Archived: Pelham House

Pelham House is a residential care home providing care and support to up to 22 people, some of whom were living with dementia. At the time of the inspection there were 15 people living at the service.

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

At this inspection we identified concerns with the oversight and governance, the environment – in particular the heating and hot water provision, and the training of staff. Further areas for improvement around the management of medicines were identified.

People, their relatives and staff commented that the heating and hot water were not always working. People told us they were sometimes cold.

Checks and audits were not consistently effective. Shortfalls found during the inspection had not been identified through the service’s checking processes. When shortfalls had been identified, follow up actions had not always been taken to ensure these were addressed.

Staff training had not been completed or refreshed as required. There was a lack of oversight of staff training needs.

Accidents and incidents were recorded, and people had been referred to health care professionals when needed. However, there was no overview of these to ensure any patterns or trends could be identified. The quality and compliance officer provided this during the inspection.

Risks to people’s health, safety and well-being were assessed and measures were in place to reduce risks to people. Some risk assessments required further development.

People received their medicines safely. We identified some areas for improvement with the medicines management to ensure the service followed best practice.

People were supported by enough staff who had been recruited safely. People told us they felt safe living at Pelham House and their relatives told us they were generally cared for well. A relative said, “[My loved one] is treated with kindness. Staff always give them time and are patient.”

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 told us they enjoyed their meals and they were offered choices. People were supported to see health care professionals, such as chiropodists and dentists, as needed.

People were supported by staff who were patient, kind and caring. Staff knew people and their needs and preferences well. People were able to participate in various activities and there were links with the local community, such as local school children visiting.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 October 2022). There were breaches of regulation and the service was placed into Special Measures. This service has been in Special Measures since 24 October 2022.

At this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. However, we identified breaches of regulation. The service has been rated requires improvement or inadequate for the last five inspections, where a rating has been given.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well-led sections of the report.

Enforcement

We have identified breaches in relation to staff training, the environment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Pelham House in a residential care home providing care and support to up to 22 older people, some of whom were living with dementia. At the time of the inspection there were 19 people living at the service.

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

People were not supported to have their medicines safely. Medicines were not always ordered on time and medicines were not always stored correctly.

Risks to people had not been consistently assessed, monitored and reviewed. When people had had several falls, they had not been referred to the relevant health care professionals for advice.

Some areas of Pelham House were not clean. Staff were not wearing face masks in line with Government guidance and there was no risk assessment to show any rationale for this or how risks to people would be mitigated.

People were not supported by staff who had been recruited safely. Staff did not always complete an induction before working with people. There had been a turnover of staff and the service was regularly using agency staff. People commented about frequently seeing new faces and having to tell staff how they should be supported. Staff training was not up to date and some staff had not met with their manager for one to one supervision to discuss their performance.

There was a lack of oversight of the service. Accidents and incidents were not regularly reviewed to ensure patterns were identified. Checks on the quality and safety of the service were not robust. For example, some checks completed by the nominated individual around medicines management did not identify the shortfalls found during the inspection.

The provider failed to maintain and sustain improvements. This was the fifth consecutive inspection which identified breaches which resulted in breaches of Regulation.

People were able to have visitors when they wished and there were no restrictions.

Staff worked with visiting health care professionals and followed advice given.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The service has been rated requires improvement or inadequate for the last four inspections, where a rating has been given.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, recruitment and the management of the service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, recruitment, risk management and governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Pelham House is a residential care home providing personal care to up to 22 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 14 people using the service.

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

Pelham House was cold. During the inspection people told us they were cold and that this was not uncommon. Staff confirmed there were times when the service was cold.

There was CCTV in communal areas of the service. There was only one sign to tell people this was in place and that was in the window at the entrance. People and relatives had not been informed of the use of CCTV. No information about CCTV had been provided to people in a way they could understand.

