Archived: Eccleston Court Care Home

Eccleston Court Care Home is a care home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 54 people.

Eccleston Court Care Home provides care across separate two units. One unit specialises in dementia care.

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

Care planning and health monitoring was taking place but was inconsistent. New systems required embedding to improve and standardise the quality of record keeping. The provider had failed again to demonstrate the required standard of governance. This is a breach of Regulation 17 (Good Governance).

Complaints had been investigated and responded to in line with the provider’s complaints policy. However, improvements and learning from complaints had progressed slowly.

Most relatives were very positive about care at Eccleston Court Care Home but told us that communication between themselves and their loved ones could be better supported by staff at the home.

People told us that activities were limited. The provider was in the process of appointing a new activity coordinator.

People were complimentary about the care and support they received from the service. One person told us, “The staff are caring and friendly I have no complaints.” Another said, “The staff are busy but very attentive. Staff treat me very well.”

Staff told us they felt supported in their role. Staff we spoke with were knowledgeable and passionate about providing good care.

There was a clear policy and system to manage infection control particularly in terms of the prevention of Covid-19. The inspector completed an infection control questionnaire on site and was assured by the findings.

There had been ongoing changes to the management team at Eccleston Court. New systems were being implemented to improve people’s experience of care.

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 requires improvement (published 28 February 2020).

Why we inspected

This was a planned inspection based on the previous rating. This was a focused inspection and the report only covers our findings in relation to the key questions Responsive and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eccleston Court Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eccleston Court Care Home accommodates up to 54 people who require personal and nursing care. At the time of the inspection there were 36 people using the service. The service consists of two separate Units, one of which provides nursing support to people who primarily have a physical health need and another that provides nursing support to people living with dementia.

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

At our previous inspection in July 2019 the provider was in breach of regulations. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations. However, improvements made needed to be embedded and sustained over a longer period of time to achieve a rating of good.

Daily checks were now carried out on the environment to make sure it was safe. Risks were identified and mitigated in a timely way. The environment was free from hazards, clean and hygienic. Staff followed good practice to minimise the risk of the spread of infection. Risks associated with people’s individual care and support needs were regularly assessed and monitored.

The deployment of staff was better organised, people’s needs were now safely met in a timely way. There were more permanent nurses employed at the service reducing the need to call upon agency nurses. People and family members commented that this had led to a much more consistent service.

Whilst care and support was planned and delivered in a more personalised a consistent approach to this was needed. Care records were completed in more detail and better reflected people’s needs and choices and how they were to be met. Care plans were developed and regularly reviewed with the involvement of people and relevant others and updated following a change in people’s need or at their request.

People were provided with more opportunities to engage in activities which were meaningful and stimulating. Staff spent more time occupying people in both group and one to one activities and conversations. Staff respected people’s choice about how they spent their time.

People were now treated well and with dignity and respect. Staff responded quickly to people’s requests for assistance and they checked on people’s wellbeing and comfort. People and family members complimented staff for their kindness and caring approach. Personal care records were now stored securely and people’s personal belongings were treated with respect. People and family members were provided with more opportunities to express their views and be involved in decisions about their care. People told us they felt listened to and they could talk to staff at any time.

The number of complaints received about the service had decreased since the last inspection. Those received were now acknowledged, investigated and used to improve the quality of the service. People and family members knew how to complain, and they were confident their complaints would be acted upon and listened to.

The management of the service had improved, however this needed to be sustained. The systems and processes in place for assessing, monitoring and improving the quality and safety of the service were more effective. Risks to the health safety and welfare of people were identified and mitigated in a timely way and records were better maintained. The culture of the service had improved and was more person-centred and positive. People and family members told us communication and the visibility of the registered manager had improved a lot.

People were safeguarded from the risk of abuse. Staff understood what was meant by abuse and how to report any safeguarding concerns. People told us they felt safe. Medicines were safety managed and people received their prescribed medicines at the right time. Accidents and incidents were well managed, and lessons were learnt and shared with staff.

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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published July 2019) and there were breaches 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.

This service has been in special measures since July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

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.

Eccleston Court Care Home accommodates up to 54 people who require personal and nursing care. At the time of the inspection there were 36 people using the service. The service consists of two separate Units, one of which provides nursing support to people who primarily have a physical health need and another that provides nursing support to people living with dementia.

