Archived: Eagle Care Home

At the last inspection in January 2017 we rated the service as ‘Requires Improvement’. However, the service remained in ‘Special Measures’ as the well led domain was rated inadequate and the service had been rated ‘Inadequate’ overall at the two previous inspections in February and July 2016. We identified three breaches which related to notifications, displaying the rating and good governance. This inspection was to check improvements had been made and to review the ratings.

Eagle Care Home provides accommodation and personal care for up to 33 older people, some of who are living with dementia. Accommodation is provided over two floors with communal areas, including three lounges and a dining room, on the ground floor. There were 18 people using the service when we visited.

The home 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.

Following the last inspection the Care Quality Commission (CQC) had agreed the provider could admit new people to the service although any admissions had to be approved by CQC and there was a limit on the number of admissions which could be made each month. The provider fully complied with this condition and the feedback we received from people and relatives at the inspection showed people’s needs were being met. People told us there were enough staff and this was confirmed in our observations which showed staff were available and responded promptly to people.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to CQC. Risks to people were assessed and managed to ensure people’s safety and well-being.

Medicines management systems had improved and were being monitored through regular audits. This helped to ensure people received their medicines when they needed them. Safe recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

People said they enjoyed the food and received plenty to eat and drink. Mealtimes were relaxed and well organised and we saw people were offered choices and given the support they required from staff. A choice of snacks and drinks were provided throughout the day.

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.

The environment was clean, fresh smelling and well maintained. People and relatives praised the care provided and described the staff as ‘kind’ and ‘marvellous’. People were treated with respect and their privacy and dignity was maintained. People looked clean, comfortable and well groomed. People told us they enjoyed the activities.

People were aware of how to make a complaint and the complaints procedure was displayed.

People’s care records were detailed, up to date and person-centred. We saw people had access to healthcare professionals such as GPs and district nurses.

People, relatives and staff praised the improvements that had been made since the last inspection. Everyone knew the registered manager and spoke highly of them acknowledging their leadership had resulted in better outcomes for people. Effective quality assurance systems were in place and we saw actions had been taken when issues had been identified.

Although the overall rating for the service is ‘Good’ we have rated the well-led section as ‘Requires Improvement’. This is because of the inspection history of the service since February 2016 and the current low occupancy with only 18 people accommodated out of the 33 places which are registered. We therefore need to be assured the improvements identified throughout this report will be sustained and developed further so that when occupancy levels increase people will continue to receive a consistently high standard of quality care.

At the last two inspections in February and July 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. Following the inspection in February 2016 we told the provider they must improve. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) were made aware of our concerns and the provider had agreed to a voluntary suspension of placements.

At the inspection on 6 July 2016 placements at the home remained suspended and although some improvements had been made we found continued regulatory breaches. We identified seven breaches which related to staffing, recruitment, dignity and respect, nutrition, person-centred care, safe care and treatment including medicines and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Eagle Care Home provides accommodation and personal care for up to 33 older people, some of who are living with dementia. Accommodation is provided over two floors with communal areas, including three lounges and a dining room, on the ground floor. There were 15 people using the service when we visited, although one of these people was in hospital.

The home did not have 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.

The registered manager who was in post when we inspected in July 2016 left the service in September 2016 and the company director took over the management of the home. The company director was not present at this inspection and the area manager told us a new manager had been appointed who was due to start in post a few days after the inspection. Following the inspection the provider informed us the new manager had not taken up the manager’s post and a company director would be pursuing registration with the Commission as registered manager of the service. The area manager and support manager were present at this inspection.

We found there were enough staff to meet people’s needs as the staffing levels for most of the day were the same as at our last inspection when there were eight more people living in the home. At our previous inspections people had used all four of the communal areas and we had found there were not always staff available. At this inspection people stayed in the main lounge and dining room where staff were present, and the other two lounges were not used.

People told us they felt safe. Staff had a good understanding of safeguarding procedures and we saw incidents had been reported, dealt with and referred to the local authority safeguarding team but had not always been notified to the Commission as required. Risk management had improved and we saw detailed plans in place which showed how risks were mitigated.

Improvements had been made in the way medicines were managed, which ensured people received their medicines as prescribed. However, we found stock balances were not always recorded accurately and there was some conflicting information about the quantity of thickener to be used in one person’s drinks. The support manager told us these would be addressed.

The home was generally clean, although we noted an odour in one of the lounges. The home was well maintained although we found restrictors put in place to limit how far the windows could open were not effective as they could be removed and the windows could be opened fully which posed a risk to people. The support manager told us they would raise this with the provider.

