Keychange Charity Erith House Care Home

People’s experience of using this service:

People using the service benefitted from a kind, caring and committed staff team. People and their relatives told us they were treated with kindness, compassion and respect.

We observed positive and compassionate interactions between staff and the people they supported. People were able to be as independent as they wanted and were also provided with prompt, sensitive support when needed.

People were placed at the heart of the service and were as far as possible involved in decisions about their care and lifestyle. People and their relatives told us they were listened to and their care was provided in a way they wanted and preferred.

People’s care was delivered safely and people said they felt safe living at Erith House. The staff team was consistent, employed in sufficient numbers and had the skills and training to understand and meet people’s needs safely and effectively.

People’s risks were understood and managed well. People’s rights and independence were respected and promoted. Management and staff understood their role with regards to the Mental Capacity Act (2005). People’s consent was sought before care and support was provided. When people were unable to consent, and make decisions for themselves appropriate processes were followed. People were protected from discrimination and abuse and staff understood how to safeguard people.

People lived in a home that was well maintained, comfortable and designed to meet their needs. Consideration had been given to supporting people to occupy their time and maintain relationships with family and friends. Relatives were made to feel welcome and were kept informed about issues relating to their loved one’s care.

People lived in a service, which had a positive culture and was led by committed and enthusiastic staff and management. Management and staff had good relationships with health and social care professionals and liaised with these services to help ensure people’s full range of care needs were met.

The provider’s values were available for people to see and included, “We seek to deliver services of the highest possible quality and constantly improve through listening, reflecting, learning and action”. We found the culture and atmosphere of the home warm, welcoming and inclusive. Staff were valued for their contribution and their ideas and were listened to and respected.

Systems had been developed to ensure performance remained good and continued to improve.

Rating at last inspection: At the last inspection the service was rated as Good. The last report was published in November 2016.

Why we inspected: This was a planned inspection. The service remained Good.

Follow up: We have made a recommendation in relation to the environment and the needs of people living with dementia. We will continue to monitor this service to ensure people receive safe, compassionate, high quality care.

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

This unannounced inspection took place on 19 and 21 October 2016. The service was last inspected in December 2013 when it met the regulations that were inspected.

A registered manager was employed by the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager of the service was registered to manage another Keychange Charity service in the local area. They were supported in their role by a deputy manager in each service.

We received a mixed response from people and staff when we asked if there were enough staff on duty at all times. Some people and staff felt there were enough staff available, while others felt there were times when there was not. During the inspection we saw people’s needs being met in a timely way and call bells were answered quickly.

We have made a recommendation relating to staffing levels.

People received individualised personal care and support delivered in the way they wished and as identified in their care plans. Although people’s care plans contained repeated information, they did have all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed.

People’s needs were met by kind and caring staff. One person told us “I’ve never been happier, everything about it (Erith House) is right.” One relative told us staff “care about people as individuals.” We saw many ‘thank you’ notes from families, expressing their gratitude to staff. For example, one note said ‘A heartfelt thanks for the exceptional care you gave our mum over the years.’ People’s privacy and dignity was respected and all personal care was provided in private.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet and they told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals.

Not everyone wanted to be involved in planning their care. We saw that where people or their relatives wished to take part in planning care they could. Relatives told us that staff always kept them informed of any changes in their relative’s welfare.

Activities and outings were on offer if people wished to participate. One person told us they did not want to participate and preferred reading in their room or the garden. Other people told us how much they enjoyed the visiting entertainers. One visitor told us they were pleased their relative had the choice about taking part in activities. They said they felt the service “encouraged but did not pressurise” their relative to join in.

Staff confirmed they received sufficient training to ensure they provided people with effective care and support and meet their needs. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with vulnerable people.

The registered manager was very open and approachable. People were confident that if they raised concerns they would be dealt with. People, relatives, staff and healthcare professionals spoke highly of the registered manager. People and staff the registered manager was good, approachable and would listen to them. One person told us that although the home was well managed, they missed seeing the registered manager as much now they had two services to look after. They said they “feel better when she is around.”

There were effective quality assurance systems in place to monitor care and plan on-going improvements. Monthly audits were undertaken including medicines, care plans and accidents and incidents. Records were well maintained.

We spoke with some family members of people who use the service and we were told "I am very happy with the service, they keep us informed and always ask if we are ok about something they plan to do". This showed us that people's wishes and preferences were listened to and action taken to meet their requests and needs.

We saw that all relevant safety and maintenance checks had been made. We read environmental risk assessments and noted that there where robust security arrangements in place to protect the people living and working at the service.

We found that the staff were well qualified to do the job expected of them and that they were given opportunities to gain additional qualifications to enhance their learning.

There were sufficient robust systems in place to effectively monitor service provision. Records were kept and updated and any necessary changes were implemented without delay.

People living at the home we spoke with told us they were looked after very well. One said 'The ethos here is kindness, everyone is exceptionally kind'.

Assessments of people's needs had been completed and care was planned and delivered accordingly. People's needs were reviewed and appropriate referrals were made to health professionals. People's rights were protected when they were unable to make decisions for themselves. Systems were in place to protect people from abuse.

Staff had the knowledge and skills to meet people's needs. They were employed in sufficient numbers.

People said they knew how to complain and felt satisfied complaints would be dealt with appropriately.