Archived: Eagle Nursing Home

Eagle Nursing Home 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.

The service is registered to provide accommodation for up to 29 older people or people living with a dementia type illness or mental health problems. On day one of our inspection there were 23 people living in the service.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Since our inspection the registered manager left the service.

We last inspected the service in January 2017. The service was rated requires improvement.

On this inspection we found five breaches of the regulations. This was because the registered provider failed to ensure that there were systems and processes in place to assess, monitor and improve the quality and safety of the service to keep people safe.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was not always enough staff on duty with the right skill mix to keep people safe and respond to their care needs in a timely manner. People were at risk of harm from poor infection control practices, environmental issues and poor management of risk factors. Medicines management was not always practiced safely.

The provider followed national guidelines to lawfully deprive a person of their liberty. Care staff often worked on their own initiative without supervision and visible leadership. People were not always provided with their choice of food or with a balanced and nutritious diet.

People and their relatives were not involved in planning their care. Care was not person centred, but was task orientated. Staff had little insight into the needs of people with cognitive problems and poor spatial awareness. There was a high staff turnover and people did not always know the staff looking after them. Staff treated people with dignity.

People did not always receive personalised care that was responsive to their needs. Staff did not acknowledge their likes and dislikes. People lacked social and emotional stimulation. Individual faith beliefs were acknowledged. People received compassionate care at the end of their life.

There was a lack visible leadership and effective role models to support inexperienced staff. The provider did not have a clear vision or philosophy to promote a positive culture. The providers approach to quality assurance and clinical governance processes were inconsistent and ineffective and did not lead to improvements in the care people received. The provider did not carry out the correct safety checks when recruiting staff.

At the last inspection the service was rated ‘Good’.

We carried out this unannounced inspection on 25 and 26 January 2017.

A newly appointed manager was in post who had not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the home. 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.

During our inspection we found some areas in which improvement was needed to ensure people were provided with care that was safe, effective, caring, responsive and well-led and that the provider's regulatory responsibilities were being met in full.

This was because the registered provider had not ensured the arrangements for the safety, housekeeping and maintenance of the building were consistently being planned for and managed.

People and their relatives were not fully involved in planning how they wished their care to be provided. People were supported to make decisions for themselves. However, when people needed help to make specific decisions about how care was provided information about which decisions had been made and by whom had not been fully reflected in the care records. Care plan reviews did not give clear enough information about the effectiveness of the care plan, who had been involved in the reviews or any actions planned or taken after reviews had been completed. We also observed some of the care was task led rather than person focused.

Although people were supported to have access to the food and drinks they needed to keep them healthy the menus were not varied and access to a range of meal options and choices for people was limited.

The provider’s quality assurance and audit systems were not reliably or consistently managed so as to enable them to quickly identify and resolve shortfalls in the services provided for people.

In other areas, the provider was meeting people’s needs effectively.

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. 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 this inspection seven people who lived in the home had their freedom restricted in order to keep them safe and a number of other people were awaiting the outcomes of their assessments for a DoLS authorisation. The registered persons had acted in accordance with DoLS guidance to ensure people had their rights protected.

Staff understood how to identify report and manage any concerns related to people’s safety and welfare. Staff knew how to manage and minimise any identified risks and care was supported through staff communicating with a range of visiting health and social care professionals. Clear arrangements were also in place for ordering, storing, administering and disposing of people’s unused medicines.

The registered provider had clear recruitment processes in place and background checks had been completed before new staff were appointed to ensure they were safe to work at the home. Staff were well supported by the new manager to provide care in a way which ensured people’s needs were met and they were provided with training to develop their knowledge and skills.

The provider, manager and staff recognised people’s right to privacy, respected confidential information and there were systems in place for handling and resolving formal complaints. When individual concerns or complaints were raised with them the provider and manager took action to address them quickly.

People were invited to comment on the quality of the services provided the arrangements in place for people and their relatives to give regular feedback about the home were in place.

We inspected the home on 5 April 2016. There were 26 people living in the home when we carried out our inspection.

At the time of our inspection the home did not have a registered manager. However, the registered provider confirmed they had appointed a new manager in February 2016 and an application to register the new manager had been submitted to the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the manager had taken the necessary steps to ensure that people only received lawful care that respected their rights.

Staff were appropriately recruited to ensure they were suitable to work with vulnerable people. They had received training and support to deliver a good quality of care to people. An active training programme was in place to support staff to maintain and develop their skills.

Staff knew how to respond to any concerns that might arise so that people were kept safe from harm. People had been helped to avoid the risk of accidents and medicines were managed safely. There were enough staff on duty to give each person the individual support they needed.

People and their relatives were involved in planning their care and had been consulted about their individual preferences, interests and hobbies. However, the home did not always enable people to carry out meaningful activities on a flexible and planned basis in order to enable people, including those living with dementia to be stimulated or maintain and further develop their interests and hobbies.

People were supported by staff to be able to access a range of external health and social care professionals when they required any additional specialist support. People’s medicines were managed in a safe way.

People and their relatives could freely express their views, opinions and any concerns to the provider, manager and staff. The provider and manager listened to what people had to say and took action to resolve issues or concerns when they were raised with them. There were systems in place for handling and resolving any formal complaints. The provider and manager reviewed and reflected on concerns or untoward incidents and took any additional actions needed to keep developing and improving practices for the future.

People living at the home, their family and visiting health and social care professionals were invited to comment on the quality of the services provided. The provider and manager had developed a culture based on listening and learning about how care should be provided in order to identify and take action to keep improving the services provided at the home.

We looked at records. These included care records and information about how the service operated.

We also used a method of inspection called a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to understand the needs of people who we were not able to speak directly with.

In order to do this we observed how staff used their training and experience at lunch time to interact sensitively with, and support people with their meals, care and activity needs.

People were supported sensitively and their dignity maintained when staff provided physical care. Staff also encouraged people to take part in meaningful activities.

One person told us, “They (staff) have looked after me well.” The person indicated they had access to a call bell if they needed any additional support and said, “I like it here, the food is good. They (staff) have helped to keep me safe and the manager is easy to speak to.”

We found that the environment was maintained appropriately to support the safety of the people who lived there.

We also found the Home Owner and Manager had monitored the service regularly and gained views on the service from people who used the service and their relatives.

Throughout the SOFI we saw all staff treated people with respect and courtesy. The atmosphere in the home was relaxed and during our observation we saw frequent positive and friendly interaction between staff and people who used the service. We saw people were given choices and supported to make decisions. Staff took their time to understand people where they had communication difficulties.

We were able to speak with three people who used the service. They told us they liked living at the home and we received comments such as, "The staff are kind", "The staff are always happy to help" and "The food is very good, no complaints at all."

We spoke with two visitors during the day. They spoke highly of the staff, facilities and described how their relatives had settled at the home. One person told us, “The staff and care they provide is wonderful, there’s a very positive family atmosphere here.”