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Inspection carried out on 26 April 2019

During a routine inspection

About the service: Ellesmere House is registered to provide accommodation with personal care to a maximum of 28 people. The service also offers day care and respite services. The home is situated in a small village in Ellesmere and supports older people, some of whom were living with dementia. At the time of our inspection 18 people were being supported.

People’s experience of using this service:

The atmosphere at Ellesmere House was calm and homely; the registered manager and staff had developed strong, familiar and positive relationships with people. Throughout the inspection staff were seen to be warm and affectionate towards people and approached tasks in a calm and compassionate way. Staff were seen to be genuinely motivated to deliver care in a person-centred way based on people's preferences. Staff treated people with kindness and respect and were seen to use techniques to help relax people with positive outcomes. Everyone we spoke with told us Ellesmere House was homely and that staff were always kind and caring towards them.

People told us they felt safe living in the home. Risks that people faced were identified and assessed and measures in place to manage them and minimise the risk of harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received their medication at the right times. The environment was safe and people had access to appropriate equipment where needed.

Enough suitably qualified and skilled staff were deployed to meet people's individual needs. Staff received a range of training and support appropriate to their role and people's needs. Staff clearly knew people and their needs well and were seen to provide care and support that was based on their needs and preferences. People's needs and choices were assessed and planned for. Care plans identified intended outcomes for people and they were to be met in a way they preferred. People told us they received the right care and support from staff who were well trained and knew what they were doing. People received the right care and support to eat and drink well and their healthcare needs were understood and met. People who were able, consented to their care and support. Where people lacked the capacity to make their own decisions they were made in their best interest and in line with the Mental Capacity Act.

People received personalised care and support which was in line with their care plan. People knew how to make a complaint and told us they were confident about complaining should they need to.

The registered manager was keen to create a community feel within the home and where possible made efforts to engage members of the local community with the service and people living there. The service promoted a positive culture that was person-centred and inclusive. The registered manager was described by staff as approachable and supportive and helped to create a warm and happy environment to work in. Effective systems were in place to check the quality and safety of the service and improvements were made when required.

Rating at last inspection: Good (report published 18 October 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 7 February 2017

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

This inspection took place on 7 February 2017 and was unannounced. The inspection team consisted of one inspector.

Ellesmere House is registered to provide accommodation with personal care to a maximum of 28 people. Most of the people using the service were living with dementia.

A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The acting manager had applied and was going through the process of registration with CQC.

People were confident about the management and staff that supported them in the service. They considered the service had improved for the better. At our last inspection we found that quality systems the provider had in place had improved and were starting to be used more effectively. At this inspection we found that improvements that had been made were being sustained.

Inspection carried out on 24 August 2016

During a routine inspection

This inspection took place on 24 August 2016 and was unannounced. At our previous inspection no improvements were identified as needed.

Ellesmere House is registered to provide accommodation with personal care to a maximum of 28 people. There were 15 people living at the home on the day of our inspection. The home supports older people, some of whom lived with dementia.

No registered manager is in post at the home. 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.

We had previously completed a comprehensive inspection at Ellesmere House on 14 July 2015 and found the provider was not meeting the law. They were in breach of regulations relating to how they obtained people’s consent and also the governance of the service. We gave the service an overall rating of requires improvement. We asked them to take action to make improvements in how they involved people in decision making and how they monitored the quality and safety of the service. We went back again 12 January 2016 to complete a focused inspection on these two concerns. We found the provider had made sufficient improvement to how they involved people in decision making. The provider had not made improvement in how they monitored the quality and safety of the service. Because the provider and registered manager had not made the improvements we had asked them to we issued a warning notice to each of them. A warning notice is issued when registered persons do not meet legal requirements. If they do not meet the conditions of the warning notice we may consider further enforcement action. We gave the provider and registered manager a timescale by when improvements must be made by. We returned to the service 24 May 2016 and completed a focused inspection on this one concern. We found the conditions of the warning notice had been met.

At our focused inspections we did not have enough evidence to show improvement in the overall rating of the service. This comprehensive inspection was completed to ensure the provider had maintained the improvements they had put in place at the focused inspections.