People were offered and assisted with a choice of hot and cold drinks throughout the day. Food and fluid charts were more fully completed to show what people had had to eat and drink. Some aspects of the dining experience had improved as we saw staff were present and gave people the support they need with meals and drinks. However, the choice of meals was limited and although the cook told us there were other alternatives available we saw these were not offered or provided to people.

Staff recruitment processes had improved and we saw thorough checks were being completed before new staff began working at the home. New staff were given an induction which the area manager told us was based on the Care Certificate although we were not assured this was the case as there was no evidence of observations or competency assessments.

Staff had received training updates and further training was booked. Supervisions and appraisals had lapsed although some supervisions had recently been completed and dates had been planned in for the rest of the year.

The support manager was aware of the legislative requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Ten people had DoLS authorisations. Yet we found although some conditions were being met, a condition applied to one authorisation had not been implemented, which was what we had found at our previous inspection. Similarly training in MCA and DoLS which we had been told was planned in for all staff had not been completed. Only three staff had received this training since the last inspection.

New care documentation had been put in place which was person-centred and provided more detailed information about people’s needs. However, this was not always up to date. For example, the care records for one person showed they had an infection and described the precautions staff had to take when providing care, yet our discussions with the area manager showed this was not correct.

A daily programme showing a range of activities was displayed. Activities were provided by the care staff. A relative told us they thought the provision of activities had improved since the last inspection.

People and a relative told us staff were good and caring and we saw this ourselves. Staff knew people well, were patient and kind in their interactions and took time to engage with people. People’s privacy and dignity was respected and their independence promoted.

Staff told us the home had improved, they felt supported in their roles and said things were better organised. A relative told us they thought the home was more organised and cleaner. Recent survey results showed relatives were satisfied with the service provided.

Quality assurance systems had been introduced and needed embedding to ensure continuous improvements. The systems in place to manage accidents and incidents had not improved since the last inspection as it was not always clear what the outcome was and there was no analysis to identify trends or look at lessons learnt. The area manager told us they were planning to introduce a system for this.

The area manager told us the required notifications had been made to the Care Quality Commission about events and incidents that had occurred in the home. However, we found we had not been notified about six safeguarding incidents or a serious injury incident. This meant the provider had not fulfilled their legal obligation to notify us of these incidents and meant we could not be assured the provider was working transparently to allow us to monitor ongoing risks at the service.

The provider is required to display the inspection rating for the most recent report in the home and on their website. We found the rating was displayed in the home but not on the provider's website, which was the same as we had found at our previous inspection.

We identified three breaches of regulation - regulation 17 (good governance), regulation 18 (notification of incidents) and regulation 20A which requires the provider to display the rating.

Although some improvements had been made at this inspection the overall rating for this service had previously been ‘Inadequate’ and the service retains a rating of inadequate in the well led domain. The service therefore 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.

At the last inspection on 8 and 12 February 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We identified seven regulatory breaches which related to safeguarding, staffing, consent, dignity and respect, nutrition, person-centred care, safe care and treatment including medicines and good governance. Following the inspection we took enforcement action. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) were made aware of our concerns and placements at the home were suspended. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Eagle Care Home provides accommodation and personal care for up to 33 older people, some of who are living with dementia. Accommodation is provided over two floors with communal areas, including three lounges and a dining room, on the ground floor. There were 23 people using the service when we visited.

The home has a registered manager who has been in post for over two years and was present at the 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.

Although we found some improvements had been made to the care people received in areas such as safeguarding, activities and the cleanliness of the environment, we found a number of regulatory breaches remained.

We found there were not always enough staff on duty to keep people safe and meet their needs. Although the provider told us they had worked out they were overstaffed by nine hours, they were not able to show us how these calculations had been made. We found there were times during the inspection when staff were not available to meet people’s needs. We found shortfalls in the recruitment procedures had not been identified or resolved by the provider.

Risks to people were not managed well. For example, we found some staff did not know the correct procedures to follow in the event of a fire. Safeguarding had improved as staff had received training and knew the reporting procedures. We saw incidents were recognised, dealt with and reported appropriately.

Medicines management was not always safe which meant people were at risk of not receiving their medicines when they needed them. A medicine error occurred on the day of the inspection, which was recognised promptly and the correct action taken. However, the correct administration procedures had not been followed and if they had the error would not have happened.

We found the home was clean and improvements had been made to the environment such as new flooring, better lighting and a new call bell system.

