We inspected Pendlebury Court Care Home on 18 April 2018. The service was registered to accommodate up to 39 older people, with age related conditions, including frailty, mobility issues and dementia. On the day of our inspection there were 36 people living in the care home. The service was last inspected on 26 September 2016; no concerns were identified and the service was rated Good overall.

There was no registered manager in post, although the acting manager was present on the day of the 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 received care and support from staff that were appropriately trained and competent to meet their individual needs. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager.

People’s needs were assessed and improved care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to guide staff on how keep people safe from harm.

People were supported with patience, consideration and kindness and their privacy and dignity was respected. People were protected from potential discrimination as staff were aware of and responded effectively to their identified needs, choices and preferences. People’s individual communication needs were assessed and they were supported to communicate effectively with staff.

Thorough staff recruitment procedures were followed and appropriate pre-employment checks had been made.

Systems were in place to ensure medicines were managed safely in accordance with current regulations and guidance. People received medicines when they needed them and as prescribed.

The acting manager worked in cooperation with health and social care professionals to ensure people received appropriate healthcare and treatment in a timely manner. People were able to access health, social and medical care, as required.

The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). 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 provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to their comments and views.

The provider had failed to consistently notify the Care Quality Commission of events in line with statutory requirements.

We inspected Pendlebury Court Care Home on 26 September 2016. This was an unannounced inspection. The service was registered to accommodate up to 39 older people, with age related conditions, including frailty, mobility issues and dementia. On the day of our inspection there were 38 people living in the care home.

At our last inspection on 09 April 2014 we found all regulations were being met and no concerns were identified.

A registered manager was 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 were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained, competent and confident to meet their individual needs. People were able to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were opportunities for additional staff training specific to people’s needs, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

Up to date policies and procedures were in place to assist staff on how keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff demonstrated a sound understanding of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

Quality assurance audits and a formal complaints process were in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who used the service, their relatives and other stakeholders.

As part of our inspection we spoke with twelve people receiving care and four of their relatives, the manager and deputy manager and staff working at the home. We also observed people receiving care and examined records at the home. Below is a summary of what we found.

Is the service safe?

The premises were clean, well maintained and accessible for physically disabled people. We saw appropriate security measures were in place to protect people living at the home. Procedures were also in place for responding to foreseeable emergencies to reduce the risks to people at the home. We found systems were in place to reduce risks within the home, for example for the safe storage and use of hazardous substances such as cleaning products and medication. The manager was aware of how to recognise if people were at risk of being deprived of their liberty and what action to take if this was the case. We saw safe techniques were used by staff when helping people with mobility difficulties.

Is the service effective?

People’s needs were being met at the home. We found that people's needs were assessed and care files included information about people’s diagnosed health conditions or disabilities. This meant they received care that protected their welfare and safety. We found adequate amounts of food and drink were available for people and that their dietary needs were met. People and their relatives told us the food was good and there was plenty of choice at mealtimes. One person said, "The food is fantastic. Really nice and just like you'd get at home."

Is the service caring?

People told us they were happy with the care they received at the home. One person said, "The staff are marvellous.” We observed staff providing people’s care were gentle and encouraging. We saw they used safe procedures for helping people to move around and to eat their meals. People told us they were treated with dignity and respect. One person told us, "They try their best here. The staff are respectful and ask me what I want to do. They try to keep people happy."

Is the service responsive?

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Two people told us they were supported to go to church and this was important to them. We saw staff tried to provide activities that matched people’s interests and hobbies. One person said they had always liked to make things and that they had attended craft sessions at the home including glass painting. Two people chose to smoke and arrangements had been made for them to this in a safe, sheltered place. People told us they knew how to make a complaint if they were unhappy. One person said, “They listen to what I have to say and help me with anything I need." People we spoke with and their relatives told that they were asked for their views about the care delivered at the home. We saw an independent advocate visited the home regularly and that the manager received reports from them detailing people’s comments and any concerns.

Is the service well-led?

The manager completed regular checks and audits of medication, infection control systems and other aspects of safety and care at the home. Records showed incidents and accidents, complaints and quality audits were reviewed by the manager and changes were made to improve the service where required. People using the service, their relatives and other people involved with the service completed satisfaction surveys every 6 months and records showed action was taken where any improvements were required. Team meetings were held where staff were asked for their views about the home. Professional advice was sought and used to provide people with safe, appropriate care, for example from external health professionals.

Relatives we spoke with told us they were happy with the care provided by the home. One person said “Staff were very friendly and helpful and they were happy with the care provided”. We spoke with three relatives who visited the home whilst we were there. They told us they were generally happy with the service.

We spoke with a health professional who visited twice a week. They told us the quality of care had improved in recent months.

We saw people’s care plans had been revised and updated during the year. Care plans had been personalised to include information about the person and described how they wished care to be provided. However, we found in some cases decisions about people’s care were made without their informed consent or proper consideration of their best interests.

People’s health needs in relation to food were not always properly managed and some people were at risk of an inadequate diet.

The provider was developing systems for assessing and monitoring the quality of care provided and some were already in place.

We found people’s records had been revised and the quality of record keeping was being monitored by the manager.

People told us, “I like the staff here”, and we observed that staff treated people in a respectful and sensitive manner. However, we found that people were not always informed and involved regarding their care. We also found that consent was not always being obtained for people's care, especially if they could not make decisions for themselves.

People were generally happy with the care at Pendlebury Court. One person told us that staff were caring, and another that, “the meals are really nice”. We found that people's needs were assessed, and that care plans were in people's files. However, we found that the planning and delivery of care did not always meet the person’s individual needs and or ensure the welfare of the person. For example, we found that care plans did not include details of people's health needs, and that information was not always accurate.

We found that the building was large and had been purpose built as a care home. However, the layout and decor was not fully suitable for the needs of people with dementia, and some areas of the building had flooring that were slippery and not fully safe.

We found that staff were properly recruited and trained, and that people were protected from abuse. We also saw that people were asked for their views, and that the quality of care was monitored at Pendlebury Court.