Archived: Eagles Mount Care Home

Eagles Mount Care Home is a nursing and care home for up to 72 older people some of whom were living with dementia or had nursing needs. At the time of this inspection 15 people were living or staying at Eagles Mount Care Home.

The home is purpose built and is divided into three separate living units. The provider was in the process of undertaking extensive refurbishment to the lower floor of the premises. We acknowledge our inspection took place during the Covid 19 pandemic which had had a significant impact on both people and staff in the service during the early days of the pandemic. Throughout this difficult time people and staff had been well supported by the management team.

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

There was a calm and welcoming atmosphere at Eagles Mount Care Home, people were relaxed and chatting to staff who were attentive to their needs. Risks to the premises had been assessed and regularly reviewed. Action had been taken to address specific risks such as the use of portable heaters, safe storage of razors and ensuring heavy items of furniture such as wardrobes were secured to reduce the risk of harm to people.

Staff confirmed they understood the risks and actions needed to minimise the risk of avoidable harm. One member of staff told us, “All the wardrobes are secured now.”

Medicines were managed safely and stored securely. Additional audits and processes had been implemented to ensure people had their topical medicines administered as prescribed. Each bedroom had a small, secure cabinet installed for people to store any items that may pose a risk to them or others. These items could include razors and dissolvable denture cleaning tablets.

People, staff and visitors to Eagles Mount Care Home were protected from risks of infection as policies and staff practices were reflective of current best practice guidance. Staff had access to personal protective equipment (PPE) and the home was active in carrying out whole home testing in response to the coronavirus health risk.

The provider had made amendments to audits, policies and processes to ensure effective governance and highlight potential shortfalls to improve the safety and quality of care people received.

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 (published March 2020). We identified a continued breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of Regulation 17.

Why we inspected

We undertook this targeted inspection to monitor the service to check the provider had addressed the shortfalls identified in the previous inspection. This targeted inspection found improvements had been made in all areas where shortfalls had previously been identified.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at entire key questions, only the part of the key question we are specifically concerned about. Targeted inspection do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this report.

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 coronavirus and other infection outbreaks effectively.

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.

Birds Hill Nursing Home is a nursing and care home for up to 72 older people some of whom may be living with dementia and or have nursing needs. The home is purpose built and is divided into three separate living units. There were 62 people living or staying there at the time of the inspection.

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

At the last inspection we identified a breach in regulations regarding the assessment and planning of people’s needs. Changes in their health were not always responded to appropriately to make sure all their healthcare needs were met in a timely way. These issues had been fully addressed at this inspection.

Also, at the last inspection, we also found a breach in regulations relating to systems to monitor and improve the quality and safety of the service. Some improvements have been made but this regulation remains in breach because some shortfalls regarding the oversight of the service were found at this inspection. In addition, we found some shortcomings in relation to infection control, risk assessment and medicines. We have made recommendations about these.

People told us that the service provided staff who were caring and supportive. They received care that was responsive to their individual needs and staff had a good understanding of how people preferred their care and support provided.

We saw people were very relaxed and content in the company of staff throughout our visits. Peoples needs were regularly assessed and reviewed in detail and action was taken to respond to people’s changing needs.

The provision of activities that were meaningful to the people living in the home was carefully planned. People told us they were happy with how they spent their time.

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take medicines safely.

The service supported people nearing the end of life to have a comfortable and dignified death by working closely with health care services and through consulting people about their end of life wishes. Staff talked with pride about the care they were able to give to people in their final days.

There were sufficient numbers of staff to meet people’s needs. Safe recruitment practices were followed, and appropriate checks completed to ensure that only suitable staff were employed. Staff received induction and on-going training and support that enabled them to carry out their roles positively and effectively.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People and where appropriate their relatives were involved in decisions about their care.

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 (published 25 January 2019). The rating has now improved to good.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement We have identified one breach in relation to governance and oversight of the service 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 for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Birds Hill is a ‘nursing 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.

Birds Hill Nursing Home is a nursing and care home in Poole for up to 72 older people some of whom may be living with dementia and or have nursing needs. There were 62 people living at the home which is divided in to three separate living units over three floors. One of the living units, Nightingale was specifically for people living with dementia, Merlin was for older people some of whom may have nursing needs and or be living with dementia and Starling was for people with high level and complex nursing needs and or people living with dementia.

