Archived: Ebberly House

Ebberly House is a residential care home providing personal care to and support to 15 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

Ebberly House is a large end of terraced house with bedrooms on three floors and stair lift to access all floors.

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

People and their relatives said Ebberly House provided people with safe, compassionate and respectful care and support. Comments included, “This is a really lovely home, people all lovely, very giving and forgiving, and very supportive, encouraging, sincere. Everything more than you can ever expect from any person.” One relative said, “Staff are wonderful.”

Most risks to people's safety were assessed and managed well, however this was not always the case. Risks from hot water outlets had not always been fully audited. Also individual personal evacuation plans had been developed but were not easily accessible in the event of an emergency. Following feedback the registered manager and provider acted swiftly to address these areas.

We found the audit for medicines needed some improvement and issued a recommendation. There was no direct impact and low risk for people. By our next visit to the service, the audit had been improved.

Since the last inspection the registered manager and the deputy had completed in-depth training in understanding people’s rights. 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.

There were sufficient staff with the right skills and support to meet people’s needs and wishes.

People enjoyed a variety and choice of meals. Their healthcare needs were closely monitored and the service worked in partnership with other professionals to achieve good outcomes for people, including end of life care.

Staff provide a varied programme of activities taking into consideration peoples past and their hobbies and interests. Some staff came in on their own time to provide extra visits and support to enable people to access the local community.

People, staff and family found the registered managers approach to be open and inclusive. The service used various methods to ensure peoples views were heard and acted upon.

Rating at last inspection and update: The last rating for this service was requires improvement (published 27 November 2018 ) and there was a breach of regulation. 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Ebberly House is two joined, adapted houses. The service is registered for a maximum of 19 people. Many people using the service are elderly and frail and some live with dementia. The home provides accommodation over two floors. There were 18 people using the service at the time of this inspection.

The service 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.

This inspection took place on 24 and 25 October 2018 and was unannounced.

At the last comprehensive inspection in June 2016 the service was rated Good overall, because we found no concerns. At this inspection we found the evidence could no longer support that rating and now the overall rating is Requires Improvement.

Why the service is rated Requires Improvement.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS). Registered person’s running a care home are required by law to make DoLS applications if people using the service are not free to leave and/or are under constant supervision. People were receiving care and treatment in their best interests but this was not recorded and the registered manager had not made any applications for DoLS. This had also been raised at the previous inspection in June 2016 but had not been progressed. Those applications were made following our feedback, however one application was made for a person who did have capacity to make decisions. This showed there was still some lack of understanding of the Mental Capacity Act.

People were safeguarded from abuse because staff knew how to report any concerns and the registered manager understood their responsibilities. However, some staff did not receive safeguarding training. The registered manager said this would be corrected.

The ethos and culture of the service was one of kindness and caring, which was led by the registered provider and registered manager, who were very visible at the service. People and their family members spoke highly of the care provided and expressed complete faith in the management and staff.

There were arrangements should a person want to make a complaint, but people said there was nothing to complain about.

People’s safety was promoted through the arrangements for staff recruitment, staff numbers, medicines management and safety within the premises. The standard of cleanliness was very high.

Staff training had been innovative, helping staff and people’s family members understand what it was like to live with dementia. Staff received support in their role and regular supervision.

Staff knew people’s individual needs and people received a service, which took their individuality into account, such as meeting disability and faith needs. Each person had a detailed plan of their needs and wishes and how staff should ensure those needs were met. Plans included assessment and management of risks, so people’s safety was promoted.

People’s health was closely monitored and staff responded quickly if concerned. People’s family members praised the end of life care provided at Ebberly House, one saying, “We trusted them. Staff were so kind.” Staff had received specialist training in this.

People praised the food provided and people’s dietary needs were closely monitored.

People enjoyed each others company and the friendliness of staff. There were some regular activities arranged for people and opportunities for celebration were not missed.

People’s views were sought through day to day contact, a monthly review of their care plan and a recent survey, which included people’s family, staff and professionals external to the home.

There were some systems in place to monitor the standard of service, such as medicine and record checks and safety checks within the building.

We found one breach of Regulations in 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 the report.

The service is registered to provide care and support for up to 19 people. Most people using the service are older and some are living with dementia. At the time of this inspection there were 18 people living at Ebberly House.

There was a registered manager in place. 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 had been at the service for over 20 years and been registered as the manager for several years. She and the staff team work hard to ensure people receive safe, effective and compassionate care. The registered provider visits the service frequently to provide support and to ensure the environment is safe and well maintained.

People and their relatives were very complimentary about the care and support they received and about the leadership of the home. Comments included ‘‘Staff are lovely, very kind, very caring.’’ Another said ‘‘Yes staff are good here, very kind and always have a laugh and a joke with you.’’

Care and support was well planned by a staff team who understood people’s needs and were supported and trained to do their job effectively. Care records were more detailed than seen during the previous inspection, which showed improvements had been made.

People were kept safe because staff understood what may place people at risk and what types of abuse to watch for. Staff were confident about how to report abuse and that the registered manager took all concerns seriously and acted on issues quickly and appropriately. Recruitment was robust which ensured only staff who were suitable to work with vulnerable people were recruited.

