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Edwina Mountbatten House Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 25 March 2019

During a routine inspection

About the service: Edwina Mountbatten House is a care home. It does not provide nursing care. It can accommodate up to 16 people. At the time of the inspection there were 13 people using the service. The registered provider, The Countess Mountbatten of Burma Memorial Trust, is a registered charity run by a board of Trustees.

Rating at last inspection: At the last inspection in February 2018, we rated the service as ‘Requires improvement’. That inspection identified two breaches of the Regulations. There had been a failure to ensure that there were strong governance systems in place and records relating to people’s care were not always complete. The provider had also failed to ensure that new staff received appropriate training.

We also made four recommendations. These were:

- That a systematic approach be used to determining the numbers of staff deployed.

- That a more robust pre-admission assessment form be developed.

- That action was taken to ensure that infection prevention and control policies and procedures reflected statutory guidance.

- That staff be provided with training to equip them with the skills they needed to develop end of life care planning with people and their relatives.

People’s experience of using this service:

This inspection found some improvements had been made but many of these were yet to be fully embedded.

The systems in place were not yet being fully effective at identifying compliance with the Regulations and delivering all the improvements needed to achieve a rating of ‘Good’.

People had always received their medicines as prescribed and staff were not always following best practice frameworks in relation to the management of medicines.

Some of the risks associated with people’s care had not been consistently assessed and planned for. Whilst accidents and incidents were documented and investigated. It was not always clear that sufficient action had been taken to reduce similar incidents from happening again.

Whilst planned staffing levels had not always been achieved, people and staff did not feel this had impacted upon the provision of safe care.

Systems and processes were in place to safeguard people from the risk of abuse.

The home was visibly clean and staff followed appropriate infection control measures.

Improvements continued to be embedded to ensure that staff, new to care, consistently received a comprehensive induction mapped to the Care Certificate standards. Staff received regular training opportunities to keep their knowledge up to date.

The registered manager had started to implement an effective and robust supervision programme.

There was a clear focus on the importance of seeking peoples consent, and there was evidence that people were always offered choice and control over the care they received.

Overall assessments of people’s needs were suitably detailed and holistic. Staff were using evidence based guidance to enhance the care provided and to achieve positive outcomes for people.

Where necessary a range of healthcare professionals including GP’s and district nurses had been involved in supporting people to maintain good health.

People told us the environment was homely and comfortable and they were positive about their rooms which they had been able to personalise according to their individual tastes. However, we found that the environment was still not consistently decorated and equipped to a good standard throughout. This had been a concern at out last inspection.

The provider remained committed to the programme of refurbishment which it was hoped would now start in the Autumn. We have made a recommendation about consulting best practice guidance on how to effectively design environments for people living with dementia including the use of appropriate technology, signage and decorating styles.

People continued to be treated with kindness, respect and dignity. Staff understood the importance of supporting people to maintain their independen

Inspection carried out on 19 February 2018

During a routine inspection

Edwina Mountbatten House is a care home without nursing. People in care homes receive accommodation and their care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. The service provides accommodation for up to 16 people. There were 14 people using the service at the time of the inspection. The registered provider, Countess of Mountbatten of Burma Romsey Memorial Trust is also a registered charity run by a board of Trustees. The Trustees meet on a regular basis to discuss and decide on all issues concerning Edwina Mountbatten House.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection, the service was rated overall as ‘Good’. At this inspection we found the service was now rated overall as requires improvement.

Improvements were required to ensure staff were recruited safely and in line with regulatory requirements.

Although some people's care plans provided sufficient detail about how to mitigate known risks, others did not.

Improvements were needed to ensure that medicines were managed safely at all times.

New staff had not completed a training and development programme which helped to equip them with the right skills and knowledge to carry out their roles.

The provider had failed to meet a condition of their registration with the Care Quality Commission by admitting more than the maximum number of service users allowed.

More sophisticated systems were needed to support the registered manager and registered provider to measure the quality of service and delivery of care, treatment and support given to people against the fundamental standards, key lines of enquiry and best practice guidance.

Other areas were good.

There were sufficient numbers of staff deployed to meet people’s needs at this time. The level of dependency of people using the service was increasing however, and so the registered manager would benefit from having a systematic approach in place to determine and review staffing levels. We have made a recommendation about this.

Pre-admission assessments were undertaken but we have made a recommendation about making these more comprehensive in order to support robust decisions about new admissions to the home.

The home was clean throughout, although we have made a recommendation that the registered manager ensure action is taken to fully incorporate statutory guidance in relation to infection control into the policies and procedures within the home.

Staff had received training in safeguarding adults, and displayed a commitment to protect people from abuse. Staff understood their responsibility to report incidents or accidents that could affect the safety and wellbeing of people using the service and these were monitored for trends or themes.

An internal redecoration and refurbishment programme was underway to help ensure the home design and layout met the needs of people using the service.

People’s personal choices and freedoms were respected and people were encouraged and supported to make decisions about their care and support

People were positive about the food provided. People received and were supported to access healthcare services when needed.

People told us they were cared for by kind and caring staff who respected their choices, their privacy and dignity and encouraged them to retain their independence.

People received care that was responsive to their needs. Staff knew people well and had a good knowledge of their likes and dislikes.

People had access to a range of activities and leisure opportunities. Pe

Inspection carried out on 19 and 20 October 2015

During a routine inspection

Edwina Mountbatten House is owned and operated by The Countess Mountbatten of Burma Romsey Memorial Trust. It is a small care home, located in the centre of Romsey, and provides care and accommodation for up to sixteen older persons. The accommodation is arranged over two floors with a stair lift available to access the upper floor. Its central location within Romsey means that people are able to walk into town to access the shops or for other social activities.

The home does not provide nursing care and people living at the home were generally quite independent and only required minimal support with some aspects of personal care or support with their medicines management and the provision of meals. There were 16 people living in the home when we inspected.

The service had 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 and associated Regulations about how the service is run.

Some areas required improvement. Some people’s care plans needed to be updated to include more detailed and specific guidance to support staff to provide their care in a manner that was responsive to their individual needs.

People told us they felt safe and there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.

Safe recruitment practices were followed and appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff deployed to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. No-one living at Edwina Mountbatten House had their liberty or freedoms restricted and therefore no applications were required at this time.

People were supported to have enough to eat and drink. The meal time experience was a sociable and positive experience, which people seemed to enjoy.

People told us they were happy with the care provided and said they had good relationships with staff. They told us they received personalised care and were encouraged make choices about how they spent their time.

People spoke positively about how well organised and managed the service was. There was an open and transparent culture within the service and the engagement and involvement of people and staff was encouraged and their feedback was used to drive improvements. There were some systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.