There was a registered manager, which is a requirement of the service’s registration. 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.

We received concerns and allegations in relation to whether people’s health care needs were being effectively met and how well-led the home was. We reviewed this information and planned to carry out an inspection focusing on the questions, Is the service effective? and Is the service well led? During the inspection, we also identified that one person’s concerns and complaints were not fully responded to, so we also focused on the key question Is the service responsive?

Some people’s needs were not fully assessed and planned for and/or changes in their health were not responded to appropriately to make sure all their healthcare needs were met in a timely way. This had placed some people at risk of avoidable harm and was a breach of the regulations.

Most staff had the support and training they needed. Staff were well trained. The implementation of clinical and professional support for nursing staff was an area for improvement.

Overall people’s rights were protected and staff understood and acted in accordance with the Mental Capacity Act 2005 (MCA). However for those people who were supported by one member of staff at all times and who were not able to consent to this, the decision had not been considered under the MCA. This was an area for improvement and the registered manager agreed to address the shortfalls.

People's independence and wellbeing was enhanced by the design and environment of the home. People had been involved in choosing the décor and furniture throughout the building.

People were supported to eat and drink enough to obtain a balanced diet. People’s dietary needs and preferences were met.

People received very personalised care and support they needed and in the ways they preferred. Staff took the time to get to know people and their life and social histories so they could truly understand their experiences.

Overall, people and relative’s complaints were taken seriously and used as an opportunity for learning and improvement. However, one person’s concerns had not been recorded or fully addressed. The director of care took immediate action to address the person’s complaint.

There was a programme of quality checks and audits to monitor and improve the quality and safety of the service. However, these had not always been proactive and effective in identifying concerns and there was not sufficient oversight of the suitability of agency staff. This was a breach of the regulations. The registered provider took immediate action in response to the shortfalls identified.

At our last inspection in May 2017 the service was rated Requires Improvement overall, we found breaches of the regulations relating to risk and medicines management, record keeping and people's assessments and care planning. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Safe’ and ‘Responsive’ to at least good.

At this inspection we found significant improvements throughout the service had been made and these breaches of the regulations had been met. The manager and provider acknowledged they now need to embed and sustain these improvements.

Birds Hill is a ‘nursing 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.

Birds Hill Nursing Home is a nursing and care home for up to 72 older people some of whom may be living with dementia and or have nursing needs in Poole. There were 62 people living at the home which is divided in to three separate living units over three floors. One of the living units, Nightingale was specifically for people living with dementia, Merlin was for older people some of whom may have nursing needs and or be living with dementia and Starling was for people with high level and complex nursing needs and or people living with dementia.

There was not a registered manager for 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 2008 and associated Regulations about how the service is run. There had been an unsettled period of management at the home. The manager had previously worked at the home as the deputy manager for 20 months and they had applied to register with the CQC.

The culture at the home had improved and there was an open, friendly and homely atmosphere. People and staff were relaxed and comfortable with each other. People were supported with kindness and compassion by staff who knew them and understood the care they needed. There were processes in place to ensure people did not experience discrimination in relation to their care and support.

Risks to people’s personal safety had been assessed and plans were in place to manage these in the least restrictive way possible. Medicines were managed and administered safely. This was an improvement. There were also risk assessments and action plans in relation to the premises, which were maintained in good repair.

People received very personalised care and support they needed and in the ways they preferred. Staff took the time to get to know people and their life and social histories so they could truly understand their experiences. Their needs and preferences were consistently assessed or planned for. People and their representatives were actively involved in developing and contributing to their care plans. Care plans were written in an exceptionally person centred way with detailed instructions on how to provide care which focused on people’s strengths and abilities. Records were person centred and reflected the care, treatment and support people received. This was a significant improvement that had a very positive impact on people’s lives.

Following our feedback people’s clinical care needs not being consistently included in care plans, the manager and provider took immediate action to address this. They also produced an action plan that focused on how to further develop the nursing elements of people’s care into their care plans and the service as a whole.

People’s rights were now protected and staff understood and acted in accordance with the Mental Capacity Act 2005 (MCA). This was an improvement.

