Emsworth House Care Home with Nursing

Emsworth House Care Home with Nursing is a care home. The home is registered to provide accommodation and nursing care for up to 79 people. At the time of the inspection, 66 people were living at the home. The home comprises single room accommodation arranged in two separate sections; the residential unit provides accommodation with personal care and the nursing unit provides accommodation with nursing care. Each unit also has a wide range of communal areas where people can spend time and socialise.

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

Quality assurance systems had not been effective in identifying the concerns we found at inspection or driving the necessary improvement. When the registered manager was made aware of any issues, they acted to address them and told us of their plans to further improve.

There were not enough staff deployed to safely support people throughout the day and ensure their needs were always met. Risks to people were not always assessed, monitored or mitigated effectively. Medicines were not always managed safely.

The provider had effective safeguarding procedures in place and people were protected from the risk of abuse. Recruitment practices were safe. The home was clean overall, and the provider had effective processes in place to prevent the spread of infection.

Not all staff had received appropriate training to ensure they had the skills and knowledge to effectively support people.

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. However, improvements were needed with The Mental Capacity Act 2005 (MCA) records, and we have made a recommendation about this.

People received enough to eat and drink and told us the food was satisfactory. Improvements were needed to ensure people had the right support at mealtimes to make it a more enjoyable experience. The service had good relationships with external professionals to ensure joined up care and good health outcomes for people.

People and their relatives provided positive feedback about the caring nature of the permanent staff, and we saw kind and caring interactions during our observations. The registered manager was working on developing a more person-centred culture in the service.

The registered manager was open, honest and told us they were committed to make the necessary improvements to ensure the service provided safe, compassionate and well-led 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 (report published 5 September 2019). This service has been rated requires improvement for the last three consecutive inspections. We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 full details of the report which is on the CQC website at www.cqc.org.uk

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to staffing, risk management, medicines management, training and governance at this inspection. We have also made a recommendation in relation to MCA records.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Emsworth House Care Home with Nursing is a care home. The home is registered to provide accommodation and nursing care for up to 79 people. At the time of the inspection, seven rooms were closed for refurbishment and 69 people were living at the home. The home comprises single room accommodation arranged in two separate sections; the residential unit provides accommodation with personal care and the nursing unit provides accommodation with nursing care. Each unit is based over two floors with inter-connecting passenger lifts. Each unit also has a wide range of communal areas where people can spend time and socialise.

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

People told us they felt safe and happy living at Emsworth House. However, we found some improvements were required to ensure people consistently received effective, high quality care.

Staff did not always follow best practice guidance in relation to legislation designed to protect people’s rights.

The provider’s quality assurance systems were not always effective in identifying and bringing about improvement.

There were usually enough staff deployed to meet people’s needs and safe recruitment procedures were followed.

People felt safe and were protected from the risk of abuse.

The home was clean and staff used appropriate techniques to prevent the spread of infection.

Staff were suitably trained and supported in their roles.

People’s dietary needs were met and people were encouraged to drink well.

People were supported to access other healthcare services in a timely way.

Adaptations had been made to the home to meet the needs of the people living there.

People and family members spoke positively about staff and we observed positive interactions between people and staff.

People’s privacy and dignity were protected and people were encouraged to be as independent as possible.

People were empowered to make decisions and were involved in creating their care plans.

A range of activities and events were arranged to help people lead active, fulfilled lives.

People felt listened to and knew how to raise concerns.

Staff were highly experienced in supporting people at the end of their lives to have a comfortable, dignified and pain-free death.

Managers had developed a positive culture that was person-centred, open and inclusive.

Staff had developed links with community groups for the benefit of people.

The service has been rated Requires improvement as it met the characteristics for this rating in three of the five key questions. More information is in 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 requires improvement (published 14 July 2018). The service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous inspection rating.

Follow up

We will continue to monitor the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home comprises single room accommodation arranged in two separate sections of the home; the residential unit provides accommodation with personal care and the nursing unit provides accommodation with nursing care. Each unit is based over two floors with inter-connecting passenger lifts. Each unit also has a wide range of communal areas where people can spend time and socialise.

This inspection took place on 14 and 17 May 2018 and was unannounced. At our last inspection in February 2016 we did not identify any concerns and rated the service ‘Good’ overall.

There was a registered manager in post at 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 and associated Regulations about how the service is run.

The provider had clear recruitment procedures in place, although some pre-employment checks were not completed for staff appointed during a recruitment event held earlier in the year.

People and their relatives had mixed views about the staffing levels, commenting that they sometimes had to wait for support. However, the registered manager was in the process of recruiting additional staff to cover busy periods.

There were appropriate arrangements in place for obtaining and administering medicines safely. However, risk assessments for some high risk medicines were not put in place until we brought this to the attention of the registered manager and some medicines were not stored safely.

