Eboracum House

Eboracum House is a residential care home providing personal care for up to 18 people. There were 16 people living at the home at the time of the inspection. Accommodation is provided over two floors in a detached period building with a large garden.

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

Since the last inspection there had been changes in the management team and the service had a new manager and operations manager. The previous registered manager had left the service 8 months ago and the provider had recently appointed the operations manager to oversee improvements at the service until a new registered manager was appointed.

The providers operations manager had now submitted an application to register themselves as the new manager of Eboracum House. We are currently assessing this application.

New systems and processes had been introduced to monitor the service, however new processes required embedding into practice and sustained to continue to drive improvements. Staff felt supported by the manager and told us they were approachable and felt ‘things had improved’ at Eboracum House.

Some actions recommended in the services fire risk assessment, which was completed in October 2022, such as fire evacuation drills had not been completed and personal emergency evacuation plans (PEEPs) required more detail. The manager responded after the inspection. They confirmed all the actions from the fire risk assessment and PEEPS had now been completed.

The home was clean, but areas of the home were tired and required refurbishment and redecoration. The manager shared a refurbishment plan with us, and we could see some refurbishment and redecoration of the home had commenced.

People were safeguarded from the risk of abuse. Risks in relation to people's care were identified and detailed information about how risks could be mitigated. People were protected from the risk and spread of infections. Accidents and incidents were recorded and analysed to identify any trends or patterns. This helped to mitigate future risks and ensured lessons were learned. The provider had a safe recruitment process which assisted them in recruiting suitable staff.

A training plan evidenced staff had received appropriate training to carry out their roles effectively. Competency assessments were also in place for things such as medicine administration.

People's needs were assessed, and care delivered in line with best practice. Care plans and supporting documentation included people's individual choices and preferences. We observed lunch being served and found people were supported to maintain a healthy and balanced diet which included their preferences.

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.

Throughout the inspection we observed staff interacting with people in a caring and considerate way. We saw staff gaining people's consent prior to carrying out care tasks. People we spoke with were complimentary about the care and support they received.

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 23 July 2021). Although we saw improvements had been made, the service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 requires improvement based on the findings of this inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

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

Eboracum House is a residential care home providing personal care for up to 18 people. There were 14 people living at the home at the time of the inspection. Accommodation is provided over two floors in a detached period building with a large garden.

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

Governance arrangements were in place and regular checks and audits had taken place. However, medicine audits had failed to identify the discrepancies in medicines stock levels we found during the inspection. Management oversight had failed to ensure consistent deployment of staff in some identified roles.

Care plans were detailed and had been reviewed regularly.

We have made a recommendation about including and recording people’s involvement in their care planning.

People felt safe living at the home and systems were in place to safeguard people from abuse. People were protected from the risk of acquiring infections by robust infection prevention and controls. The home was clean and odour-free. Lessons learnt were shared with staff during meetings and supervisions.

Training was up to date and staff had started to receive regular supervisions and appraisals. People were supported to eat and drink and had a good choice of food. People’s weight was monitored. Staff ensured people received appropriate healthcare, when needed. People’s rooms were personalised and appropriate signage to support people living with dementia was in place. 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 were caring and supported people with dignity. Staff encouraged people to make choices and supported them to maintain their independence. People’s privacy was respected.

The home was responsive to people’s needs and choices.

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 inadequate (25 January 2021) and there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 25 January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eboracum House is a residential care home providing personal care to up to 18 people. There were 14 people living at the home at the time of our inspection.

Accommodation is provided over two floors in a detached period building with a large garden.

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

Systems were not robust to safeguard people from abuse. Not all risks had been appropriately assessed. Individual plans to support people to evacuate safely in the event of a fire were not readily available. Staff told us, and we observed, staffing levels were not sufficient to support people safely. There was no management oversight of how staff were deployed. Medicines were not administered safely. Staff were wearing PPE appropriately, however cleaning was not well-managed or appropriate to support robust infection prevention and control processes.

Care plans were detailed and had been reviewed regularly, however there was some inconsistency in the information recorded; some information was out of date. Training was not up-to-date and there were inconsistencies in the records kept. People were supported to eat and drink however where people were at risk of malnutrition or dehydration there were inconsistencies about how this was managed. A handbook used to record information about people was not reviewed. Staff recorded when they had contacted health professionals however there were inconsistencies about how this was recorded and how health concerns were followed-up. People’s rooms were personalised and were homely, however personal information abut people was recorded in a visible place outside their room, which did not promote confidentiality, privacy and dignity. There were inconsistencies about whether people had capacity to consent to their care and support, and consent was not consistently recorded. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Governance arrangements were not robust and checks and audits had not identified the issues we found. Manager oversight was not evident. Not all checks and audits were documented. The home manager had not submitted statutory notifications as required. There was no overarching plan to track improvement actions.

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 28 February 2019).

