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Inspection carried out on 10 January 2018

During a routine inspection

Essendene EPH 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.

Essendene accommodates 13 people in one building. At the time of the inspection, 8 people were living at the service.

There was a registered manager in post. 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 in post since the 21 December 2017.

At the last inspection, the service was rated overall Good. At this inspection we found the service remained Good.

Why the service is rated Good:

People told us they felt safe and relatives felt very confident that their family members were well looked after.

The premises were clean and safe for people as regular checks of the environment and any equipment were undertaken.

People received safe care as any risks had been identified and action taken to reduce any risk of harm. However, improvements were required to the way in which these were documented.

Care plans for people new into the service were personalised but improvements were required to ensure that the care plans for long standing residents were as up to date and detailed in their content. There was a detailed monthly review that reflected peoples' current needs.

People remained protected from the risk of abuse as staff had received training and understood their safeguarding responsibilities and the reporting process.

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.

People were supported to have enough to eat and drink and received timely support to access healthcare professionals when their health needs changed. If people had particular wishes for end of life care these were discussed and recorded.

There was a stable staff team many of whom had been at the service for a number of years. They were observed to be kind, caring and knew people well. People received care and support how they liked it and their independence was encouraged.

People's viewpoints were actively sought and the service responded positively to feedback and complaints. The home environment was warm and welcoming with lots of opportunities for activities, stimulation and social interaction that met people’s needs and preferences.

Staff received training and support with learning to help equip them with the skills and knowledge required to support people effectively. Staff felt well supported through the supervision and appraisal process and the regular presence of the management team.

There was robust oversight of the service and clear lines of accountability at staff, management and provider level. The registered manager and provider were at the service on a daily basis.

Lessons were learned from accidents, incidents and complaints. These were recorded with actions taken to minimise the risk of re-occurrence.

The registered manager was new to this position, having previously been a member of the care team. They were in the process of reviewing and putting into place more formal quality assurance systems place to monitor the safety and effectiveness of the service and drive improvements.

Inspection carried out on 6 October 2015

During a routine inspection

This inspection was carried out on 6 October 2015 and was unannounced.

Essendene care home is a small service providing personal care and accommodation to older people and people who are living with dementia. The service supports 13 people. There are nine single rooms and two double rooms within the service. At the time of our inspection there were seven people living at Essendene.

There was a registered manager that has oversight of the whole service. 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.

At the last inspection on 11 May 2015 we found that there were a number of improvements needed. These were people being at risk of receiving care and treatment that did not meet their needs or reflect their preferences. Care and treatment was provided to people without appropriate consent being sought and did not take regard of the Mental Capacity Act 2005 (MCA). Also the provider failed to have proper and safe systems for management of medicines and there was no system or process in place to identify, manage and assess risks to health, safety and welfare. We asked the registered provider to take action to make a number of improvements. After the inspection, the registered provider informed us they would meet all the relevant legal requirements by the end of July 2015. We found on this inspection that the provider had made improvements in these areas.

Staff were caring and they always treated people with kindness and respect. People were happy with the care that they had received. Relatives and visitors told us that they had no concerns about the care that they observed. They said they had always been made to feel welcome when visiting.

Staff were respectful of people’s personal choice and provided care and support in a dignified way.

Care plans and risk assessments accurately recorded people’s individual care and support needs. Records were personalised and contained information about how a person wanted to be supported.

The automatic lift doors were broken and the appropriate safety check (LOLER) had not been completed. Staff and people living at the service had to manually open the doors of the lift. The registered provider contacted engineers during our visit to arrange for the appropriate checks to be undertaken.

The registered provider had undertaken some checks in relation to the safe management of Legionella. However there was insufficient records to determine whether these met Health and Safety requirements. We contacted the Health and Safety Executive following the inspection who confirmed they would provide advice to the registered provider.

Staff had completed safeguarding adults training and were able to describe the different types of abuse and knew how to report concerns they had about people’s safety. Records showed that safeguarding concerns had been addressed in partnership with the local authority.

There were safe systems in place for the management of medicines. This included the completion of a robust monthly audit which identified any areas of concern. Medicines were administered safely and administration records were up to date.

People received their care from people who were of suitable character and the registered provider had a good understanding of safe systems for recruitment of staff. Staff attended regular training sessions in areas such as moving and handling, first aid and safeguarding adults to update their knowledge and skills. Staff had regular team meetings and supervisions to discuss areas of improvement in their work.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had a good knowledge and understanding of the Mental Capacity Act 2005 and their role and responsibility regarding this. Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and were able to show an understanding of the key principles. Staff practice showed that people’s consent was considered before any daily care or support was provided.

Where a person’s liberty was being restricted or they were under continuous supervision, we found that the registered manager had made the appropriate application to the supervisory body under Deprivation of Liberty Safeguards.