Staff sought verbal consent before providing care or support and acted in people’s best interests, although they had not always recorded decisions they had taken on behalf of people.

People expressed mixed views about the quality of the meals, Some people complained that the meat was tough and we found people did not always receive they support they needed to eat.

We observed that one staff member did not always treat people with consideration and respect. However, most people told us they were supported by kind, caring and compassionate staff and we observed other staff treated people with kindness.

Staff also told us people could choose the gender of the staff member who supported them with personal care, but we found these arrangements were not robust and people’s preferences were not always met.

There was a comprehensive quality assurance system in place, but this was not always effective as it had not picked up the concerns we identified.

People received personalised care from staff who understood their individual care and support needs. Care plans provided comprehensive information and were reviewed regularly, although information was not always clear and easy to find.

Effective systems and processes were in place to protect people at risk of abuse. The registered manager conducted thorough investigations in allegations of abuse when required.

All areas of the home were clean and there were systems in place to protect people from the risk of infection.

Risk assessments had been completed for all identified risks to people, together with action staff needed to take to reduce the risks. Staff knew what to do in the event of a fire and had been trained to administer first aid.

Staff were supported appropriately in their roles and completed a comprehensive training programme to help ensure they had the skills to support people. Registered nurses demonstrated an evidence based approach to their practice.

The home had been adapted to make it supportive of people’s needs and staff created a relaxed environment in which people felt at ease.

People were supported to access other healthcare services when needed. Staff encouraged people to be as independent as possible and involved them in discussing the care and support they received. They respected people’s beliefs and supported them to follow their faith.

Staff were responsive to changes in people’s needs, including at the end of their lives, when people were supported to have a comfortable, dignified and pain free death.

People enjoyed living at Emsworth House and felt it was run well. They had access to a range of activities within the home. The provider sought and acted on feedback from people and people felt able to raise concerns.

Staff were organised and communicated effectively between themselves. The provider had clear expectations about the values staff should work to and these were clearly communicated to staff.

There was an open and transparent culture. Visitors were made welcome at any time and the provider notified CQC of all significant events. Positive links had been developed with the community, to the benefit of people.

A registered manager was 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.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs. Staffing numbers were sufficient to meet the needs of people.

Medicines were administered, stored and ordered in a safe and effective way.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

Systems in place to manage the cleanliness and infection control in the home were very good.

Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People’s nutritional needs were met in line with their preferences and needs. People who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

The service had received an award for their end of life care. This empathetic and caring approach to the care of people who were close to the end of life was embedded in the service.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

Complaints had been responded to in an effective and timely manner and this work needed to be sustained.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People, their relatives and staff spoke highly of the registered manager and were involved in the running of the home. Audits and systems were in place to ensure the safety and welfare of people.

There were policies and procedures in place for staff to use to assist them to provide care and support to people in line with their needs and wishes for example confidentiality, supervision, cleanliness and infection control and mental capacity.

One person who used the service gave us positive comments. They said, 'Staff here are really lovely and helpful'. One relative told us 'Dad really likes it here and staff are friendly'.

We found that the service placed the needs, wishes, preferences and decisions of people who used the service at the centre of assessment, planning and delivery of care treatment and support.

We were shown a number of different assessments that were carried out which reflected people's needs and preferences. However it was unclear when the information had been reviewed.

We were told that before people received any care or treatment they were asked for their consent. We looked at seven people's care plan files and found most had been signed by the person who uses the service.

Where people did not have the capacity to consent the provider acted mostly in accordance with legal requirements.

We found that there were systems in place to reduce the risk and spread of infection. Although we saw that the audits were undertaken, we could not see that where an action had been highlighted as needed, there had been a follow up to ensure the action had been taken.

The provider had policies and procedures in place for supporting staff and induction training was provided. We found that training records were kept and some members of staff required training updates. We found that supervisions were completed regularly and in line with the policy and included individual performance plans (IPP). One member of staff told us they felt supported and that they were offered lots of training.

We found a number of different quality monitoring tools that were used to regularly assess the quality of the service being provided. They were effective in the monitoring of the service.

In order to check that the home remains compliant with the regulations we carried out a desk top review of the service on 26 March 2013. At this review we looked at two outcomes and associated regulations:

In order to check compliance we used information given to us by the service in their Provider Compliance Assessment (PCA). This is a statement from the provider as to how they are complying with the outcomes and the associated regulations. We looked at records of visits to the service by Hampshire County Council who are the registered providers. We also looked at information held in the Care Quality Commission's records and in the Commission's Quality Risk Profile (QRP) of the service.

We have not visited Emsworth House Care Home with Nursing as part of this review because they were able to demonstrate that they were meeting the regulations without the need for a visit.