Pelham House Residential Care Home with Dementia

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

Medicines were not always administered or stored safely. The clinical room and enclosed cupboards where medicines were stored were left unlocked and unattended. This meant there was a risk of people consuming medicines that they were not prescribed. There were some risk assessments in place, however risks were not always properly assessed or didn’t contain enough information to enable staff to support people appropriately.

Risks to people were not always managed effectively, including people’s health needs. These included that people lived with diabetes and used a catheter.

Staff had not always recognised potential safeguarding incidents and lack of management oversight meant these had not been reported to the local authority in line with the providers policy. Some people told us they felt safe. One person said, "I do feel safe. There are enough people that make sure I am. If I needed anything I, would ask”.

There were sufficient staff deployed, however, the provider did not knew what staff were being sent from the agency or what skills and experience they had. This meant that there was a risk of staff being deployed to areas of the service without having the necessary skills to support people appropriately.

There was a lack of oversight of the quality and safety of the service by the provider. There were not adequate systems and processes in place to monitor the quality of care or sufficiently robust to identify any shortfalls or concerns. .

People told us positive things about the care they received from staff. One person said, "I think the staff are caring and look after me well. They are all very kind and patient".

People gave feedback about the service using surveys and questionnaires, but people said they hadn’t completed them for a while.

People told us that they used their call bells if they needed assistance and these were responded to in a timely fashion.

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 6 December 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns in relation to the care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of specific health needs. This inspection also examined those risks.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

The overall rating for the service is requires improvement based on the findings of this inspection.

Since the inspection, the local authority has carried out a number of quality assurance visits and to date, report that the provider has engaged with them in addressing the shortfalls that are set out in this report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding and good governance.

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

Pelham House Residential Care Home with Dementia is a residential care home providing accommodation and personal care to up to 30 people in one adapted building. The service provides support to people with a range of health care needs, such as dementia, diabetes and frailty of old age. At the time of our inspection 28 people were using the service.

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

Medicines were not always administered safely. Medication administration records should be signed after each person received their medicines, but this was not done. Some people did not receive their prescribed medicines on time. Staff did not always change their disposable gloves or sanitise their hands between interacting with people and a change of activity. Some personal information about people’s care needs was on display on notices outside their bedrooms. Auditing systems implemented by the provider were not sufficiently robust to identify concerns found at this inspection.

People were safe living at the home. One person said, “I do feel safe. There are people round us day and night. If I needed anything I would only need to ask”. Staffing levels were sufficient to meet people’s care and support needs. Call bells were responded to promptly. Risks to people, including environmental risks, were identified, assessed and managed safely.

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 positive about the care they received from staff. One person said, “I think the staff are marvellous. There is a mixture of people here to help us and others that make meals, clean and such like. We get new ones sometimes. They are all very kind and patient”. People’s feedback about the home was gained through questionnaires.

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 5 August 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to the cleanliness of the home and the care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating remains requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. 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 Residential Care Home with Dementia on our website at www.cqc.org.uk.

We carried out an unannounced comprehensive inspection of this service on 27 October 2022. Two breaches of legal requirements were found. 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 and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to Safe and Well-led which contain those requirements.

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.

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 monitor the service and will take further action if needed. We have identified a breach in relation to the administration of medicines, the use of personal protective equipment by staff and personal information about people on display. 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’ registered to provide personal care for up to 30 older people in one adapted building. At the time of the inspection there were 28 people living in the care home. Some people were living with dementia or frailty and other associated health conditions.

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

There was a failure to assess, monitor and mitigate risks relating to the health, safety and welfare of people. People's care plans and risk assessments lacked important detail to guide staff on how to make people safe.

Governance processes were not effective in identifying some service shortfalls. There was not an adequate process for assessing and monitoring the quality of the services provided or to ensure that records were accurate and complete.

Processes were in place to minimise the risk of infection. This included processes to mitigate the risk of contracting and spreading COVID-19 within the care home. Processes were in place to support safe visiting to the care home.

Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns. 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 treated with kindness and compassion and staff were friendly and respectful. People and their relatives told us they were happy with the service they received. Staffing levels were enough to meet people’s individual needs.

