We carried out an unannounced inspection of Pemberton Fold on 31 May 2017. We last inspected the service on 06 and 13 April 2016 when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care & treatment and staffing.

The service sent us an action plan identifying the actions they intended to take to address the breaches of regulations identified. At this inspection we found improvements had been made and the service was now meeting all regulatory requirements.

There was a registered manager in place. 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 who used the service, their relatives and professionals we contacted, told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise highlighted risks. Safeguarding policies were in place and staff had an understanding of the types of abuse and procedures for reporting concerns.

The environment was effective for people living with dementia and provided stimulation. There was signage to aid people’s orientation and help them to be as independent as possible.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of DoLS and the MCA, the importance of consent to care and treatment and how to act in peoples best interests.

People who used the service and their relatives told us the staff were caring and kind. We observed care in the home throughout the day. Staff interacted with people who used the service in a kind and considerate manner, ensuring people’s dignity and privacy were respected.

Relationships between people who used the service and staff members were warm. Conversations were of a friendly nature and staff’s attitude to people was polite and respectful using their chosen names, to which people responded positively.

There was an appropriate complaints procedure in place. Complaints were followed up appropriately and people who used the service and their relatives knew how to make a complaint.

A number of audits were carried out by the service, issues were identified and action plans put into place. Medication policies were appropriate and medicines were administered, stored, ordered and disposed of safely.

People’s care plans showed evidence of effective partnership working and we saw information in peoples care files that showed the involvement of relatives where appropriate.

People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Care plans included appropriate personal and health information and were up to date.

We observed the lunchtime meal. There was a relaxed unrushed atmosphere and we saw that staff interacted with people in a respectful and dignified manner, recognising people as individuals’ and encouraging their engagement. There was a seasonal menu cycle in use which was nutritionally balanced and offered a varied selection.

The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose, which is a document that includes a specific set of information about a service.

The home had an End of Life Care Policy in place and people’s wishes regarding end of life were recorded in their care files, including any updates. There was evidence of multi-disciplinary team reviews in people’s care files and evidence of best-interest decisions and discussions

We saw that prior to any new admission a pre-assessment was carried out with the person and their relative(s).

The service produced regular newsle

We carried out an unannounced inspection of this service on 06 April 2016. We returned to the service on 13 April 2016 and this visit was announced. The inspection team consisted of two adult social care inspectors from the Care Quality Commission (CQC) and a specialist pharmacist advisor.

Pemberton Fold is a purpose built care home operated by Community Integrated Care (CIC). The service is registered with CQC to provide personal care and accommodation to a maximum of 60 people. Accommodation is provided on four separate units over two floors. The home is large and spacious and all bedrooms have en-suite facilities.

At the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care & treatment and staffing. You can see what action we told the provider to take at the back of the full version of this report.

We looked at night time staffing levels across the four units and found there was one care assistant on each unit. They would be supported by a team leader on each floor who would ‘float’ between the two units. This meant that during the night, each team leader would be responsible for up to 30 people per floor. Staff told us that night time staffing levels had been reduced as each unit previously had two care assistants on duty at night, in addition to the team leaders. During the day, we found that staffing increased to two care assistants per unit and again, they would be supported by a floating team leader on each floor.

Throughout the inspection we observed that people were left unsupervised in communal areas for prolonged periods of time. This was because staff were busy elsewhere assisting other people and no one was available to supervise in these areas. We found that care staff were responsible for laundry duties which meant they were not always available to respond in a timely way when people needed help.

We found that people who used the service were not consistently protected against the risks associated with medicines. Across each of the four units we found a variety of issues concerning how peoples medicines were managed. We found that people did not always receive their medication as prescribed, that insufficient time was being maintained between doses and that medicines were given after food that were prescribed before food. We also found that one person had not been given their medication for four consecutive days and that medication administration records (MAR) contained errors and omissions.

We saw the service had a corporate medication policy but found a lack of clarity around how the staff interpreted elements of the corporate policy. For example, how and when medication might be given covertly. Giving medicines ‘covertly’ means it can be hidden within people’s food or drink to ensure the medication is taken. Giving medication in this way can be used to ensure people who lack mental capacity and refuse their medication can still receive the medicines which are important to them.

We looked to see how the service sought to protect people from abuse and found appropriate safeguarding systems and procedures were in place. Staff knew how to recognise and respond to signs of potential abuse.

We looked at people’s care files to understand how the service managed risk. We found the service undertook a range of risk assessments to ensure people remained safe. They included personal emergency evacuation plans in the event of an emergency, mental health, nutrition & diet, mobility and moving & handling assessments.

We looked at how accidents a