Peterhouse provides nursing and personal care for up to 39 people who were living with a range of health care needs. This included people who live with a stroke, diabetes and Parkinson’s disease. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care needs.

Accommodation is provided over two floors with a lift that provided level access to all parts of the home. People spoke well of the home and relatives confirmed they felt confident leaving their loved ones in the care of staff at Peterhouse.

There is a registered manager at the home. 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.

We inspected Peterhouse on 6, 7 and 11 October 2016. This was an unannounced inspection which meant the provider and staff did not know we were coming. There were 34 people living at Peterhouse during the inspection process.

Quality assurance systems were in place but had not identified the shortfalls found in care documentation and record keeping. Whilst people’s medicines were stored safely and in line with legal regulations, people did not always receive their medicines as prescribed. There were also missing signatures for medicines. These had not been followed up to ensure that people had received their prescribed medicines. We also found poor recording and lack of directives of topical creams and ‘as required’ medication for pain relief. There were some inconsistencies in the completion of fluid charts and in diabetic guidance for staff to follow. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff but we asked that advice was sought from the fire service in respect of night evacuation plans.

Staff knew people well, they were kind and caring and treated people with respect. They had a good understanding of their care needs and individual choices.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes, catheter care and dementia. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

Staff knew how to safeguard people from the risk of abuse. Risk assessments were in place and staff had a good understanding of the risks associated with the people they cared for. There were enough staff in place, who had been appropriately recruited, to meet the needs of people.

People were encouraged and supported to eat and drink well. One person said, “The food is good, always tasty and looks nice.” There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People’s special dietary requirements were met. People’s weight was monitored, with their permission and advice sought as required. Health care was accessible for people and appointments were made for regula

We spoke with seven people who use the service and looked at their care records. We spoke with relatives and staff members

People who use the service told us that the staff were very helpful and considerate. They told us that the staff were always asking if they were happy and understood the situation. One person told us that “it’s a very different world now from when I was young. The staff help me a lot and I know they will respect my decision. I can say if I’m not happy with anything”.

The care plans were person centred and showed that the person and their family were central to their formation. They were signed by the person. Any observation charts (such as turning charts, food and fluid charts, mattress checks) were kept in a folder in the person’s room.

Relatives told us that they felt the home was a very friendly place, always clean and the staff were very responsive to the people’s needs. One person we spoke with expressed their gratitude for the efforts the staff made to include them in activities and prevent them becoming depressed and isolated.

We saw the home had a detailed safeguarding and whistleblowing policies. We spoke with staff who told us that they felt supported by the management and that they were confident in raising issues. People who use the service told us that the staff were well trained and knowledgeable. They said that they felt safe at the home and told us that the staff always treated them with dignity and respect

We carried out this inspection to follow up on the compliance actions made in October 2012. We spoke with six people who used the service, two visitors and four staff members, including the home manager and general manager. The general manager was the nominated individual (NI).

We looked at the systems the home had in place that ensured appropriate care, treatment and support for people who used the service. We saw that people were assessed and plans of care were used to inform the care provided. Care provided was reviewed and professional advice was used to ensure care was appropriate when necessary. One person who was using the service told us, ‘’The care and support could not be better, I am very well looked after.’’

We looked at the systems in place to review and monitor the quality of the service provided at Peterhouse. Systems established included ways of gaining people’s views and responding to these. A number of audits had been completed and some were planned. These took account of records maintained and staff practice in the home.

We spoke with 11 people who used the service and three visiting relatives. People told us that they were treated with kindness and respect, and that the care and treatment provided was good. Staff were always helpful and suitable staff were available to attend to their needs. They felt they were safe and supported appropriately. One person told us. ’’It is fantastic here staff are so supportive and kind. ’’ Another said ‘’The staff are marvellous always kind and helpful.’’ The main concern raised was in relation to the quality of the food provided.

Although people were satisfied with the care received. There was evidence that people’s care and treatment needs were not fully assessed in all cases. The care plans viewed demonstrated that care and treatment needs were not always planned for. Systems to monitor and maintain the quality of service were not established.

We looked at the systems and processes that the home had in place to ensure the environment was safe and that people using the service were protected from abuse. These processes ensured a safe and well maintained home and that staff knew what constituted abuse and what to do if it was suspected.