The inspection took place on the 4 July 2017 and was unannounced.

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, alw

The inspection took place on the 30 September 2015 and was unannounced.

Pelham House Nursing Home provides nursing, care and support for up to 30 older people and people living with dementia. On the day of our inspection 19 people were using the service. The home is a large detached property spread over two floors with a maintained garden and patio area. On the day of the inspection the provider was in the process of changing their registration from a nursing home to a residential care home.

The service did not have 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. The previous registered manager had recently left. The current manager was applying to become the registered manager of the service.

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.

The experiences of people were positive. People told us they felt safe living at the service, staff were kind and compassionate and the care they received was good. One person told us that the reason they felt safe was, “It’s the environment and the staff”. We observed people at lunchtime and throughout the inspection and found people to be in a positive mood with warm and supportive staff interactions.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate the risks. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The manager made sure there was enough staff on duty at all times to meet people’s individual care needs. When new staff were employed at the home the manager followed safe recruitment practices.

People’s individual needs were 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 supported people to eat and drink and they were given time to eat at their own pace. The home met people’s nutritional needs and people reported that they had a good choice of food and drink. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to and could choose activities in line with their individual interests and hobbies.

The home considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

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

There was a positive and open atmosphere at the home. People, staff and relatives found the manager approachable and professional. One person told us “It’s a well-run place. It’s very comfortable”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One staff member told us “We have just completed self-assessment supervision and have put down what extra training or support we would like. I will discuss this with the manager who I know will support me.”

The inspection team was made up of two inspectors. The focus of the inspection was to check if the provider had taken sufficient action to meet the compliance actions set at our visit in January 2014. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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”.

We spoke with 11 people who lived at the home, two relatives, five staff members, one agency staff member. We read three care plans and looked at other records.

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.

We spoke with people and their relatives who told us that they were treated as individuals and that they were given information and choices in relation to their care. One person said that "I am usually able to take care of myself in the mornings , but on the days I need help they are always ready to do so’’. People told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations.

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.

During our visit to the Pelham House Nursing Home, the service was found to be well managed. The premises were found to be clean and well maintained with a relaxed and homely atmosphere.

People told us that they were happy, settled and well cared for. This was also evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

As far as practicable and in accordance with their wishes and individual care plans, people were enabled and encouraged to make choices about their daily lives.