Esmere Gardens

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

A thorough assessment of people’s needs was completed by a senior staff member ahead of the person moving into the service. This enabled open discussions about people’s care and to ensure their needs could be fully met. These assessments were then used to develop individual care plans, setting out how their assessed needs should be met.

People and their relatives praised the assessment process, describing how it had involved a comprehensive tour of the care home and detailed explanations about care options. Everyone said they felt fully informed following this process and that the management team had undertaken this in a professional manner. One healthcare professional said, “From my experience with dealing with them, they are very thorough and efficient when a new resident arrives, we have a detailed medication list and summary care record sent to confirm their current medications, conditions.”

The registered manager told us at the point of assessment they were open with people and their families about the needs the service can support with and be able to meet. This was to ensure people living in the home already were not compromised and staff had time and were effectively equipped to provide safe care. One staff member said, “We read the care plan, we make time to read it and learn people’s needs. We need to get know them. The nurses and the care practitioner write the care plans. They have information in that we need.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider used recognised national tools to assess people’s risk of malnutrition and developed plans with them to meet their needs. We observed staff providing good support and encouragement for people to eat safely and maintain their nutritional intake. One staff member said, “The choice here is really good, its fresh and lots of variety and I have eaten it and it’s good. Some people have swallowing needs and are referred to SALT (Speech and Language Therapy team) and have minced and moist and thickeners.” (‘Minced and moist’ refers to a specific food texture for people with swallowing difficulties, in line with the International Dysphagia Diet Standardisation Initiative).

The kitchen staff understood people's nutritional needs and could talk confidently about people's allergies and dietary requirements. We saw this information was clearly displayed. The chef was able to speak to people and receive their feedback directly about the food

The physical environment was warm, welcoming and afforded people privacy or time that could be spent with others. We spoke to the provider about the design of the building in meeting the needs of people who lived with dementia, such as way-finding information, interest points and colours. The provider was receptive to this feedback and has since completed a nationally recognised audit tool to see if any improvements can be made to enhance the environment.

People and their relatives were positive about the home and the layout, and we saw people navigating the spaces independently or supported by staff. One healthcare professional said, “They do make adjustments for residents who require extra support.”

The home used a variety of technology aids to enhance people’s care experience. One of these was the circadian lighting system (this follows natural daylight throughout the day to support the body's internal 24-hour clock and promote well-being and sleep). Everyone had access to the call bell system in their bedrooms including when in communal areas. We saw staff responding to people in a timely manner.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

There were some mixed reviews on previous working relationships with the service and external professionals. The service was in the process of upskilling nurses in some areas of practice which whilst doing this, had meant the service had been more reliant on external healthcare professionals for support. There had also been some improvement needed around the management, recording and delivery of palliative care which some professionals highlighted had been a concern.

People had transfer forms which detailed information about the person that would need to be shared in the event they transferred into a different setting, for example, into hospital for necessary treatment. These were not all completed with relevant information for every individual, and some needed adding to.

However, other professionals spoke of improved positive working relationships which benefitted from clear communication commenting, “They are very responsive and act quickly to any changes indicated” and “They have been very responsive to emails. Yes, they appear to follow through on plans made. I have had to be clear on laying out my plans and there has been an occasion when information was not relayed between staff, but this has since improved.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s specific health needs were recorded in their care plans with information available for staff about these health conditions. We spoke with the registered manager about ensuring this information was tailored to the person, so staff understood how it directly impacted and presented for them. The registered manager was responsive to developing plans further to include this.

People had weekly access to a physiotherapist which had been sourced by the provider as a provision to everyone in the home needing this support. This enabled people to receive physiotherapy in a timely way. There had been a positive impact of this for residents receiving this including increased mobility.

