Eldon House Residential Home

Eldon House is a residential care home that provides care and accommodation for up to 20 people, some of whom are living with dementia. At the time of the inspection there were 15 people living in the service.

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

The service was in the process of improving the environment. However, action was required to complete this by making improvements to decoration and replacing furniture and flooring. We have made a recommendation about this.

Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Medicines were safely managed.

There were processes in place to prevent and control infection at the service, through regular COVID-19 testing, additional cleaning and safe visiting precautions.

There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. There was time for people to have social interaction and activity with staff. Staff knew how to keep people safe from harm.

People living at Eldon House had care plans which detailed their needs and preferences. Staff knew people's care needs well.

People had access to call bells to alert staff if they required any assistance. We saw people received care and support in a timely manner and calls bells were quickly answered.

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.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

We were assured that risks in relation to the COVID pandemic had been managed appropriately. Staff had access to appropriate PPE and hand washing facilities, which they used effectively and safely.

The service sought the views of people, families, staff and other professionals and used feedback received to improve the quality of the service provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 30 October 2018).

Why we inspected

We received concerns in relation to staffing, continence management, the environment and the quality of care people received. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Effective section of this report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We found the following examples of good practice.

The home was clean and uncluttered in appearance. There were procedures to ensure that infection control risks were reduced. For example, increased cleaning of communal areas and high touch areas such as door handles and light switches. Appropriate waste bins were available for the disposal of clinical waste, including PPE.

Procedures were in place regarding self-isolation for people who were admitted to the home from the community or other health care provision. The admission procedure had been reviewed and developed to reduce the risk of infection from COVID-19.

The home had a contingency plan to reduce the risk of cross infection should there be an outbreak of COVID-19 in the home. This included self isolation for residents who showed symptoms and separating staff teams so they cared for a reduced number of people and did not care for both symptomatic and non symptomatic residents.

The home had designated and separate entrances for staff and visitors. A changing area was available for staff coming into the home and before leaving their shift. The provider supported staff by washing their uniforms if required. This helped to reduce the risk of infection being brought into the home.

Due to the current national lockdown, visiting was restricted. Information was provided to friends and families by telephone call, letter, email and on the home’s website regarding the visiting arrangements. Where visiting would be allowed for compassionate reasons (for example for people receiving end of life care), suitable infection control procedures would be followed when visitors entered and moved around the building. Visitors were screened for COVID-19 prior to entering the home. Visitors were required to wear masks and, as necessary, other protective personal equipment (PPE).

The registered manager was in the process of developing plans and procedures for when visiting to the home is permitted in line with national guidelines. A ‘pod’ style building was being purchased for the grounds to use for visits and when the weather improves, a summer house would also be available. A room next to the front door was being refurbished to allow visitors without the need to access further into the home.

People were supported to speak with their friends and family using IT systems and the telephone as necessary. A recent activity had supported residents to write letters to their loved ones.

Appropriate testing procedures for COVID-19 had been implemented for all staff and people who used the service following national guidance regarding the frequency and type of testing.

An electronic recording system evidenced staff assessed residents for the development of COVID-19 symptoms. This included twice daily monitoring of physical symptoms such as temperature checks.

Infection control policies and procedures had been updated in line with the national guidance relating to COVID-19. Staff had access to the policies and procedures including updates. The training for staff regarding infection control had been updated to include guidance relating to COVID-19.

The registered manager had completed risk assessments regarding the environment and risks to staff and residents. The registered manager was aware of staff members who were at increased risk from COVID-19 and measures that would be required to keep them safe, should there be an outbreak in the home.

Plentiful supplies of PPE were available in the home. This included masks, gloves, aprons, gowns, visors and goggles. Signage regarding the requirement for wearing PPE and handwashing was displayed. When visiting resumed following this lockdown the registered manager intended to increase the signage at each entrance to provide a visual reminder to visitors. Additional signage would be used to advise all staff of the PPE to be worn when a person was assessed at higher risk of infection. For example, for a new admission or for someone showing symptoms or testing positive for COVID-19.

Staff breaks were staggered to reduce the risk of groups of staff congregating together.

Eldon House Residential Home is a care home without nursing for up to 20 people. On the day of our inspection there were 20 people living at the service. It specialises in care for older people some who are living with dementia.

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.

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.

At the last inspection on 30 January 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service remains Good:

We met and spoke with most of the people living in the service during our visit. However, some people were not able to fully verbalise their views. Due to people’s needs we spent time observing people with the staff supporting them. Others could tell us about the care and support they received. Staff told us and we observed used other methods of communication with people who could not verbally express their views, for example by the use of pictures.

People remained safe at Eldon House. People who were able to told us they felt safe living there. One person said; “Its safe for me, I wouldn’t change a thing its perfect.”

People continued to receive their medicines safely by staff who had received regular updated training. People were protected by safe recruitment procedures. This ensured staff employed were suitable to work with vulnerable people. People, relatives and the staff team confirmed there were sufficient number of staff to keep people safe. Staff said they could meet people’s needs and support them when needed. However, some people and staff felt the service would benefit from and extra staff member during the evening time, for example working until 10pm to support the night staff. The area manager confirmed they had discussed this with the provider and looking at how to address this issue.

After our visit we received information of concern that the management team had informed staff there would not be a third member of staff placed on the evening shift to support the night staff in assisting people to bed at a time of their choice. However, we followed this up with the registered manager who provided reassurances that this statement was not correct and the new rota put in place from the 1 November 2018 would include a third staff member working until 10pm.

