Archived: Estherene House Limited

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.

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

Is the service safe?

The provider did not have appropriate arrangements in place for the safe administration and recording of medicines and was failing to protect service users against the risk of unsafe use and management of medicines

We looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. We found that not all medicines could be accounted for numerically and there were gaps in records of medicine administration so we could not be assured people's medicines were being administered as intended by their prescribers. We noted that whilst there was some supporting information available to assist staff to safely administer people's medicines, there was a lack of robust guidance for people prescribed some medicines for occasional use and for people liable to have their medicines given concealed in their food or drink. Whilst we found medicines were being kept securely we could not be assured by records that medicines requiring refrigeration were always being kept at appropriate temperatures. We noted that the competence of staff handling and administering people's medicines had not all recently been assessed but action was already underway to resolve this.

We spoke with 11 people who used the service. We also spoke with the registered manager and four staff members. We looked at six people's daily records. Other records viewed included staff training, supervision and the staff rota. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The staff rota and discussions with the registered manager and staff showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them. One person said, "They (staff) come when I press the buzzer." Another person said, "There is always someone around if I need help."

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I am very happy and well looked after." Another person said, "I have nothing bad to say about the place."

People's daily records showed where people were provided with the care that they needed and when they needed it.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "They (staff) are all very nice."

Is the service responsive?

People's choices were taken into account and listened to. This was confirmed by the people who used the service and their records which showed their choices of when they wanted to get up in the mornings were respected.

Is the service well-led?

The service had taken action to address the shortfalls identified in our inspection of 5 March 2014. The service notified us of action they had taken when they had received concerns about the service provided.

We found that the provider had improved the way they notified us when people passed away and when serious incidents occurred.

The provider had improved the way they stored and accessed their records.

We found that staff had a good understanding of their job role and the actions they would need to take in in case of emergencies, when they suspected abuse and how they would protect people from the risk of infection. The service was still working on providing staff with refresher training to ensure they were provided with up to date information which they needed to meet people's needs effectively. Staff told us that they were well supported but there was no formal supervision process in place. The provider told us how they were going to address this.

We observed lunch time and people clearly enjoyed their meals. They confirmed that they were given choices in what they ate and drank and that soft drinks and water were available as required. Care plans noted people's preferences and dietary requirements. There was some evidence that weight and fluid intake was noted, but records were not accessible so it was not clear that people's food and drink intake was being regularly monitored.

It was not clear that staff had all the training that they needed to carry out their duties. The training records that we were provided with showed that training had not been undertaken in several areas, or that it needed to be refreshed. However, we saw plans for training several staff in safeguarding and manual handling in the near future.

While the provider had kept records of people who had suffered injuries and those who had died, this information had not been provided to the Care Quality Commission as required by law.

The quality assurance process had been developed to include family questionnaires and audits. The manager told us that work was in progress on questionnaires for the visiting professionals and the people who used the service.

Medicines management practices had improved, however, their remains some shortfalls with staff administration practices. The pharmacy technician (PT) from the Medicines Management Prescribing Team from NHS Norfolk & Waveney told us that they would continue to work with the service to help improve their practices.

The human resource policy and practices had been developed to ensure appropriate recruitment and retention practices were in place. Further work was in progress to enhance the training matrix and record keeping.

The overall impression was that the service had started to develop infection prevention and control policies and practices and they were in the early stages of development.