Archived: Engleburn Care Home

Engleburn Care Home is a care home providing personal care for up to 76 older people. The service is a large purpose-built home with 4 separate residential units, one of which specialises in accommodation for people living with dementia. Each unit has a dining room, lounge and activities area. At the time of our inspection there were 70 people using the service.

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

People were happy with the care they received. There were enough trained and competent staff in place to meet people’s needs. There were safe systems in place around the recruitment of staff. There were systems in place to help keep people safe from suffering abuse or coming to harm. Staff had completed pro-active work to reduce the need for people to take medicines and reduce risks related to falls. The home was clean and there were procedures in place to minimise the risk of infections spreading.

There was a positive atmosphere at the home, staff were engaging with people and motivated in their role. The registered manager understood the requirements of their role and was responsive to feedback from stakeholders when suggestions were made about how to improve the service. There were effective audits in place to monitor the quality of care and safety of the service. The provider worked with stakeholders when people’s needs changed to help ensure appropriate care arrangements were in place.

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; the policies and systems in the service supported this practice.

Rating at last inspection and update

The last rating for this service was good (published 2 September 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service and some specific concerns we received around safeguarding, falls and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 remained good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Engleburn Care Home is a residential care home providing personal care to people aged 65 and over, some of whom are living with dementia. The service can support up to 76 people. 72 people were living at the home at the time of the inspection.

Engleburn Care Home is a large purpose-built home with three separate residential units, one of which specialises in accommodation for people living with dementia. Each unit has a dining room, lounge and activities area.

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

People and their relatives told us they felt safe living at Engleburn Care Home. They told us there were always staff around and call bells were answered quickly. Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse.

Environmental risks, such as fire and legionella, were assessed and measures were in place to reduce and manage the risks. Risks to people’s safety, including falls, mobility and malnutrition were identified and assessed. Staff knew people well and how to mitigate any risks. Medicines were managed safely and effectively by staff who were trained and competent to do so. Medicines administration records (MAR) confirmed people had received their medicines as prescribed.

Staff received frequent training, support and supervision and felt supported by the management team.

People told us they enjoyed their food and received choices in line with their preferences. Staff were aware of people's likes and dislikes and any allergies, and special diets were provided for people who required this.

People were supported to have maximum choice and control of their lives. Where people lacked mental capacity to make decisions, these were made in line with the Mental Capacity Act and staff supported them in the least restrictive way.

People were treated with respect, dignity, kindness and compassion. People and relatives told us the staff were helpful and friendly and we observed this during the inspection. People and their relatives felt involved in decisions about their care and had regular care plan reviews. Staff were trained in how to provide compassionate and sensitive end of life care to people and their families.

There was an open culture within the home. There were appropriate management arrangements in place and relatives told us they could raise any issues with the registered manager who was approachable. There were systems in place to monitor the quality and safety of the service provided.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published August 2019).

Why we inspected

The inspection was prompted in part due to some concerns we had received about staffing and people’s care. A decision was made for us to inspect and examine those risks. We also inspected to check that improvements had been made in the areas rated as requires improvement at the last inspection.

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 found no evidence during this inspection that people were at risk of harm and could not substantiate the concerns raised with us. Please see the safe, effective and responsive and well led sections of this full report for details.

Follow Up

We will continue to monitor information we receive about the service until we return to visit as per our

re-inspection programme. If we receive any concerning information we may inspect sooner.

Engleburn Care Home is a residential care home that provides personal care to 73 people aged 65 and over at the time of the inspection. The service can support up to 76 people some who may be living with dementia.

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

People and their relatives told us they felt safe living at Engleburn Care Home. However, people told there were insufficient staff deployed to meet their needs and wishes in a timely manner.

Risk management needed to be improved including falls, mobility, pressure care and infection control.

People and their relatives did not always feel involved in their care plan reviews. Some care documentation needed to be more detailed and more clearly reflect people’s needs and risks

There were systems in place to monitor the quality and safety of the service provided, however these were not always effective. There were appropriate management arrangements in place.

People were treated with kindness and compassion. Whilst staff were able to identify and discuss the importance of maintaining people’s dignity, respect and privacy at all times, we found this did not always happen in practice.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed. However, we have recommended the provider review some of their systems.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse.

Staff received frequent support and one to one sessions or supervision to discuss areas of development. They completed training and felt it supported them in their job role.

People were supported with their nutritional needs when required. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes. A nutritional manager monitored people’s weight and ensured people had an enjoyable meal time experience.

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; the policies and systems in the service supported this practice.

