This was an unannounced comprehensive inspection carried out on the 20 June 2018, with a further announced visit on the 22 June 2018.

Pencombe Hall is a ‘care home’. People in care homes received 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. Pencombe Hall accommodates up to 32 people within one adapted building, and provides care for older people, living with dementia, mental health or physical disabilities. At the time of our inspection, 24 people were living at the home.

A registered manager was in post and present during our inspection. 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.

At our last comprehensive inspection of the service on 24 November 2017, we identified three breaches of regulation under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person-centred care and good governance. We gave the service an overall rating of Requires Improvement. Following the last inspection, we asked the provider to complete an action plan, which they sent to us setting out the improvements they intended to make.

At this inspection, we found the provider was still not meeting the requirements of Regulation 9, of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014), regarding person centred-care. The provider had failed to ensure care was appropriate and reflected people's needs. The provider had failed to meet the requirements of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with regard to the need for consent. They had failed to take appropriate steps to ensure people who lacked mental capacity to give consent to their care and treatment, had decisions made in their best interest in line with The Mental Capacity Act 2005. The provider had also failed to meet the requirements of Regulation 17, Health and Social Care Act 2008 (Regulated Activities) Regulation 2014, because the provider had failed to effectively assess, monitor and improve the quality of service provided and ensure records were up to date and accurate.

The provider had taken steps to adapt the home for people living with dementia, however further improvements were still required.

The administration and management of medicines was safe.

People and their relatives consistently told us they or their family members were safe living at the home. Safe staffing levels maintained at the home meant people’s individual needs could be met.

We saw staff engaging with people in a compassionate and caring manner. People and their relatives confirmed they were involved in decisions about people’s care and support needs. People and their relatives felt that staff had the necessary skills and knowledge to meet their needs.

Staff demonstrated a good understanding of people’s needs and the importance of encouraging people to be independent.

People and their relatives knew how to raise any concerns and complaints about care at the home. They felt comfortable to raise any concerns or complaints with staff or the registered manager.

You can see what action we have told the provider to take at the back of the full report.

This was an unannounced inspection carried out on the 24 November 2017.

Pencombe Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 32 people in one adapted building. At the time of the inspection there were 26 people living at the home.

There was a registered manager in post at the time of our inspection. 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.

This home was last inspected on the 23 May 2016, where we rated the service as ‘Good.’ During this inspection, we identified three breaches of regulation under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person-centred care and good governance.

Risks to people’s health and well-being had not always been assessed and action had not been taken to reduce such risks. People were at risk falling down the stairs, which could be easily accessed from the bedroom floors. These people were described as living with dementia, they walked around independently and were at risk of falls. Measures taken to keep these people safe were limited.

People’s care was not always person centred to meet their specific needs. For example, the care file of one person we looked at indicated the person had diabetes and nocturnal epilepsy; and experienced simple focal seizures. There was no epilepsy care plan in place to guide staff on individual risk factors, such as triggers for seizures and the specific care required. We saw there was a system for reporting of seizures, but when this was cross-referenced with the accident and incident records, it showed not all seizures (or suspected seizures) had been recorded . Failure to record or monitor seizures accurately, placed the person at risk of not having any changes to their condition/needs identified and acted on.

The provider had failed to effectively assess, monitor and improve the quality of services provided. Audits were not carried out in key areas such as environmental risk assessments, provision of choice at meal times, the suitability of environments for people living with dementia, and person centred care. Feedback from people was neither captured, nor used as a way of continually improving the service.

The provider was not able to demonstrate what processes they had in place to address people’s requirements in respect of equality, diversity and human rights. For example, training had not been provided for staff in equality, diversity and human rights and specifically in respect of lesbian, gay, bi-sexual and transgender issues (LGBT). The registered manager was not aware of the ‘accessible information standard,’ nor of its requirements.

We have made a recommendation about dementia friendly environments.

People were not always offered a choice in support of their individual wishes and preferences.

Staff were able to explain the principles of the Mental Capacity Act (MCA) legislation, however, they were unable to tell us who was the subject of an approved Deprivation of Liberty Safeguard (DoLS) and whether there were relevant conditions they needed to be aware of.

The provider continued to protect people from avoidable harm and abuse. There were appropriate recruitment procedures in place, which ensured staff were suitable to support people who used the service. However, the registered manager had not always followed procedures to ensure safe recruitment.

Arrangements to manage people's medicines were safe.

Staff knew people well, with people being comfo

This inspection took place on 23 May 2016 and was unannounced.

Pencombe Hall provides accommodation and personal care to up to 32 older people some of whom are living with dementia. At this inspection 28 people were living there.

A registered manager was in post and present during our inspection. 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 safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had the risks associated with their care assessed and staff knew what to do to minimise the risk of harm. The registered manager undertook investigations into any incidents or accidents to identify learning and to reduce the possibility of reoccurrence.

There were enough staff to support people and to meet their needs. The registered manager had systems in place to ensure additional support was provided when needed. The registered manager completed appropriate checks on staff before they started work to ensure they were safe to work with people.

People received their medicine from staff who were trained to safely administer these and who made sure they had their medicine when they needed it. The registered manager completed checks to ensure staff followed safe practice when assisting people with their medicines.