People were supported to have a healthy balanced diet. A good choice of food was available and we observed people being offered alternative choices to the main meal provided. Care plans detailed people’s likes and dislikes and specialist dietary requirements.

The registered provider had introduced quality assurance systems in place to audit the service. Records showed that checks were regularly carried out in a number of different areas including medication, equipment and the environment. The audit system in place was effective and well managed and ensured people were protected from unsafe or inappropriate care and support.

Inspection carried out on 11 May 2015

During a routine inspection

This inspection took place on 11 May 2015 and was unannounced. This meant that the provider did not know we were visiting.

We last inspected this location on 17 January 2014 and found that the registered provider met all the regulations we looked at.

Essendene EPH is a care home providing accommodation and personal care to people over 65. It is registered for 13 people who are accommodated in nine single and two double rooms. At the time of our inspection there were 11 people using the service.

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 was also one of the registered providers.

We found a number of 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 the report.

People we spoke with were happy with the care that they had received. They told us that staff were kind, patient and tried to help them to be independent. Relatives told us that they had no concerns about the care that they observed and felt that the service was good. Whilst we observed some positive interactions between people using the service and staff, we were concerned that staff described people to us in a way that did not afford dignity and respect.

Staff who provided care had been through recruitment and selection processes that ensured that they were appropriately skilled to carry out their job roles. We saw that there were enough staff working on the day of the visit to meet the assessed care needs of people. However, staff carried out a variety of other tasks including domestic chores, laundry and cooking and so were very busy. Staff had little time to engage with people aside from when delivering care.

We found the care that people received was not always safe. This was because people did not always get the medicines that they required. Also, the registered provider did not keep accurate and up to date records for each person. This meant that staff, who did not know a person well, may not provide the right level of care and support.

People told us that they enjoyed the food although there was not always a choice. We saw that people, who were able to help themselves, ate well. We saw that people who required assistance to eat and drink were not always supported with appropriately and did not get the dedicated time they required.

The registered provider did not have a system in place to ensure that they monitored and evaluated the quality, safety and effectiveness of the care and service being provided. This meant that they could not always identify potential risks and take steps to make the required improvements. We saw that, on occasions, they were reliant on other professionals to bring these to their attention.

Inspection carried out on 17 January 2014

During a routine inspection

We spoke with nine people who used the service. They all told us they were happy at the home and had no concerns with the care provided. They also told us they received their medication in a timely manner. Comments from them included; "The staff are helpful all of the time", "It is a marvellous place to live", "This is better than any other home I've lived in. The staff are lovely" and "It's great. They always keep my room clean and tidy too".

We observed the lunchtime period at the home. We saw staff assisted people to eat where they were not able to feed themselves. We saw that staff who were assisting people to eat were sat down with the person concerned and gave them undivided attention. We saw that people who used the service and staff interacted positively throughout this period. Drinks were served throughout lunch to ensure people remained hydrated.

At the beginning of our inspection we were given a tour of the home by a senior member of staff. We found the home to be very clean throughout.

It was clear that people were given the right information of who to complain to if they weren�t happy or had any concerns about the service.

We looked at four staff personnel files during our inspection. We saw that Criminal Record Bureau(CRB) disclosure checks, and more recently Disclosure and Baring Service checks(DBS), were completed for all members of staff.

Inspection carried out on 26 February 2013

During a routine inspection

We found that people�s privacy, dignity and independence were respected. People�s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person who uses the service said, "I like it here, it's very nice and comfortable. I have no problems or complaints."

People experienced care, treatment and support that met their needs and protected their rights. Everyone we spoke with liked living there. One person who uses the service said, "You couldn't get a better place. They look after you and that's what matters." Another said, "They look after you pretty well. They are nice people. Very pleasant and understanding."

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough qualified, skilled and experienced staff to meet people�s needs. One person who uses the service said, "This is a smaller home so you get more individual attention."

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. One family member said, "The home is fabulous. They are always doing something. The care staff here are lovely. They are very approachable."

Inspection carried out on 4 October 2011

During a routine inspection

When we visited Essendene we spoke with people who live there and they told us; �This is a lovely place to live�; �I like the staff they are very nice� and �the staff are really nice and they are like friends.� They told us that they know all the staff as they had been there for a long time and that they were all very respectful and always knocked on their bedroom door and waited to be invited in.

When we spoke with the people living at Essendene all were very happy with the care and support they received. They told us that they felt safe and had no concerns about the care and treatment they received from staff that support them. One person told us, �The owners are always around but you can speak to any one if you have a problem� and �I don�t have any complaints it is lovely here.�

We spoke with the people living at Essendene and they all said that they were happy living there and with the care that they received.