About the service:

Pembroke Lodge is a residential care home, providing accommodation and personal care to 13 people. The home is registered to provide a service to a maximum of 20 people, who can reside in both single and double occupancy rooms. The service operates as part of a wider service offered by the provider, that includes both supported living and domiciliary care services. Located within close proximity of Reading town centre, the service is able to access a number of amenities accessible by public transport and by the “buggy” owned by the service.

People’s experience of using this service:

We found some very positive examples of the difference staff had made to people’s lives, specifically in ensuring care was delivered safely and effectively in line with people’s needs and desires. However, the service did not ensure documentation was updated to reflect people’s needs.

Staff had received all mandatory training, however refresher courses had not always been completed. We made a recommendation regarding the effectiveness of audit systems specifically in relation to care and training. This meant we rated Well-Led as Requires Improvement on this inspection.

People told us they felt safe living at the service. We heard examples of how the service embraced and promoted people and staff’s equality and diversity. The caring and compassionate relationship between people and staff was evident in communication observed, and feedback provided by people.

The outcomes for people using the service reflected their specific needs. People's support focused on them having as many opportunities as possible for them to retain existing skills and independence. Care was person-centred and people were supported to do things they enjoyed, as well as encouraged to learn and try new things. Activities were promoted and access to the community encouraged. People’s health needs were met, with appointments made with health professionals as and when required. Meals were prepared in line with people’s specific health needs with alternatives made available from the menu.

Management led the inclusive, caring and compassionate culture of the service with clear dedication and were well respected by people and staff. We were told that management ensured sufficient staff were available to meet people’s needs, covering shifts to ensure consistency in care is provided. Staff felt well supported and believed everyone worked to provide a good service for people. People and staff were involved in the design and delivery of care.

Rating at last inspection:

At the last inspection, with the report published in December 2016, the service was rated Good.

Why we inspected:

This was a planned inspection that was scheduled based on the previous rating. We inspected to ensure the service had sustained its Good rating.

Follow up:

We will follow up on this inspection through ongoing monitoring of the service, through conversations and notifications with the provider, local authority and safeguarding team.

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

This was an unannounced inspection which took place on 08 November 2016.

Pembroke Lodge is registered to provide care (without nursing) for up to 20 older people. There were 14 people resident on the morning of the visit and a person moved in at lunchtime on the day of the inspection. The building offers accommodation over three floors. The first and second floors are accessed via a staircase or lift. Part of the second floor requires people to gain access from the staircase. Only people who are able to negotiate stairs safely are allocated rooms in this area.

We inspected the service on 13 and 14 August 2015, at that inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as requires improvement in areas such as care plan records, choice of foods and the environment for people living with dementia.

The service has a registered manager, who is also one of the providers, running the service. 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 management team kept people, visitors to the service and staff safe. Risks were identified and managed to make sure that people and others were kept as safe as possible. Staff were provided with training in the safeguarding of vulnerable adults and health and safety. Staff were able to describe how they kept people safe from all forms of abuse.

People were provided with safe care by adequate numbers of appropriately skilled staff being made available. The service’s recruitment procedure, generally, ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by senior staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The management team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. Care staff knew who and when to discuss consent issues with the management team. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. Where people did not have the capacity to make their own decisions about all aspects of their care, appropriate DoLS referrals were made to the local authority.

People’s health and well-being needs were met by staff who were trained and supported to offer effective day-to-day care. People were assisted to make sure they received health and well-being care from appropriate professionals. Staff were trained in necessary areas so they could effectively meet people’s diverse and changing needs.

People and staff built effective relationships and staff provided caring and compassionate support. Staff encouraged people to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times.

People benefitted from a well-managed service. The registered manager and management team were described as approachable and open. The service made sure they maintained and improved the quality of care provided.

The inspection took place on 13 August 2015, and was unannounced.

Pembroke Lodge is a care home which offers accommodation for people who require personal care. At the time of our inspection there were 17 residents. The registered manager told us this was their choice as they felt they could best support 17 people than the 20 they are registered for. Some of the people living at the service may require specialist care associated with dementia. We have recommended specialist training in the subject of dementia.

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.

Staff knew how to keep people safe by reporting concerns promptly. Systems and processes were in place to recruit staff who were suitable to work in the service and to protect people against the risk of abuse. There were sufficient numbers of suitably trained and experienced staff to ensure people’s needs were met.

We observed good caring practice by the staff. People and relatives of people using the service said they were very happy with the support and care provided.

People told us communication with the service was good and they felt listened to. All people spoken with said they thought they were treated with respect, preserving their dignity at all times.

People were supported with their medicines by suitably trained, qualified and experienced staff. Medicines were generally managed safely and securely. However, where medicines were required to be administered on an as required basis, guidelines were not available.

People received care and support from staff who had the appropriate skills and knowledge to care for them. All staff received induction, training and support from experienced members of staff. Whilst staff stated they felt supported by the management and said they were listened to if they raised concerns it was found that supervisions, appraisals and team meetings were held infrequently. This potentially affected the level of support staff had to carry out their duties.

People who could not make specific decisions for themselves had their legal rights protected. People’s support 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. However care plans and risk assessments were found not to be updated in conjunction with changing needs of people. This could therefore mean that care was not always responsive or effective in response to care needs. We have made a recommendation about developing individuality and choice.

The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty. Applications had been made as required, and were recorded on the providers computer system.

It was found that quality assurance audits and governance of documents were completed by the service. This therefore allowed continual assessment and changes to be made where the service felt necessary. However audits of documents related to care and wellbeing were not completed.

We found these issues to be breaches of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not maintained accurate records in order to meet the requirements of the fundamental standards. You can see what action we told the provider to take at the end of the full version of this report.

We spoke with five people living at the home. However, some people who use the service had complex needs and were unable to tell us about their experiences. We contacted ten relatives of people living at the home. They were happy with the quality of care. They told us, “the staff are always really friendly, caring and endlessly patient.” and “we have been delighted with the caring attitude of staff.”

Care plans were person centred and individual for the differing needs of people living at the home. Relevant risk assessments were completed including falls, moving and handling and nutrition.

People had choices of suitable food and drink. Care workers supported people to eat and monitored people who were at risk of weight loss or gain.

Care workers were able to identify signs of abuse and what they would do if they had concerns. The home had safeguarding and whistleblowing policies in place and the manager was able to confirm how they would escalate concerns to the local authority.

The provider had taken appropriate action to address concerns in relation to requirements relating to the employment of staff, identified during a previous inspection in February 2013. We reviewed five of the 25 recruitment files which now contained all the information required.

Care workers told us they felt supported and had access to appropriate training and professional development to enable them to carry out their roles safely and effectively.