People told us they felt safe living at Pelham House and that the staff were kind and caring. People’s health care needs had been assessed with people and their relatives and measures were in place to keep people safe. Staff followed guidance in care plans and risk assessments to provide people with the support they needed.

The service was clean. Staff wore personal protective equipment, such as gloves and face masks, in line with guidance. People and staff were regularly tested for Covid-19 to help keep them safe. People were supported to have their medicines on time and as prescribed.

People were supported by staff who had been recruited safely and in line with guidance. There were enough staff on each shift to meet people’s needs. Staff were not rushed and had time to spend with people.

The manager promoted an open and inclusive culture. They were supported by a deputy manager and worked as a cohesive team. Staff told us the morale and teamwork had improved and they felt listened to and valued. The manager had implemented new care plans, risk assessments and checks on the quality of the service and the oversight of the service had improved. These improvements need to be embedded into day to day staff practice.

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

Rating at last inspection and update

The rating at the inspection on 4 August 2021 was Inadequate (published 9 September 2021). There were breaches of regulation and the service was placed into Special Measures. The rating at the inspection on 19 August 2021 was not rated as we only looked at parts of the key questions we had concerns about.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 9 September 2021. At this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. However, we identified a new breach of regulation.

Why we inspected

We carried out an unannounced inspection of this service on 4 August 2021 and an unannounced inspection on 19 August 2021. Breaches of legal requirements were found. Following the inspection, we met with the provider. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing, fit and proper persons employed, and good governance.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the previous to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring and Well-Led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pelham House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to Good Governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Pelham House is a residential care home providing personal care to 22 people at the time of the inspection. The service can support up to 22 people.

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

People were not protected from the risks of avoidable harm. Risk assessments were not robust and did not give staff the required guidance to support people safely. People did not always receive their medicines as prescribed.

There were not enough staff to meet people’s needs. An overview of personal emergency evacuation plans had not been updated for five months, despite the service now having a further eight people living at the service since it was last completed. Staff told us there were not enough staff on duty at night and that people’s call bells were sometimes ignored.

There continued to be a lack of oversight and scrutiny. The new manager had not received a handover from the previous manager and the auditing systems was ineffective and not robust.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 9 September 2021).

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of risks to people’s health, safety and welfare, staffing and management oversight of the service. A decision was made for us to inspect and examine those risks.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pelham House on our website at www.cqc.org.uk.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified continued breaches in relation to unsafe medicines management, poor assessing and mitigating of risk, inadequate staffing levels, and a lack of leadership and oversight.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures

Pelham House is a residential care home providing personal care to 21 people at the time of the inspection. Some people were living with dementia. The service can support up to 22 people.

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

People were not supported to have their medicines safely and on time. There had been medicines errors and action had not been taken to address these. Temperature checks, to make sure medicines worked effectively, were not consistently completed.

People were not protected from the risks of avoidable harm. Risks were not well managed. Staff did not have clear guidance to follow to help reduce the risks to people’s health, safety and welfare.

There were not enough staff to meet people’s assessed needs. Action had not been taken to increase staffing levels when people’s needs had increased. Staff were not always recruited safely.

There was a lack of leadership, oversight and scrutiny. Checks and audits to monitor the quality of the service were not robust and effective. Action was not taken when shortfalls were identified. The culture within the staff team was poor and morale was low. Staff did not feel listened to.

We were assured the provider was protecting people from the risks of infection. Staff wore personal protective equipment, such as facemasks. The service was clean.

People were supported by staff who knew them well. People and their relatives had developed strong relationships with staff. People were treated with dignity and respect by staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (Published 18 January 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns about people’s safety and welfare, and medicines management. As a result, we undertook a focused inspection to review the key questions Safe, Caring and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated to Inadequate. This is based on the findings at

this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pelham House on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to unsafe medicines management, poor assessing and mitigating of risk, staffing levels, recruitment and a lack of leadership and oversight.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

People told us they felt safe living at the home. Comments included, “Staff are dedicated, supportive and caring”, “They do a terrific job, I can’t speak highly enough of them” and “I must say I feel well looked after, that says it all really”.

