Archived: Ennis House

Ennis House is a residential care home that can provide personal care for up to 40 people. There were 25 people living at the home at the time of the inspection, some of whom were living with poor metal health.

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

The quality assurance system implemented before the previous inspection remained in place. Some environmental improvements had been made. However, due to the impact of COVID-19 further time was needed for these to be fully implemented and embedded into everyday practice. The care manager was aware of this.

Infection prevention and control measures were in place to help keep people safe. These were well thought out, changes were made as identified and in line with current guidance.

There was a relaxed and friendly atmosphere at the home, staff knew people really well. Feedback from those involved with the service was positive. Relatives thought well of the provider and staff.

Rating at last inspection

The last rating for this service was requires improvement (published 12 December 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had regarding complaints about the service. We also wanted to ensure that environmental improvements previously identified had been maintained.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit.

Ennis House is a residential care home providing personal and nursing care for up to 40 people. It is made up of three houses that have been joined together. At the time of the inspection 34 people were living in two of the houses, with only two rooms used in 'Oakleigh' and the third house not in use.

People were living with a range of mental health needs or dementia. Some were independent and required minimal assistance, whilst other needed support with personal care and to move around the home safely.

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

People said they were comfortable and felt safe at Ennis House. Staff knew people very well, they understood their needs and how to provide the support people wanted. The ethos of the home was to provide person centred support and empower people to make decisions about their day to day lives.

Since the last inspection the quality assurance system had been reviewed and several audits had been introduced to monitor the services provided. These had identified areas where improvements were needed, and action had been taken to address them. However, additional work was needed to ensure that when the monitoring process found areas that may put people at risk, they were dealt with immediately, and that the improvements we have seen since the last inspection are embedded into day to day practice. For example, the debris that had accumulated in the garden and adjoining building.

The safeguarding policy had been updated, staff had attended relevant training and knew what action they should take if they had any concerns. Audits had been used to identify any trends or themes for accidents or incidents, to reduce the risk of them re-occurring, and action had been taken to reduce the risk of infection.

Induction training had been developed in readiness to support new staff. There was ongoing training and supervision to ensure staff were aware of their roles and responsibilities, and they developed the skills and understanding to provide the support people wanted and needed.

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. Mental capacity assessments had been completed in relation to decisions regarding people’s care and staff understood Deprivation of Liberties Safeguards (DoLS) authorisations, and applications had been made in people’s best interests.

People were supported to eat a healthy diet and access health services when they needed them. A range of activities were offered, based on people’s preferences and choices and people were supported to decide how and where they spent their time.

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 with six breaches of regulation and we took enforcement action (Published 29 May 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

People at the home were living with a range of complex mental health care needs and dementia. Most people were independent and needed minimal assistance while others required some assistance related to their personal care and day to day support.

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

People’s experience of using this service:

The provider lacked effective quality assurance systems to identify concerns in the service and drive necessary improvement. Where the need for improvement was identified these were not always addressed in a timely way. Improvements were needed to the recruitment of new staff.

There was a reliance on the care manager for oversight of the service. In their absence staff did not have access to all the information they may need.

The home was in need of general maintenance throughout. Infection control procedures were not always being followed to prevent spread of infection. A fire risk assessment had been completed however, we found an area of the home that had not been included in this risk assessment.

People were not consistently protected against the risk of abuse. There was a lack of oversight of incidents. This had resulted in reoccurring incidents not being recognised and therefore had not been reported as a safeguarding concern. There was no overview or monitoring of incidents, accidents and safeguarding to identify any trends or themes for individuals or the home in general.

Mental capacity assessments had not been completed in relation to key decisions which had been made regarding people’s care. There was no information about whether people had capacity or whether decisions had been made in their best interests. Staff were unable to tell us whether people had Deprivation of Liberties Safeguards (DoLS) authorisations in place or if applications had been made.

Some people were able to independently engage in activities of their choice. However, improvements were needed to ensure people, who were less able, were able to access a variety of meaningful activities. There was no guidance for staff about how people could be supported to maintain their interests.

The provider had identified staff had not all received the training updates they needed and not all staff had received supervision. This was being addressed at the time of the inspection and a plan was in place to ensure this was completed. Staff told us they felt well supported.

Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff about individual and environmental risks.

People were supported by staff who treated them with kindness, respect and compassion. Staff understood people’s needs, choices and histories and knew what was important to each person. People were enabled to maintain their independence and make their own decisions and choices about what they did each day.

People were supported to receive their medicines safely and when they needed them.

People's health and well-being needs were met. They were supported to have access to healthcare services when they needed them. People's dietary needs were assessed, and people were provided with a choice of freshly cooked meals each day.

Rating at last inspection:

Requires Improvement. (Report published 18 April 2018.)

