The Care Quality Commission
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Archived: Englishcombe House Residential Home

Overall: Good read more about inspection ratings

33 Englishcombe Lane, Bath, Somerset, BA2 2EE (01225) 428369

Provided and run by:
Cedar Care Homes Limited

All Inspections

08 December 2015

During a routine inspection

The inspection took place on 08 December 2015 and was unannounced. The service was last inspected in April 2013 and met with legal requirements.

Englishcombe House is a care home that is registered to provide personal care for up to 20 people. There were 13 people at the home on the day of our visit.

There was a registered manager for the 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.

We found that one staff member only had a Criminal Records Bureau Check carried out seven months after they had started employment. This meant there was a lack of assurance for that period that the staff member was suitable.

One person had been assessed as not having mental capacity in relation to receiving help with personal care. Their care plan explained that ‘gentle restraint’ might be needed to assist the person safely to bathe. However, there was no restraint policy and guidance in place to help staff to follow the persons care plan safely.

We have made a recommendation about the safe use of restraint.

People said they always felt safe there and that staff treated them properly. Where risks to people were identified suitable actions were put in place to reduce the likelihood of them reoccurring. Staff had been on training to help them to understand what it was and how to report concerns.

People were assisted by enough staff to provide them with safe care. Staffing numbers were increased when it was needed. For example, when people’s needs changed due to being physically unwell.

Staff were caring in their manner with people when they assisted them with their needs. One person said “They are lovely”. Staff were polite and showed respect to the people they supported people.

People were provided with a varied diet that supported them to be healthy. The menus included likes and preferences of people who lived at the home. People spoke highly of the food that they were served . One person said, “It’s lovely food”.

The provider had a system in place so that the requirements of the Mental Capacity Act 2005 were implemented when needed. This legislation protects the rights of people who lack capacity to make informed decisions In relation to different aspects of their lives.

People were able to take part in a variety of individual social activities as well as group ones. People told us that entertainers performed at the home regularly and they went out for trips into the local area.

People’s care plans explained how to meet their care and support needs. If people wanted to, they were involved in the planning and writing of their care plans. This was to help ensure that people were supported in the way they preferred.

People were supported with their physical health care needs and the staff consulted with external healthcare professionals to get specialist advice and guidance when required.

Staff felt they were properly supported in their work. People who lived at the home and the staff said they felt they could see the registered manager any time that they wanted to talk to them.

Staff had a good understanding of the providers visions and values. They were able to explain that a key value was to treat people as if they were still living in their own home .

There was a system in place to check and improve the quality of the service. Audits demonstrated that regular checks were undertaken on the safety and quality of the service.

27 August 2013

During a routine inspection

At the time of our inspection, the people who lived at Englishcombe House had varying degrees of dementia. We therefore received limited information from people about how they experienced care and support. People we spoke with told us 'the staff are very nice here' and 'you couldn't be in a nicer place.'

We talked with other people who visited the service on the day of our inspection. This included two relatives and three professionals who worked for health or social care services. All the visitors we spoke with told us they thought the home was good, and they did not have any concerns about the care or safety of people.

People and relatives told us they thought the food was good and that different main meal choices were available every day. We spoke with the chief who demonstrated an understanding of nutrition. The chief showed us a list of what individual people liked and disliked to eat and preferred portion size. This ensured meals offered were appetising and appropriate for people.

We spoke with four care staff who demonstrated they knew how to recognise the signs of abuse and the various forms it could take. Care staff told us about the safeguarding adult's policy, where it was, how to access it and how to use it. Records showed care staff consulted other health or social care professionals for advice about safeguarding people. This meant reasonable steps were being taken to provide safe and appropriate care and safeguard people from abuse.

Care staff told us they felt supported by the manager and had regular supervision and annual appraisals. Care staff told us there were opportunities to gain extra qualifications to support their roles. The manager showed us records that confirmed care staff had attended regular training. This meant care staff were appropriately supported by senior staff and the service provider.

We looked at care plans and other records and viewed all areas of the home. We saw systems, policies and maintenance checks were in place that monitored the quality of the service. We saw records of complaints from family on behalf of people. These recorded how complaints had been resolved. This meant the provider was monitoring the quality of the service and making improvements to the service.

1 May 2012

During a routine inspection

We visited Englishcombe House on 1 May 2012 and spent most of the day at the service. We looked at all areas of the home, including the bedrooms, kitchen and communal areas. We met and talked with all members of staff on duty on the day of our visit.

At the time of our visit, most people who lived at Englishcombe House had either a clinical diagnosis of dementia, or were suffering from the symptoms of dementia. We talked with a number of people who were able to share their general views about the service and the staff who cared for them. We also met with family members of one person who was living at the home.

