Archived: Pembroke Residential Home

Pembroke Residential Home is a care home providing personal and nursing care to eight people at the time of the inspection. The service can support up to 12 older people, some of whom may be living with dementia.

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

People received safe, person-centred care from a staff team who knew their needs well. Risk assessments detailed preventative measures in place, so staff could manage them. Medicines were managed, stored and disposed of appropriately. Staff felt supported through regular supervisions, meetings and training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were offered choice and their decisions were respected. People were supported to access appointments in relation to their health and well-being. People’s nutrition and hydration needs were monitored when issues were identified. People enjoyed plenty of choice during mealtimes and were offered regular refreshments throughout the day.

Staff were kind and caring towards people, whilst respecting their privacy and dignity. Staff described how they promoted people to be as independent as they could be. Care plans included relevant information about people’s likes, dislikes and preferences. These were reviewed regularly or when people’s needs changed. Staff engaged people in activities and events, some people accessed facilities outside the service independently.

The staff were friendly and welcoming. The registered manager encouraged an open and honest culture within the service. The registered manager was proactive throughout the inspection and committed to continually improving the service. The registered manager had engaged people, their relatives and staff through meetings, satisfaction surveys and informal chats to gain their feedback about the service. Quality assurance processes were in place which identified where improvements could be made and any actions taken.

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 11 August 2017).

Why we inspected:

This was a scheduled inspection based on the service’s 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.

We previously carried out an inspection on 1 March 2016, where we identified that personal emergency plans were in place but had not been readily accessible to emergency services. There were excess stocks of medicines and no sample signature records for staff dispensing medication had been put in place. We also found that best interest decisions had not been decision specific and care plans had not been updated to reflect these decisions. Care records contained a lack of information when reviews of care had taken place. Audits had not always recorded the checks that had been carried out and there was no system in place for formally seeking and recording feedback from people using the service.

Pembroke residential home provides accommodation for up to 12 people who require assistance with their health and well-being and live with a dementia type illness, sensory impairment or learning disability. Pembroke residential home is a converted house in Saltburn-by-the-Sea and is situated on the sea front with extensive views of coast. There are gardens to the front and rear of the service.

At the time of the inspection, there were ten people using the service who were supported by the registered manager and 15 care staff.

The registered manager has been registered with the Care Quality Commission since 21 March 2011. They had been the manager of the service for ten years and had worked at the service overall, for 23 years. 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 this inspection, we identified that improvements had been made to the service since the last inspection on 1 March 2016.

Staff understood the procedures which they needed to follow to keep people safe and the action they needed to take to raise any safeguarding concerns. Staff training in safeguarding adults was up to date and safeguarding alerts had been carried out when needed.

Risk assessments were in place for people and for the day to day running of the service and had been regularly reviewed. Health and safety certificates for the service were up to date and included gas and electrical safety certificates as well as checks of water temperatures. Fire safety checks had been regularly carried out and staff had participated in planned fire drills.

Recruitment records were in place and showed robust checks had been carried out to ensure only suitable candidates were employed to work at the service. There were sufficient staff on duty during the day and throughout the night.

Good procedures were in place for managing people’s medicines.

Staff were supported to carry out their roles safely. All staff participated in supervision, appraisals and training. New staff were supported by more experienced staff to get to know people and to understand the day to day running of the service.

Staff had followed the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied for and granted for one person. The person was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they received a nutritious diet and were happy with the variety and quality of food. People at risk of dehydration or malnutrition were receiving appropriate care from staff and health professionals.

People were involved with a variety of health and social care professionals. All visits and recommendations by professionals had been recorded in people’s care records.

Dementia friendly signage, toilet seats and grab rails were in place. People’s rooms were personalised with their belongings and arranged in a way that suited them.

People told us they enjoyed living at the service and received good care from staff. People told us that staff protected their privacy and dignity at all times.

People were involved in planning and reviewing their own care. People told us they felt listened to. Staff had involved local advocacy services for people to ensure their voice was heard.

The service provided end of life care to people and worked in line with people’s needs, wishes and preferences.

People received person-centred care which reflected their needs, wishes and preferences. Care records contained information about the care and support people needed and these had been regularly reviewed.

Activities which met people’s individual needs were provided at the service. People told us they were happy with this provision which included in-house activities and regular visits from an external entertainer.

Information about how to raise a complaint was on display and everyone we spoke with was aware of this; however none wished to do so. People told us they felt able to raise any concerns informally with staff.

Staff told us they enjoyed working at the service and received good support from the registered manager and provider. People and staff told us the registered manager was always visible.

Quality assurance procedures were in place and had improved since the last inspection. Information was shared with people and staff and feedback sought to ensure the quality of the service improved.

The service had links with the local community. People shopped in their local community and received visits from local schools.

Pembroke Residential Home is situated in Saltburn-by-the-Sea. It is a converted house, and has a private garden. The service can accommodate a maximum of 12 people. At the time of the inspection 10 people were using the service, some of whom were living with a dementia.

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 were safely supported with their medicines, but effective processes were not in place for monitoring medicine stocks. This led to large stocks of unused medicines building up, including controlled drugs. Personal emergency plans were in place but these were not readily accessible to the emergency services.

Care records contained evidence of mental capacity tests and best interest decisions being undertaken, but these were limited to personal hygiene decisions. Following our inspection in March 2015 the registered manager said that best interest decisions and care plans would be updated. Our judgment was that this had not yet been done.

The registered manager carried out quality assurance checks, but there was not always a record of these and they had not identified the issues we found in relation to medicines or best interest decisions. Care plans were reviewed, but it was not clear how this was done. There was no evidence that audits of care plans took place.

The registered manager and staff asked people for their feedback on the service, but a questionnaire planned for 2015 had still not been sent to people.

Risks to people arising from their health and support needs or the premises were assessed, and plans were in place to minimise them. These plans sought to minimise risks whilst allowing people the independence to do what they wanted to. Checks were carried out to monitor the safety of the premises.

Staff understood safeguarding issues and could describe the types of abuse they looked out for. Staff said they would be confident to raise any issue they had, including whistleblowing.

Robust recruitment procedures were in place to ensure that only suitable staff were employed.

There was a low turnover of staff at the service, and the registered manager periodically reviewed people’s support needs to ensure that staffing levels were sufficient to support them safely.

Staff received training to ensure that they could appropriately support people, and felt confident to raise any additional training needs they might have.

Staff received support through supervisions and appraisals, and staff felt these were useful in monitoring their support needs.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People spoke positively about the quality of the food provided.

Care plans contained evidence of regular involvement in delivering people’s care by external professionals.

Staff treated people with dignity, respect and kindness. People and their relatives spoke highly of the care they received. There was a friendly, homely atmosphere at the service.

The service provided people with information on advocacy services. Procedures were in place to provide end of life care to people that needed it.

The care people received was based upon their assessed needs and preferences. Care plans were regularly reviewed and daily notes kept to ensure staff were aware of people’s current needs.

People were supported to access activities, and were seen to be engaged in these during the inspection.

The service had a clear complaints policy that was applied when issues arose, and this was prominently displayed in a communal area.

Staff were able to describe the culture and values of the service, and felt supported by the manager in delivering them.

The registered manager understood their responsibilities in making notifications to the Commission.

We found two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to monitoring medicine stocks, recording best interest decisions, audits of the service and seeking feedback from people. You can see what action we took at the back of the full version of this report.