There was no registered manager in post and the provider is recruiting for this role. An interim manager was in place from another one of the provider’s homes. The interim manager had been supported by the provider in implementing and sustaining the improvements needed. However, the provider had not made sure they were meeting all of their regulatory responsibilities in the absence of a registered manager.

Staff had a good understanding of people’s needs and received training to make sure they had the skills to meet people's needs. This training was not always put into practice as staff did not always put their knowledge of delivering person centred care into practice. This was recognised by the manager who identified this as a training need for staff and agreed to take action.

Improvement had been made in how the service captured people’s capacity to make their own decisions about their day to day care. Staff supported people to make their own decisions and asked their permission before supporting them. However, some people required specific measures to keep them safe and not all staff were aware who had these measures in place.

Improvement had been made to make sure people’s changing needs were accurately recorded. People’s needs were assessed and they felt involved in what happened to them. Care was planned and delivered in a way that was individual and personal to them.

Staff had a good knowledge of how to keep people safe from harm and abuse. They understood how to raise concerns about a person’s safety or when they felt they were at risk of harm. Plans were in place to assess and m

Inspection carried out on 24 May 2016

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

This inspection took place on 24 May 2016 and was unannounced.

Ellesmere House is registered to provide accommodation with personal care to a maximum of 28 people. There were 18 people living at the home on the day of our inspection. Most of the people using the service were living with dementia.

A registered manager was not in post. 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.

We previously carried out an unannounced focused inspection of this service on 12 January 2016. A continued breach of legal requirements was found and we issued the provider and registered manager with a warning notice. We told the provider and registered manager they were required to meet the legal requirements by 22 April 2016.

We undertook this focused inspection to check the requirements of the warning notice had been met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ellesmere House on our website at www.cqc.org.uk

After our last inspection we asked the registered persons to take action to make improvements to their quality monitoring systems. Although these were in place they were not always used. We also asked them to take action to address issues we had identified at previous inspections. At this inspection we found that improvement had been made in all areas we had identified as a concern. Action was taken immediately when we found a corridor door open when this was meant to be kept shut. People, relatives and staff had been kept informed of recent changes within the home. They were also encouraged to ask questions, raise concerns and make suggestions for improvements. The provider had improved the systems they used to assess and monitor the quality of care and their effectiveness was kept under review.

Inspection carried out on 12 January 2016

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

This inspection took place on 12 January 2016 and was unannounced.

Ellesmere House is registered to provide accommodation with personal care to a maximum of 28 people. There were 19 people living at the home on the day of our inspection. Most of the people using the service were living with dementia.

A registered manager was in post and was present during 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.

We carried out an unannounced comprehensive inspection of this service on 14 and 15 July 2015. Breaches of legal requirements were found and we gave the home an overall rating of requires improvement. After this comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 11 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ellesmere House on our website at www.cqc.org.uk

After our last inspection we asked the registered persons to take action to make improvements to the way they supported people to make decisions about their own care. At this inspection we found that improvement had been made. People’s right to make their own decisions and choices were supported by staff. Staff and the registered manager understood the procedures they must follow when supporting people to make decisions and when they may need to make decisions on their behalf.

After our last inspection we asked the registered persons to take action to make improvements to their systems to assess, monitor and improve the quality and safety of care. At this inspection we found that improvement had not been made in all the areas we had identified. The registered persons had not completed actions they told us they would and there was confusion about who had responsibility for implementing and monitoring progress against actions plans. Although quality monitoring systems were in place these were not always followed or monitored and action was not always taken when issues were identified.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 14 and 15 July 2015

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

This inspection took place on 14 and 15 July 2015 and was unannounced.

Ellesmere House is registered to provide accommodation with nursing and personal care to a maximum of 28 people. There were 19 people living at the home on the day of our inspection.

A registered manager was in post and was present during 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.