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

Parts of the environment were unsafe putting the health and safety of people and others at risk. The safety of the environment was not monitored to ensure risks to people and others were identified and mitigated. Fire doors and communal areas were obstructed, and good practice was not always followed to minimise the spread of infection.

The deployment of staff was disorganised which led to people’s needs not being met in a timely way. A number of permanent nurses had left the service over recent months and there was a high use of agency nurses which unsettled people and family members.

Assessments lacked information about people’s needs and how they were to be met. Assessments and care plans were not personalised, they did not reflect people’s choice and preferences. People and/or relevant others were not always involved in the development and receiving of care plans.

There was a lack of opportunity for people to maintain their interests and hobbies. On both days of the inspection staff on Eccleston Unit spent very little time engaging people in conversation or activities. Staff told us they were unable to socialise with people because they were so busy meeting people’s physical care needs. People were given limited choice and flexibility with regards to some aspects of their personal care.

People and family members commented that the staff were kind and caring in their approach and we observed examples of this. However, people were not always treated with dignity and respect. People were left waiting for longs periods of time for assistance with personal care needs. Personal care records about people were not always stored securely. Personal belongings of people no longer living at the service were not treated with respect. There were limited opportunities for people to express their views and be involved in decisions about their care.

The number of complaints received about the service had increased since March 2019. Complaints received about the service were not always recorded and responded to and they were not always used as an opportunity to make improvements to the service.

The systems in place for monitoring the quality and safety of the service were ineffective. They failed to identify the areas of concern found during this inspection. There was a lack of oversight by senior managers and the provider to ensure that the systems for assessing and monitoring the quality and safety of the service were implemented. People and family members commented on a lack of communication and visibility by the manager.

People told us they felt safe living at Eccleston Court. Overall, feedback received about the caring approach of staff was positive. However, our findings did not support this positive feedback.

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

The last rating for this service was requires improvement (published 12 June 2018)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the relevant key question sections of this full report.

During and following the inspection the provider took action to mitigate the risks and this has been effective.

The overall rating for the service has changed from requires improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eccleston Court Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches at this inspection in relation to the five key questions we ask is the service; safe, effective, responsive, caring and well-led.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

The last inspection of the service was carried out in June 2017 and during that inspection we found breaches of regulations in respect of the safety of the environment, staff training and supervision, dignity and respect, records and assessing and monitoring the quality and safety of the service. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led.

During this inspection we found improvements had been made and that further improvements were required.

Eccleston Court 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. Eccleston Court accommodates up to 54 people who require personal and nursing care. At the time of the inspection there were 46 people using the service. The service consists of two units, one of which provides nursing support to people who primarily have a physical health need and another that provides nursing support to people living with dementia.

The service has 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.

Improvements had been made to people’s safety. Hazards associated with the environment which posed a risk to people’s safety were mitigated. Rooms and cupboards containing hazardous equipment and materials were kept locked when not in use. A serving oven was closely supervised by staff when it was being used in communal areas. Fluid thickener which can pose a risk to people if ingested was stored in a safe place and closely supervised by staff when it was being used in communal areas.

Improvements had been made to the way people were treated and how confidential information was managed. Staff had undergone training and supervision to help raise their awareness about treating people with dignity and respect and person centred care. Staff were kind and patient in their approach and they provided people who needed it with emotional support. Staff spoke with, and about people in a respectful way and they maintained people’s privacy and dignity when providing them with personal care. Personal information about people was kept confidential, records were securely stored and discussions about people took place in private. Family members were made to feel welcome at the service. They were offered refreshments and were given a choice of where they spent time with their relative.

Improvements had been made to staffing. Staff had undergone training and supervision for their job role. A programme of ongoing training was in place for all staff which covered mandatory topics such as health and safety and topics relevant to people’s needs. Staff reported that they felt well supported by the management team and were confident about approaching them should they need advice or support. Staff were provided with formal one to one supervisions and underwent observations of their practice. These provided staff with an opportunity to reflect on their work, discuss their training and development needs and explore how they could develop in their role.

