The Pembury

The Pembury had been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service lived as ordinary a life as any citizen.

This inspection took place on 16 October 2018. At the last comprehensive inspection in March 2016 the service was rated as Good overall. 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.

A registered manager was in post who had been registered with the Care Quality Commission (CQC) in 2010. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager was supported by a manager who had responsibility for the day to day management of The Pembury. Both the registered manager and the manager were the registered providers for The Pembury and its sister home The Padova. 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 registered manager was not present during this inspection. The manager was in attendance.

People’s care and support was centred on their individual needs and wishes. They had lived together for some time and had been supported by a core group of staff providing them with consistency and continuity of care. They had positive relationships with staff, who understood them well, anticipating what would make them anxious or uncertain. Staff treated them with kindness and compassion. They understood and respected people’s diverse needs. Staff knew how to keep people safe and how to raise safeguarding concerns. Risks were well managed encouraging people’s independence. There were enough staff to meet their needs. This was kept under review as people’s needs changed. Staff recruitment and selection procedures ensured all necessary checks had been completed prior to employment.

People made choices about their day to day lives. 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. People were involved in the planning and review of their care and support. They chose the activities they wished to take part in. They said they liked to go horse riding, to the cinema and to garden centres. They went on holidays, day trips, to social clubs and local places of worship. People kept in touch with those important to them.

People’s preferred forms of communication were highlighted in their care records. Staff were observed promoting effective communication, taking time to engage with people. Good use was made of easy to read information which used photographs and pictures to illustrate the text. People had access to easy to read guides about safeguarding, complaints, breast screening and diabetic eye screening. People also had easy to read information about staff on duty, activities and menus.

People’s health and wellbeing was promoted. A weekly menu encouraged people to have vegetables and fruit in their diet. They helped to prepare and cook their meals. People had access to a range of health care professionals. They had annual health checks. People’s medicines were safely managed. People had expressed their wishes about how they would like to be cared for at the end of their life. They were supported during stays at hospital and when discharged home. A relative commented, “The love and care they have all shown to [Name] at this time of her life is so lovely and heart-warming.”

People, their relatives and staff were invited to give feedback through quality assurance surveys, meetings, complaints and compliments. They had information about how to raise a complaint. The manager and provider completed a range of quality assurance audits to monitor and assess people’s experience of the service. Any actions identified for improvement were monitored to ensure they had been carried out. The manager worked closely with local organisations and agencies and national organisations to keep up to date with current best practice and guidance. Comments about The Pembury included, “It’s absolutely outstanding” and “It’s fantastic.”

Further information is in the detailed findings below.

We last inspected in April 2014 and found the provider was meeting all of the requirements of the regulations at that time.

There was registered manager in post on the day 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.

People and their relatives were positive about the home, the staff and management. People were safe and looked after well at the home. Support workers managed the risks of people’s care. They ensured people had the medicine they needed to meet their needs and their ongoing healthcare needs were met. People received a healthy and balanced diet.

People enjoyed living at the home and were supported to live active social lives, which included attending school or college, going to the theatre and activities and events in the community. People were supported to be involved in day to day activities, such as baking, cooking and cleaning.

Support workers were supported by a committed provider and had access to training, supervision and professional development. There were enough staff with appropriate skills, deployed to meet the needs of people living at the home. Support workers spoke positively about the home and the continuity of staff.

The provider ensured people, their relatives and external healthcare professional’s views were listened to and acted upon. The provider ensured support workers were involved in day to day decisions and promoted support workers to take on responsibilities such as key worker duties. Relatives and healthcare professionals spoke positively about the management and the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. Some people using the service had complex needs which meant they were not always able to tell us their experiences. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Care records and risk assessments identified the support people needed to keep them safe. People we spoke with confirmed their care plans were an accurate reflection of the care they needed and received. Other health and social care professionals were contacted for advice when needed. The provider was the financial appointee for five people living at the home. Records were kept of transactions and these were audited to identify potential financial abuse.

The safeguarding policy shown to us was a generic policy from an external company that had not yet been adapted to reflect the practices of this care home. The provider told us they would adapt the policy following our visit but we have not yet checked this has been completed.

Staff had received training about safeguarding and the Mental Capacity Act 2005 and knew what to do as a result of a safeguarding concern. People we spoke with told us they would tell staff if they were unhappy or felt unsafe. Care staff knew how to recognise someone being deprived of their liberty and actions to take as a result. There were no restrictions in place at the time of our inspection. We saw information about safeguarding and the Deprivation of Liberty Safeguards (DoLS) available to people in an easy to read format.