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 19 September 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. The inspection was prompted in part to follow up actions recommended by the coroner in response to a person’s death in 2017.

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.

We carried out an unannounced comprehensive inspection of this service on 11 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. 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 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance.

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 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 Residential Care Home with Dementia is a residential care home providing personal care in one adapted building to 26 people aged 60 over who were living with dementia. The service can support up to 30 people.

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

The management of medicines was not consistently safe. The system for monitoring the stock of medicines was not consistently robust. Medicine care plans were in place, but these failed to consistently include information about the purpose of people’s medicines and the potential side effects.

Quality assurance systems were in place, but these were not always effective in driving improvement and identifying shortfalls. Accurate records had not always been maintained.

CCTV was installed within the service. People and their relatives had been informed about the CCTV, however, people’s capacity to consent to the use of the CCTV had not been assessed. Action was taken during the inspection process, however, internal audits failed to identify this shortfall. This is an area of practice that needs improvement.

There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service. Staff supported people using appropriate equipment to ensure infection control procedures were followed

Staff could recognise and knew how to report suspected abuse or poor practice. The registered manager was aware of the process to follow should an allegation be made. Learning was derived from safeguarding concerns and shared with staff to promote safe practice.

Risk assessments were in place and actions were implemented to mitigate the risk of skin breakdown or falling. Staff worked in partnership with the district nursing team and where people required support to reposition, this was regularly provided.

The provider and registered manager were working hard to promote a positive and empowering culture at the service. Staff spoke highly of the service and confirmed they felt supported within their roles. People and their relatives spoke highly of the registered manager and of the homely atmosphere within the service.

Rating at last inspection:

The last rating was Good (published on 24 July 2017).

Why we inspected:

The inspection was prompted in part due to concerns received about call bells not being answered quickly and walking aids being removed from people, lack of activities and a task centred culture. A decision was made for us to inspect and examine those risks. 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 changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement.

Please see the Safe 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 Residential Care Home with Dementia on our website at www.cqc.org.uk.

Enforcement:

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. 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. 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 Residential Care Home with Dementia is registered to provide residential care for up to 30 older persons. On the day of our inspection there were 25 people using the service with a range of support needs, including people living with dementia. The home is a large detached property spread over two floors with a large well maintained garden.

At the last inspection on 30 September 2015, the service was rated Good. At this inspection we found the service remained Good.

People and relatives told us they felt the service was safe. One person told us “Yes I feel safe, the staff reassure me all the time it feels so different now I don’t have to worry like I did before”. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us “The cook asks me every day what I like, today is sausages she knows I don’t like them so I think I am going to have a tuna salad, breakfast I have porridge some of them have wheat flakes you can choose, the only complaint I have about the food is there is too much of it, so that can’t be a bad thing can it”.

Throughout the inspection there was a hive of activities with people enjoying themselves in various areas in the home. We observed appropriate activities with most people taking part. One person said “Sometimes we go to the garden centre, they like to take us out we have a good look around. Every day some activity goes on like clapping or music, good fun”.

People’s individual needs continued to be assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. Staff spoke positively about training and supervisions they received from the manager and commented on how they found they could ask questions freely. One member of staff told us “We get training and have had loads recently. I have recently done bowl and bladder training and have some more coming up soon”.

At the last inspection on 30 September 2015 we found the service was not consistently well-led. The home’s quality assurance process needed improvement to demonstrate how the provider was striving to improve and develop the service. At this inspection we saw the provider and manager had taken action to improve the consistency of monitoring the quality of the service following our last inspection. Quality assurance audits completed by the manager and provider were completed to ensure a good level of quality was maintained. We saw audit activity which included medication, care records and infection control.

People, staff and relatives found the management team approachable and professional. One person told us “The new one (manager) seems very nice, always around and asks how things are”. A relative told us “Now there is a new manager she seems ok, but I don’t know her very well but she is approachable and the senior member of the team you can always ask. We do get asked to fill in questionnaires and surveys, yes our opinion does matter and you feel they listen to you”.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with nine people using the service, two relatives and ten of the staff supporting them. We also looked at records including three care plans and three staff recruitment files.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

At our previous inspection we raised concerns about the cleanliness of parts of the service and some infection control measures. The manager and provider responded promptly to these concerns. As a result, at this inspection we found that people were being cared for in an environment that was safe, clean and hygienic. The laundry had been cleaned and refurbished. Staff were following infection prevention and control guidelines which helped to protect people from the risk of infection.

