We carried out an unannounced inspection on 5 June 2017. This meant the provider, registered manager, staff and people using the service did not know that we would be carrying out an inspection of the service. We returned on 23 June 2017 to carry out a second day of inspection which was announced.

We previously carried out an inspection on 1 March 2016, where we identified that personal emergency plans were in place but had not been readily accessible to emergency services. There were excess stocks of medicines and no sample signature records for staff dispensing medication had been put in place. We also found that best interest decisions had not been decision specific and care plans had not been updated to reflect these decisions. Care records contained a lack of information when reviews of care had taken place. Audits had not always recorded the checks that had been carried out and there was no system in place for formally seeking and recording feedback from people using the service.

Pembroke residential home provides accommodation for up to 12 people who require assistance with their health and well-being and live with a dementia type illness, sensory impairment or learning disability. Pembroke residential home is a converted house in Saltburn-by-the-Sea and is situated on the sea front with extensive views of coast. There are gardens to the front and rear of the service.

At the time of the inspection, there were ten people using the service who were supported by the registered manager and 15 care staff.

The registered manager has been registered with the Care Quality Commission since 21 March 2011. They had been the manager of the service for ten years and had worked at the service overall, for 23 years. 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 this inspection, we identified that improvements had been made to the service since the last inspection on 1 March 2016.

Staff understood the procedures which they needed to follow to keep people safe and the action they needed to take to raise any safeguarding concerns. Staff training in safeguarding adults was up to date and safeguarding alerts had been carried out when needed.

Risk assessments were in place for people and for the day to day running of the service and had been regularly reviewed. Health and safety certificates for the service were up to date and included gas and electrical safety certificates as well as checks of water temperatures. Fire safety checks had been regularly carried out and staff had participated in planned fire drills.

Recruitment records were in place and showed robust checks had been carried out to ensure only suitable candidates were employed to work at the service. There were sufficient staff on duty during the day and throughout the night.

Good procedures were in place for managing people’s medicines.

Staff were supported to carry out their roles safely. All staff participated in supervision, appraisals and training. New staff were supported by more experienced staff to get to know people and to understand the day to day running of the service.

Staff had followed the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied for and granted for one person. The person was 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 told us they received a nutritious diet and were happy with the variety and quality of food. People at risk of dehydration or malnutrition were receiving appropriate care from staff and health professionals.

People were involved with a variety of health a

This inspection took place on 1 March 2016 and was unannounced. This meant that the provider did not know we would be visiting. The service was last inspected on 23 March 2015.

Pembroke Residential Home is situated in Saltburn-by-the-Sea. It is a converted house, and has a private garden. The service can accommodate a maximum of 12 people. At the time of the inspection 10 people were using the service, some of whom were living with a dementia.

There was a registered manager in place. 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 safely supported with their medicines, but effective processes were not in place for monitoring medicine stocks. This led to large stocks of unused medicines building up, including controlled drugs. Personal emergency plans were in place but these were not readily accessible to the emergency services.

Care records contained evidence of mental capacity tests and best interest decisions being undertaken, but these were limited to personal hygiene decisions. Following our inspection in March 2015 the registered manager said that best interest decisions and care plans would be updated. Our judgment was that this had not yet been done.

The registered manager carried out quality assurance checks, but there was not always a record of these and they had not identified the issues we found in relation to medicines or best interest decisions. Care plans were reviewed, but it was not clear how this was done. There was no evidence that audits of care plans took place.

The registered manager and staff asked people for their feedback on the service, but a questionnaire planned for 2015 had still not been sent to people.

Risks to people arising from their health and support needs or the premises were assessed, and plans were in place to minimise them. These plans sought to minimise risks whilst allowing people the independence to do what they wanted to. Checks were carried out to monitor the safety of the premises.

Staff understood safeguarding issues and could describe the types of abuse they looked out for. Staff said they would be confident to raise any issue they had, including whistleblowing.

Robust recruitment procedures were in place to ensure that only suitable staff were employed.

There was a low turnover of staff at the service, and the registered manager periodically reviewed people’s support needs to ensure that staffing levels were sufficient to support them safely.

Staff received training to ensure that they could appropriately support people, and felt confident to raise any additional training needs they might have.

Staff received support through supervisions and appraisals, and staff felt these were useful in monitoring their support needs.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People spoke positively about the quality of the food provided.

Care plans contained evidence of regular involvement in delivering people’s care by external professionals.

Staff treated people with dignity, respect and kindness. People and their relatives spoke highly of the care they received. There was a friendly, homely atmosphere at the service.

The service provided people with information on advocacy services. Procedures were in place to provide end of life care to people that needed it.

The care people received was based upon their assessed needs and preferences. Care plans were regularly reviewed and daily notes kept to ensure staff were aware of people’s current needs.

People were supported to access activities, and were seen to be engaged in these during the inspection.

The service had a clear complaints policy tha

We inspected Pembroke Residential Home on 23 March 2015. This was unannounced which meant that the staff and provider did not know that we would be visiting.

This is a first inspection of a newly registered service. Pembroke Residential Home is an established service which had been registered previously under a different provider. Pembroke Residential Home provides care and accommodation for a maximum number of 12 older people and / or older people with dementia. The service is a converted house situated in Saltburn-by-the-Sea on the sea front. Accommodation is provided over two floors.

The service had a registered manager. 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.

There were systems and processes in place to protect people from the risk of harm. However some staff had not received safeguarding training for a number of years. Checks of the building and maintenance systems were undertaken to ensure health and safety. We did note that the hoist was due for servicing in March 2015. The registered manager contacted us after the inspection and told us that this had been arranged for 8 April 2015.

We saw records which confirmed that the periodic hard wire and fixed wire testing in June 2014 highlighted recommendations for action. We were told that this had been overlooked. The registered manager contacted us after the inspection to inform that electrical work identified as a result of the testing would commence on 6 April 2015 and would be completed over a two week period.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. However some care records needed further development to ensure that they were focussed to the specific need of each person to ensure care and support was delivered in a way that they wanted it to be.

There were individual risk assessments in place. Some risk assessments needed development to ensure that they clearly highlighted the individual measures to keep people safe.

Staff told us that they felt well supported and that they received supervision on a regular basis. We saw records to confirm that this was the case. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. We saw that staff appraisals had been planned for 2015.

Staff had undertaken training in fire safety, moving and handling, infection control, dementia awareness and emergency aid. Health and safety training was undertaken on a three yearly basis. Five out of 14 staff employed had received updated training in respect of this. The registered manager told us that where gaps in training had been identified this training was planned. Staff told us that they thought the training they had received was good and provided them with the skills and knowledge they needed to care and support people.

There were two care staff on duty during the day from 8am until 9pm and on night duty there was one staff member on duty. In addition, the registered manager of the service worked supernumerary hours Monday to Friday. The registered manager and other staff could be called upon at any time if needed.

The registered manager told us that the majority of staff had attended training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Staff had an understanding of the principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions. However, ‘best interest’ decisions were not always clearly documented.

At the time of the inspection there wasn’t anyone who used the service who was subject to a Deprivation of Liberty Safeguarding (DoLS) order. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. Staff we spoke with had an understanding of DoLS.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. However, the medicine audit was basic and required further development.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged and they were encouraged to take part in activities. People told us that they were happy with the activities provided by staff at the service.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. However the audits were more of a tick box process and did not describe what the registered manager had undertaken as part of the audit.