Earlham House

Earlham House is a residential care home which provides accommodation and personal care to up to eight

people with mental health needs. At the time of the inspection seven people were living at the service.

Earlham House is a care home set up in an adapted residential building over two floors with a garden.

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

Staff recruitment checks were verified by the provider, however, we have made a recommendation in

relation to the availability of recruitment records.

People and relatives told us they felt safe at the service. People were protected from the risk of abuse or harm because staff knew the action to take should they suspect or witness any abuse. Risks to people were assessed and appropriately managed to ensure people received safe care. Appropriate infection control practices were followed by staff. Learning from incidents was discussed and shared with staff.

Staffing levels were determined by the level of individual care required for people using the service. We had some concerns about staffing levels at night.

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.

Systems for monitoring the quality of the service were in place and regular audits took place. Continuous learning took place to improve the quality of the service provided to people. However, frequent management changes meant there was sometimes inconsistencies in the way the service was managed by different people.

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 requires improvement (published 25 February 2022).The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we made a recommendation in relation to staff training in relation to medicine competency. At this inspection we found the provider had made improvements, medicine competencies had been completed for staff administering medicines.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 and 15 June 2022. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, need for consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For the Effective Key Question, we checked whether the service had followed their action plan and now met the requirements of Regulation 11 (need for consent). As we only checked the part of this Key Question we had concerns about, the rating for Effective has not changed and remains requires improvement. 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 remains requires improvement. This is based on the findings at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Earlham House is a residential care home which provides accommodation and personal care to up to eight people with mental health needs. At the time of the inspection seven people were living at the service. Earlham House is a care home set up in an adapted residential building with a garden.

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

We found recruitment practice at the home was unsafe. This meant we could not be assured that staff employed were of good character and safe to work with people. Risk assessments were not always up to date. This meant we could not be assured that risk to people had been assessed and mitigated. There were issues with the way staff were deployed, therefore we could not be assured that people had their needs met, due to staff shortage. Accidents and incidents were not always recorded, and complaints not dealt with in line with the providers policies and procedures, therefore learning from these were not always explored to identify improvements needed to service delivery. We were not always assured that Infection control practices were appropriately followed. This put people at risk of infection, such as COVID-19 virus.

Systems for monitoring the quality of the service were ineffective in identifying some of the issues found during our inspection.

Staff training was not always effective in ensuring staff understood their responsibilities in reporting and acting on abuse and staff competency to administer medicines assessed. We have made a recommendation in relation to staff training.

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. However, we found the principles of the Mental Capacity Act 2005 were not always followed by the service. We have made a recommendation in relation to the consent and the Mental Capacity Act

Relatives told us people were safe living at the service. However, not everyone living at the home felt safe due to behaviours that challenged the service. People were involved in decisions about their care and staff were described by most relatives as caring and kind.

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 requires improvement (published 6 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvements had been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and concerns raised in relation to staffing, care provided to people and food provision.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to recruitment, staffing levels, mental capacity assessments, complaints and management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Earlham House is a residential care home providing accommodation and personal care to up to eight adults over the age of 18 with mental health needs, including dementia and paranoid schizophrenia.

People’s experience of using this service

Risks to people had not always been assessed and managed. Health and safety risks in relation to the environment had not been assessed. Safe recruitment practices were not followed. Audits for identifying and addressing concerns were not effective in addressing these prior to our inspection. This put people at risk of harm.

Staff were aware of their responsibilities and knew what action to take should they suspect any form of abuse. People were protected for the risks associated with the spread of infection. Systems were in place to record and respond to accidents and incidents, including lessons learnt.

At the time of our inspection there were sufficient staff to meet people’s needs. People we talked with spoke positively about the staff and supportive and caring relationships had been developed between staff and people. The service involved people in choices and decisions about their care. Staff provided a service that met people’s diverse needs. People’s privacy, dignity and independence were promoted.

Systems were in place to support staff in their role including training, supervision and appraisals. People’s care and support needs were assessed and monitored to ensure the service was able to meet their needs.

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. The provider and staff understood the need to obtain consent before delivering care.

Care plans were personalised. Staff understood how to provide a person-centred service. People’s communication needs were met. However, this was not always documented in their care plan. We have made a recommendation in relation to documenting people’s communication needs. The provider had a system to deal with complaints appropriately. The service had a policy in place to provide people with end of life care should this be required.