Engleburn Care Home met the characteristics of Good in some areas and of Requires Improvement in others. Overall, we have rated the service as Required Improvement.

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

Rating at last inspection

The last rating for this service was good (published 16 May 2017).

Why we inspected

This was a scheduled inspection that was prompted in part due to concerns received about risks to the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, caring, responsive 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection was unannounced and was carried out on 11 and 13 April 2017. The lead inspector returned on 18 April 2017 to check an issue identified the previous week had been addressed and to provide written feedback about the inspection.

At our previous inspection in April and May 2016 we identified that some improvements were required to identifying and managing risk to people, monitoring the quality of the service, record keeping, dignity and respect, safeguarding and submitting notifications. Following the inspection, the provider sent us an action plan telling us the steps they were taking to make the improvements required.

At this inspection we found significant improvements had been made and the provider was meeting the regulations.

There was a registered manager in place at the home. 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 2008 and associated Regulations about how the home is run.

Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks. Care planning had been improved to provide more detailed guidance for staff.

Systems were in place for the storage and administration of medicines, including controlled drugs. Staff were trained and their competency assessed to ensure they remained safe to administer medicines.

People and relatives told us they felt the home was safe. Staff had received safeguarding training, understood the different types of abuse and explained the action they would take if they identified any concerns. There were sufficient staff deployed to meet people’s care, emotional and social support needs.

The registered manager had identified and implemented a number of audits and monitoring systems. Incidents and accidents were recorded and actions taken to reduce the risks of similar incidents happening again. The environment and equipment was regularly checked and servicing contracts were in place.

People’s rights were protected because staff understood the principles of the Mental Capacity Act 2005 and ensured decisions were made in their best interests. The registered manager understood the Deprivation of Liberty Safeguards and had submitted requests for authorisation when required.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

People were supported to maintain their health and well-being and had access to healthcare services when they needed them. People were supported to have enough to eat and drink and their specific dietary needs were met.

Staff were kind and caring and treated people with dignity and respect and ensured their privacy was maintained. People had access to a choice of planned activities throughout each week.

Initial assessments were carried out before people moved into the home to ensure their needs could be met. People, their relatives or other representatives were involved in decisions about their care planning.

People and relatives confirmed they knew how to make a complaint and would do so if they needed to. People and relatives were encouraged to give their views about the service.

Staff felt supported by the registered manager and were confident to raise any issues or concerns with them.

Engleburn Care Home is registered to provide nursing care for up to 76 older people, some of whom live with dementia. There were 68 people living at the home at the time of our inspection. The home is separated in to two units. Engleburn provided support for people who were more independent. Foxholes provided care and support for people with more advanced dementia.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager currently managed the home with the support of two deputy managers. They also managed a second home belonging to the provider and had identified that it was difficult covering two large homes. New management arrangements had been put in place to take effect from June 2016 which included the appointment of a new manager to take full time responsibility for Engleburn Care Home.

We received mixed feedback from people and relatives during the inspection, with some saying they had a positive experience of receiving care whilst others less so. We also identified inconsistent quality in the delivery of care, safeguarding, record keeping and monitoring systems within the home.

People were not always protected from possible abuse. Staff were able to identify some signs of abuse and understood who to report concerns to within the home. However, staff had not identified that unexplained bruising could be a sign of abuse and a number of such incidents had not been investigated and had gone unreported to the local authority and to CQC.

We received mixed feedback about the level of staffing and whether it was sufficient to meet people’s needs. Staff told us they thought there were enough staff most of the time but some staff said there could sometimes be pressure points in the day, such as early mornings. People and relatives said they thought there were times when there were not enough staff and gave examples of times when care had been delayed.

Staff interacted positively with people when they delivered care. We observed staff showing kindness and re-assurance to people when they became upset or worried and people’s dignity was respected by most staff. However, we observed other care practices and written notices around the home which did not always refer to people with dignity and respect.

Staff regularly involved people or their relatives in reviewing their care plans. Reviews took place on a regular basis or when someone’s needs changed. However, we found some examples of care plans which were out of date and did not reflect people’s most current circumstances or support needs. Health professionals visited the home regularly to provide advice and treatment when necessary. However, it was noted that not all staff were able to identify when people needed medical advice or treatment in a timely way.

Staff received induction and training in a range of areas to support them to meet people’s needs. However, there were some key areas of training which had not been kept up to date by all staff, such as safeguarding people from abuse.