At our previous inspection we also raised concerns about the management of medication. At this inspection we found that action had been taken and that medication was stored, administered and disposed of safely.

We looked at the recruitment processes and found them to be safe and thorough. The service had carried out relevant checks to ensure that staff had the necessary skills and aptitudes to work with people living at Pelham House Nursing Home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, the manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

We found that care plans provided up-to-date information about people's care needs and preferences. This meant that people were sure that their individual care needs and wishes were known and planned for. We found that people's needs were assessed and monitored effectively.

Problems with care records identified at our previous inspection had been addressed. A new electronic care system had been put in place. The service had introduced a 'resident of the day system' whereby at least once a month each person's care was reviewed and their records updated. This meant accurate records in relation to each person's care and treatment were now maintained.

People expressed satisfaction with the food at Pelham House Nursing Home. One person said, 'I think the food is excellent'. We saw that there was a choice and that staff supported people to eat and drink in accordance with their needs. At lunch, we observed that the mealtime was well paced, allowing people the time they needed to eat their meal. Concerns identified at our previous inspection with regard to people not receiving adequate hydration had been addressed. We found that drinks were readily available and that people were supported to drink enough to meet their needs.

Staff received training and felt well supported. This helped them to deliver safe and effective care to people. People that we spoke with were very happy with the staff working at the service. One said, 'It would be very difficult to criticise'. A relative told us, 'We haven't got a complaint in the world, the care and the food is just spot on'.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People that we spoke with were largely satisfied with the care that they received. One said, 'It's homely here'. Another told us, 'They give me a hand when I need it. I only have to ask'.

Staff told us that they had time to deliver good care to people and that they were able to spend time with them. We observed that staff were quick to respond to people's needs and clearly knew them well. One member of staff told us, 'I think staffing is getting better'. We noted that new staff had been employed at the service, including in domestic positions. This helped the smooth running of the service and allowed care staff the time to focus on ensuring that people received the support they required. One person told us, 'The staff team seems to be building up now. I can't complain, I like it here.'

Is the service responsive?

People, their relatives and staff told us that they were able to raise suggestions or concerns. One relative told us, 'I tell them and something gets done about it'. Where issues or concerns were identified we noted that the service had taken appropriate action. We found that the service listened and responded to feedback received from people, their representatives and from staff.

Is the service well-led?

At the time of our last visit, a new manager had just started at the service. This manager was in post at this visit and was in the process of registering with us. Since our last inspection we found that improvements had been made in relation to infection control, medication practices, records and ensuring that people received sufficient hydration. This was also confirmed by people and staff that we spoke with and by examining records.

We saw there were systems for monitoring the quality of services provided. The manager demonstrated a commitment to making improvements to the quality of service provided to people. One person told us, 'The manager wants to make things better and better'. Another told us, 'I'm quite happy, it is very well run'.

At the time of this inspection a new manager was completing the registration process to become the registered manager for the home. The existing manager was remaining in post for a period of induction for the new manager.

People who lived there told us they were happy with the care they received. One person told us 'it's a good place to live' and another 'the staff are very kind and helpful.' We saw staff interacted and assisted people in a dignified and patient manner.

We saw information regarding a person's physical and mental health needs and how to meet these was recorded. Not all records we saw were completed or up to date.

People who lived there said they enjoyed the food which they described as 'delicious' and 'lovely'. We saw people did not have access to drinks at all times during the day and hot drinks were not provided regularly.

The procedures and practices in place for the prevention and control of infection did not meet with the current guidance.

The systems for storage, administration, recording and disposal of medicines in the home did not meet guidance or legislation.

Staff were recruited in a manner which ensured they were fit to carry out their work.

People who lived there and their relatives were aware of the procedure for making a complaint.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so. We saw that activities were altered to suit individual needs.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.