Eglantine Villa Care Home

Eglantine Villa Care Home is a care home providing accommodation with personal and nursing care for up to 49 people. The service is arranged across two units Jasmine and Lavender. Jasmine is arranged across two floors and Lavender providing care for people living with dementia is on one level. At the time of our inspection there were 47 people using the service.

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

The registered manager had created a clear person centred culture in the service with a focus on overcoming barriers to support people to achieve their goals. Staff took the time to get to know people very well and care and support was highly personalised.

Risk assessments were comprehensive and people were encourage to take risks. People told us they had choices and their preferences were respected. For example, one person told us, “I can have a bath or shower whenever I want.” Personal communication needs had been assessed and the service had implemented signage in Braille in response to this.

People, and their relatives where appropriate, were involved in decisions about their care and they received care which promoted their dignity and encouraged independence. For example one person said, “I feel independent, they allow me to do what I want to do.” Another person liked to use a wheelchair without foot plates; a risk assessment was in place for this and their wishes were respected. This enabled the person to be more mobile and independent.

People told us they could choose what to eat and said the food was good and their preferences were met. People said their rooms were personalised. One person said, “I have my own pictures up and I feel the room is my own.” Everyone spoke highly of the care workers, one person described them as “angels”.

People stayed as active as possible with a range of innovative and meaningful activities that had been planned around individual requests. People were involved in planning the activities and attended meetings to discuss ideas and things they would like to do. People were encouraged to ‘make a wish’; and staff supported them to reach their goals as far as possible.

The registered manager had promoted a positive learning culture in the service and when things went wrong, lessons were learned and shared to minimise the risk of recurrence. Effective quality assurance processes were in place to monitor the service and regular audits were undertaken to assess quality and gather feedback. Actions plans were in place where necessary following audits and these were monitored through to completion.

The service took an active role in projects for the benefit of people living in the service, to maximise the quality of care and to strive to achieve the best outcomes for people. For example, an aromatherapy project was in the planning stages during our inspection.

People had been involved in planning and delivering interactive staff training, that made them feel valued and respected. 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 and their relatives spoke highly of the management team and staff. People and their relatives knew who the manager was. One relative said, “Across the board with the staff there is good professionalism and empathy. The communication coming out under the management is very good indeed.” The registered manager actively encouraged engagement and ownership for staff and supported them to form focus groups to drive continuous improvement.

A commitment to staff wellbeing had resulted in lower staff turnover and reduced sickness. People, relatives, managers and staff worked together as a team. People, relatives and staff all said the registered manager was supportive, approachable and had an open-door policy.

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 outstanding (published 24 December 2019).

Why we inspected

We received concerns in relation to standards of personal care, medicines management and the environment. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

The overall rating for the service remains outstanding based on the findings of this inspection.

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

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eglantine Villa Care Home is a residential care home providing personal and nursing care for 49 older people in two adjoining buildings. Jasmine Lodge provides care for up to 24 older people with nursing needs. Lavender Cottage provides residential care for up to 25 older people with dementia. There were 44 people living at the service at the time of the inspection.

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

People, their relatives, health care professionals and staff spoke positively about the service. Comments included, “The whole team are very professional in every way but are also very upbeat and fun for [our loved one] to be with” and “[Staff] are wonderful. We never leave worrying about [our loved one] and if they are not well staff always ring and let me know. Excellent.”

People were supported to take positive risks, maximising control over their lives. There was a strong, empowering and distinctive approach to safety and risk management. Staff used innovative and creative ways to manage risks whilst supporting people to remain as safe as possible. People had developed strong, trusting relationships with the staff team and felt safe living at Eglantine Villa. There were enough staff to provide people with the support they needed, when they needed it. Staff worked flexibly as a cohesive team to ensure people received an outstanding quality of service. People were supported by staff who had been recruited safely and were involved as much as possible in the recruitment process.

There was a thorough, co-ordinated and holistic approach to planning, managing and reviewing people’s care and support. Technology and evidence-based techniques were used to support the delivery of high-quality care. The registered manager and staff worked with health care organisations and education institutes, taking part in research projects to improve the service they provided. People, their relatives and staff were involved in the planning and delivery of training. 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 encouraged to maintain a healthy and balanced diet and people told us they thoroughly enjoyed their meals. Staff were creative in their approach to encouraging people to eat well and remain as healthy as possible. Staff worked closely with local health care professionals.

People felt respected and valued as individuals and were fully involved in making decisions about their care and support. People and staff valued each other’s differences. A relative commented, “[Our loved one] was treated with respect and dignity. We were welcome at any time and always met with a professional and efficient service.” The strong, visible person-centred culture was evident and close bonds between people, relatives and staff were clear. One relative said, “Simply put, the staff feel like an extension of our family.”

People’s individual needs and preferences were understood by staff. People’s choices regarding their lifestyle, culture and religion were embraced. Staff regularly went the extra mile to support people to be as independent as possible and live life to the fullest. People stayed as active as possible with a range of innovative, meaningful activities offered each day. People regularly suggested ideas for things they would like to do and staff, as far as possible, supported them to reach their goals. People were supported to have a comfortable, dignified and pain-free death by staff who worked closely with end of life health care professionals. Staff responded quickly to people’s changing needs. They provided emotional support and practical assistance to people’s friends and family at this difficult time.