People told us "it's all very nice here" and "everybody's nice here". We heard that "the staff are kind" and a family member told us "we are quite impressed with the care the staff show to the residents". People said that they were happy to ask if they wanted anything and that staff acted "in our best interests" if people were not feeling well.

Staff told us they worked well as a team and new staff who had joined in the last few months had settled in well and taken to the role and the team quickly. Staff said they were well supported in their role and felt that they were able to provide safe and effective care.

One area of concern we had was around consent and people being assessed for their capacity to make decisions. A review of care records showed that assessments were inconsistent in some cases. Family members were being asked to take decisions about a person's care when the records stated that the person had the capacity to take their own decisions. There was also a lack of understanding among staff of the use of advance directives.

Otherwise we found the home to be clean and well maintained. People were warm and comfortable and we observed good care by staff.

20 June 2011

During a check to make sure that the improvements required had been made

Following our compliance review of Englishcombe House in February 2011, we talked to the manager in June 2011 about how the required improvements have been made to outcome 8. We were told that a senior care coordinator had been appointed the lead person on infection prevention and control. The service now has a copy of the Code of Practice for preventing and controlling infections in adult social care settings.

Where appropriate, the service has installed signs for hand-washing procedures and discussed hand-washing routines and protocols with all members of staff. Anti-bacterial gel has been obtained and is being used when and where appropriate. Members of staff and also visitors are made aware of how to use this gel effectively and appropriately.

Infection control audits are now taking place on a regular basis in all areas of the service.

We asked the provider to send us an action plan following our compliance review in February 2011. The provider did so and told us also that members of staff have all watched a training film on infection control provided by the Health Protection Agency.

10 February 2011

During a routine inspection

We visited Englishcombe House on 10 February 2011. The home is registered to care for 20 people and at the time of the visit there were 18 living at the home. All the people who use the service are suffering from dementia and related conditions with some at an advanced stage of the disease.

We were able to discuss some aspects of the care provided with five of the residents, and we also met with three regular family visitors who came to the home during our visit. We also talked prior to the visit to the local authority and the NHS and to their staff who place people who use the service at Englishcombe House. During the visit we talked to two of the regular visiting GPs and an NHS community psychiatric nurse.

We found that the home was well staffed for the number of people who were being cared for. The home was also well managed and the staff were supported to carry out their roles. We observed people being given healthy and nutritional food, and people who were no longer able to feed themselves, being helped to eat. We confirmed with people who use the service that they are given a good choice of food, and what they like to eat is taken into account.

The visitors said that the staff were 'very, very good' and 'will do anything to help at any time'. Staff always kept them updated with any news of their relatives or changes in their relatives' health status. The staff listened to and reacted well to any concerns that the relatives/carers might have. The visitors said that their relatives were well fed, kept warm, clean and well dressed, and seemed happy. They commented that the food seemed to be 'excellent', 'marvellous' and 'very much enjoyed'. Staff were very welcoming to them as visitors and it helped to make the visit easier, given the difficulty of otherwise communicating with their relative.

One visitor told us how hard it had been for him and his father to see his mother's mental health deteriorate and for her to have to move into a care home. But the circumstances had been made much easier to accept given the kindness of the staff and the 'high quality' of care given. The staff made themselves well known to the visitors and 'always make me and Dad welcome' and 'they know all of us personally'.

We were told by the visitors that people who use the service appear to be able to have privacy and their dignity is well maintained. They have plenty of sleep, generally undisturbed by other people, and are not made to get up in the morning until they are ready.

We were told that there seemed to be plenty of activities and a lively atmosphere. We were also told that staff and the activities organiser were always looking for new ways to entertain and stimulate the people they care for. Events arranged for people include outings, gardening, cooking and baking, artwork, exercises, shopping and caring for the chickens that live in the garden.

People who wanted more peace and quiet were able to spend time in the upstairs lounge, which was generally kept quieter and held a much appreciated fish tank.

The community psychiatric nurse that we spoke to at the home said that the staff were 'thorough' in their working practices, had 'excellent diagnostic skills' and that other staff in the community mental health team were very complimentary about the service and staff.

We found the home to be clean and well maintained. Staff were well trained in key skills and delivered care with patience and kindness. We have made requests for a number of minor improvements, including a better appreciation of the Deprivation of Liberty Safeguards (DOLS); improved knowledge of the infection control Code of Practice and hand-washing regimes; inclusion in the medication administration records of any known allergies; secure disposal of out-of-date Criminal Records Bureau checks; and dedicated training in appropriate activities.