Improvements had been made to care records, however further improvements were required to ensure that they were up to date and accurately reflected people’s needs. Care plans had not been developed for some people’s needs which were identified in assessment records. In addition some records were incomplete and had not been signed. Whilst we did not evidence any impact on people there was a risk that they may not receive the right care and support. Charts in place for monitoring aspects of people’s care included essential information and directions for staff to follow and they had been completed to reflect the care given.

Improvements had been made to how people’s ability to consent was assessed. The management team and staff had completed training in the mental capacity act and associated deprivation of liberty safeguards (DoLS). They had a good understanding of their responsibilities for ensuring decisions were made in people’s best interest. Assessments had been carried out to determine people’s ability to consent to their care and treatment. A DoLS application had been made for people who lacked capacity to make their own decisions and those that were authorised were held in people’s care files. Expiry dates of DoLS were monitored to ensure where appropriate, new applications were made in a timely way.

Improvements had been made to the system for checking on the quality and safety of the service. Information collated with regards to falls, weight loss, pressure wounds, accidents and incidents was analysed to identify any trends or patterns. Following analysis of the records appropriate action was taken to mitigate risk and reduce further occurrences.

We have made a recommendation about the environment. Some parts of the service lacked aids and adaptations to promote stimulation and wayfinding for people living with dementia. This included signs to help people navigate themselves to their bedrooms and other areas and items to support reminiscence such as pictures of the local areas and favourite pastimes of people.

People were protected from the risk of abuse. Staff had undertaken safeguarding training and they had a good understanding of what was meant by abuse, the different types of abuse and how to report it. The registered manager had correctly followed both the registered provider’s and relevant local authority’s procedures for reporting allegations of abuse. They worked alongside the appropriate agency to ensure that people were protected from further risk of abuse.

People’s nutritional and hydration needs were assessed and planned for. People identified as being at risk of malnutrition and/or dehydration had their food and fluid intake monitored in line with their care plan. The texture of food and drink was modified for people at risk of choking in line with guidance from speech and language therapists (SALT). Information about people’s dietary needs, and any intolerances or allergies they had was held in the kitchen as a reference for staff responsible for preparing meals. People living with diabetes were provided with food and drink which contained low sugar content. Two people made negative comments about the food; however other people commented that they got a choice of food and drink which they enjoyed.

Medication was safely managed. Safe systems were in place for receiving, storing, administering and disposing medication. Medication was administered by appropriately trained staff that underwent regular checks on their practise to ensure they remained competent. Each person had a medication administration record (MAR) listing each item of their prescribed medicines, instructions for use and when they were to be given. MARs were signed to show people had received their medicines at the right times. Identifiable codes were used for circumstances when people had not received their medicines for example if they refused or were in hospital.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Eccleston Court is registered to provide nursing and personal care for up to 54 people with physical health needs, or people living with dementia. At the time of the inspection there were 45 people using the service. The service consists of two units, one of which provides nursing support to people who primarily have a physical health need and another that provides nursing support to people living with dementia.

At the time of the inspection there was no registered manager in post within the service. The previous registered manager had left in December 2016. A new manager had started within the service, just prior to the inspection in May 2017.

During the inspection we identified breaches of Regulations 10, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We are taking a number of appropriate actions to protect the people who are living in the service.

People within the service were not always safe. It was standard practice for sluice rooms in one unit to be left unlocked which placed people at risk of harm through coming into contact with hazardous materials. Fluid thickener was kept unsecured in people’s bedrooms, which can pose a risk of death if ingested inappropriately. Cupboards containing cleaning materials and alcohol had been left unlocked in the kitchenette in one unit, and staff did not know where the keys were to secure these. An oven was being used to cook people’s food in a communal area, and adequate action had not been taken to address the risks around this following a ‘near miss’ incident that had occurred a short time prior to the inspection visit. This showed poor risk awareness.

People were not always treated with dignity and respect. Staff did not always work in a person-centred way, and we observed examples where people living with a sensory impairment were treated in an undignified manner. People’s family members did not always feel welcome within the service, and some of them commented that they felt there may be reprisals from making a complaint. Staff took their breaks in communal areas; these areas were meant for people using the service, which gave the environment a feel of being oriented to meet the needs of staff rather than the people they cared for.

Staff did not have up-to-date training in areas needed for them to carry out their role effectively, and supervisions and appraisals had not been completed. Staff did not always demonstrate a good knowledge around health and safety, or person-centred care which demonstrated a lack of training in these areas.