People received care from staff who had the skills and knowledge to meet their needs. Staff attended training that was relevant to the people they supported. Staff were supported by the provider and the registered manager who promoted an open and transparent culture. Staff received regular one on one support sessions where they could discuss aspects of their work and identify any improvements if needed.

Staff provided care and support which was personalised and respected people’s likes and dislikes. People took part in activities they liked and found stimulating. People felt involved in the day to day running of the home and were kept up to date with changes and developments. People’s independence was encouraged and staff respected their privacy and dignity.

People were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and information was given to them in a way they could understand. People were involved in decisions about their day to day care. When people could not make decisions for themselves staff understood the steps they needed to follow to ensure people’s rights were upheld.

People, relatives and staff felt able to express their views and felt their contributions mattered. The provider and registered manager undertook regular quality checks in order to drive improvements.

On the day of the inspection 28 people were receiving care and support at the home. During the inspection we read two people’s care records and spoke to several people who used the service. We spoke with a visiting relative and staff. We observed people’s care throughout the day.

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. People we spoke with confirmed they felt safe living at the home. One person said, “It’s good here they keep people clean”. Another person said, “The girls are quite good here, yes I feel safe”. A relative who was visiting said, “From what I have seen I am impressed”.

Staff received appropriate professional development and were able to obtain further relevant qualifications. Robust procedures were in place for the management and administration of medicine. This ensured that people were kept safe and their needs met.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. Refurbishment work was ongoing. This meant that action had been taken to provide a safe and comfortable environment for people who used the service.

Is the service effective?

People’s health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Some people did not always understand what a care plan was but said that staff helped them in the way they wanted.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. A call system was available throughout the home to enable people to request help.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were happy at the home and that staff were good. A visiting relative said, “The staff are good and communicate well”.

People using the service, their relatives and friends completed an annual satisfaction survey. This information had been analysed to identify areas for improvement.

People’s preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We saw staff respond quickly to meet people’s needs. This was also confirmed by people we spoke with. People had the opportunity to engage in a range of activities.

People told us they would speak with staff if they had a concern. Staff confirmed they would help people to make a complaint if they need help. People told us that they had no complaints and were happy with the care they received.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff told us that they enjoyed working at the home and felt that people received good quality care.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “They are marvellous” and another said, “A good lot, the ****** lot”.

We found that many of the people who lived in this home had difficulty in communicating. We could not be sure that they understood what we were asking them.

As we were unable to talk with many of the people who lived in this home we gathered evidence in different ways. We looked at records, talked with staff and observed the way that the care was provided.

However, some people were able to tell us that they were well looked after. They said that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect.

Many people were able to make it clear to us that they liked living at Pencombe Hall. Some said such things as “I like it here” and “Yes, it’s nice”.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

We saw that staff were always available when people needed help. People told us and we saw that staff were friendly and always acted professionally.

The service’s management held regular meetings with the people who live in the home to find out what they thought about how their care was delivered.

We did this review because we had received anonymous information which raised concerns about some aspects of how people were being cared for at the home. We went to the home unannounced and during our visit checked the things we had been told before later discussing them with the registered manager. We identified some areas of care that needed to be developed and found the registered manager receptive to making improvements. We observed some examples of good practice and some kind and attentive care by staff. We also observed some actions by staff which showed a lack of awareness about the importance of communicating with people carefully.

During the day we spent most of our time in the communal rooms with the people who lived at Pencombe Hall, observing what life was like for them there and how the care staff treated them. Many of the people who lived at the home were not able to speak with us due to having dementia type illnesses. The time we spent observing was important in helping us gain an impression of people’s day to day experiences there.

We spoke with a health professional and with an adult social care worker who both had regular contact with Pencombe Hall. They told us that they found the staff helpful and open and had not had concerns about the care provided. Both of them told us that the staff at the home contacted them appropriately for support and assistance in making sure people’s needs were met.

We saw that people living at the home were occupied at various times of the day. In the morning a person came to run an exercise class and care staff spent time with a group of people doing some craft work. We saw a person reading their daily paper and another strolling around the home chatting to people. Later in the day people were watching a DVD of a popular singer which some sang along to. One person got up to dance and a member of staff noticed a person watching and helped them to get up and dance as well. A group of ladies sat chatting and laughing and appeared to be enjoying each other’s company.

We were able to have a conversation with a person who was sitting in an area on their own. They explained that this was their choice and that they appreciated not being made to join in because they would not enjoy this. The person gave us a positive account of the way the care staff behaved and spoke to people. The person told us that the staff were “very patient”.

We observed that food was not presented in an appetising way for people who needed a soft diet. More detailed information was needed to inform staff which foods would benefit people who were nutritionally at risk. We saw some staff checking what sort of cake a person wanted with their cup of tea and offering them another cake when they had finished the first. However we also saw a carer give beakers of lemonade to people without telling them what it was or asking them if they wanted it.

The records of people’s care contained a lot of information but some of this was contradictory or did not contain sufficient guidance to make sure all staff knew the correct way for something to be done. For example in one place we saw information about a person which correctly showed they needed a lot of help due to their poor mobility but this was contrary to other information which said they were able to walk independently. This could lead to staff not being aware of the correct information to follow.

Following our visit the registered manager confirmed that she had already begun to make some of the changes she acknowledged were needed when we were at the home. She told us that she had found our visit challenging but was viewing it as an opportunity to take stock of how they run the service.