Pembroke Lodge

Pembroke Lodge is a residential care home, providing accommodation and personal care to up to 20 people, who can reside in both single and double occupancy rooms over three floors. The service provides support to people living with dementia, mental health needs, physical disability, sensory impairment and older people. At the time of our inspection there were 17 people using the service.

People’s experience of using this service and what we found

The provider did not always operate effective quality assurance systems to oversee the service and identify shortfalls in the quality and safety of the service or ensure expected standards were met. The provider did not ensure clear and consistent records were kept for people, their care, and the service management. The provider did not always ensure management and mitigation of risk to people and their care. Safe recruitment processes were not always used to ensure staff were suitable to support people. The management of medicines and premises was not always safe. Not all staff were up to date with, or had received, their competency checks and mandatory training. When incidents or accidents happened, it was not always clear they were fully investigated, and if any lessons were learnt or themes and trends reviewed. The provider did not inform us about notifiable incidents in a timely manner. The provider did not demonstrate they understood and maintained clear records to meet requirements of duty of candour. People's, relatives' and staff’s feedback were not sought to drive continuous improvements in the service.

People’s families and other people that mattered felt they were involved in the planning of their care. However, care plans and related documents had some information about people, but it did not always contain information specific to people's needs and how to manage any conditions they had. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support this practice and needed improvements.

We have made a recommendation about the premises being suitable for people living with dementia and maintaining accurate records in regard to people’s capacity assessments, consent and decision making.

People and relatives were positive about staff being kind, caring and respectful and our observation confirmed this during the inspection. People and relatives felt they could approach the management team with any concerns and felt they had good communication and relationships with the service.

People had meals to meet their nutrition needs. Hot and cold drinks and snacks were available between meals. Relatives said they were kept informed about their relatives’ health and welfare. People said they were safe living at the service and relatives felt their family members were kept safe. Staff told us they understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. The management team was working with the local authority to investigate safeguarding cases and make other improvements.

Staff members felt staffing levels were sufficient to do their job safely and effectively. Staff had supervision and appraisals, and team meetings. The management team appreciated staff’s work, contributions and efforts to ensure people received the care and support they required. Staff felt they could approach the management team for support and advice.

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

Rating at last inspection and update

The last rating for this service was good (report published 30 May 2019). At our last inspection we recommended that the provider had to review the effectiveness of audit systems specifically in relation to care and training. At this inspection we found that the provider had not acted on the recommendation made and had not made improvements.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received information of concern in relation to people safety and how it was managed as part of quality assurance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pembroke Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to quality assurance; risk management; notification of incidents and changes to statement of purpose; record keeping for care and support planning; duty of candour; management of medicine; staff training and competence, and recruitment at this inspection. We have made a recommendation about the premises being suitable for people living with dementia, assessing capacity and seeking consent.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

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.

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.