Medicines were being appropriately managed and monitored. Where minor errors had been made, these had been picked up quickly via audits. We found one error during the inspection, which was quickly rectified and had minimal impact on the person concerned.

There were enough staff with the right skills to meet people’s needs in a timely way. Staff showed a caring attitude and approach to people. Staff confirmed they had good training and support to do their job effectively.

People were offered a wide variety of meals, snack and drinks throughout the day. Where people had been identified as being at risk of losing weight, additional monitoring measures were in place to ensure they were offered extra snacks and support to eat sufficient amounts to stay healthy. People were complimentary about the food. One person said ‘‘I can’t fault the food, we even had a curry last week which some of us really enjoyed.’’

Well managed systems were in place to ensure the quality of care and support were continually reviewed and monitored. Where improvements were needed, prompt action was taken to drive up improvements.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 16 people living at Ebberly House. The summary is based on conversations with six people living at the service, one relative, four staff, the manager and the provider. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people. Following the inspection we spoke with the community nurse team who make regular visits to the home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found care and support was being well planned. The manager had made the decision she would no longer provide emergency respite placements following an accident which occured as a result of the service not receiving full and accurate information about the persons needs. This meant new people being admitted to the home always had detailed assessments completed to ensure staff understood their individual needs.

Care was delivered by a staff group who understood the needs of people they supported, but it was not always safe because there were key times when there were insufficient staff to ensure the safety and well being of people throughout the home. For example around tea time there were two staff on duty for up to 19 people. During this period, staff needed to prepare and service the evening meal as well as attend to people's personal and health care needs.

We found the quality monitoring systems and checks needed to be more robust to ensure people's safety. For example, the coroner reported that a contributory factor to a death was a wardrobe falling on a person. The home's own weekly checks had not identified all possible risks which could cause injury. The provider took immediate action when we identified the risks but had not identified the risk using their own quality monitoring.

Is the service caring?

People received a caring service. People we talked with during this inspection described care staff as ''Kind and helpful''. One person told us ''Most staff are wonderful, they can't do enough for you.''

When we talked with staff about people's needs, we heard how they worked with people in a supportive way to encourage their independence as much as possible. We observed care staff supporting people in a kind and respectful way. One relative told us she was ''very impressed with the level of caring from staff, they went out of their way to ensure x final days were comfortable and they died with dignity and with people who knew them and cared from them.''

Is the service effective?

The service was effective because it was clear from people we spoke with they were happy with the way care and support was being delivered to them. One person told us ''I spend all my time in my room, staff respect this and assist me when I call them and check on me at regular intervals.''

Staff we spoke with had a good understanding of people's needs and wishes and could describe ways in which they had adapted their care to accommodate people's changing needs. Where people had increased healthcare needs, it was clear from records that health care assistance had been sought. The community nurse team said people were referred to them in a timely fashion and staff listened and acted upon their advice. This meant people received effective health care where needed.

Is the service responsive?

The service was responsive to people's needs and wishes. For example where people's needs had changed, care plan information had been updated and equipment had been considered. One person told us ''Since I have become less mobile, they have put grab rails up for me, and they now provide the commode next to my bed instead of assisting me to use the en-suite, which I find too far to get to now.''

Is the service well led?

The manager has been in post for a number of years but due to an error in transferring information when re-registering under the Health and Social Care Act 2008, their manager's registration did not transfer over. She is now in the process of re-registering. Staff we spoke with said they felt well supported by the manager and in their view the service was being well led. However we found gaps in the quality monitoring which had not picked up areas in the home which could make the environment unsafe. This meant the service was not always well led.

We saw accident and incident reports showed a pattern of falls occurring around tea time when there were two staff on duty. The provider had not then looked at staffing levels to see the current arrangements met people's needs and dependency levels.

We followed up two areas where improvements had been required at the last inspection. We found that the provider had set up robust systems for monitoring and recording staff supervision, training and health and safety checks around the home. This meant the provider was compliant.

People told us they felt ''safe, comfortable and well cared for.'' A relative told us ''We're very happy with the quality of care here'. The home was clean and well maintained. One person commented 'we have superb rooms, which are very cosy'.

Staff told us they enjoyed working at Ebberly House and were 'encouraged to lots of training'. All of the records gave a good overview of how staff monitored people's physical and emotional well-being and reflected what people's needs were. Quality assurance records showed the provider had sought and acted on people's feedback and learning from their own monitoring systems.

The provider was compliant with all of the five outcomes we looked at.

People we spoke with told us that their care was planned and delivered in line with their needs and preferences. A person told us "everything here is perfect for me - I couldn't wish for a better place". A visiting social worker told us "staff are always approachable and friendly - the feedback has been very positive, it's very homely".

People told us they felt safe in the home and staff demonstrated they understood the signs of abuse and how to report any concerns. We saw that risks to people's safety and wellbeing were acted on by the manager in order to protect people from harm.

People told us that staff were kind and respectful and one person said "they know what they are doing". The majority of staff had completed a National Vocational Qualification in Health and Social Care.

We have asked the provider to make sure that staff are properly supported to carry out their responsibilities in delivering care to the appropriate standard.

We found that improvements were required to the systems for monitoring the quality and safety of the service.