Risks to people had been identified and processes ensured mitigation was in place to reduce them. This included ensuring appropriate equipment was used and healthcare professionals were involved in people’s care.

However, we found medicines were not always managed safely. The storage arrangements and temperatures of controlled medicines was not monitored. Controlled medicines are tightly controlled by the government because they may be abused or cause addiction. Other shortfalls in ordering medicines meant some people had not receive their medicine as prescribed. This concern had been addressed by the manager and processes put in place to prevent reoccurrence.

Systems to intended to support effective infection prevention and control were not embedded into daily practice. Checking procedures did not always ensure staff followed procedure.

Some checks to ensure the safety of the home environment had lapsed recently due to the impact of the COVID-19 pandemic and unprecedented pressure on staff working at the home. The provider and manager were aware of this and working through an action plan to improve the quality of the service.

Some staff had received safeguarding training. Potential safeguarding matters were brought to the attention of the manager and had been referred to the local authority safeguarding team. However, reporting had been delayed on one occasion.

The manager and provider completed checks of the environment and audits of the quality of service provided. However, these were not sufficiently robust to identify all the concerns found at this inspection, so were not fully effective in their use. Areas of the home were prepared for redecoration but this had been suspended due to the COVID-19 pandemic. A plan was in place for work to recommence.

There were enough numbers of staff to support people. Recruitment of staff was underway and the home d agency staff to fill vacancy gaps while recruitment was on going. Staff felt supported by the new manager and a schedule of supervision meetings was well progressed following a lapse.

Staff felt supported by the manager and service provider and management meetings had recently been reinstated.

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

Rating at last inspection and update

The last rating for this service was Good (Published 23 April 2018).

Why we inspected

We received concerns in relation to the management of medicines, safeguarding incidents, the experience and qualifications of staff as well as aspects of infection control processes and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pelham House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the safe management of medicines and good governance at this inspection. We have made a recommendation about staff training and signposted the provider to resources to develop their approach to infection prevention and control processes.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Pelham House is a ‘care home’. People in care homes receive accommodation and nursing or 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. At the time of our inspection 18 older people were living at the service, some of whom were living with dementia.

The service has a registered manager who was available and supported us during the inspection. 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.

The service was last inspected on 12 and 13 October 2016 and the overall rating was Requires Improvement. At that time we found two continued breaches of Regulation. These were with regards to the provider failing to: Regulation 12, safely manage people’s medicines and Regulation 17, to operate effective quality auditing systems. The provider sent us an action plan on 13 February 2017 which detailed how they planned to address these breaches of Regulations.

At this inspection on 14 March 2018, we found improvements had been made and there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The management of medicines had improved. Daily audits took place of medicines administration and recording and any shortfalls had been addressed and medical advice sought. Staff received training in medicines administration, had their competency assessed and received additional training and support when this was required.

Systems were in place to assess and monitor the quality and safety of the service. This was achieved by the use of auditing and through encouraging feedback from people, relatives and staff and continuous review.

People felt safe. Staff had received training in how to recognise signs of abuse and how to report them.

Assessments had been made about physical and environmental risks to people and actions had been taken to minimise these. Accidents and incidents were recorded and monitored.

Staffing levels had been reviewed and there were enough staff on duty to support people and pre-employment checks had taken place to ensure that staff were suitable for their roles.

New staff received an induction which included shadowing existing staff and were provided with a training programme in areas essential to their role. Staff felt well supported and received supervision and appraisal to make sure they were performing to the required standard.

Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had submitted DoLS applications to ensure that people were not deprived of their liberty unlawfully.

People had their health needs assessed and monitored and referrals were made to health professionals to help maintain their health and well-being.

People were offered a choice of what to eat and where to sit at mealtimes and enjoyed the experience.