Why we inspected

We received concerns in relation to management of the home, low staffing levels, lack of choice, and poor access to health professionals. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 changed from Good to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Since our inspection visit the provider confirmed they had re-organised folders for DOLS, statutory notifications and safeguarding. The provider has told us they have provided some staff with the opportunity to undertake a senior role and have highlighted on staff rotas to clarify who is responsible for leading each shift. They have also amended handover arrangements so there is manager oversight. This means tasks to support people safely will be managed and overseen. The provider has also organised training in continence care, care planning and record keeping, which will be completed by the end of December 2020. The provider has revised cleaning schedules and put in place checks to ensure cleaning is completed.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to consent, safe care and treatment, safeguarding, good governance, making sure appropriate staff were employed, and making sure there were enough staff to support people safely at this inspection.

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

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme.

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 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Eboracum House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Eboracum House is registered to provide accommodation and personal care for up to 18 people. Accommodation is provided over two floors, accessed by stairs or a passenger lift. Communal lounges and dining areas are provided. The home is a detached period building with a large garden close to local amenities. The care provided is for people who have needs associated with those of older people. On the day of our inspection there were nine people living at the home, two people were living on the first floor the remainder living on the ground floor and two people were staying having respite. Respite care is a short-term stay, often around one to two weeks, in a care home.

Our last inspection at Eboracum House took place on 2 and 7 November 2017. We found the service was in breach Regulation 12, of the Health and Social Care Act 2008 (Regulated Activities) 2014; Safe care and treatment and the service was rated requires improvement overall.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key question asking if the service was safe, to at least good.

The registered provider sent us an action plan detailing how they were going to make improvements.

At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the regulations.

There was registered manager at 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 and associated Regulations about how the service is run.

People living at Eboracum House told us they felt safe and they liked the staff. Staff confirmed they had been provided with safeguarding vulnerable adults training, so they understood their responsibilities to protect people from harm.

We observed that many areas of the home required refurbishment, however the provider had a maintenance programme in place which showed clear timescales of how and when the works were to be completed.

People gave us mixed feedback in relation to staffing levels. We found there were enough staff to provide basic care, but limited time was available to engage with people.

The staff recruitment procedures and checks in operation promoted people’s safety.

We found systems were in place to make sure people received their medicines safely.

Staff were provided with relevant training and supervision to make sure they had the right skills and knowledge to support people.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had access to a range of health care professionals to help maintain their health.

People and health professionals, we spoke with made positive comments about the care provided by staff.

People were treated with dignity and respect and their privacy was protected; a range of activities were available to provide people with leisure opportunities.

People were confident in reporting concerns to the registered manager or staff and felt they would be listened to and their concerns would be addressed.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Staff told us they felt they had a very good team. Staff and people said the registered manager was approachable and communication had improved within the service.

We carried out this inspection to check whether the necessary improvements had been made to the service and found appropriate action had taken place in most areas.

Eboracum House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Eboracum House is registered to provide residential accommodation for older people, including those with dementia, for up to 18 people.

At the time of our inspection the manager was registered with CQC. 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.

Risks to people were not always effectively managed as information recorded in risk assessments was not up to date and consistent with levels of risk.

A staff handover was carried out in the presence of people who lived at the service which did not respect their privacy and dignity. Care records were not securely stored. The registered provider took immediate action to resolve these concerns.

The administration and documentation of medicines did not always follow safe practice. However, other areas of medicine management were appropriately managed.

People felt safe living at Eboracum House. Recruitment processes were robust which meant people were cared for by staff who were suitable to work with vulnerable adults. Staffing levels were appropriate to meet the needs of people who lived at the service.

The recording of people’s mental capacity was decision-specific and staff demonstrated a clear understanding around offering people choice, consent to care and people refusing care. Applications for Deprivation of Liberty Safeguards authorisations had been made where required and authorisations granted by the local authority were all in date.

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 supported this practice.

People were supported to receive timely access to healthcare services. People felt staff were suitably trained and training records demonstrated high levels of completion. Staff were also supported through supervision, appraisals and staff meetings.

People and relatives knew how to complain if they were dissatisfied with the service they received. Complaints were responded to and feedback from satisfaction surveys was on display in the service.

People were satisfied with their meals. Kitchen staff were aware of people’s specific dietary requirements, although records to reflect these needs required updating. The lunchtime meal experience was positive as people were well supported.

People and relatives spoke positively about the care they received from staff. Staff knew how to respect people’s privacy and dignity and we saw this happened in practice.

Care plans were more person-centred at this inspection and included detailed life histories. We recommended the registered provider update some information seen in care plans which was not consistently recorded.

People’s equality, diversity and human rights were considered by the registered provider as part of meeting their care needs.

A programme of audits was in place. Some actions required timescales and confirmation of completion. A home improvement plan was in place which meant there was oversight of the service. The registered manager said she would introduce a safeguarding and complaints log to help evidence learning outcomes in response to such concerns. Not all notifications made to the local safeguarding authority had been submitted to the CQC. You can see how we dealt with this in the main body of our report.

We found a single breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

Eboracum House provides accommodation for up to 18 older people who have personal care needs, some of whom are living with dementia. At the time of this inspection there were 12 people who used the service and one person who was staying at the home for a short period of respite care. Respite care is where a person uses the service for a short period of time.

