OSJCT Eresby Hall

About the service: OSJCT Eresby Hall is a residential care home. It provides personal care and support for up to 42 older people or people living with dementia. There were 38 people living in the service on the day of our inspection.

People’s experience of using this service:

• People had their risk of harm assessed. Improvements had been made to safety and security since our last inspection. Staff knew how to keep people safe from the risks of harm and abuse.

• People were cared for by sufficient numbers of skilled, competent and experienced staff. Medicines were managed safely. The service was clean and homely

• People’s physical, mental health and social needs were assessed and care was delivered in line with legislation and national guidance. Staff work with other professional groups to deliver effective care and support.

• People’s rights were maintained and staff followed the principles of the Mental Capacity Act 2005.

• People were provided with a nutritious, varied and balanced diet.

• People were cared for by kind, caring and compassionate staff, who treated them with dignity and respect.

• People were enabled to take part in a wide range of individual and group activities.

• There was a robust process to manage complaints and lessons were learnt and improvements made when things went wrong.

• The manager was an approachable and visible leader. There was a positive culture in the service. The manager and their team were committed to improving the quality and standards of care people received. There was a good governance framework, leading to improvements in the service.

The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2017. More information about this is in the full report.

Rating at last inspection: OSJCT Eresby hall was last inspected on 15 December 2017 (report published 30 March 2018) and was rated as requires improvement overall.

Why we inspected: We asked the provider to complete an action plan at our last inspection. We wanted to see if the provider had made progress with their action plan and that the service was safe and well-led.

Follow up: We will continue to monitor intelligence we receive about OSJCT Eresby Hall 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

We carried out this inspection on 15 December 2017. The inspection was unannounced. There were 40 people living in the home at the time of our inspection.

The service was run by a company who was the registered provider. At the time of this inspection the home did not have a registered manager in post. The registered persons had notified us about the reason for the change in manager and had kept us updated regarding the leadership arrangements in place at the home. As part of this inspection the registered persons had confirmed they had appointed a new manager and an application for the new ‘acting manager’ to register with the Care Quality Commission (CQC) was in the process of being submitted. After we completed our inspection the manager completed their registration and was formally registered to manage the home.

A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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. In this report when we speak both about the company the area manager and the registered manager we refer to them as being, ‘The registered persons’.

At the last inspection on 30 October 2015 the service was rated, ‘Good’.

At this inspection the service was rated, ‘Requires Improvement’. We found there was a breach of regulations. This was because the registered persons had failed to assess risks to people’s health and safety and had not done all that is practical to keep people safe. We also found some of the arrangements used to ensure that all parts of the environment were safe were not sufficiently robust. You can see what action we told the registered persons to take at the back of the full version of the report.

In addition we found that improvements were needed to ensure that people reliably benefited from receiving well-led care. This was because the registered persons had not always ensured action was taken quickly enough when things had gone wrong. In addition, quality and environmental safety checks had had not always resulted in identified shortfalls being put right.

Our other findings at the present inspection were as follows:

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.

We found there were sufficient care and nursing staff available to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively, internally and externally.

Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach and there was a friendly, relaxed atmosphere around the home and. People were provided with food and drink that met their individual needs and preferences. The overall physical environment and facilities in the home generally reflected people’s requirements.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

The registered persons had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Through our discussions with staff it was clear they understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, four people who lived at the home were subject to a DoLS authorisation and the registered persons informed us they were awaiting the outcome of a further four applications which had been submitted to the local authority.

People were involved in giving their views on how the service was run and there was a range of audit and review systems in place to help monitor and keep improving the quality of the services provided.

We observed an activity mid-morning. Eight people were taking part. They all supported and encouraged each other. We saw the coordinator praised people for their efforts.

We saw all areas of the home were clean and furniture and equipment was in a good state of repair. People told us the home was always clean. One person said, 'It always smells nice".

Staff told us it was a good place to work. They said they were supported to attend staff and departmental meetings. They told us training good and there was plenty of it.

We asked people if they knew how to complain if they were unhappy with any aspect of life in the home. One person said, 'I have no complaints. The staff always asks if I have any'. Another person told us, 'I'm happy with the care. I'd tell them if I was unhappy'.

We did not speak with people who lived in the home. This was because we were mainly checking records and speaking with staff. We did speak with a relative who was visiting.

The manager had worked hard to ensure compliance with the standard. Training had increased since we visited in November 2012 and reflected the care needs of people in the home. A member of staff told us, 'The training has improved and it is much more flexible.'

Supervision and appraisals sessions had been undertaken for all members of staff and reflected the organisations updated policy on such matters. Induction programmes had been put in place for all staff who had previously not undertaken it.

We saw examples of good care for people who were supported appropriately when it was needed, although people were encouraged to be as independent as possible. All but one care record we looked at were detailed and comprehensive.

People told us they felt safe living in the home and felt someone would do something about it if they didn't. Staff knew what to do if they suspected abuse.

People told us they thought the staff knew how to care for them. Staff felt supported by the new manager in post although training sessions, supervision and annual appraisals were not up to date according to the organisation's policies.

People were asked about their opinion of the service provided by the home and a detailed audit of systems and processes took place on a regular basis. Actions needed were documented.