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Inspection carried out on 1 July 2019

During a routine inspection

About the service:

Eagle House Care Home is a residential care home providing personal care to 23 older people and people with a dementia related condition at the time of the inspection. The service can support up to 40 people.

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

People received personalised and responsive care from staff who were trained and supported in their role. Staff were aware how to minimise risks to people’s safety and knew how to identify and report any signs of abuse. People received their medicines as prescribed.

The home was clean and suitable for people’s needs. Risks to people’s safety and wellbeing were assessed and minimised. Checks of the environment and equipment were conducted and the provider took action during the inspection to make some window restrictors more robust.

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 were supported by staff who were caring and attentive. Staff were knowledgeable about people’s needs and had access to detailed care plans, guiding them how to support people. Trips and activities were planned taking account of people’s interests and life histories. There were good links with the local community.

Staff worked well with other professionals to ensure people received compassionate end of life care.

Systems were in place to check the quality and safety of the service and regular audits were conducted. We received positive feedback from staff and relatives about the management and leadership of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated Good overall (published 30 December 2016).

Why we inspected:

This was a scheduled inspection based on the service’s previous rating.

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.

Inspection carried out on 1 December 2016

During a routine inspection

Eagle House provides personal care and support to up to 40 older people some of whom are living with dementia. The service is centrally located in a town, close to local facilities. On the day the inspection took place, there were 24 people living in the service and one person was attending the service for day care.

The service had a registered manager in post. 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. Following the last focused inspection in January 2016, the registered provider took the decision to appoint the registered manager from another of their services locally, to manage Eagle House. An assistant manager and a new deputy manager provided support with the day-to-day administrative and management duties.

At the rated comprehensive inspection in September 2015, we found there were shortfalls with the staffing levels, environment, infection control and governance systems and there were breaches in regulations. We rated the service as ‘requires improvement’ in the effective, responsive and well-led domains, ‘good’ in the caring domain and ‘inadequate’ in the safe domain. We rated the service as ‘requires improvement’ overall. We then completed a focused inspection in January 2016 to review the safe domain and found the necessary improvements to the staffing levels and infection prevention and control systems had been made. Following the focused inspection in January 2016, the rating for the safe domain improved to ‘requires improvement’. We undertook this unannounced inspection on the 1 and 2 December 2016.

People and relatives spoke positively about the service and said it provided good quality care in a personalised and friendly way. We observed a positive and inclusive atmosphere within the home and people told us they felt safe living in the service. We saw staff interacting with people and they did so in a kind, caring and sensitive manner. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people.

We saw there were enough skilled and experienced staff on duty to meet people’s needs. We found staff had been recruited using a robust system that made sure they were suitable to work with vulnerable people. They had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills.

We found staff ensured they gained consent from people prior to completing care tasks. The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People praised the food provided by the home and improvements had been made to the menus to offer more choice. Staff provided a person centred approach at mealtimes and people’s nutritional needs were met by the service.

People’s privacy and dignity were respected and staff provided people with explanations and information, so they could make choices about aspects of their lives. People and their relatives said staff were always kind and caring and treated them well. Staff demonstrated a good understanding of the people they were caring for. Information on people’s lives had been sought to help staff provide individualised care.

People’s healthcare needs were assessed and met by the service in conjunction with a team of health professionals. The care files we checked were individualised and reflected people’s needs and preferences in detail. Care plans and risk assessments had been reviewed and updated on a regular basis.

We found people received their medicines as prescribed. Medicines were obtained, stored, administered and recorded appropri

Inspection carried out on 7, 8 and 25 January 2016

During an inspection looking at part of the service

Eagle House Care Home provides personal care and support to up to 40 older people some of whom are living with dementia. The service is centrally located in the town close to local facilities. On the day the follow up inspection took place, there were 23 people living in the service and two people using the day care service.

This inspection was unannounced and undertaken on 7, 8 and 25 January 2016. We had previously inspected the service in September 2015; it was rated as Requires Improvement overall but we issued three requirement notices for breaches in regulations for staffing, maintenance of the environment and governance. We also issued a warning notice for the breach in regulation for maintaining standards of hygiene (this was a continued breach as concerns were first identified at the inspection in January 2015). The acting manager sent an action plan in response to this inspection telling us what measures the registered provider was going to take in order to address the issues. The inspection visit was to check the improvement action taken in respect of staffing and standards of hygiene had been sustained, that staffing levels were sufficient to meet the needs of people who used the service and Eagle House was clean and fresh. The findings of this inspection have not changed the service’s overall rating; however it did improve the rating of the specific question ‘Is the service Safe?’ from ‘Inadequate’ to ‘Requires Improvement’.