The home worked with health and social care professionals and family members to ensure decisions made in people’s best interests were reached and appropriately documented. However, some staff were not sufficiently knowledgeable about the requirements of the Mental Capacity Act 2005 (MCA) to be able to explain how to safeguard people’s best interests and the MCA was not always implemented correctly.

The management team understood about the deprivation of liberty safeguards (DoLS) and submitted applications to the local authority for DoLS where appropriate. Some applications were still waiting to be processed by the local authority.

People received a choice of food and drink to meet their specific choices and dietary needs and where required, were assisted by staff to eat their food. However, some people told us their food was often cold.

The home employed activities co-ordinators to provide opportunities and help encourage people to participate in activities. Most people’s records documented their hobbies, interests and described what they enjoyed doing in their spare time. However, arrangements were not always in place to ensure people who preferred to stay in their rooms or who were unable to join activities in the lounge had regular opportunities for activities or social interaction.

People and relatives were given opportunities to provide feedback, compliments and comments. Some people and their relatives told us they knew who the registered manager was and felt able to raise concerns with them or the deputy managers. Others told us they did not know who the registered manager was and never saw them. We observed during the inspection that the registered manager spent most of their time in their office whilst the deputy managers provided supervision and guidance to staff.

The home had a range of audits in place to help monitor the quality of the service. However, not all of these were effective as we identified a number of areas of concern which their audits had not picked up, such as inaccuracies and discrepancies in record keeping. When we raised this with the registered manager and deputy managers they put systems in place to address this in future, but it was too soon to assess these for effectiveness.

Medicines were managed, stored and administered safely. People were asked for consent before receiving their medicines and accurate records were maintained.

We found 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and 1 breach of the Care Quality Commission (Registration) Regulations 2009.. You can see what action we have told the provider to take in the main report.

During this inspection we looked at evidence to help us answer four key questions: Is the service safe? Is the service caring? Is the service responsive?

Is the service safe?

We found that the service was safe. We spoke to staff who understood the safeguarding vulnerable adults policy and knew how to report any concerns. We saw throughout the day that people were supervised and support was available when needed, such as when getting up from their chair.

Most staff felt there were enough staff on duty. Two members of staff told us there had been problems with low staffing levels but these were being addressed and had improved. We saw that, on the day of our inspection, staffing levels were adequate and based on the complexity of people's needs.

We observed an emergency situation occur and saw that staff attended immediately. Risk assessments were carried out verbally between the staff involved throughout the emergency and safety procedures were communicated to reduce the risk of any injury to the person.

We spoke with one person who told us that a member of staff could sometimes be abrupt with them. We reported this back to the registered manager, with permission from the person, and saw that it was investigated immediately and reassurance was given to the person.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Relevant policies and procedures were in place and staff were knowledgeable about DoLs. Applications for DoLs had been made when required, and others were in progress.

Is the service caring?

We found the service to be caring. During our observations we saw that staff were kind, compassionate and attentive to people. The atmosphere in the home was calm and relaxed, and people seemed happy and content. People we spoke with told us 'Staff are smashing. Wonderful' and 'We always have a laugh' and 'They're always smiling. It makes a lot of difference.'

Is the service responsive?

We found the service to be responsive. We observed staff responding to people's needs in a timely way. Call bells were answered promptly and people who chose to stay in their rooms, or were unable to get out of bed, were checked regularly to see if they were okay, or if they needed anything.

At lunchtime, we saw that staff were vigilant and attended to people who kept getting up and wandering around, and who were at a risk of falling.

People we spoke with told us 'If I want anything I just ask' and ' You don't see staff ambling along. They're all walking briskly. They know what they're meant to be doing and do it exceptionally well.'

We spoke with five members of staff, one person who lived at the home and with the registered manager. We looked at two people's care planning records, staff duty rosters, records about people's menu and meal choices and other documents relating to people's care.

At this inspection we found that people's care needs were being met, including their dietary and fluid intake needs.

There were sufficient numbers of staff on duty to meet the needs of the people accommodated.

People were consulted about how they should be looked after where they were able to be involved. For people who lacked the mental capacity to be involved in these decisions, we found their relatives were consulted and their views taken into account. We also found that health professionals were involved in these best interest decisions for people who lacked mental capacity.

People were well cared for in the home. Their needs had been assessed and care plans put in place to minimise risks of receiving inappropriate or unsafe care.

The design of the premises took account of the needs of people with dementia and provided a safe environment in which to care for people.

There were well publicised complaints procedures. Complaints were investigated and people responded to within the timescale set out in the procedure.

Appropriate staffing levels were maintained to look after people. We also found that there were systems in place to alter these levels when this was necessary.