Staff treated people with kindness and respect for their privacy and dignity. Staff knew people well and remembered the things that were important to them so that they received person-centred care.

People had been involved in their care planning and care plans recorded the ways in which they liked their support to be given.

A part-time activities coordinator had been employed and people were offered small group and one to one activities which met their individual needs.

Staff understood the aims and values of the service and a number of staff had worked at the service for many years. They said their contributions were valued and that there was a relaxed pace at the service which benefited people.

The service was clean on the day of the inspection and equipment was routinely maintained to make sure it was in good working order.

The registered manager was supported by a deputy manager and was praised by people, relatives and a health care professional for their commitment to improving the service.

Pelham House is a care home which provides care and support for up to 22 older people. There were 19 people living at the service at the time of our inspection. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes and a person confined to constant bed care. Some people needed support with aspects of their personal care and mobility needs. Other people were more independent and needed less support from staff.

Pelham House is a large domestic-style house, previously arranged as two attached houses, now converted to a single property. People’s bedrooms were provided over two floors, with stair lifts in-between. There were communal sitting and dining rooms on the first floor together with a kitchenette and informal seating. There was a large enclosed well maintained garden, providing planted areas, a fish pond and a furnished patio.

A registered manager was 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.

Pelham House was last inspected on 10, 11 and 12 February 2016. They were rated as inadequate overall at that inspection and placed into Special Measures. The provider sent us regular information and records about actions taken to make improvements following our inspection.

At this inspection we found that significant improvements had been made. However, we identified continued concerns around the administration and storage of some medication. Checks and audits had not identified or addressed these concerns.

Our inspection found the service offered people a homely, supportive environment and their care needs were being met.

A survey of people living in the service found they felt safe. Staff knew how to recognise signs of abuse and how to report it.

Assessments had been made about physical and environmental risks to people and actions had been taken to minimise these. Incidents and accidents were managed appropriately to avoid recurrences.

There were enough staff on duty to support people, and proper pre-employment checks had taken place to ensure that staff were suitable for their roles.

Equipment had been serviced on a regular basis to ensure that it remained safe for use.

Staff had received training in a wide range of topics and this had been regularly refreshed. Supervisions and appraisals had taken place to make sure staff were performing to the required standard and to identify developmental needs.

People’s rights had been protected by assessments made under the Mental Capacity Act (MCA). Staff understood about restrictions and applications had been made to deprive people of their liberty when this was deemed necessary.

Healthcare needs had been assessed and addressed. People had regular appointments with GPs, health and social care specialists, opticians, dentists, chiropodists and podiatrists to help them maintain their health and well-being.

Staff treated people with kindness and respect for their privacy and dignity. Staff knew people well and remembered the things that were important to them so that they received person-centred care.

People had been involved in their care planning and care plans recorded the ways in which they liked their support to be given. Bedrooms were personalised and people’s preferences were respected. Independence was encouraged so that people were able to help themselves as much as possible.

Staff felt that there was a culture or openness and honesty in the service and said that they enjoyed working there. This created a comfortable and relaxed environment for people to live in.

Systems were in place to assess and monitor the quality and safety of the service. This was achieved by the use of auditing and through encouraging feedback from people, relatives and staff and continuous review.

People’s safety had been protected through cleanliness and robust maintenance of the premises. Fire safety checks had been routinely undertaken and equipment had been serviced regularly.

People enjoyed their meals, any risks of malnutrition or dehydration had been adequately addressed. There were a range of activities.

The registered manager was widely praised by people, relatives and staff for his commitment to improving the service. There was an open, transparent culture amongst staff and management.

The provider had displayed their improvement plans prominently. People knew how to complain but said they felt no need to.

The service is no longer rated as inadequate and will be taken out of special measures. This is an improving service; there is still an area to be addressed to ensure people’s health, safety and well-being is protected. We will continue to monitor Pelham House to check that improvement continues and is sustained. We identified two 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.