People, relatives, health care professionals and staff felt the service was well-led. Relatives commented, “We would have no hesitation in recommending this home” and “[Our loved one] is in excellent hands, enjoying continuous personal attention despite being bed ridden. They are always included.” Staff were very well supported and highly motivated. People, relatives, health professionals, the local community and staff were empowered to provide feedback, and this was welcomed.

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 Outstanding (report published January 2017).

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.

When we last inspected in April 2014, we identified a breach in regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010, because accurate and appropriate records were not consistently maintained. We had requested the provider to take action. At this inspection, we found that improvements had been carried out.

There was a manager in post who was registered with 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 knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow and to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. They communicated effectively with people and treated them with utmost kindness and respect. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions. When applicable, meetings were held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food and their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were person-centred, reviewed monthly or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors. People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People or their legal representatives were actively involved with the review of people’s care plans. People’s care was personalised to reflect their wishes and what was important to them and staff paid particular attention to their emotional wellbeing, their preferences and specific requirements. The delivery of care was in line with people’s care plans and risk assessments.

There was a wide range of person-centred activities that were inclusive, flexible and suitable for people who lived with dementia. Research on activities and innovative initiatives were used effectively to enhance people's experience and meet their psychological and social needs. Individual activity plans were developed in partnership with people to ensure individual interests were acted on.

The registered manager promoted an open and positive culture which focussed on people, carried out innovative research aiming to improve people’s quality of life at national level and promoted strong links with the community. Staff told us they felt valued and extremely supported by the manager, the management team and the provider.

Feedback from people, their representatives and staff about the overall quality of the service was actively sought and acted on. This feedback described the service and its management mostly in emphatic terms. Staff and the management team responded to people’s feedback and provided an environment where people felt valued and in control of their lives.

Emphasis was placed by the management team on continuous improvement of the service. A robust system of monitoring checks and audits identified any improvements that needed to be made and action was taken as a result.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

People who lived in on the Lavender unit were experiencing dementia. This meant they were not always able to tell us about their experiences. The report is based on our observations during the inspection, talking with people who used the service, and the staff supporting them, and looking at records.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff.

There were systems in place to make sure that the manager and staff learned from events such as accidents and incidents and the risks associated with the environment. Risks to people's health and welfare were identified or managed to ensure people were protected from risk of harm.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. There were personal emergency evacuation plans for staff to follow in the event of a fire.

We looked at staff rotas and found they take people's care needs into account when making decisions about the numbers of staff on duty, their qualifications, skills and experience. This helps to ensure that people's needs are always met.

Is the service effective?

People's health and care needs were assessed with them, and they were involved as far as possible in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans. However, people's individual care records were not always accurate or up to date.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to maintaining accurate, up to date and person centred care plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw that people were comfortable with the staff who were working with them.

Staff knew people well and were able to describe people's preferences, interests and diverse needs. This meant that care and support was provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities regularly. An activities coordinator provided a programme of activities for people to choose from. The home had access to an adapted minibus, which meant that people were able to take part in outings.

Staff responded quickly when people needed support or reassurance.

Is the service well-led?

The service had an effective quality assurance system, records seen by us showed that identified shortfalls were addressed promptly.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We talked with people who used the service or their relatives about what they had experienced. One said 'Staff are so very helpful, this is an excellent home' another said 'I am impressed with the home, the staff are helpful and they have a good attitude'. People told us that they felt the home provided safe care.

We found that people who used the service were not always protected from the risks of inadequate nutrition and dehydration. We found that the registered person could not provide evidence that they were meeting people's assessed needs around eating and drinking. There were records in people's care plans called lifestyle profiles; these provided information about peoples likes and dislikes around eating and drinking that supported hydration and nutrition. We noted that the corresponding information was not being recorded in people's food diaries.

We found that the registered person was not always ensuring there were sufficient numbers of staff available to support the effective delivery of the service.

We found that the prescriptive staff routine did not promote a caring and needs led culture.

We saw from the staff records that staff were receiving supervision and that there was a supervision schedule. We saw that the manager of the home kept records of staff training and we noted that recent staff training had included but was not limited to administration of medication, nutrition and hydration, first aid and fire training. This meant that staff were being supported to update and develop their skills.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We saw a copy of the complaints procedure and that complaints were monitored under the governance structure of the BUPA Group. Staff told us that they were aware of the complaints procedure. This meant that the provider had an overview of complaints about the service and how they were resolved.

We found that records were not always accurate which did not protect service users from inappropriate care or treatment.

The people living there could make choices about their lives. We observed people making choices about what ate and drank, what they did and where they spent their time. Two relatives spoken with told us that their relative had chosen to live at the home because they thought it was homely.

We saw that people were encouraged to do things for themselves so promoting their independence skills and self esteem.

We saw that people were supported to have regular health checks to ensure their well being. Other professionals were involved in people's care and staff followed their advice to help to meet people's needs.

Systems were in place to ensure that people were safeguarded from harm. We saw that people were comfortable in the company of staff. One relative said, 'The staff put care into caring here.'

We saw that more staff had been recruited to work there which meant that people were supported to meet their needs.

People were asked for their views about the home and these were listened to. Audits were completed and action taken where needed to make improvements.