Care records did not always contain accurate and up-to-date information about people’s needs, which meant that relevant information was not available to staff around how to support people. Staff did not always fill in daily monitoring charts correctly. For example one person’s nutritional monitoring chart incorrectly recorded that a person had eaten their porridge, however we observed that they had, in fact not eaten this.

People’s confidentiality was not protected. Staff spoke without discretion about people’s needs in communal areas, and personal information was not stored securely. Staff confirmed that handovers took place in a communal area, during which personal information about people’s needs was openly discussed.

Audits were not being completed by the service. For example, an analysis of information relating to care records, accidents and incidents, pressure wounds had not been undertaken which meant that trends and patterns could not be identified. The registered provider had completed a quality monitoring visit, which had identified areas that required improvement. However, we found that this process had not picked up on other issues. We also found that whilst action had been taken to address some of the issues identified, other areas remained unaddressed, for example staff training.

The registered provider had failed to take the required action in relation to a safeguarding concern as required by the local authority. This had been a recurring safeguarding concern relating to one person, which had occurred four times since December 2015. This showed that lessons had not been learnt, and demonstrated that the registered provider had failed to comply with the local authority’s safeguarding procedure.

People commented that they enjoyed the food that was available. We observed mixed examples of good and poor practice by staff during meal times. In one unit staff were attentive to people’s needs during meal times. However in the other unit staff were having discussions between themselves, and ignored the needs of one person with a sensory impairment. Catering staff did not have a good knowledge of people’s dietary needs, and had failed to ensure diabetic options were available for people’s desert.

Mental capacity assessments had been completed for some people and not others. Where people required their medication to be administered without their knowledge, a mental capacity assessment had not been completed and a best interests decision made. We have made a recommendation to the registered provider around ensuring they are compliant with requirements of the Mental Capacity Act 20015.

People received their medication as prescribed. The registered provider had successfully identified some issues around medication and made efforts to make improvements. We checked a sample of seven people’s medication and found the stock levels to be correct.

Activities and entertainment were provided to people to help keep them entertained. There were two activities co-ordinators in place to support people, and we observed examples of them doing arts and crafts and spending time with people on a one-to-one basis. However family members of those people living with dementia commented that they did not feel there was sufficient social stimulation for their relatives and that they spent a lot of time in bed.

We observed some examples of good practice amongst staff, where they were attentive and supportive of people. One member of staff showed us that they, along with a colleague made small gifts for the family members of people who had passed away within the service. This demonstrated an example of compassion by some members of staff.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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 always seems to be someone about to assist, I never have to wait long', 'The staff do work hard but that's to be expected if I need anything I just act', 'My mother is very positive about the staff and would tell me if there was a problem' and "I feel well looked after here. The staff are really kind and try to help me".

Nine relatives/visitors were spoken with. One person told us, 'This was not an easy decision. It upset us all for a long time but since [name of relative] has been here she has improved a lot and looks happier. I don't worry about her anymore. I go home knowing that she so much safer and so much healthier.'

At this inspection we found that improvements had been made in the management of medicines.

We looked at a variety of records regarding six peoples care including, assessments, care plans, medication records and daily records. We saw that the care plans were not based on the individual person's choices and needs. Staff had informed us that they found the care records difficult to work with and found that information was repeated in several areas. We also saw that confidential records regarding people's care were not kept securely at all times.

A selection of audits (checks) carried out by the manager were viewed. These provided information covering various areas of management within the service, including the environment, records and health and safety. The checks showed that the service checked on the quality that it provided in order to recognise any areas that needed development.

Relatives spoken with told us that they were happy with the care and support their relatives received. They told us that they were always made to feel 'welcome' in the service and were kept up to date about their loved ones needs.

On checking medication management we found that people did not always received their medicines as prescribed. Records regarding medication did not always follow best practice. Management staff in the home told us that this would be addressed as a matter of urgency. We will be arranging for a pharmacist inspector to check on progress in the future.

We observed staff interacting with people who lived in the service during our visit. We observed some examples of where staff supported people well, such as acknowledging anxieties and attempting to reassure them. We spoke with some people living in the home during our visit they told us that "I like the staff they are very kind' and 'it's not my home but it will do as they do look after you here'.