We carried out an unannounced comprehensive inspection of Pendruccombe House on 6 November 2018. Pendruccombe House is a ‘care home’ that provides care for a maximum of 54 adults. 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.

Pendruccombe House is made up of two connected buildings, a residential home and a nursing home. There is a large kitchen and a laundry which serve both buildings. On the day of the inspection, 23 people were living in the nursing unit and 17 in the residential unit.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Everyone told us they considered Pendruccombe House to be a safe and supportive environment. The premises were well maintained and regular checks were carried out to ensure equipment and utilities were safe to use. Risk assessments were in place for falls, moving and use of medicines. Some people could behave in a way which could put themselves or others at risk. Staff had a good understanding of how to support people at these times but this was not recorded in their care plans. No risk assessments had been developed to guide staff on how best to support people to help ensure a consistent approach and we have made a recommendation about this in the report.

Staff told us they enjoyed working at the service and were happy to talk with us about their experiences. They told us they were well supported by the management team and able to raise any ideas or concerns. Training was updated regularly across a range of areas to enable staff to meet people’s needs.

People were supported to take their medicines as prescribed. Staff worked with external healthcare professionals to make sure people’s needs were met. Kitchen staff had a comprehensive understanding of people’s dietary requirements and preferences.

Care plans were well organised, informative and up to date. They covered a range of areas and gave a good picture of people’s health and social needs. Monitoring of people’s health was effective and staff were quickly alerted to any changes in people’s needs. Regular audits were carried out which helped highlight any gaps in care provision or areas for improvement.

The inspection took place on 12 and 13 April 2016 and was unannounced.

Pendruccombe House provides nursing care and accommodation for up to 54 persons. There is a Residential Home and a Nursing Home that are on two distinct sites on the same location; plus a domiciliary care agency which provides a personal care service to people living in their own home which operates from the same location. On the day of the inspection, 49 people were living at the home and 20 people were being supported with their personal care needs in their own homes.

The service had a registered manager 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.

People and staff were relaxed throughout our inspection. There was a very calm, friendly and homely atmosphere. People told us they enjoyed living in the home . Comments included, “I’m very happy here. There’s good food and lovely staff.”

People and their relatives spoke highly of the care and support that staff gave. Care and support focussed on the person, their individual needs, their likes, dislikes and the routines that were important to them. When people's needs changed staff reacted promptly, and involved social and health care professionals if needed. One person commented, “The staff are very, very good. They’ve got my full recommendation. I’m only too pleased to talk about them.”

People were provided with adequate food and fluids to maintain their nutritional needs. Staff supported people to eat and drink as needed. Where concerns were raised action was taken. People chose the meals they wished to eat and decided where to eat them. Special diets were available for people with particular dietary needs. People who were at risk of choking had their meals prepared in line with their care plan to help reduce the risk.

People told us they felt safe. All staff had undertaken training on safeguarding vulnerable adults from abuse. They demonstrated good knowledge of how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service's safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Medicines were managed, stored and disposed of safely and people told us they received their medicines on time. However, where medicines needed two signatures to confirm they had been administered safely, the person providing the second signature had not always received medicines training. Also, there was no clear direction given to staff on the precise area prescribed creams should be placed and how often; some creams had been recorded as ‘no creams available’ for several days and creams were not all dated when opened, so staff knew when to dispose of them. The registered manager and staff took immediate action regarding these concerns.

People and those who mattered to them knew how to raise concerns and make complaints.

New staff received a comprehensive induction programme. There were sufficient staff to meet people's needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.

Staff described the management as supportive and approachable. Staff talked positively about their jobs. This helped ensure positive progress was made in the delivery of care and support provided by the service. A member of staff told us, “The managers are really supportive and encourage us to come forward with any ideas.”

The registered manager and staff understood their role with regards to the Mental Capacity Act (2005) and whe

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them and observing care practices.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Pendruccumbe provides care and accommodation for people in need of both nursing and personal care. The home is split in two buildings adjacent to each other. We visited both buildings during this inspection.

We observed members of staff going about their duties during the course of the day. The staff we spoke with were happy in their work and had worked at the home for some time. One said “The manager and staff were good to work with and I enjoy the challenge of the work”.

Is the service safe?

We judged the service to be safe on the day of the inspection.

Systems were in place to help the registered manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Pendruccumbe alerted the local authority and the Care Quality Commission when notifiable events occurred or when they had any concerns regarding people who used the service. Pendruccumbe had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people’s needs were met.

Is the service effective?

We judged the service to be effective on the day of the inspection.

People’s health and care needs were assessed with them, although people were not always involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

The quality of recording seen was of a good standard enabling nurses and care staff to use the information correctly.

Is the service caring?

We judged the service to be caring on the day of the inspection.

We spoke with five people and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “wonderful” and “Staff are very friendly” and “Very considerate carers”. When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences and interests had been recorded and basic life histories were evident.

Pendruccumbe had regular support from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

We judged the service to be responsive on the day of the inspection.

The care records showed evidence of the lifestyle of these people and we observed that staff spent one-to-one time with people throughout the day.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

We judged the service to be well led on the day of the inspection.

The registered manager told us that regular staff meetings were held and an open door policy was in place. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and 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 that were in place. This helped to ensure that people received a good quality service at all times.

We visited the home over two days and spent time in both the Residential and Nursing Home. An expert by experience person supported the inspection on the first day.

We found that the people in the home felt their dignity was respected and there was evidence in the care plans that people were asked about their choices of gender as their carer. People or their representatives were not being routinely asked to sign their care plans or involved in the running of the service and we have asked the provider to remedy this.

We found that people’s care plans were clear, structured and staff ensured that people’s care was provided in line with the care plan and their welfare was protected. People told us they were happy with their care and how the staff looked after them.

We found that the home had active safeguarding policies and practices in place and this ensured people who lived at Pendruccombe House were safe and protected from abuse.

We found that staff were well trained, supported and their practice appraised to ensure they were able to deliver care that was informed by current practices. We were concerned about how new staff were recruited and we have asked the provider to act on this.

We found there was a clear policy in respect of monitoring the quality of the home and a publicly available complaints procedure. We also saw that there were regular audits in place to ensure that people were safe while being cared for with both homes.