Archived: Everley Residential Home

Everley Residential Home is a residential care home providing personal care and accommodation to people aged 65 and over who may also be living with dementia or physical disabilities. The care home is registered to provide support to 16 people in one adapted building, at the time of inspection 10 people lived at the home.

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

Care and treatment was not provided in a safe way. People were at risk of dehydration and this had not been addressed by the registered manager or provider. People had lost weight, and this had not been escalated to relevant professionals.

People were not protected from potential harm and abuse. People had been subject to abuse and this had not been escalated and investigated to prevent further occurrences. Abuse or improper treatment was not always reported, investigated or acted on.

The provider's systems failed to identify that care and treatment was not provided in a safe way. Audits did not identify risks to people, safeguarding concerns and a failure to report incidents. Staff practice was not effectively monitored.

An infection prevention control audit was carried out by CQC during the inspection. It was found the provider was not meeting government guidelines in regard to COVID-19. People had not been isolated in the home on return from hospital increasing the risks of potential COVID-19 spread. Staff and people had not received regular COVID-19 tests.

Relatives had not been informed when things had gone wrong or their loved ones had been subject to harm or abuse. The provider and registered manager failed to act in an open and transparent way when things went wrong.

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 (06 August 2020). The service remains rated inadequate. This service has been rated inadequate for the last two consecutive inspections. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve, but they failed to submit this. At this inspection improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 06 August 2020. During this inspection the provider was not able to demonstrate that improvements have been made. The service remains in Special Measures.

Why we inspected

We received concerns in relation to the overall management of the home, people’s health needs and people’s weights. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, governance, the registered managers ability to carry out the regulated activity, infection control and the environment, a failure to notify and a failure in duty of candour at this inspection.

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.

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 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.

Special Measures

The overall rating for this service is ‘inadequate’ and the service remains 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 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.

Everley Residential Home is a residential care home providing personal care and accommodation to people aged 65 and over who may also be living with dementia or physical disabilities. The care home is registered to provide support to 16 people in one adapted building, at the time of inspection 13 people lived at the home.

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

Care and treatment was not provided in a safe way. People were not protected from potential harm and abuse. Abuse or improper treatment was not always reported and investigated. Medicines were not managed safely.

The provider’s systems failed to identify that care and treatment was not provided in a safe way. Audits did not identify concerns with risks to people, safeguarding, peoples right to life, medicines, care plans and recruitment.

Staff did not always feel listened to by the management team. Staff concerns were not always acted on. Staff practice was not effectively monitored.

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 requires improvement (20 June 2019). At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and governance and in part due to a notification that related to an allegation of abuse. A decision was made for us to inspect and examine those risks. The information CQC received about the incident indicated concerns about the management of risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. However, the provider had failed to notify CQC of events that occurred in the service in line with legal requirements. This was a breach of regulation and we would usually issue a fixed penalty notice. We did not take this action at this time but will continue to monitor the service.

We have identified breaches in relation to safe care and treatment, infection control and the environment, safeguarding, governance, the registered managers ability to carry out the regulated activity and a failure to notify at this inspection.

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.

Follow up

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.

Special Measures

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 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.

Everley Residential Home is a residential care home providing personal care and accommodation to people aged 65 and over who may also be living with dementia. The care home is registered to provide support to 16 people in one adapted building, at the time of inspection 15 people lived at the home.

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

The manager lacked oversight and had no access to action plans and finances. Systems were not effective for monitoring the quality and safety of the services provided. There was good involvement with community professionals. Staff knew how to raise concerns about poor staff practice.

Concerns were identified with infection control, environmental health and lack of maintenance. People received medicines as required however stocks did not always balance meaning medicines were not always safely managed. Improvements were required with recruitment checks and assessment of staffing levels. People told us they felt safe and staff knew people well.

Peoples social needs were not always met, and activities were lacking. The number of complaints were recorded but the detail of what the complaint was, was not always documented. People felt able to talk to staff who would listen to them. End of life preferences were recorded for people.

The provider could not demonstrate that they promoted people’s privacy and dignity. People liked the staff. Peoples religious wishes and beliefs were recorded. Relationships with family were encouraged and maintained.

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 had choice over what they ate, and their nutritional needs were met.

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 29 August 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the premises and equipment and governance at this inspection.

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

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Everley 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.

Everley accommodates a maximum of 16 older people that may have dementia or physical disabilities. People live in a building that was converted into a care home.. There was 16 people living at the home on the first day of inspection, and 15 on the second.

The provider is required to, and has a registered manager for the home. They were present throughout our inspection. 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 felt there was enough staff to keep them safe, and respond to their requests for assistance in a timely manner. Staff were of the view additional staff may help improve people’s safety and the provider was reviewing staffing levels on a monthly basis in response.

Improvement was needed to ensure that systems for infection control were effective. People received their medicines in a safe way. People felt safe and there were systems in place to identify and respond to risks. Staff were aware of safeguarding systems, although improvement in recording equipment people may use for lifting could be improved.

People’s rights were promoted. Staff sought people’s consent. Risks to people’s health were assessed and identified. Staff were supported and had received training although some training needed update. The provider had sourced a new training provider to update staff on key areas of skill and knowledge relevant to their job. People were supported to maintain a healthy diet, good fluid intake and had a choice of meals. People were supported to access the health care they needed.

The environment was small and homely although may not always be suitable for people with limited mobility if accommodated on the first floor. There was scope for improvement in respect of the environment regarding its decoration, and safety in respect of, for example infection control.

People were supported by staff who were caring and treated them with dignity and respect. People were valued by staff. People's independence was promoted. People were supported to express and make choices regarding their daily living. People were supported to maintain contact with significant others.

People and their representatives were involved in their care planning. Staff understood people's needs, likes, dislikes and personal preferences. People had the opportunity to engage in activities if they wished. People could make a complaint and thought they would be listened too. The provider was working with health professionals to develop ways of responding to people’s wishes and needs at times when they may be unable to share these.

Systems for quality monitoring were in place, but development of these needed to continue to address some aspects of quality within the service. The management team were well known to people, relatives and staff, who considered them approachable. The provider understood their legal responsibilities and were open and honest about the challenges faced in respect of improving the service so people were safe and received good quality care. We found the provider was learning from incidents and events following input from other agencies.