Pemberley House

Pemberley House is a nursing and residential home supporting up to 72 people who may be living with physical disabilities or dementia. The home is split into five units, each of which has ensuite bedrooms, living areas, a kitchenette and an outdoor space. At the time of our inspection there were 56 people using the service.

There were two companies registered as providers for Pemberley House: Willowbrook Healthcare Limited and WT UK OPCO 1 Limited. Both legal entities are equally responsible for how the service is run and for the quality and safety of the care provided.

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

Some aspects of health and safety in the home were not managed safely. Medicines were not always managed safely, and people did not always receive their medicines as prescribed. Recruitment procedures did not reflect the requirements of the regulations, and not all staff had appropriate pre-employment checks.

Quality assurance measures in place were not always robust, some issues identified on inspection were not appropriately identified and prioritised by the provider. Some records were not up to date or consistent. Staff described a blame culture between managers and other staff.

The home décor was not always well maintained and was not in line with dementia friendly guidance. Some staff training was not up to date in line with the provider’s policy, particularly aspects of clinical care for people.

People’s care plans were not always person-centred. Activities in the home were limited, particularly for people who were less able to participate in group activities. Staff and relatives fed back that there was not always time for staff to dedicate one-to-one time with people for reminiscence or activities. The home was in the process of recruiting another activities co-ordinator.

Some aspects of care were not in line with best practice, the home had not yet rolled out up to date guidance on standardised food textures. We identified people, or their legal representatives were not always asked for proper informed consent to share pictures and videos of them.

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 said that staff were caring and kind. We observed staff were patient and compassionate towards people. Staff knew people well and managed their anxiety well. The home was clean and tidy, and risks to people’s individual health and safety were appropriately assessed.

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

Rating at last inspection

This service is registered under two legal entities. The service was inspected when registered with Willowbrook Healthcare Limited. The last rating for the service was good.

Since that inspection, the service registered with a second legal entity, WT UK OPCO 1 Limited, on 6 September 2019. This is the first inspection since this registration.

Why we inspected

This inspection was prompted by a review of the information we held about this 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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, fit and proper persons employed and good governance at this inspection.

We made recommendations for the provider to implement best practice in relation to food textures, in reflecting dementia friendly décor; and reviewing their social media policy in line with the mental capacity act.

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.

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.

This inspection of Pemberley House took place on 20 and 21 June 2017. The home is registered to provide accommodation with personal and nursing care for up to 72 people. At the time of our inspection there were 51 older people living at the home, some of whom were living with dementia.

Accommodation at the home is provided over three floors, which can be accessed using the stairs or passenger lifts. There are usually five different areas within the home, referred to as communities. Two communities are located on each of the first two floors, with a single community situated on the top floor. At the time of our inspection the third floor was not occupied. Each of these households is staffed independently and has its own lounge and dining areas. This provided people with a sense of homeliness. Each household was designed to and furnished to meet the needs of the people living in them.

There is a large enclosed garden and patio area which provides a secure private leisure area for people living at the home. The home also has a boutique café with internet and computer facilities for people to meet and keep in touch with family and friends. The home contains a purpose built salon to provide hairdressing, manicures and other therapeutic services.

The previous inspection of Pemberley House in June 2016 found the service required improvements in most areas of care provision. At this time a different provider had legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The current provider took over the management of the home and began to provide a service on 2 May 2017.

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 were protected from abuse because staff were trained and understood the actions required to keep people safe. Staff had completed the provider’s required safeguarding training and had access to guidance to help them identify abuse and respond appropriately if it occurred. Staff were able to demonstrate their role and responsibility to protect people.

The risks relating to people’s health and welfare were assessed and recorded, along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence. People’s care plans had been reviewed to ensure they included all of the information staff required to meet people’s needs.

The registered manager completed a daily staffing needs analysis to ensure there were always sufficient numbers of staff with the right skills mix and experience to keep people safe. Staff had undergone relevant pre- employment checks as part of their recruitment to assure the provider of their suitability to support vulnerable older people.

People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed annually by the registered manager.

The provider’s required staff training was up to date which ensured staff understood how to meet people’s support and care needs. Training was refreshed regularly to enable staff to retain and update the skills and knowledge required to support people effectively.

Staff had received individual supervisions and appraisals from their supervisors who completed competency assessments in relation to staff skills such as moving and positioning.

Staff protected people’s rights to make their own decisions and supported them to make as many decisions as possible. Where people did not have the capacity to consent to care, legislation designed to protect people’s legal rights was followed correctly and confidently by staff.

People were treated with dignity and respect at all times. Staff demonstrated caring and positive relationships with people and were sensitive to their individual choices. Staff were skilled in supporting people to express their views and communicated with them in ways they could understand.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary, in a patient and friendly manner.

People and where appropriate their relatives were supported to be actively involved in making decisions about the care they received. Staff had developed positive caring relationships with people and spoke with passion about people’s needs and the challenges they faced.

People’s privacy and dignity were maintained by staff who had received training and understood how to support people with intimate care tasks. Staff demonstrated how they encouraged people to be aware of their own dignity and privacy.

The management team were committed to ensuring people were involved as much as they were able to be in the planning of their own care. Staff reviewed people’s needs and risk assessments monthly or more frequently when required to ensure that their changing needs were met.

The registered manager sought feedback from people, their families and staff, which they used to drive continuous improvement in the service. People had access to information on how to make a complaint, which was provided in an accessible format to meet their needs.

People benefitted from a well-managed and organised service. The provider’s clear vision and values underpinned staff practice and put people at the heart of the service. Staff were aware of the provider’s values, which they demonstrated in practice whilst providing people’s daily care and support. People, relatives, staff and health and social care professionals spoke positively about the open culture and positive management of the home.

The registered manager was approachable and well supported by the provider. There were comprehensive quality assurance processes in place using formal audits and regular contact with people, relatives, professionals and staff. The registered manager was responsive to new ideas and had developed links with external organisations and the community.