The service is required to have 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 2008 and associated Regulations about how the service is run. The registered manager was not present during our inspection. The deputy manager had been appointed to the role of acting manager in May 2015 and was present throughout the inspection.

We found improvements had been made to the standards of cleaning and hygiene throughout areas of the service and further improvements were made during the inspection. To support more effective hygiene practices in the service, we found new furniture, furnishings, bedding and flooring had been provided. A new quality audit tool and more comprehensive cleaning schedules and systems of daily checks had been put in place which helped the acting manager to monitor the standards of hygiene in the service and identify any shortfalls.

The care staffing levels were further reviewed and increased during our inspection and we found there were sufficient staff on each shift to meet people’s individual needs and support them safely. New dependency assessments had been introduced and the information was used to inform the staffing calculations. One person was now provided with one-to-one support. The domestic hours had been increased and new care, domestic and laundry staff had been recruited. Two new senior care staff had been appointed and 16 (supernumerary) hours were provided to senior care staff to assist the acting manager with her role. The acting manager confirmed they were in the process of recruiting a new activity co-ordinator to facilitate the activity programme.

We are keeping these areas under review and monitoring them to make sure the improvements are consistent over time.

Inspection carried out on 2 & 7 September 2015

During a routine inspection

At the last inspection on 13 and 14 January 2015 we found a breach in regulations which related to infection prevention and control. The overall rating for the service was, “Requires improvement”.

Following the inspection in January 2015 we received an action plan from the registered provider detailing how improvements would be made including a timescale. At this inspection we found some improvements had been made, however we identified continued and further breaches in regulations.

There was a registered manager in post. 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 registered manager was not present during our inspection. The deputy manager had been appointed to the role of acting manager in May 2015 and was present throughout the inspection.

This inspection was unannounced and took place on 2 and 7 September 2015.

Although we found some improvements had been made in regard to standards of hygiene and cleanliness, these were not comprehensive and significant shortfalls were identified. Many areas of the environment and furnishings still required redecoration and renewal. There was no formal maintenance programme in place.

We found there were insufficient staff at times during the day to meet the needs of people who used the service. Some people’s needs had changed and their needs were more complex. Staffing levels had not kept pace with this.

Care plans were person centred but we found evidence they had not always been updated following changes in people’s needs. Staff had not maintained accurate and detailed supplementary records to monitor people’s fluid and food intake and repositioning support.

The quality of the service had not been monitored effectively and shortfalls had not been dealt with or had not been identified. There was a lack of established quality assurance processes to ensure continuous improvement.

The above areas breached regulations in cleanliness and infection control, staffing, care records, premises/equipment and monitoring the quality of the service. You can see what action we told the registered provider to take at the back of the full version of the report.

We found the staff recruitment and selection procedures were robust which helped to ensure people were cared for by staff who were suitable to work in the caring profession. In addition, all the staff we spoke with were aware of signs and symptoms which may indicate people were possibly being abused and the action they needed to take.

Staff had access to training relevant to their roles. Delays with the provision of some training courses were being followed up by the acting manager.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GP’s, hospital consultants, community mental health nurses, opticians, chiropodists and dentists. People received their medicines as prescribed and medicines were held securely.

Staff supported people to make their own decisions and choices where possible about the care they received. When people were unable to make their own decisions staff mostly followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. Arrangements at lunchtime to provide one main meal and only offer alternatives if people didn’t eat this, could limit some people’s choices.

Although some improvements had been made with activities, staff often struggled to find time to do these due to other work pressures.

There were positive comments from people who used the service and their relatives about the staff team and the approach they used when supporting people. Staff respected people’s privacy and dignity.

There were systems in place to manage complaints and people who used the service and their relatives told us they felt able to raise concerns and complaints.

Inspection carried out on 13 & 14 January 2015

During a routine inspection

We carried out an unannounced inspection of the service on the 13 and 14 January 2015. Eagle House Care Home provides accommodation and personal care for up to 40 older people who may have a dementia related condition. At the time of the inspection visit there were twenty seven people using the service.

The last inspection took place on the 10 December 2013 during which we found there were no breaches in the regulations we looked at.

The service has 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 2008 and associated Regulations about how the service is run.

The service had areas that were not clean, hygienic and there were malodours. There were concerns with how soiled laundry was stored. This put people at risk of transferring and acquiring infections and was a breach of regulations. You can see what action we told the registered provider to take at the back of the full version of the report.

Staff completed safeguarding training and there were policies and procedures in place to make sure they had guidance about how to safeguard vulnerable people from the risk of harm and abuse.

There were sufficient staff available to meet people’s needs and keep people safe. Staff had the right skills and experience and received an initial induction and on going training and support. Recruitment practices were safe and relevant checks had been completed before staff commenced work.