The home was last inspected on 6 and 7 August 2014 where we gave it an overall rating of inadequate. At the last inspection we asked the provider to take action to make improvements to ensure people were protected against risks associated with infection control and management of medicines. We also asked the provider to make improvements to systems relating to obtaining people’s consent, recording why some decisions had been made on people’s behalf and to the assessment and monitoring of the quality of the service provision. We had asked the provider to send us an action plan detailing how they would make the improvements requested. The provider did not send this by the date we had requested and we sent them a reminder for them to do this. We found that most of these actions had been completed but we still had concerns in some of the same areas.

People’s ability to make their own decisions about their care had not been appropriately assessed. Where decisions had been made on people’s behalf there were no records to show why these decisions were in their best interests.

Staff were aware of changes in people’s needs and the support they needed. However, this had not always been updated in their care records.

Systems were in place to assess and monitor the quality of the service provided but they were not always effective in identifying shortfalls. The opinions of the people who lived at the home were sought but the provider did not always act on their feedback in a timely manner. Concerns we had identified at our last inspection had not been fully addressed and similar concerns were found at this inspection.

Staff had received training to enable them to support people safely however, this was not always kept up to date. Checks had been completed on new staff to make sure they were suitable to work at the home.

Staff knew how to protect people against the risk of abuse or harm and how to report concerns they may have. People received their medicine as prescribed and information was available to staff on the support people needed.

People received food and drink which was in accordance with their needs and preferences. Arrangements for meeting people’s health care needs were in place and people saw health care professionals when they needed to.

People’s permission was sought by staff before they helped them with anything and they received care and support when they needed it. Staff treated people as individuals and knew their preferences in relation to their care. People were treated with dignity and were offered choices in a way they could understand.

People and their relatives were involved in developing people’s care plans and identifying their preferences, likes and dislikes. Staff encouraged people to take part in activity sessions and respected people’s wishes not to participate. However, alternatives were not always offered if people were not interested.

Relatives were comfortable to raise concerns or complaints but had not needed to. Staff were aware of the provider’s complaints process and would support people in raising concerns.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 6 and 7 August 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service

This inspection was unannounced which meant the provider did not know we were coming. We conducted this inspection over two days.

Ellesmere House provides accommodation for up to 28 people who require personal care. On the day of our inspection 21 people were living at the home. Most of the people living at Ellesmere House were living with dementia.

The home was last inspected on 19 April 2013. At this inspection the requirements of the Health and Social Care Act 2008 were met. 

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found a number of breaches 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 this report.

We found that people’s safety was at risk of being compromised in some areas. The management of medicines was not ensuring people were protected against the risks associated with medicines.

We found the home’s infection control procedures were not meeting the regulation. Hazardous substances and equipment used in the home were not stored safely and could cause harm to people.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack capacity to make decisions are protected. This includes when balancing autonomy and protection in relation to consent or refusal of care or treatments. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This includes decisions about depriving people of their liberty so they get the care and treatment they need where there is no less restrictive way of achieving this. Under DoLS providers are required to submit applications to a supervisory body for authority to do this. Staff had little knowledge of MCA or DoLS. Staff also did not know how to support people when they could not make their own decisions. This meant that people could be at risk of not having their human rights met and the service not acting in accordance with the law.

Staff were supported in their roles. However, we found that not all staff had received training which would help them meet the needs of the people who had dementia.

Where people had not given consent to their own care and treatment, relatives had consented on their behalf. However, there was no evidence to say why these people had not given their own consent.

We found that the current systems for quality assurance were not driving improvements to the home. We also found concerns during our inspection which the registered manager had not identified. People and their relatives were not fully involved in giving their opinions about the home. Although, quality audits were completed and issues identified, there was little evidence that these findings contributed to improving the service the home provided.

We found that the registered manager had not informed the CQC of two deaths that had occurred in the last 12 months. By law the registered manager must complete statutory notifications and submit them to the CQC for specific events.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 19 April 2013

During a routine inspection

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, �Very good staff� and another said, �The staff are excellent�.

We saw maintenance, repair and improvement work being carried out in communal and private areas within the home. This involved such things as new flooring, decorating and installing new doors in the corridors.

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