Pembroke Care (Reading) Domiciliary Services

Pembroke Care (Reading) Domiciliary services is a domiciliary care agency. It provides personal care and support to people living in their own homes or assisted living houses and flats. At the time of the inspection 11 people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Risks to people’s safety were not always fully assessed and documented in their care plans.

People’s medicines were not always managed safely. PRN protocols were not in place for people who were prescribed ‘as required’ medicines.

Records of staff training were incomplete. They did not include information about how often training should be completed or when staff training was due. We have made a recommendation the provider improves their records of staff training to ensure they are complete and accurate.

There were shortfalls in governance and leadership. Systems and processes were not in place to ensure the provider maintained a detailed oversight of the service and of the necessary improvements needed to ensure quality and safety for people living there. There was a lack of evidence to demonstrate people's feedback was sought and acted upon and to demonstrate staff reflected on practice to improve care delivery.

People were protected from the risk of abuse and there were sufficient numbers of staff to ensure people received continuous care from staff they knew. People were protected from the risk of acquiring an infection.

People’s needs, choices and preferences were assessed and regularly reviewed and updated. Staff completed training to help them meet people’s needs. People were supported to maintain a healthy diet and adequate fluid intake. Staff worked collaboratively with external professionals to help meet people’s health and wellbeing needs.

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 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 good (published 8 January 2020). At this inspection the service has been rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about an incident of abuse perpetrated against a person by a staff member. As a result we undertook a focussed inspection to review the key questions of safe, effective and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

The overall rating for the service has changed from good 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 Pembroke Care (Reading) Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staff training, and 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.

Pembroke Apartments is a domiciliary care agency. It provides personal care and support to people living in their own homes or assisted living houses and flats. At the time of the inspection nine people were using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People were supported with the administration of their medicines in a safe way. Medicine administration records were reviewed to ensure these were completed accurately. We have made a recommendation that the provider ensures appropriate guidance is in place for staff for people who receive ‘as required’ medicine.

There were systems in place to ensure people receive appropriate end of life care should this be required. There was no one receiving end of life care at the time of inspection. However, people’s end of life preferences had not always been recorded. We have made a recommendation that the provider ensures they appropriately explore, and record people’s end of life needs and preferences.

There were systems in place to monitor the quality of the service and make improvements when needed. However, the registered provider did not use these effectively. Care plan audits had not been undertaken regularly and systems in place to record actions taken to improve the quality and safety of the service were not always effective. We have made a recommendation that the provider implements an effective auditing system which identifies areas for improvement and that records reflect this.

People were supported by staff who were kind and caring. Staff were dedicated to ensuring people experienced the best possible care and support. People's equality and diversity needs, and preferences were respected.

People had care assessments that identified their needs. Risks associated with people's health and wellbeing needs were identified and managed to mitigate risks found. People told us the service was safe. Staff knew how to recognise and report any concerns about people's safety and welfare. Robust recruitment procedures helped to protect people against the risk of being supported by unsuitable staff.

People and their relatives were happy with the support offered and felt very comfortable with all staff who were flexible, understanding and sensitive to people's needs. Staff clearly knew people well. Privacy and dignity were promoted and respected.

Staff received training, supervision and appraisal which supported them to have the knowledge and skills to do their job well and effectively meet people's needs. Staff supported people to have enough to eat and drink and to access healthcare services when they needed.

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 and their relatives told us they were satisfied with the management of the service. People understood how to make a complaint about the service if they were unhappy with aspects of their care.

People who use the service, relatives and staff could express their views about the service which were acted upon. The management team provided leadership that gained the respect of staff and motivated them as a team.

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 10 June 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 had a registered manager. 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 told us they had been involved in the planning of their care. They felt that the service provided exceptionally responsive care, often going above and beyond what was expected of them. Care plans provided details on how to support people in the way they wanted. This allowed people to remain involved in the management of their support package, and ensured it was effectively delivered. People’s care plans were updated as required, and the staff appropriately made changes.

People told us that they felt safe. Staff were able to explain signs of abuse and what they would do if they suspected anything was wrong. The service had systems in place to ensure sufficient suitably qualified staff were employed to work with people. They were matched to meet people’s needs, in terms of language, knowledge, likes and dislikes. The staff team was consistent, remaining with the provider for long periods of time. This allowed the care to be consistent and people to feel safe with staff.

People received care and support from staff who had the appropriate skills and knowledge to care for them. All staff received comprehensive induction, training and support from experienced members of staff. We were told that the constant presence of management, made certain care was delivered to a high standard. Staff reported feeling supported by the registered manager and the management team. They said they were listened to if they raised concerns, and were kept abreast of any operational changes.

People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions had been made about their care, where they lacked capacity, these had been made in the person’s best interests. Staff had an understanding of the Mental Capacity Act, and used the principles when working with people.

People stated that they felt the service was respectful and preserved their dignity and independence. Where possible choice was given and the person was encouraged to complete tasks independently. This promoted well-being for the person.

People were supported with their medicines by suitably trained, qualified and experienced staff. Details were provided on each person’s file on what the medicine was for and how this needed to be administered. Where required, relationships with external health professionals had been developed. This allowed people to receive a good quality of support from staff who were kept abreast of any changes to people’s health needs.

People told us communication with the service was good and they felt listened to. People felt they were treated with respect, with staff preserving their dignity at all times. The service was described as “wonderful” by many of the people we spoke with.

The quality of the service was monitored regularly by the manager, however there was no documentation in place to evidence this. Subsequent to our visit, the manager created paperwork to illustrate when this was completed, allowing a paper trail to be maintained. A quality assurance audit was completed annually with an action plan being generated, although this was not always followed up on, or evidenced. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service. We found evidence of compliments. Whilst no complaints had been received in the last 12 months, management were able to describe what protocols they would follow should an issue arise.