Enderby Grange

Enderby Grange is a residential care home providing accommodation for people who require personal care to up to 40 older people, some of whom are living with dementia. The service is a purpose-built home, providing bedroom and communal rooms on both the ground and first floor. At the time of our inspection there were 33 people using the service.

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

Visiting professionals and many staff said communication could be improved to ensure all staff were up to date as to people’s health, wellbeing, and care needs.

A majority of family members told us the management team listened and acted upon any issues they raised. People spoke of their confidence to raise concerns, and of the positive relationships they had with the management team and care staff. Staff told us they worked effectively as a team and that the management team supported them.

People and most family members were complimentary about the care.

The provider had systems in place to monitor and improve the quality of the service provided. The provider sought the views of relatives, and working with other stakeholders, including social and health services.

Potential risks to people were assessed and kept under review. Measures were put in place to reduce potential risks and included learning from incidents, for example; increased monitoring and observations of people by staff who had been identified as being at high risk of falling.

People were supported by sufficient staff who had undergone a robust recruitment process and had undertaken training in topics to promote their safety. Medicine systems and practices were managed safely. People lived in an environment which was well maintained and clean, with safe infection and prevention measures.

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. People spoke of their independence being promoted.

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 20 May 2022).

Why we inspected

We received concerns in relation to the medicine management, infection control and the management of risk in relation to people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 the same based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Enderby Grange 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.

Enderby Grange is a purpose built residential care home providing accommodation and personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 40 people. Care is provided across two floors and there are several communal areas.

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

People felt safe and staff understood their responsibilities to protect people from abuse and avoidable harm. Risks were assessed and managed. Staff were recruited in a safe way and there were enough staff to meet people’s needs. People received their medicines in a safe way.

People had their needs assessed and staff considered their protected characteristics under the Equality Act to make sure these could be met.

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 had the training and support they required to meet people’s need. Staff knew people well and communicated with people effectively and provided Person centred care and support. People told us staff were kind and caring and involved them in making decisions about their care and support.

People, staff and relatives said managers were supportive, accessible and approachable. Quality monitoring was effective, people were asked to provide feedback and this was used to drive improvements.

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 January 2020). 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

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

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

We found the following examples of good practice.

¿ There was a separate isolation area in the premises to prevent cross contamination and the spread of the COVID 19.

¿ People were supported to maintain contact with family members and friends via phone and video calling.

¿ Staff were observed to wear the correct Personal Protective Equipment (PPE) in line with government guidance. PPE was accessible throughout the service.

¿ Cleaning schedules had been increased to ensure high touch surfaces were cleaned regularly. Additional cleaning had been introduced to maintain good hygiene standards.

¿ The service had adequate space to enable people to socially distance within the service.

¿The service had an up to date infection control policy.

Further information is in the detailed findings below.

Enderby Grange is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of the inspection. The service can support up to 40 people. Care is provided across two floors and there are several communal areas.

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

There were still not always enough staff to ensure people’s safety and meet their needs. Some people told us they had to wait for support at certain times of day. Following inspection, the registered manager advised us of action taken to improve staffing levels and ensure people’s safety.

Overall, improvements had been made to ensure people were protected from risks associated with their care and support. Some further work was needed to ensure people received consistent support in relation to their behaviour. The registered manager took swift action to address this. People were protected from abuse and improper treatment. The home was clean and hygienic and measures were in place to reduce the risk of infection. People received their medicines as prescribed and staff were recruited safely.

Since our last inspection, improvements had been made to auditing systems. This meant these systems were now effective in ensuring the safety and quality of the service. People, staff and others were involved in the running of the home and we received positive feedback about the management team. There was a positive culture at the home and effective partnership working to improve the quality of care.

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 11 October 2019) and there were multiple breaches of regulation.

We served a warning notice, in relation to safe care and treatment and staffing. The warning notice told the provider they must become compliant with the legal regulations by 7 October 2019. The provider also completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made, but further improvements were still required to ensure there were enough staff.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which an allegation of abuse was raised. This incident may be subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people’s behaviours. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the ‘Is the service safe’ section of this full report.

This inspection was also carried out to follow up on actions we told the provider to take at the last inspection.

As a result of the above, we undertook a focused inspection to review the Key Questions of Safe and Well Led only. We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider still needed to make further improvements in relation to staffing. Please see the ‘Safe’ section of this full report.

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

Enderby Grange is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 40 people. Care is provided across two floors and there are several communal areas.

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

There were not always enough staff to support people promptly and safely. Staff did not have enough time to plan and engage people in activities on a regular basis. People did not always receive individualised support when they were distressed, and their privacy was not always maintained. People were not always protected from the risk of harm and lessons were not always learnt from when mistakes happened. Staff did not always demonstrate they had the training and skills required to support people safely and with dignity. We made a recommendation around ensuring staff were skilled in doing this.

Care plans did not always have up to date personalised information about people’s preferences, including the care they wanted at the end of their lives. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way and in their best interests; the policies and systems in the service did not support this practice.

The oversight and governance of the home was not always effective in resolving areas which required improvement. CQC did not receive all of the information we require to be able to monitor how certain incidents are managed and resolved.

Staff were recruited to ensure that they were safe to work with people. The environment was clean and hygienic, and staff understood how to minimise the risk of infection. It was an accessible, well maintained building.

People received their prescribed medicines safely. There were links with healthcare professionals to attend to any health needs promptly. People had nutritious meals and their weight was closely monitored.

The registered manager was approachable and there were opportunities in place which encouraged people and staff to give their feedback. People and relatives knew how to raise a concern or make a complaint.

More information is in the full report.

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 1 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe staffing levels and safe care, consent to care, person centred care and governance 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.

This inspection took place on 24 January 2017 and was unannounced. We returned announced on 25 January 2017.

Enderby Grange is a care home that provides residential care for up to 40 people. The home specialises in caring for older people including those with physical disabilities and people living with dementia. At the time of our inspection there were 35 people who used the service.

The service had 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.

People who used the service were safe. They were supported and cared for by staff that had been recruited under recruitment procedures that ensured only staff that were suited to work at the service were employed.

People did not have concerns about their safety and staff knew how to protect them from abuse and avoidable harm.

People's care plans included risk assessments of activities associated with their personal care and support routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

People received their medicines as prescribed. The registered manager had made arrangements for the safe storage and handling of medicines. Only staff that were trained handled medicines.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights. There were people at Enderby Grange who were being cared for under Deprivation of Liberty Safeguards.

People enjoyed the food that was offered to them and were supported to maintain a healthy diet. They could choose what they ate and their preferences and requirements were known and met by staff.

People had access to healthcare professionals when they needed them.

People told us they were treated with dignity and respect. People’s care plans were centred on their individual needs. Their care and support was based on these. People knew how to raise concerns if they felt they needed to. People were confident they would be taken seriously by the provider.

People had access to a variety of activities if they chose to take part.

Staff meetings and meetings for the people using the service and their relatives had been held and surveys had been completed. This provided people with the opportunity to be involved in how the service was run.

The quality assurance procedures were used to identify and implement improvements to people's experience of the service.

We found people were able to make informed decisions about their care and support. One person told us the staff are 'thoughtful and kind. They always ask for my consent and I feel involved in my care.'

We found people experienced care and support that met their needs and protected their rights. We found people's care needs had been assessed. Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.