There was a registered manager in post. They had registered with us in January 2017 and had been in post since November 2016.

Staff had undertaken training in safeguarding vulnerable adults; however safeguarding concerns were not always recognised or appropriate action taken to protect people from harm.

Risk assessments were not risk specific and did not explain the measures which needed to be in place to minimise risks to people.

Medicines were not always managed safely as the medication administration records were not completed correctly or clearly and there was inconsistent monitoring of the temperatures at which medicines were stored.

There were sufficient staff on duty and there was a recruitment policy which was robust but we found one instance where this had not been followed to ensure the member of staff was of good character and suitable to work with vulnerable adults.

All staff had not undertaken all the training they required to ensure they were suitably skilled and knowledgeable to carry out their roles effectively and training was not always refreshed in line with the organisation’s policy. Staff had received some supervision sessions however there had not been any appraisals carried out recently.

The home was not always working in line Mental Capacity Act 2005 and we could not evidence that consent to care had been sought or gained appropriately from people who use the service.

People told us the food was good and we saw people had access to drinks and snacks throughout the day.

Staff were kind, caring and sympathetic; however they did not always protect the dignity of the people they cared for.

Care plans were not person centred and did not contain sufficient detail about people in relation to their preferences, likes, dislikes and needs. Whilst care plans were reviewed each month care plans were not re-written to reflect changes to people’s needs.

The home had an activities coordinator and we saw there were planned activities which people engaged in and enjoyed. However, the activities coordinator only worked part time which meant there were prolonged periods of time where people did not have meaningful activities to occupy them.

Complaints had been recorded, investigated and responded to appropriately.

There was visible leadership within the home as the registered manager was accessible to people and staff during the day. People and staff spoke positively of the registered manager, who they told us was approachable.

Processes to monitor the quality and safety of the service were not effective or consistent and had not addressed the breaches found at the last inspection nor identified the concerns found during this inspection. The registered provider did not have oversight of the performance of the home.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Eboracum House provides accommodation for up to 18 older people who have personal care needs and some of who are living with dementia. There were 16 people living at the home at the time of our inspection.

There was no registered manager at the home. However there was a manager who was in the process of registering with the Care Quality Commission. 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 found the management of medicines was not safe. We found multiple and serious concerns about the storage of medicines and concerns about the records which were kept to show what medicines had been administered to people who lived at the home.

Recruitment processes were reviewed and we found the provider was carrying out appropriate checks which allowed them to make safer recruitment decisions.

The home appeared to be generally clean; however there were areas where malodours were present. There was work in progress to eliminate these odours and the hours for domestic staff had been increased to include weekends to improve the general cleanliness in the home.

We found concerns in relation to the safety of the building with regard to an electrical installations report which had been carried out in June 2015. There were areas of serious concern identified which had not been actioned. The operations manager took immediate action on the day of inspection to ensure this work was carried out.

We saw staff had undertaken a range of training to ensure they had the required skills and knowledge to carry out their roles. Staff received supervision and appraisals and told us they felt supported by the management team.

We found consent to care was not always clearly sought or gained, as care plans were not signed by people to show their agreement to the support they received. We saw no evidence that people or their relatives were involved in their care planning.

The provider had made applications for Deprivation of Liberty Safeguards to be authorised for people who had been assessed as not having the mental capacity to make decisions about where they lived. We were however concerned other people were being deprived of their liberty which had not been recognised as there was a door from the main area of the service to the entrance which some people would not be able to open as there was confusion handles fitted and the top handle was very high up.

People and their relatives spoke very positively about the quality of the food which was served and the variety of meals, drinks and snacks which were available to people throughout the day.

There had been little thought given to the suitability of the environment for people living with dementia, as the bedrooms were not easily distinguishable from each other and corridors were hung with mirrors which people may find confusing and disorientating.

Staff were kind, caring and compassionate when supporting people. We heard friendly chatter throughout the day and staff made every effort to include people in conversations. Staff respected the privacy and dignity of the people who lived at the home and maintained their confidences.

Care plans had recently been re-written and there was some evidence that they were more person-centred, however there were sections which were still missing, these included ‘about me’ and end of life care planning.

Most people felt that activities had improved, although some people told us there was still little going on. There was a recently appointed activities coordinator in post.

Staff morale was good. People, their relatives and staff all told us the manager and the operations manager were visible in the home and were approachable and supportive.

Processes which were in place to monitor the quality and safety of the service were not effective as they had not recognised all the concerns we found during inspection, and in cases where concerns had been identified action had not been taken to resolve the concern effectively and in a timely manner.

We found records were not always filled out correctly and were not filled out consistently. This was the case with Medication Administration Records (MARs), repositioning charts and food and fluid records.

The provider was notifying the Care Quality Commission appropriately of notifiable events and incidents.

The provider was not meeting the requirements of four regulations of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

People were supported to have adequate nutrition and hydration.

During our inspection we conducted a tour of the premises and found it was clean, tidy and free of any unpleasant odours. There were systems in place to reduce the risk and spread of infection.

We found people's needs had been met by sufficient numbers of appropriate staff.

We found accurate and appropriate records had been maintained.