People’s risks were assessed, monitored and managed by staff to ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

People continued to receive a caring service. The staff team had the skills and knowledge required to effectively support people. Staff had completed safeguarding training. New staff completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company. One staff member said; “I wouldn’t work anywhere else!”

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's healthcare needs were monitored by the staff and people had access to healthcare professionals as required.

People’s care and support was based on legislation and best practice guidelines, ensuring the best outcomes for people. People’s legal rights were upheld and consent to care was sought. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

The service responded to people's individual needs and provided personalised care and support. People’s equality and diversity was respected and people were supported in the way they wanted to be. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history including previous employment and family history. People’s cultural, religious and spiritual needs were also documented. People’s wishes for their end of life were clearly documented.

People continued to receive a caring service. People were observed to be treated with kindness and compassion by the staff who valued them. The staff, some who had worked at the service for many years, had built strong relationships with people. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service continued to be well led. Clear leadership and governance was provided with the provider’s governance framework, monitoring the management and leadership of the service. The provider’s values and vision were embedded into the service, staff and culture. The provider had monitoring systems which enabled them to identify good practices and areas of improvement. People, relatives and staff said the management team and the provider were approachable and made themselves available to speak to people. The provider and the management team listened to feedback and reflected on how the service could be further improved.

People lived in a service which had been designed and adapted to meet their needs. The provider monitored the service to help ensure its ongoing quality and safety.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection of Eldon house on 30 January 2016. We saw people were happy living at Eldon house. The atmosphere was friendly and relaxed and we observed staff and people using the service enjoying each other’s company. People’s comments included; “Staff are good, they take care of me”, and “The staff are very kind and very understanding.” People told us they were completely satisfied with the care provided and the manner in which it was given.

When we arrived at Eldon House we had difficulty gaining entry to the service. When we phoned the service there was no reply and the call went to voicemail. Three relatives said that contacting the service by phone could be difficult. However when they physically visited the service they had the key code so that they could enter the property themselves. We discussed with the area manager the difficulty in gaining access and our concern that if there was an emergency situation services might face similar problems. The area manager reassured us that this would be addressed immediately. Following the inspection we were told by the area manger that the service had already obtained quotes to connect the gate intercom to the call bell system.

People looked well cared for and their needs were met quickly and appropriately. People who used the service and their relatives were complimentary about the care they received from staff who they felt were knowledgeable and competent to meet their individual needs. Relatives comments included; "Staff are so attentive and “I couldn’t ask for a better home, staff go that step beyond.” Relatives told us they were always made welcome and were able to visit their family members at any time

People told us “I feel safe here they take care of me.” They told us they were completely satisfied with the care provided and the manner in which it was given. Relatives felt their family member was cared for safely. Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person as possible so that they could get to know the persons wishes and preferences. Relatives felt this gave staff a very good understanding of their family member and how they could care for them.

People were supported to live their lives in the way they chose. People’s preferences in how they wanted to spend their day were sought, listened to and respected. Activities were provided by the service individually and in a group format. Activities available included arts and crafts and outside entertainers coming into the service. Visitors told us they were always made welcome and were able to visit at any time.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the service involved family and relevant professionals to help ensure decisions were made in the person’s best interests.

People’s care plans identified the person’s care and health needs in depth and laid out how the person wished to be supported by the service. They were written in a manner that informed, guided and directed staff in how to approach and care for a person’s physical and emotional needs. Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all the staff. People that used the service and their relatives told us they were invited and attended care plan review meetings and found these meetings really helpful.

People told us staff were very caring and looked after them well. From our observations and discussion with staff it was evident that staff genuinely cared for the people they supported. The registered manager told us “They are not residents, they are my family.” We saw many examples of staff providing physical reassurance to people. People responded positively to this physical reassurance from staff. This demonstrated the strong relationships which had formed between people who lived at the service and staff.

We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a really good knowledge of the people they supported.

Peoples' privacy, dignity and independence were respected by staff. We saw many examples of kindness, patience and empathy from staff to people who lived at the service.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. We saw staff respond to peoples requests for assistance promptly. Relatives commented staff were always available if they had any queries at any time.

Staff told us they attended meetings (called supervision) with their line managers. Staff attended ‘group supervisions’ which allowed staff to discuss new and current guidance. Staff had an annual appraisal to review their work performance over the year.

Staff attended regular training to ensure that their skills remained up to date with recent guidance. They all received a thorough induction when they started work at the service and fully understood their roles and responsibilities, as well as the values and philosophy of the home. People and relatives felt staff were skilled and competent to undertake their job.

We saw the service’s complaints procedure which provided people with information on how to make a complaint. People and relatives told us they had no concerns at the time of the inspection and if they had any issues they felt able to address them with the management team.

The registered manager promoted a culture that was well led and centred on people’s needs. People told us how they were involved in decisions about their care and how the service was run. The management and running of the service was ‘person centred’ with people being consulted and involved in decision making. People were actively involved in decision making so the service was run to reflect their needs and preferences.

The service was keen to gain the views of people’s relatives and health and social care professionals. The provider had an effective system to regularly assess and monitor the quality of service that people received and was continuously trying to further improve the quality of the service.

We toured the building and spent time observing people and staff during the day. We noted there was a strong odour in some parts of the home at the time of our inspection. We saw people's privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff. Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. Comments included 'it's lovely here, they (staff ) are all lovely' and 'food is terrific'.

We found peoples' views and experiences had been taken into account in the way the service was provided and delivered in relation to their care.

People were protected from the risks of inadequate nutrition and dehydration.

We found that people who used 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 happening.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.