Medicines were stored, administered and recorded safely. We did, however, find some liquid homely remedies were not being dated on opening and some medicines were not counted each month to check the number of tablets being carried over. We also found two 'as required' medicines had not been destroyed when they were no longer needed. The provider told us they would address these issues following our inspection. We have not yet checked this has been done.

Staff received appropriate medicines training and their competency to administer medicines was assessed before they administered independently. Although there were two medicines policies available at the home neither was an accurate reflection of the procedures in place. The provider told us they would adapt one of the policies to reflect the procedures in place at the home. We have not yet checked this has been completed.

Is the service effective?

People's health and care needs were assessed. This involved the person where possible. Staff were aware of changes in people's needs and shared these with colleagues. We did, however, find that some relevant information recorded elsewhere in people's care records, such as notes from medical appointments, had not been included in their detailed care plans. We also found there was limited information on the support people needed to communicate or if they became anxious. Staff we spoke with had a detailed understanding of people's behavioural and communication needs.

Staff told us they encouraged people to be independent and to complete everyday tasks themselves as far as possible. Staff discussed people's progress with them at client meetings and updated each other at staff meetings. We observed staff taking the time to allow people to do things independently and often heard staff asking people if they would like to help with tasks around the home.

People were supported to eat and drink sufficient amounts to meet their needs. Their dietary requirements were recorded in their care plans to ensure staff knew how to support them. People had their weight monitored regularly to ensure they maintained a healthy weight. Staff also used weight changes to identify if someone was unwell or unhappy. People were provided with a choice of suitable and nutritious food and drink. Staff explained to us how they supported people to eat the food they needed and preferred.

Is the service caring?

People's preferences, interests, wishes and diverse needs were noted in their care records. Staff spoken with had a good understanding of how people wished to be supported and provided care in accordance with their wishes. All the interactions we observed between people and staff were patient, caring and professional. People clearly enjoyed the relationship they had with staff.

Feedback from people included, 'Staff are good. I like it here' and 'I am happy here. Everything is nice. Staff are nice.' We spoke with two relatives. One told us they were 'more than happy' with the care provided. They told us their relative was very happy and 'had a better social life than [them]'. Another relative commented on the positive family environment at the home.

Staff had worked with people to identify their cultural and religious preferences. They then sought to meet these preferences. The home had also worked sensitively to identify people's sexual needs and provide appropriate support. Each person had an end of life care plan which contained detailed information important to the person and was in an easy to read format. People and their relatives had been involved in putting the information together which was sensitively written.

Is the service responsive?

As people's needs changed the service adapted to accommodate them. Other health and social care professionals were involved when needed to assess people's needs and provide guidance and support. A professional who visited the home regularly told us people seemed 'very well cared for' and said staff informed them promptly if they were worried about someone.

Is the service well led?

A quality assurance system was in place which included gaining the views of people who lived in the home. A satisfaction survey was completed in February 2014 and all of the responses showed the home as excellent or good. Some of the comments received included, 'All of them are very nice' and 'It's the best, I like it here'. People were also listened to via 'client meetings' and using complaints.

The relatives we spoke with told us they could raise a concern if they needed to. One comment had been shared by a relative and this had been appropriately addressed. Staff told us they felt listened to and well supported.

Audits were in place to monitor the safety of the environment people lived in. This included cleanliness monitoring and annual health and safety checks. Staff told us maintenance requests were dealt with in a timely fashion to keep people safe. We did not see evidence of unaddressed maintenance work. The administration of medicines was audited although we found the audits did not look at the dating of creams, drops and liquids on opening, the disposal of expired medicines or the balance of tablets not in the monitored dosage system. Checking these issues could protect people from medicines errors.

We were able to speak with four people living at the service. People told us that 'I like living here and the staff'. People also told us that 'the food here is really good'. Monitoring by senior staff had ensured that staff followed support plans and respected the wishes of people using the service.

There were sufficient skilled and experienced staff to safely meet the needs of people who used the service. The standard of induction and subsequent training for staff provided them with the skills they needed to do their work well.

The building had been well maintained and there was an on-going programme of refurbishment and redecoration to benefit people living at the home.

There were systems in place to monitor the quality of care provided at the home. Quality assurance measures had sought the views of people living at the service, their friends, families and visiting professionals.