This service provides accommodation and personal care for up to older 22 people. There were 21 people living at the service at the time of our inspection. The home is arranged over two floors, people had their own bedroom and access to the first floor is gained by stair lifts, making all areas of the home accessible to people.

The service had a registered manager in post who is also the provider. A registered manager is a person who is 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 inspection highlighted shortfalls where some regulations were not met. We also identified areas where improvement was required and made recommendations that the service should adopt.

Some practices for the receipt, administration, storage and disposal of medicines did not promote proper and safe management. This was because people did not always receive their prescribed medication; procedures for the receipt of medicines did not ensure staff knew when medicines were available for administration; guidance for the disposal of spoiled or obsolete medicines was not followed and procedures intended to ensure the correct storage temperatures of medicines were not in place.

People were not safeguarded against the risks of abuse because staff did not recognise or react appropriately to acts of neglect. Two referrals were made to the Local Authority Safeguarding Team as the result of this inspection because of concerns identified where medication was not administered as prescribed.

Some equipment used in the service was not adequately cleaned, placing people, staff and potentially visitors at risk of contracting acquired infections.

Some equipment used to support people with their mobility was not serviced when it should have been. This placed people at risk of injury because the equipment had not been certified as safe to use.

Aspects of recruitment processes were incomplete because decisions about the employment of some staff were not recorded.

Mental capacity assessments did not meet with the principles of the Mental Capacity Act 2005 and assessments contradicted other assessments held in people’s care files.

Planning and delivery of training had not ensured a continuous learning process and staff lacked some skills and knowledge to support the people they cared for.

Advanced decisions about people’s end of life wishes were not actioned which may result in people receiving resuscitation when they did not want to.

Staff lacked ownership and accountability for concerns they should have identified as part of their duties; this resulted in inactivity, placed people at unnecessary risk and did not demonstrate the culture of a caring service.

Elements of care planning did not fully establish some people’s needs or reflect their wishes about how they wanted to be supported.

Quality assurance checks had failed to identify the concerns evident at this inspection; some records were inconsistent and incomplete and robust processes were not in place to ensure feedback received from people was acted upon.

Where the service had a legal obligation to notify the Commission of certain decisions and events, notification was not made.

People, visitors and staff spoke positively about the service and enjoyed being there.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breached the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the

system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent

enforcement action.

At this inspection we spoke with ten people who lived in the home, a visitor, four members of staff and the manager. We found that people and/or their representatives were involved in making decisions about their care and that people were given the opportunity to consent to the care, treatment and support they received.

We found that people's needs were assessed and regularly reviewed and that their care records were sufficiently detailed to reflect the care and support they required from staff.

We found that the home was clean and had effective systems in place to help protect people from the risks of cross-infection. There was guidance and training for staff to help ensure they understood the importance of infection control.

We found that there were enough suitably trained and qualified staff to support people's needs. One person we spoke with who lived in the home told us 'staff are around when I need them; staff here are very good'.

People who lived in the home told us they were happy with the care they received and that they had seen some recent improvements. One person told us that the provider had 'definitely made improvements in the last year; I'm very lucky, it's lovely here'. Other people told us 'staff look after me very well indeed' and 'It's the best thing I did coming in here'.

People generally spoke highly of the staff. One person said 'Staff are very good and very caring'. Some people said occasionally staff needed reminding about particular requirements or preferences, however, they felt that their views and opinions were not taken into account when planning care and support. One person said 'I have never seen my care plan and would like to be involved in what is in there'.

People said they had opportunities to take part in activities and enjoyed the events that the service arranged. We saw a notice on the exit door to the garden advising people that they could not use the outside space due to the uneven paving, but if they did, they did so at their own risk.

We found non compliance because people did not always experience care that met their needs, there were ineffective systems to reduce the risk of infection and there were not enough staff.