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Eversleigh Residential Care Home Good

Reports


Inspection carried out on 12 July 2018

During a routine inspection

This inspection took place on the 12 July 2018 and was unannounced. Eversleigh Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing, or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Eversleigh Residential Care Home provides personal care support and accommodation for up to 30 older people, some of whom have physical or mental health needs and/ or live with dementia. At the time of our inspection there were 20 people using the service. There was a manager in post and they were in the process of registering with the CQC to become the registered manager for the service. 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.

At our last inspection of the service on 25 and 30 August 2017 the service was rated as Requires Improvement. This was because we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines were not always managed, stored and administered safely and appropriately.

At this inspection we found the service had made the required improvements and demonstrated that they met the regulations and fundamental standards.

Medicines were now managed, administered and stored safely. Risks to people were assessed and managed safely by staff. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take. There were systems in place to ensure people were protected from the risk of infection. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed to meet people’s needs in a timely manner.

There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals that enabled them to fulfil their roles effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of the importance of seeking consent and worked within the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The home environment was suitably adapted to meet people’s needs and equipment was available for people who required it. People’s nutritional needs and preferences were met. People told us they had support to access to health and social care professionals when required.

People and their relatives told us staff treated them well and respected their privacy and dignity. People were involved in making decisions about their care and had care plans which reflected their needs and preferences. There was a range of activities available to meet people’s interests. The service worked in partnership to provided care and support to people at the end of their lives where possible. People’s care plans were reviewed and monitored on a regular basis to ensure they were reflective of their current needs. People and their relatives were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met. There were systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered. People, relatives and staff spoke positively of the care and support provided and the management and running of the home.

Inspection carried out on 25 August 2017

During a routine inspection

This inspection took place on 25 and 30 August 2017 and was unannounced. We visited the service early in the morning as we had received concerns about staff levels during the night. At our last inspection of the service on 6 and 7 June 2016 we found the service to be meeting regulatory requirements and was rated 'good'. Eversleigh Residential Care Home provides personal care support and accommodation for up to 30 older people some of which have physical or mental health needs. At the time of our inspection there were 26 people using the service.

There was a registered manager and home manager in post at the time of our inspection. 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.

At this inspection we found a breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not always managed, administered and stored safely. Staff did not always receive appropriate training updates when required that enabled them to fulfil their roles effectively and this required improvement. There were systems and processes in place to monitor and evaluate the service provided, however these were not always robust or effective and did not identify the issues we found at the inspection. This required improvement.

There were staff recruitment practices in place. Risks to the health and safety of people were assessed and reviewed in line with the provider's policy. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were suitable numbers of staff on duty to meet people’s needs. Staff new to the home were inducted into the service appropriately. Staff received supervision and appraisals of their work performance.

There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required. People were treated with respect and their support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint. People using the service and their relatives were asked for their views about the service to help drive improvements.

Inspection carried out on 6 June 2016

During a routine inspection

This inspection took place on 6 and 7 June 2016 and was unannounced. When we last visited the service on 1 and 2 June 2015 we found the service was meeting the regulations. However, it was rated as Requires Improvement as we were unable to monitor the full effectiveness of some of the providers newly established systems and processes that were implemented to address areas of concern at our previous inspection on 10 and 13 October 2014.

Eversleigh Residential Care Home provides personal care support and accommodation for up to 30 older people. At the time of our inspection there were 18 people using the service. There was a registered manager in post and a newly appointed manager was due to register with the CQC. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

Risks to the health and safety of people using the service were identified, assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place to protect people from possible abuse and harm. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately. Staff received training that enabled them to fulfil their roles effectively and meet people’s needs. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People were supported to maintain relationships with relatives and friends. People’s support needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.

There were systems and processes in place to monitor and evaluate the service provided. There was a registered manager in post at the time of our inspection and they were knowledgeable about the requirements of a registered manager and their responsibilities with regard to the Health and Social Care Act 2014. People’s views about the service were sought and considered through residents meetings and satisfaction surveys.

Inspection carried out on 1 & 2 June 2015

During a routine inspection

This inspection took place on 1 and 2 June 2015 and was unannounced. We had previously carried out an unannounced comprehensive inspection of the service on 10 and 13 October 2014 when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2010). These were in relation to assessing and reviewing people’s care and welfare, respecting and involving people, medicines, procedures to manage foreseeable emergencies, systems to monitor the safety of the premises and equipment. The provider sent us an action plan detailing the action they would take to meet these legal requirements. We carried out this inspection to check the action plan had been completed and to provide a review of the rating for the service. Following the inspection in October 2014 the local authority imposed a suspension of new placements at the service which remained in place at the time of this inspection.

At the time of our inspection there was a registered manager in post and a new permanent manager due to commence. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider. Eversleigh Residential Care Home provides personal care support and accommodation for up to 30 older people. At the time of our inspection there were 23 people using the service.

At this inspection we found that action required had been taken and improvements had been made. However we were unable to monitor the full effectiveness of some of the systems and processes that were implemented to address areas of concern as most were recently established.

