in their care files, including any updates. There was evidence of multi-disciplinary team reviews in people’s care files and evidence of best-interest decisions and discussions

We saw that prior to any new admission a pre-assessment was carried out with the person and their relative(s).

The service produced regular newsletters for people and their relatives. We found that resident’s surveys were also undertaken.

The home employed an activities coordinator. A wide variety of information and photographs of previous activities was displayed throughout the home.

Staff supervisions were undertaken regularly and we saw these were used to discuss issues appropriately on a one to one basis. The manager carried out staff competency checks under the home’s competency framework.

There was a business continuity management plan in place that identified actions to be taken in the event of an unforeseen event.

Throughout the course of the inspection we saw the registered manager walking around the home observing and supporting staff.

Pemberton Fold is a purpose built care home operated by Community Integrated Care (CIC). The service is registered with CQC to provide personal care and accommodation to a maximum of 60 people. Accommodation is provided on four separate units over two floors. The home is large and spacious and all bedrooms have en-suite facilities.

At the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with CQC 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.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care & treatment and staffing. You can see what action we told the provider to take at the back of the full version of this report.

We looked at night time staffing levels across the four units and found there was one care assistant on each unit. They would be supported by a team leader on each floor who would ‘float’ between the two units. This meant that during the night, each team leader would be responsible for up to 30 people per floor. Staff told us that night time staffing levels had been reduced as each unit previously had two care assistants on duty at night, in addition to the team leaders. During the day, we found that staffing increased to two care assistants per unit and again, they would be supported by a floating team leader on each floor.

Throughout the inspection we observed that people were left unsupervised in communal areas for prolonged periods of time. This was because staff were busy elsewhere assisting other people and no one was available to supervise in these areas. We found that care staff were responsible for laundry duties which meant they were not always available to respond in a timely way when people needed help.

We found that people who used the service were not consistently protected against the risks associated with medicines. Across each of the four units we found a variety of issues concerning how peoples medicines were managed. We found that people did not always receive their medication as prescribed, that insufficient time was being maintained between doses and that medicines were given after food that were prescribed before food. We also found that one person had not been given their medication for four consecutive days and that medication administration records (MAR) contained errors and omissions.

We saw the service had a corporate medication policy but found a lack of clarity around how the staff interpreted elements of the corporate policy. For example, how and when medication might be given covertly. Giving medicines ‘covertly’ means it can be hidden within people’s food or drink to ensure the medication is taken. Giving medication in this way can be used to ensure people who lack mental capacity and refuse their medication can still receive the medicines which are important to them.

We looked to see how the service sought to protect people from abuse and found appropriate safeguarding systems and procedures were in place. Staff knew how to recognise and respond to signs of potential abuse.

We looked at people’s care files to understand how the service managed risk. We found the service undertook a range of risk assessments to ensure people remained safe. They included personal emergency evacuation plans in the event of an emergency, mental health, nutrition & diet, mobility and moving & handling assessments.

We looked at how accidents and incidents were managed and found accident & incident reports were completed by staff in a timely manner and then entered onto a corporate management system which detailed prevention measures or remedial action taken by the service to mitigate future risks.

Systems and procedures for the recruitment of staff were safe and robust. This was evidenced through our examination of employment application forms, job descriptions, employee’s proof of identity, written references and training certificates. Disclosure and Barring Service (DBS) checks had also been completed to ensure the applicant’s suitability to work with vulnerable people.

We looked at induction and training & professional development staff received to ensure they were fully supported and qualified to undertake their roles. We looked at eight staff files and saw the staff that had been recently recruited had undertaken a comprehensive induction programme and completed mandatory training. New staff were also given the opportunity to shadow more experienced colleagues and were required to complete a formal probationary period.

Supervision sessions were completed on a regular basis and appropriate records were maintained. We saw discussions had taken place around training, professional development and staff conduct at work. Annual appraisals were also completed and records maintained.

We looked at the mealtime experience on one of the units and found the atmosphere was calm and relaxed. Some people chose to eat in their rooms and we saw staff taking their choice of food and drink to them. In the dining room, staff assisted people to tables and explained the food options to them and awaited their choices. People and staff were engaged in conversation as staff offered a choice of drinks with the meal. We saw staff were patient with people and provided sufficient time whilst they decided what they wanted.

We found Pemberton Fold’s approach to end of life care was good. The service was well engaged in the ‘Six Steps’ End of Life Care Programme. This is the North West End of Life Programme for Care Homes and is co-ordinated by local NHS services. This means that for people who are nearing the end of their life, they can remain at the home to be cared for in familiar surroundings by people that they know and trust.

We looked to see how information was shared with people and their relatives and found regular resident and family meetings were taking place. We saw that regular newsletters were produced and distributed which provided details of forthcoming events, special occasions and updates about new members of staff.

At the time of our inspection visit there was a vibrant atmosphere across the service. The activities coordinator was planning a ‘food cruise’ event and was decorating the communal area to resemble a cruise ship. Themed food and drink from around the world was planned with catering staff for people during the cruise event. The excitement and anticipation of the food cruise event was clearly evident as we observed people having fun and the sound of laughter carried through the home as people were making decorations and costumes.

We looked at how the service managed complaints and saw a complaints policy and associated procedures were in place. The policy clearly explained the process people could follow if they were unhappy with any aspect of the service at Pemberton Fold. Details of the complaints process was displayed around the home to guide people and their relatives regarding the procedure. We looked at the complaints log and found that accurate and up to date records where maintained.

We saw that staff meetings were held on a regular basis and appropriate records were maintained. Staff told us they were able to contribute to agenda items and that staff meetings were useful and productive.

Audit and quality assurance was completed on a regular basis and covered a variety of topics. We saw that where internal audits had identified issues, action was taken and lessons learnt. However, given the issues we found around the safe management of medicines, quality assurance and oversight in these areas was not effective.