Holbeach and East Elloe Hospital Trust

Holbeach and East Elloe Hospital Trust is a nursing home providing personal and nursing care to 43 people aged 65 and over at the time of the inspection. The service can support up to 47 people. Holbeach and East Elloe Hospital Trust provides beds for residential care, local GP’s and reablement beds.

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

The risks to people’s safety were not always well managed and lessons were not always learned to reduce risks to people’s safety. People’s personal emergency evacuation profiles (PEEPs) lacked clear individualised information to support people in an evacuation. The provider addressed this following our visit.

The service was at times short of staff, however the provider was working to improve recruitment of new staff. Staff were not always provided with supervision to support them in their roles.

Quality monitoring processes were not always used effectively to monitor the care people received. There was a lack of ways for people and relatives to feedback their opinions of the service to the provider.

More positively, people’s medicines were well managed, and the service was clean with staff showing good knowledge of infection prevention and control practices. People’s care plans contained good information to support their care and nationally recognised assessment tools were used to assess people’s needs.

People lived in a well-maintained environment and the provider continued to work to improve the building for the people who lived there.

People’s nutritional and health needs were well managed. Staff worked with external health professionals effectively to achieve good outcomes for people. Staff received appropriate training for their roles.

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.

Staff supporting people were kind and caring and treated people with respect. People were supported to see their family and friends and take part in social activities at the service.

People and relatives felt able to raise any concerns to the staff team and were confident issues would be dealt with. People were protected from the risk of abuse as the provider had systems and processes in place to manage any safeguarding concerns.

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 12 November 2021). This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We inspected this service as part of our inspection programme.

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 and well led sections of this full report.

Since our inspection the provider has worked to address the concerns we found at our inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holbeach and East Elloe Hospital Trust 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.

Holbeach and East Elloe Hospital Trust is a residential care home registered for personal and nursing care for up to 47 people. On the day of our inspection 43 people were living at the service.

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

People lived in a safe, well maintained environment. The risks to their safety were assessed and appropriate measures in place to support their ongoing safety. They were supported by a caring and knowledgeable staff group. There were enough staff to support people’s needs and the registered manager undertook safe recruitment processes so people were supported by suitable staff.

Staff managed people’s medicines safely and in line with their preferences. Staff were knowledgeable of and practiced safe infection control and prevention practices. Staff were aware of how to protect people from abuse, and when necessary the registered manager investigated and promoted learning from events.

There were quality monitoring processes in place to monitor standards of care. People, relatives and staff felt the service was well managed and worked in an open and inclusive way.

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 28 October 2019) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 28 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the management of safe care and treatment and governance of the service.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Holbeach and East Elloe Hospital Trust on our website at www.cqc.org.uk.

Holbeach and East Elloe Hospital Trust is a nursing home providing personal and nursing care to 44 people aged 55 and over at the time of the inspection. The service can support up to 47 people. Holbeach and East Elloe Hospital Trust provides beds for local GPs and reablement beds.

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

Systems and records were not being used effectively to identify risks to people or enable staff to reduce risks. Medicines were administered and stored safely. However, records lacked guidance for staff on the use of ‘when required’ medicines and topical medicines records were not completed correctly. Accidents and incidents were recorded but did not reflect lessons learnt. There were no structured fire drills or practice fire evacuations taking place and personal evacuations plans were generic.

The provider’s governance systems had not identified all the areas for improvement highlighted during the inspection. Records were not always accurate, up to date or in place.

Care plans were task orientated and not always person centred. There was not enough information on how people communicated or how staff should communicate with them. Complaints were investigated but records were not fully completed.

Staff recruitment records were lacking in detail. There were enough staff employed to meet the needs of the people. Staff understood the principles of safeguarding and how to raise a concern. The home was clean and staff had access to plenty of personal protective equipment (PPE).

Staff had not received training in line with the provider’s policy and new staff had not commenced the Care Certificate. The Care Certificate is an identified set of standards that health and social care workers adhere to in their daily working life. Staff were not receiving supervision in line with the providers policy. The registered manager acted on this following out initial feedback.

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, there were gaps in staff knowledge around the Mental Capacity Act and Deprivation of Liberty Safeguards. People were happy with the food provided. The environment was very clinical and did not have a homely feel.

People said the staff were kind and caring. People’s privacy and dignity were respected, and independence was encouraged.

People were happy with the activities provided.

Staff felt the management were supportive and approachable. Feedback was sought from people who used the service, relatives and staff and used to improve the service.

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 30 November 2016)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

We inspected the home on 25 October 2016. The inspection was unannounced. There were 37 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for four people living in the home and was waiting for these to be assessed by the local authority. Staff at all levels had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Any decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection in June 2015. The registered manager had a positive and forward-looking approach and was committed to the continuous improvement of the home in the future. The provider had recently received a national award to reflect the quality of the end of life care received by people and we found strong evidence of a caring and sensitive approach in this area.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

There were sufficient staff to meet people’s care needs and staff worked together in a well-coordinated and mutually supportive way. The provider supported staff to undertake their core training requirements and encouraged them to study for advanced qualifications. Staff were provided with close supervision and shift handover meetings were used effectively to ensure staff were aware of any changes in people's needs. The registered manager maintained a high profile within the home and provided strong, compassionate leadership to her team.

There was a warm, relaxed atmosphere in the home and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink that met their individual needs and preferences. A range of activities and events was organised to provide people with stimulation and occupation.

We found that people who used the service were given appropriate information and support regarding their care or treatment. People were supported in promoting their independence and community involvement.

During our inspection we observed care being given and reviewed nine sets of care records. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care records. We also found that appropriate arrangements were in place in relation to the recording of medicines. Medicines were prescribed and given to people appropriately.

At the time of our inspection there were enough skilled, experienced and qualified to staff to meet people's needs. We spoke with five members of staff one of whom told us, 'There are safe levels of staffing. If people go off sick they phone and get cover straight away. People here get the care they need.'

We also found that people who used the service, their relatives and staff were asked for their views about their care and treatment. When necessary, changes were made to reflect people's views.

On the day of our visit there were 38 people living at the home. People we spoke with told us they were happy with the care they received. One person told us, 'If I go to any other place I wouldn't get the service I get here.' Another person told us, 'I love it here.'

We could see people were happy and relaxed with the staff who were aware of their needs and knew how to meet them safely.

We saw the home was kept clean and tidy. Staff were able to tell us how they worked to reduce the risk of infection.