The provider sent us an action plan and told us how they would address these issues.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found that whilst some improvements had been made to the environment further improvements were needed. We also found further areas of concern that required improvement.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also continue to monitor intelligence we receive about the service until we return to visit as per our re-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

At our previous inspection in March 2015 the service was rated ‘good’ in all areas.

Ennis House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ennis House provides personal care and accommodates up to 40 people in one adapted building. At the time of the inspection there were 33 people living at the home. People at the home were living with a range of complex mental health illnesses. Most people were independent and needed minimal assistance and others required some assistance related to their personal care and day to day support at the home.

The home is managed by a registered provider who was supported by a care manager. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found improvements were required to ensure the provider is meeting all of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home was in need of maintenance and general redecoration throughout. The provider and staff were aware of what was required, however no or limited action had been taken. There was a lot of ‘clutter’ at the home. This had not been taken into account when assessing risks to people. Risks in relation to infection control and fire had not been safely managed.

Although there was a training programme in place not all staff had received the training in line with the provider’s policy. Quality assurance systems were not always effective at identifying and addressing areas that needed to be improved in a timely way.

Care documentation did not always support individual and person centred care. It did not reflect the support people received and required. Improvements were needed to ensure people were able to access a variety of meaningful activities.

Despite these concerns there were also positive aspects of the service. People were supported by staff who knew them well. They understood people’s individual needs and preferences. Staff were committed to ensuring people lived happy lives.

Medicines were managed appropriately and people received the medicines they had been prescribed. People’s nutritional needs were assessed and met and they were supported to enjoy a variety of food and drink of their choice.

There were enough staff on duty, who had been appropriately recruited, to meet the needs of people. Staff had a clear understanding of the procedures and their responsibilities to safeguard people from abuse.

Staff had an understanding of the Mental Capacity Act 2005 and DoLS assessments had been made to determine peoples’ capacity. Appropriate referrals were made to the local authority if people needed to be deprived of their liberty to ensure their safety and well-being.

There was a positive culture at the service. People spoke highly of the staff team. They told us staff were kind and caring. People were supported to maintain and develop relationships and friendships that were important to them. People’s dignity and privacy was respected.

People were supported to attend healthcare services and maintain good health. A complaints procedure was in place and complaints were responded to appropriately.

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

We spoke with eight people who lived at the home. People told us they were comfortable and did not have any concerns about the home.

We spoke with one visitor, three members of staff and the provider during the inspection. We looked at the garden areas, the internal environment of the home including bedrooms, and the cleaning schedule.

We found that since the last inspection carried out on 28 May 2014 some improvements had been made. However, we identified at this inspection that further improvements were required to ensure that the premises were suitable and safe for people who lived at, were employed at or visited Ennis House.

We spoke with ten of the people who lived at the home. People told us that they were very happy living at Ennis House. One person said, 'The staff are excellent, they know how to look after us'. Another person told us, 'I feel safe here, the staff know what I need'.

We spoke with five care staff, the administrator and the provider. We reviewed four care plans and associated documentation; we looked at the complaints book and the complaints procedure, safeguarding policies and staff training records, and we looked at the premises.

We considered our inspection findings to answer 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?

Is the service safe?

We found during our inspection that people were safe, their rights and dignity had been respected; staff had attended training and knew how and when to report safeguarding concerns. There were policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although no applications were in place at the time of the inspection.

Is the service effective?

We found during our inspection that the service was effective. Staff we spoke with demonstrated an understanding of people's specific needs, and we observed staff supported people to maintain their independence and make choices.

Is the service caring?

We found during our inspection that the service was caring. We observed that people were supported by respectful and kind staff.

People's preferences, interests, and diverse needs were supported. We saw how some people chose to go into the town centre; one person preferred to watch television and people chose to spend time in their rooms and in the lounge areas of the home.

Is the service responsive?

We found the service to be responsive during our inspection. Staff were available to support people when needed, whilst allowing people to decide how they spent their time.

Is the service well led?

We found during our inspection the service was well led. Staff we spoke with said management was very supportive, and were available at any time if they had any concerns.

There were processes in place to ensure that people, wherever possible, were supported to give informed consent about the care they were receiving.

People had their individual needs and wishes recorded in a plan of care. Improvements were needed to ensure that care was clearly recorded and carried out to a consistent standard.

The home's staff worked with a variety of healthcare professionals including local doctors and mental health teams.

In order to ensure that people were being kept safe from risk of abuse. Improvements were needed to the way identified concerns are responded to and managed.

In order to ensure that people are living in a safe and hygienic environment, improvements were needed to the repair, decoration and furnishings in the home.

Staff were only employed following a structured recruitment and interview process and relevant checks were carried out prior to them starting work.

There was a complaints policy in place. In order to ensure that people's concerns were fully addressed, improvements were needed to the way complaints are recorded and acted upon.