Staff spoke positively about the leadership in the service. The provider had systems to capture feedback from people about the quality of the care provided. The provider carried out quality checks to identify areas for improvement. This identified that there were a number of improvements required to the building.

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 13 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches of regulation. Safe recruitment practices were not always followed. Risks to people had not always been identified to ensure people’s safety, this included ensuring the premises and equipment were safe. Quality assurance was not always effective.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of the quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home was kept clean and well maintained. Staff supported people with personal care and helped them to keep safe. People were supported to have choice and control of their lives with the exception that people were not allowed a key to the front door.

People said they were happy living in the home, felt that staff supported them well and were able to do the things they wanted to do. Comments included; “I like it here” and staff were “really good.” Staff had positive relationships with people living in the home.

Staff had regular training relevant to their role and said training and supervision were good and they felt well supported by the manager.

Staff gave people good support with their health needs including going to their medical appointments with them if required. People were involved in planning their care and were supported to lead the lifestyle they wanted.

The manager notified other authorities of any important event and ensured records were organised and accurate.

The previous inspection was a focused inspection to check on whether the provider had made improvements in health care plans, staff training and notifications. These improvements had all been made and the home was rated Good. The manager showed evidence of learning from incidents and acting on the feedback from other authorities to ensure continuous improvement in the quality of the service. The service met all relevant fundamental standards. Further information is in the detailed findings below.

Earlham House is registered to provide accommodation and personal care to eight people who have mental health issues. The home has 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.

This inspection took place to check on legal requirements which were not being met at the last inspection in September 2015. These related to recording people's health needs in a care plan, staff training in First Aid and the Mental Capacity Act 20105 and informing us of important events in the home.

We found improvements had been made in all areas and people were happy with their service. Staff had completed training in First Aid so knew how to respond in the event of a medical emergency in the home. They had been trained to understand the implications of the Mental Capacity Act 2005 for people in the home and understood people's rights to make their own decisions and choices. The registered manager had updated herself on the legal requirements and has been sending notifications of events to us as required.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe in this home. Safeguarding procedures were in place, staff had been trained in safeguarding people from abuse and they had an understanding of how to recognise and act on any signs that somebody was being abused.

Is the service effective?

People's health and care needs were assessed. Staff encouraged and supported people to eat nutritious food. People said that they had not been involved in the care planning process and did not have copies of their care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare but improvements were needed with a programme of meaningful activities and in ensuring a risk assessment addressed all known risks to a person's safety. People received good support with their health care and personal care.

There was insufficient evidence to confirm that there were enough staff to meet people's needs at all times or that staff had enough support in the form of appropriate training and supervision to meet people's needs in the areas of mental health and medicines.

Is the service caring?

We were able to speak with four people living at Earlham House and observe the experience of another. The other two people did not wish to talk with us. One person living in the home told us, "they keep it clean, cook good meals and look after you" and "I would recommend this house to anybody who wants to stay here." Another said, "it's ok, it's a roof over your head" and "staff are ok. I don't have any problems here. They generally look after me alright." People said they were treated with respect by the staff. The four people we spoke to all said they could go to bed at any time they chose. One person said, "Sometimes I go to bed at 9 or 10. Sometimes I get up and watch TV in the night. I can do what I want. They treat me with respect." They told us they were satisfied with the care they received at this home.

Is the service responsive?

People's needs had been assessed before they moved into the home. Staff understand their needs and wishes well and people said they were satisfied with the service they were receiving. We judged that staff were not always responsive to the needs of one person who had more complex needs and had limited meaningful activities within the home.

Is the service well-led?

The Registered Manager had been employed for some years and had formed a good relationship with people living in the home. The office was well organised and records easy to find and understand. Staff were clear about their roles and responsibilities. People living in the home told us they would tell the manager if they had a problem. The provider did not have an effective system to regularly assess and monitor the quality of service that people receive or identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We noted that allegations of abuse had been recorded but procedures were not followed to ensure these were reported and investigated by the local authority safeguarding team.

The home was clean and tidy and arrangements were in place to ensure that equipment and the facilities were maintained. Even though staff and people who used the service felt that the staffing level was sufficient, we have asked the provider to take note of the fact that at times there was only one member of staff working at the home.