Staff spoke about how they reviewed people’s health and encouraged them to remain healthy. This included encouraging people to drink plenty of fluids and implementing weekly weights for people experiencing sudden or unexplained weight loss. A monthly internal falls meeting had also been set up by the management team to consider how people could be supported and any risks further mitigated.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

It was unclear about the support people were receiving regarding changing their position to maintain good skin integrity. Following our inspection, the registered manager told us that no one in the service was receiving regular repositioning support. However, we saw 1 person’s skin integrity plan and Waterlow record (tool to predict the risk of developing a pressure ulcer) completed on 23 October 2025, stated they were repositioned at night due to being at high risk of developing pressure injuries. Staff were completing a repositioning chart for when they supported this person, however this was not following a regular pattern and there were gaps of different lengths when this person would receive support. One staff member also confirmed this person was being given repositioning support but was not clear on how often this was meant to happen. Another person we reviewed had a pressure ulcer and staff again confirmed this person was receiving repositioning support commenting, “We reposition [person’s name], we offer support regularly, and again before lunch” and “Repositioned every 4 hours.” This was not recorded on a repositioning chart. It was not clear to understand from speaking with staff, the registered manager and records who should be receiving this support and the frequency of this support. This was raised to the provider to address.

However, people and their relatives were full of praise for the staff team and how they supported them to have good outcomes. One relative said, “[Person’s name] weight is fine now, he had been losing weight, and we could not work out for what reason, but the loss has been corrected now, and everything is fine. “He gets [name of health condition] sometimes too, but you notice that it is all proactive here. It doesn’t matter who is involved, the nurses, the receptionist or carer, but whatever they do is all co-ordinated”. People had good information recorded around their nutritional needs and how this was being monitored. Another person living in the home told us how they had been supported to change the chair in their bedroom several times and now the current chair is comfortable and suitable for their needs.

The service used a technology sense system to help alert staff when people experienced a fall. This enabled staff to respond in a timely way. The system also allowed people at high risk of falls following an assessment to be alerted by movement so staff could check and support them if needed to prevent a fall. Staff were able to say how they monitored and looked for changes in people’s needs and presentation and the process for escalating any concerns to ensure a timely response was taken.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The service used CCTV in communal areas of the service. There were signs on entry to the service to indicate this and the service was registered with the Information Commissioners Officer and had completed a Data Protection Impact Assessment in line with requirements.

We saw the use of CCTV was discussed with people and their families as part of their pre-admission information into the home and contract signing. However, mental capacity assessments where needed had not been completed to reflect where people could not consent to understanding or making this decision or if family members had signed this on their behalf. We saw the use of CCTV was not mentioned on capacity assessments for residing in the service. This meant there was not an active mental capacity assessment to ensure this specific decision was continually reviewed and managed under an appropriate legal framework. The service could not therefore evidence how people had been supported to understand this specific decision. The registered manager confirmed this would be addressed. The provider’s policy around this was amended following our inspection.

Where people had been identified as unable to consent to decisions, a mental capacity assessment had been completed. However, these did not always provide full information on how a person’s capacity for a specific decision had been assessed or how the decision was reached. For example, 1 person was unable to understand or manage their medicines. The assessment recorded this decision had been discussed on behalf of the person but did not include any detail on how the person was supported to understand the decision needing to be made or how it was presented to them. The registered manager told us they would review these assessments to make improvements.

Staff understood how to support people who lacked capacity to consent to and make decisions. However, staff did not always know which people had Deprivation of Liberty Safeguards (DoLS) in place. DoLSare legal protections in England and Wales protecting vulnerable adults who lack mental capacity in care homes or hospitals from being unlawfully deprived of their liberty.) The registered manager kept a record of people subject to DoLS and regularly reviewed these referrals and tracked their progress where needed.

Staff understood if people lacked capacity to make specific decisions in some areas, this did not mean they could not make decisions in other areas, such as daily life decisions which staff supported them to do. One staff member said, “If people lack capacity, we learn what they need and assist them, family will help to inform us. People who are unable to tell us, we still ask them, we see them every day and can see how they express themselves. And they fluctuate in decision making, so sometimes can make the decision and some days they can’t.”