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Inspection carried out on 15 October 2019

During a routine inspection

About the service

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.

Inspection carried out on 24 October 2018

During a routine inspection

Ebberly 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.

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

Inspection carried out on 9 June 2016

During a routine inspection

This inspection took place on 9 June 2016 and was unannounced. The previous comprehensive inspection was completed in December 2014 where we found there were two requirements in two out of the five key areas. The registered manager sent us an action plan to show how they intended to meet these requirements. This included improvements to care plans and the way they recorded the care given to people.

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.

Inspection carried out on 8 December 2014

During a routine inspection

Ebberly House is a care home which is registered to provide care for up to 19 people. The home specialises in the care of older people but does not provide nursing care which is provided by community nurses. There is a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run.

At the last inspection carried out on 22 April 2014 we identified concerns relating to staffing levels and assessing and monitoring the quality of service provision around one issue. These concerns had both been addressed since that inspection.

At the time of this inspection there were 11 people living at the home and three people staying at the home for a temporary respite period . On the day of the inspection there was a friendly and relaxed atmosphere in the home and we saw staff interacted with people in a positive and respectful way. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

There was a management structure in the home which provided clear lines of responsibility and accountability. The registered manager showed great enthusiasm in wanting to provide the best level of care possible and had worked there for many years. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people.

There were some effective quality assurance processes in place to monitor care and plan ongoing improvements. For example, there were systems in place to share information and seek people’s views about the running of the home. People’s views were acted upon where possible and practical. However, although health needs were met and monitored, the care records did not always reflect the care given as daily records were not done daily, sometimes blank for a few days, so there was no clear audit trail of progress for some health needs. This had not been picked up by care plan audits. Medication audits were also carried out but done informally so not recorded using a consistent format, which meant issues had been missed, such as gaps in medication administration recording. Individual falls risk assessments were completed and appropriate action taken but there was no overview of falls to enable patterns to be identified and to monitor the success of preventative actions taken as a whole.

People said the home was a safe place for them to live. One person said, “This is a home from home, we love it!”. A recent thank you card commented, “Thank you for the wonderful way you looked after my father, living so far away it was lovely to know he was so loved and cared for”. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One person said “I don’t have to worry about anything. I wouldn’t change a thing”.

People were well cared for and were involved in planning and reviewing their care although their involvement wasn’t always recorded. There were regular reviews of people’s health and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. Health professionals told us, “Staff respond quickly and know everything they need to about people’s needs. They are very flexible and receptive to our advice”.

Staff had good knowledge of people including their needs and preferences. Staff were well trained; there were good opportunities for on-going training and for obtaining additional qualifications. Comments about staff included “It’s lovely here, the girls are wonderful. Nothing is too much trouble” and “I’ve never met such nice people”.

People’s privacy was respected. Staff ensured people kept in touch with family and friends, one person was being supported to use a lap top to communicate to family and friends and staff were regularly ensuring that people knew who was due to visit them and when. A health professional said, “Things happen quickly here, the home offers something extra and makes people feel good and relatives welcome”. Visitors were coming and going as they wished, for example one relative was taking someone out for a walk during our inspection.

People were provided with a variety of activities and time with staff. People could choose to take part if they wished. One person said “We do lots of things. We made Christmas cards yesterday. There’s a new craft kit and we have sing-alongs. I can go out when I want”. The registered manager said people didn’t have to join in but were given the opportunity. Photographs showed past activities such as carol singing and parties.

There are a number of breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 23 April 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask:

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.

Inspection carried out on 17 September 2013

During a routine inspection

During this inspection there were 13 people living at the home and we spoke with six people about their experiences. Two relatives gave us their views about the quality of the care. We spoke with four staff about their training, support and understanding of people�s needs. As part of a safeguarding process, we also received feedback from care coordinator who had responsibility for people's placements at the home. We spent time looking at key documents including care plans, daily records, maintenance, staff training and quality assurance records.

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.

Inspection carried out on 26 March 2013

During a routine inspection

We found that people were asked for their consent to the care and support they received and their decisions were respected. A staff member told us "I don't feel it is right for me to decide what people should and should not do". Where people were assessed as not having the capacity to make a decision, the appropriate steps were taken to ensure that a decision was made in their best interests.

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.

Inspection carried out on 29 March 2012

During a routine inspection

We carried out this unannounced inspection on 28 March 2012 as part of our planned inspection programme. We spent time at the home talking to seven people who currently live there as well as three members of staff, the registered manager and the registered provider.

We observed how care and support was delivered through different times of the day. We looked at some of the key records kept by the home. These included care plans, risk assessments, medications records and staff recruitment files. This helps us to better understand how well the home was run.

People we spoke with were very positive about their experience at Ebberly House. Comments included ��Staff are really lovely, we have to wait sometimes if we need the toilet but they do their best.�� ''we are treated very well, if something is not right they will sort it out�� �'staff are excellent, I am very grateful for all they do.��

We looked at how well care and support was planned and reviewed. Care plans gave good basic information about what personal, health and emotional care needs people had and how staff should meet these needs. They also included details of risk assessments to show how the home identified managed and minimised any risks for people. Plans had been reviewed and updated to reflect changing needs.

We observed care and support being delivered in a kind and respectful way. Staff we spoke with were knowledgeable about the needs of people they care for. We were told that they had good training and support to help them do their job.

We saw that there was a robust system in place for the safe handling and administration of medications, including use of topical creams and clear recording of any as needed (PRN) medications.

We saw that the recruitment system was robust and helped to protect people.