People were protected from abuse and avoidable harm. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. People involved in accidents and incidents were supported to stay safe and robust action was taken to prevent further injury or harm.

People's independence and wellbeing had been enhanced by improvements made to the environment of the home. The provider had invested in new equipment, furniture, the refurbishment of the building and used their knowledge of best practice to make the environment suited to the needs of people, including those living with dementia.

People were supported to eat and drink enough to obtain a balanced diet. People’s dietary needs were respected.

Communication needs and sensory impairments were flagged in people’s care plans. People got the support they needed to communicate in a very personalised way.

Staff told us they felt well supported to carry out their roles and told us everyone worked very well together as a team for the benefit of the people living at Birds Hill Nursing Home.

There was an emphasis on striving for improvement through quality assurance systems, audits and reflective practice. The manager and directors reflected on accidents, incidents, complaints, safeguarding investigations, audits and inspections to consider how practice could be improved. Learning from Birds Hill Nursing Home and the provider’s other services were shared between the services. The manager and provider produced an improvement plan with a focus of constantly improving the quality of service for people and also achieving a rating of outstanding.

Further information is in the detailed findings below.

Birds Hill Nursing Home is a nursing and care home for up to 72 older people some of whom may be living with dementia and or have nursing needs in Poole. There were 57 people living at the home which is divided in to three separate living units over three floors. One of the living units, Nightingale was specifically for people living with dementia, Merlin was for older people some of whom may have nursing needs and or be living with dementia and Starling was for people with high level and complex nursing needs and or were living with dementia.

The provider was registered in May 2016. The previous registered manager/provider remained in post and was registered as manager until November 2016. The provider and new management team has been fully responsible for the operation of the home from then. The registered manager has been registered since December 2016. 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.

Some risks to people’s safety were not consistently assessed and managed to minimise potential harm. This was because staff did not have access to the correct information about the risks to people and how to manage some risks.

Some people’s medicines were not consistently and safely managed or administered. This was because staff did not have clear instructions when they needed to give some people ‘as needed’ medicines. Some people had medicines that needed to be crushed and administered in food and drink but pharmacy advice had not been sought to check this was safe. The shortfalls in the people’s risk and medicines management were a breach of the regulations.

Some people’s needs were not reassessed when their circumstances changed and care plans were not updated or did not include all the information staff needed to be able to care for people. Some care plans included contradictory information. People’s needs had changed but their care plans had not been updated to reflect their current needs. However, staff were able to describe how they met people’s needs and staff delivered the care people needed despite the shortfalls in the assessments and care plans in place.

There were shortfalls and inaccuracies in the record keeping for people. This meant there was not an accurate individual record for each person. The shortfalls in people’s record keeping and the assessing and planning for people’s care needs were breaches of the regulations.

Staff were beginning to fully understand, work to and adhere to the principles of the Mental Capacity Act 2005. People were not subject to any unnecessary restrictions. There continued to be shortfalls in the correct recording of people’s consent, mental capacity assessments and decisions made in people’s best interests. This had been identified by the registered provider as an ongoing area for improvement. We have made recommendation about this.

People and relatives told us they and their family members were safe. People's independence and wellbeing had been enhanced by improvements made to the environment of the home. The provider had invested in new equipment, furniture, the refurbishment of the building and used their knowledge of best practice to make the environment suited to the needs of people, including those living with dementia.

People and relatives spoke highly of the caring qualities of staff. Staff were kind, caring and responsive to people’s needs. People’s individual care needs were met by staff who knew them well and were familiar with the care they needed. People had access to the healthcare they needed. People were occupied during the inspection and actively engaged with staff.

New staff received a six day induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. Existing staff were also receiving the same core training and new updates from the provider. Staff told us they felt very well supported by the new management team and provider. Staff employed were recruited safely.

The home was well-led and there was a positive, caring, open and improving culture. People, relatives and staff were kept informed of developments at the home and were consulted regarding how the home was run. There were regular meetings for people, relatives and staff. Staff felt well supported by and listened to by the management team.

The provider’s quality assurance system was being introduced. The provider and registered manager audited, observed practices, consulted and reported back on various aspects of the running of the home. The findings of the quality assurance system fed in to the overall improvement plan. The plan in place had identified the shortfalls found at this inspection and included realistic targets for the improvement of the service.