This inspection took place on 14 March 2018 and was unannounced.

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 contribut

This inspection took place on 12 and 13 October 2016 and was unannounced.

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

We undertook an unannounced inspection of this service on 10, 11 and 12 February 2016. The previous inspection took place on 18 February 2014 and found there were no breaches in legal requirements at that time.

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.

Our inspection on 25 March 2013 found that people and their representatives had not been involved in discussions about their care and treatment. Our inspection found that the provider had not always ensured that people received an assessment of their needs and that they were reviewed regularly. The inspection also found that the provider had not always ensured that people were protected from the risks and spread of infections and that the provider had not always ensured that there were sufficient staff on duty to support people’s needs.

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”.

We spoke with 11 people who used the service, six staff and two visiting relatives. People told us that they found Pelham House provided a good quality of service. Comments made included “I am very happy, my room is comfortable and kept clean but there is no choice of food. They have 22 to cook for you can’t expect choice”. Another person told us “I enjoy the meals, although if it is too spicy, I just leave it”. Other people confirmed that choices are not made available in advance of meal times and that they are told what is being cooked for them, however, alternatives can be found if needed.

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.

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home. One person said, ''the staff are kindness itself, really they are and are always helpful and friendly'.