People told us they felt safe living at the home and we observed call bells were effective and were answered promptly by staff. Risks to the health and safety of people using the service were identified, assessed and reviewed in line with the provider’s policy.

There were systems and processes in place to deal with foreseeable emergencies and the environment and equipment was checked on a regular basis to ensure they were safe. Medicines were administered and stored safely.

Staff recruitment procedures were safe and there were appropriate safeguarding adults policies and procedures in place. Incidents and accidents involving the safety of people using the service were recorded and acted on appropriately.

People were supported by staff that were appropriately supported to deliver care and treatment safely. Staff received appropriate training and supervision to support them in their role.

There were systems in place to assess and consider people’s capacity and rights to make decisions about their care and treatment in line with the Mental Capacity Act 2015 and Deprivation of Liberty Safeguards.

People‘s nutritional needs and preferences were met and people had access to appropriate health and social care professionals when required.

People told us staff were caring and supported them well and care plans demonstrated that people were involved in making decisions about their care and lifestyle choices. Staff responded to people sensitively when offering support and respected their privacy and dignity.

People were assessed to receive care and treatment that met their needs and care plans were reviewed on a regular basis to ensure this. People told us they felt confident in raising concerns and they would be listened to.

There were systems in place to monitor the quality of the service provided and people were provided with the opportunity to give feedback about the service or raise concerns.

Inspection carried out on 10 and 13 October 2014

During a routine inspection

This was an unannounced inspection that took place on the 10 and 13 of October 2014. At the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

Eversleigh Residential Care Home provides personal care support and accommodation for up to 30 older people who are elderly and frail. The home was built in 1888 and has undergone many improvements to the original house. At the time of our inspection there were 22 people using the service.

The provider had several managers in post over a period of approximately 18 months but none completed their probationary period or registered with the Care Quality Commission before leaving the home.

During our inspection we found that the provider had breached several regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People’s safety was not always assured in some areas. We found risks associated with the providers call bell system. Staff were unable to explain how current staff or a new member of staff could identify which room or person was calling for assistance.

People’s Personal Emergency Evacuation Plan’s lacked detail and did not state the individual support people may require in an emergency. There were also inconsistencies within the provider’s fire evacuation procedures and arrangements.

People’s risk assessments were not up to date and had not been reviewed on a monthly basis in line with the provider’s policy. The service did not always follow safe practice with regards to the storage and recording of medicines. There were no systems or processes in place to monitor the safety of the premises and equipment used to minimise the risk to people using the service.

The service was not always effective in meeting the needs of people. Restrictions such as locked key coded doors were imposed on people living at the home. The home failed to consider people’s ability to make informed decisions as required under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The service was not aware of the changes in DoLS practice and did not ensure the appropriate assessments were undertaken to ensure people were not unlawfully restricted.

Staff training had not been kept up to date. Therefore staff were not adequately trained and supported to acquire and maintain skills and knowledge to meet people’s needs effectively. We also noted that staff did not receive frequent and adequate supervision and appraisal to enable them to meet their roles effectively.

People were supported to arrange and attend health and social care appointments to maintain their physical and mental health care needs. Visiting health care professionals such as dentists, dietician’s, opticians and chiropodists were requested when appropriate.

The service promoted healthy eating and this was reflected in people’s care plans. Staff monitored people’s weight on a frequent basis and we saw that requests for involvement from dieticians were made if staff were concerned about people’s nutritional intake.

People using the service were not always involved in making decisions about their care and treatment. There was little evidence to demonstrate that staff enabled people to be able to make choices about the care and support they received and to ensure they were agreeable. People appeared clean, appropriately dressed and well cared for. People told us that they liked living at the home and staff were very caring.

The provider was not always responsive to people’s needs. Although people’s needs had been initially assessed and care plans developed, records did not always effectively guide staff so they could meet individual’s needs appropriately. For example, care plans we looked at did not always provide detailed information about how to manage people’s physical and mental health needs and were not person focused or responsive to people’s preferences, personal history, choices, cultural needs, religious beliefs and sexual orientation. However an effective complaints system was in place.

The provider had systems and processes in place to monitor areas of the service such as infection control, administration of medicines, care plans and nutrition. However, we noted that quality monitoring audits had not been completed for some time and others had not been used at all. There were processes in place for reporting incidents and accidents and we saw that these were being followed.

Inspection carried out on 14 April 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask providers when we visit to inspect a service; is the service caring, responsive, safe, effective and 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, speaking with staff supporting them and from looking at records. If you want to see the detailed evidence supporting our summary please read the full report.

Is the service caring?

During our inspection we observed staff supported and interacted with people displaying patience, care and understanding. People who used the service were appropriately dressed and had been supported with their personal care and choices regarding their meals and activities for the day.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. During our inspection we reviewed people's care plans and other records. We observed that they contained people’s personal information, photographs, physical and mental health history and life histories detailing their family and professional lifestyles. This provided staff with an overview of individuals needs and enabled them to engage with people in an appropriate manner.