We saw the provision of food and drinks for people who got up early had improved and saw people were offered early breakfasts. However, we still had concerns about how people’s nutritional needs were being met as records showed some people were often eating and drinking very little and had lost weight. We found food and fluid charts were not monitored or reviewed to make sure people were receiving sufficient to eat and drink.

We found staff had received training since the last inspection in areas such as safeguarding, first aid and basic life support. However, gaps remained and the provider was unable to provide us with up to date information about the training staff had received. Systems were in place to ensure staff received regular supervision and appraisals.

The registered manager was aware of the legislative requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Six people had DoLS authorisations, although we found conditions applied to the authorisations had not always been implemented. Staff had not received training in MCA and DoLS although we were told this was planned.

People had access to healthcare services although we found staff were not always prompt in contacting healthcare professionals when people’s needs changed. Care was not planned or delivered to meet people’s individual needs.

We observed some kind, caring and sensitive interactions between staff and people who used the service. However, we found examples which showed a lack of respect for people and compromised their dignity. The provision of activities had improved. The home employed and activities co-ordinator and we saw there were a variety of activities and events provided for people.

People and staff told us improvements had been made since the last inspection and we found the home was more organised. However, quality assurance systems were not fully embedded or robust which is evident from the continued breaches we found at this inspection.

We found continued shortfalls in the care and service provided to people. We identified six breaches in regulations – regulation 18 (staffing), regulation 12 (safe care and treatment), regulation 14 (nutrition), regulation 10 (dignity and respect), regulation 9 (person-centred care) and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Eagle Care Home provides accommodation and personal care for up to 33 older people, some of who are living with dementia. Accommodation is provided in over two floors with communal areas, including three lounges and a dining room, on the ground floor. There were 27 people using the service when we visited on the first day and 26 people on the second day.

The home has a registered manager who has been in post for over two years and was present on both days of the 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 found there were not enough staff on duty during the day and at night to keep people safe and meet their needs. This had been raised at the previous inspection and although the provider told us staffing levels had been increased this had not been sustained. We found some staff were working excessively long hours which placed people at risk of unsafe care from staff who were tired. On the second day of our visit the area manager told us staffing levels had been increased but this was only as a result of our intervention.

Risks to people were not managed well. For example, we found three people had sustained several falls yet there were no risk management plans in place to show how people were being kept safe. Safeguarding incidents were not always recognised, dealt with or reported appropriately.

Medicines management was not always safe which meant people were at risk of not receiving their medicines when they needed them.

We found the home was not clean and infection control procedures were not being followed by staff.

People’s nutritional needs and weight were not monitored or reviewed to make sure they were receiving sufficient to eat and drink. When we arrived in the morning people who were already up told us they were thirsty and hungry, yet had been given no drinks and had to wait until the cook came on duty for breakfast, which in two cases was three hours after people had got up.

The training matrix showed staff were up-to-date with most training, however a significant number had not received refresher training in fire safety and moving and handling. Systems were in place to ensure staff received regular supervision and appraisals.

The registered manager was aware of the legislative requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Two people had DoLS authorisations and conditions applied to the authorisations had been implemented.

People had access to healthcare services although we found staff were not always prompt in contacting healthcare professionals when people’s needs changed. Care was not planned or delivered to meet people’s individual needs.

We observed some kind, caring and sensitive interactions between staff and people who used the service. However, we found examples which showed a lack of respect for people and compromised their dignity. Some activities were provided which we saw people enjoyed, yet there was little to occupy and interest people at other times.

We found there was a lack of effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved and any improvements made were not sustained.

Overall, we found significant shortfalls in the care and service provided to people. The regulatory breaches we identified at the inspection in February 2015 remained and further breaches were identified at this inspection. We identified seven breaches in regulations – regulation 18 (staffing), regulation 12 (safe care and treatment), regulation 10 (dignity and respect), regulation 13 (safeguarding), regulation 14 (nutrition), regulation 9 (person-centred care) and regulation 17 (good governance).

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. 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.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe-

When we inspected the service in March 2014 we found the registered care provider did not have effective systems in place to ensure records relating to people's care and treatment provided accurate and up to date information.

On this inspection we found there had been a general improvement in the way records relating to people's care and treatment were completed and maintained. However, we saw at least once instance when there had been a significant change in a person's behaviour but the care plan had not been amended to reflect this. In addition, we found some fluid and food intake charts did not always provide accurate information. This was discussed with the manager who confirmed the matters raised would be addressed as a training issue.

