The inspection was carried out on 13 and 14 June 2018. The inspection was unannounced.Pembroke House is a ‘care home’. People in care homes receive 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.
Pembroke House provides accommodation, residential and nursing care for up to 55 older people. There were three floors of accommodation in the premises providing nursing and residential care to people with varying needs. The ground floor accommodated people with dependent residential needs and the middle floor for people requiring complex nursing care. The top floor accommodated people who were quite independent, requiring minimal support with personal care. The service provides care for former Royal Naval ratings, other ranks from the Royal Marines, their wives and widows and people who have had a connection with the Royal Navy. The Royal Naval Benevolent Trust (RNBT), a charitable non-profit making organisation, owns and manages the service. There were 49 people living at the service on the days of our inspection.
At our last inspection in August 2016 we rated the domain of ‘Safe’ as requires improvement. There was a breach of regulations in relation to Regulation 12, Safe care and treatment. The provider did not ensure people’s medicines were administered and managed safely. Following the inspection, the provider sent us an action plan to show how they intended to improve the service and meet the requirements of the regulations. Two recommendations were also made in relation to good practice; that the registered manager ensures individual risk assessments benefit from having more attention to individual detail in order to provide the correct person centred guidance to staff and the registered manager sought training from a reputable source to ensure staff completing care plans understand the detail is crucial to providing consistent person centred care. At this inspection we found that the provider had made improvements in these areas.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
People were supported to have maximum choice and control of their lives in line with the principles of the Mental Capacity Act 2005. The provider had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.
People gave us positive feedback about the service and told us they received safe, effective, caring, responsive care.
Staff provided caring and considerate support and respected people’s privacy and dignity.
People and their relatives told us they felt safe living at the home. They could tell us who they would speak to if they were worried about anything and they said they were confident they would be listened to. We spoke to staff who were able to tell us how they kept people safe. They understood their responsibilities in reporting any concerns they had and their own role in ensuring people were safe from abuse.
The provider followed safe recruitment practice. Essential documentation was in place for employed staff. Staff received supervision and said they were supported in their role. There were suitable numbers of staff to be able to provide the nursing and personal care people had been assessed as needing.
Registered nurses were employed to provide the professional expertise required to respond to people’s often complex care needs. Care staff were not expected to undertake cleaning or cooking duties as experienced chefs and domestic staff were employed. This meant care staff concentrated on providing the care people required.
An external company had been contracted to provide training for staff and a new training schedule was being put in place. All staff received the training they required to carry out their role well. Staff were very positive about the training provided and felt they were well equipped to carry out their role well. Registered nurses were supported by the provider to undertake training, ensuring their professional development continued in order to keep their registration up to date.
Nurses assessed people’s needs and identified risks, putting measures in place to manage these. Records were currently being transferred from a paper system to the new electronic system.
People’s nursing and care needs were assessed before moving into the service, by the registered manager and nurses to make sure they were able to cater for their individual needs. Following assessment, the nurses developed a care plan to record how to provide the care required, taking into account people’s individual preferences and choices. The information we saw being recorded on the new electronic system was person centred to support people well with all aspects of their care, including end of life care.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider understood their responsibilities under the Deprivation of Liberty Safeguards. People’s capacity to consent to care and support had been assessed and recorded within their care plans.
A new medicine administration system had recently been implemented and medicines were now well managed, stored securely and records showed that medicines had been administered as they had been prescribed.
People were supported to access health care services when needed. The provider worked in partnership with a range of healthcare professionals to ensure people received appropriate care and treatment.
People had sufficient food and drink and were provided with choices at mealtimes. Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.
An activities coordinator and an assistant, planned activities each week and many months ahead. A band of very active volunteers were supportive of the activities programme enabling people to attend many events and visits outside of the service. Funding available through the provider’s charitable trust added to the resources available, including a fully accessible mini bus.
Complaints were investigated and responded to, as were accidents and incidents. The registered manager took the opportunity to analyse and learn from these in order to be able to improve the service provided.
Residents and relatives meetings were held so the registered manager could listen to concerns and ensure the involvement of people in the running of the service. Residents, relatives and staff surveys were undertaken to support the improvement of the service.
The registered manager had a range of auditing processes in place to monitor the quality and safety of the service. People, their relatives and the staff thought the home was well run and the registered manager was approachable and supportive. People and staff said the registered manager was present around the home many times a day and knew people and staff well.
The provider had developed effective links with organisations that helped them develop best practice in the service. The provider used effective systems to continually monitor the quality of the service.
There were systems and processes to enable lessons to be learned and improvements made if things went wrong.
Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and had access to personal protective equipment like disposable gloves and aprons.
The premises were well maintained, clean and tidy.