Is the service responsive?

We spoke with the acting manager who informed us that the home was reviewing all care plans with each person using the service as they were introducing a new care plan format. The acting manager advised us that the new care plans have a more holistic approach. They informed us that the new care plans will also include an end of life care plan and detailed mental capacity and best interest assessment. Care and treatment was planned and delivered in a way that protected people from unlawful discrimination. Peoples care plan included information about individual needs in relation to age, sexuality, gender, culture, religion, disability and ethnicity so that these needs would be addressed and met within the home environment.

Is the service safe?

People told us that they felt safe within the home's environment and well cared for by staff who they said were caring and attentive. One person told us “The home is brilliant. The staff make it such a happy home. Everyone is so caring and understanding of my needs. I know how to complain or express any concerns but I have never needed too”. Care records we examined showed that people’s needs had been assessed and regularly reviewed to ensure that people continued to receive the level of care they needed to remain safe.

All care plans and records we looked at had been developed and reviewed with people who use the service. We observed that all care plans were signed in agreement by people using the service. People who use the service that were unable to consent or be fully active in their care plan development were represented by family members or their next of kin as appropriate.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had appropriate policies and procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We spoke with the acting manager. They had good knowledge and awareness of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. The acting manager informed us that they are a qualified trainer in the Mental Capacity Act and we found staff had been trained to understand when an application should be made. This means that people will be safeguarded as required.

Is the service effective?

At the time of our inspection there were thirty people residing at Eversleigh Residential Home. Due to their needs, some people we met were unable to share direct views about their care. Therefore we used our SOFI (Short Observational Framework for Inspection) tool during lunchtime in the main dining room located on the ground floor of the home. This tool helped us to see what people’s experiences were mealtimes are. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. We found that overall people had positive experiences. Staff members supporting people knew what support they needed and they respected their wishes if they wanted to manage on their own. We observed positive staff interactions with people who used the service which were characterised by kindness and facilitation.

We looked at care plans for people using the service. Nutritional screening tools were part of people’s care plans and were completed and reviewed at frequent intervals. People at risk of poor nutrition or fluid intake were identified. Risk assessments had been completed for people using the service which detailed special nutritional needs and potential risks during meal times. For example they detailed any assistance people required during meal times, equipment required during meal times and the likes and dislikes of individuals.

Is the service well led?

We observed staff undertaking tasks and providing care and support to people in a competent manner. People in the home interacted positively with staff. People we spoke with using the service told us they were happy with the care and support they received within the home. One person we spoke with described their care workers as "Perfect". Another person told us “I love living here; all the staff make it such a happy home”.

We looked at the records for staffing arrangements and found there were enough qualified, skilled and experienced staff to meet people's needs. We spoke with the acting manager who was new to the service. They told us that the service had good staff retention and a stable experienced team of staff. We spoke with one member of staff who explained to us that most members of staff had been employed at the home for many years.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. People who use the service, their representatives, visiting professionals and staff were asked for their views about the care and treatment provided within the home and they were acted on. We spoke with the acting manager who told us people using the service had regular meetings with their keyworker where their views and experiences of the care and support they receive were sought. Care plan records we looked at for people using the service confirmed these meetings took place.

Inspection carried out on 16 May 2013

During a routine inspection

We spoke with people using the service and staff at the home during our inspection. People told us they were very happy living at the home and staff were always polite and respectful. One person told us ''the food and staff are excellent'' Another person said "the staff are the tops". A relative told us that the staff communicate well and action any changes requested in a reasonable time frame.

We found that people were consulted with about their care and encouraged to be independent where able. Staff had a good knowledge of how to respond to any safeguarding concerns and people told us they felt safe living in the home. We found that people’s care and support needs were met and staff understood the support individuals required. Support was in place to ensure that staff received adequate supervision and training. The provider had a system in place to regularly assess and monitor the quality of service that people received.

Inspection carried out on 16 May 2012

During an inspection to make sure that the improvements required had been made

People said that they felt well cared for and that staff were kind and caring.

Inspection carried out on 17, 18 October 2011

During an inspection to make sure that the improvements required had been made

The people we spoke to told us that staff were kind and caring. They said that they felt well cared for by staff. However, we found that people did not always experience safe and appropriate care that met their needs. The home could not demonstrate that staffing levels were adequate at all times. People who used the service could not be assured that important events that affected their welfare, health and safety were always reported to the Care Quality Commission. In addition, people could not always be confident that their records were accurate and fit for purpose.

Inspection carried out on 1 June 2011

During a routine inspection

We found that people were satisfied with the care that they were receiving and generally had positive things to say about living at the home. They said that staff respected their privacy and dignity. People were allowed to care for themselves and participate in activities of their own choice. They liked the food and said that they were always offered a choice. Some people had dietary requirements and we found that the home catered for this. People said that they found the home to be a clean and pleasant environment. They also said that they got their medication when they needed it.

Reports under our old system of regulation (including those from before CQC was created)