We found people's needs were assessed and their care and treatment was planned and delivered in a way which ensured their safety and welfare. Each person's care file had risk assessments in place which covered areas of potential risk such as managing behavioural problems, mobility, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

The manager and area manager told us they were familiar with the requirements of the Mental Capacity Act 2005 (MCA). They also told us they were aware of the recent Supreme Court judgment on the Deprivation of Liberty Safeguards and the impact this had on service delivery.

Effective -

People had an individual care plan which set out their care needs. We saw wherever possible people had been involved in the assessment of their health and care needs and had contributed to developing their care plan.

The home had a good working relationship with other health care professionals and followed their guidance and advice. The input of other health care professionals involved in people's care and treatment was recorded in their care plan.

Caring '

When we inspected the service in March 2014 we found people who used the service were not involved in making decisions about their care and treatment and their privacy and dignity was not respected.

On this inspection we found the manager had spoken with the staff at length about the importance of respecting people's privacy and dignity and how this should be reflected in the care and support they provided. This showed us the manager was had taken the matter seriously and had taken appropriate action to address the concerns raised.

We saw staff generally approached people in a way which showed they knew the person and had positive interactions with them. We saw occasions where staff provided support to people and explained how they were going to assist them and talked them through the process. However, we also found that some people with more complex needs, such as those who were unable to communicate their preferences through speaking, received less staff attention and interaction than those people who were more independent. We spoke with the manager about these observations and they assured us they would speak with all staff about how they engaged with people.

We found the staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. They told us they encouraged people to remain as independence as possible within a risk management framework.

People who were able told us they were happy with the care and support they received. One person said "I have no grumbles, it is very comfortable here and I am well looked after." We spoke with the relatives of two people who used the service and they also told us they were pleased with the care and support provided. One person told us they had no concerns or complaints about the service or the staffing levels at the home. They said that although their relative could be "difficult" the staff coped with them very well.

Responsive '

People's needs were assessed and care and support was planned and delivered in line with their care plan. Care records contained good information about how care and support should be delivered.

Wherever possible people who used the service and/or their relatives were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

Well led '

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

The manager told us they also operated an open door policy and people who used the service and/or their relatives were aware they could contact them at any time if they had concerns. However, they acknowledged the most recent complaints/concerns raised by relatives of people who used the service had either been made directly to the Commission (CQC) or the Local Authority Safeguarding or Commissioning service. This demonstrated to us that people were either unaware of the internal complaints procedure or were reluctant to use it because they felt their complaints would not be dealt with appropriately. This was discussed with the manager and area manager who confirmed they would take steps to address this matter.

During our visit we spoke with the Area Manager, two team leaders, a care assistant and domestic. We also spoke with two people who used the service and four relatives. Following the visit, but as part of the inspection we also spoke with a further three members of staff.

During our visit we looked in the communal areas of the home and five bedrooms. We also looked at a selection of records kept by the service, including four people's care records, people's food and fluid intake charts and weight records.

We spoke with staff about staffing levels at the home. Three members of staff told us night staff had a list of people they had to get up each morning. This meant people's individual likes and preferences were not being respected and people who used the service were not being enabled to make their own decisions about when they chose to get up in the morning.

One person who visited the home told us, 'The laundry often gets mixed up. People have worn other people's clothes. X's are all named and I have seen other people wearing them.'

During our visit we observed staff were busy but did not appear pressured. We overheard staff speaking to people who used the service in a discreet, professional but friendly manner.

Accurate and up to date records were not maintained.

One person's file recorded their interests as including; gardening, dominoes and cards. It also noted they enjoyed watching animal documentaries, gardening and current affairs programmes. Between the 14 March 2014 and 24 March 2014 the only activity recorded was 'watched tv'.

An accurate record of people's supplementary nutritional intake was not being maintained on people's food and fluid records.

"The staff are marvellous, they really try to look after us well but they are so busy".

"We couldn't ask for better staff, I even like the boys (male staff) helping me".

"Sometimes it takes the staff a long time to come to help me and my buzzer in my bedroom isn't working. I have to shout but I don't think they always hear me".

"We have always thought the care here is good".

" I would have liked to have had a shave today today but they were very busy and I can't do it myself"

" I have been waiting a long time for them to take me to the toilet".

"The food is very good and we could not ask for better carers"

We found that people received good care, although care planning and review was not up to date.

People received a good diet which met their preferences although some people did not receive the support they needed.

The home was clean and tidy but chairs were in need of deep cleaning.

Staffing was not always adequate to meet the needs of the people living at the home.

Care records were not all up to date.

We saw that medicines were handled safely.

Both the relatives we spoke with commented that staff were always welcoming and friendly. One relative told us they had looked around several care homes but chose Eagle Care Home because 'It had a good feel about it.'