We found people received their medicines as prescribed; improvements were needed to ensure the safe storage of medicines during the medicine rounds.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. The service made appropriate and timely referrals to health care professionals and recommendations were followed. This included support to attend routine health checks.

People told us they felt included in discussions and decisions about their care and treatment. Information was available that advised people about independent advocacy services and information about the service including the registered providers’ complaints procedure. The service provided personalised care and treatment; people had been asked what was important to them and how they wished to be cared for. This information was reflected in their plans of care.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered provider had followed the correct process to submit an application to the local authority for a DoLS where it was identified this was required to keep them safe. At the time of the inspection 17 people who used the service had DoLS authorisations in place.

Staff supported people to make their own decisions and gave people choices about the care they received. When people were unable to make their own decisions, staff followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made. Advocacy services had been accessed for people where necessary.

People who used the service had their needs assessed and plans of care were in place which were personalised; this provided staff with guidance about how to care for people taking account of their preferences and wishes. A range of entertainments were provided. There was no formal activity programme and some people sat in their chairs unoccupied for large periods of time.

The environment was safe for people who used the service but improvements were needed with renewal of décor, furniture and fittings in some areas of the service.

People’s views were obtained through meetings and questionnaires. Staff monitored the quality and safety of the service but improvements were needed to widen the programme and address shortfalls in quality when they had been identified.

People told us they found the staff and management approachable and could speak with them if they were concerned about anything.

Inspection carried out on 12 December 2013

During a themed inspection looking at Dementia Services

This inspection was completed as part of the national themed inspection programme looking at dementia care. We left comment cards at the home for a week but we did not receive any completed cards.

The manager told us that of the 31 people who used the service 19 had been diagnosed with dementia. We found there was a clear focus on dementia care in the home. The manager and staff were aware of good practice guidelines and these were incorporated into the care provided at the home. Sufficient and suitably trained staff were provided to ensure people with dementia received all the care and support they required.

A detailed assessment of people needs was completed prior to admission to the home and personalised care plans were developed using this information. This meant staff had all the information they required to provide individualised care for people with dementia. It also enabled staff to be able to recognise any changes in the persons presentation or behaviours.

The staff worked well with other agencies and were proactive in ensuring that people received all the care and support they required from the appropriate agency. People were supported if they required hospital admission and information was provided to hospital staff to assist them to care for the person with dementia.

The manager had good systems in place to monitor the quality of the care provided and to ensure that people who lived in the home had their views heard.

The environment had been developed in line with some of the best practice guidance for people with dementia. For example, For example, toilets were easily distinguishable as doors were painted a bright colour and signs had been used in picture format.

Inspection carried out on 23 November 2012

During a routine inspection

People we spoke with during our visit were very satisfied with the care and activities within the service. They told us �There are varied activities in the afternoon and I get visits from my family�, �I cannot fault the place at all, the care is very good and the staff are lovely� and �The laundry service is very good and staff ask me what I want to wear when they help me get dressed.�

We spoke with people about the food provided in the service and they told us, �It is very good, I have no complaints� and �The food is lovely, there is plenty of it and it tastes nice.�

People we spoke with said that they had good access to their GP�s, chiropody, dentist and optician services, and they were satisfied with the level of medical support given to them. People who used the service were satisfied with the care they received and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us �Staff are friendly, helpful and supportive.�

People we spoke with were confident of using the complaints system in place and satisfied that staff or the manager would take action to solve their problems.

Inspection carried out on 6 February 2012

During an inspection looking at part of the service

People we spoke with were very positive about the care and support they received. They told us they liked living at the home and confirmed they were supported to make choices and decisions about the care they received. They told us they were assisted to be as independent as possible. Comments included �It�s excellent here,� �I couldn�t be anywhere better,� �I can choose what I want to do such as where to sit, and what time to go to bed,� and �The staff are lovely.�

Inspection carried out on 17 November 2011

During a routine inspection

People we spoke with were very positive about the care and support they received. They confirmed they were supported to make choices and decisions about the care they received. They told us they were assisted to be as independent as possible. Comments included �It�s nice here�, �It�s very pleasant, you get everything you want�, �It�s great, we get lovely food� and �They don�t rush us we can take our time�.

They told us they felt safe. Comments included �I feel safe enough�, �We all get on, I would tell the staff if I wasn�t�, �They are very good to us� and �I feel safe, you can go to any of the girls or the manager�.

They told us they liked the staff and described how key workers supported them. Comments included �They are always talking to us�, �They are OK, I can�t fault them�, �They are nice girls, we couldn�t get any better attention� and �There are always enough to help me�.

They told us they liked living at the home. Comments included �Its good in all ways, the staff are always there, they listen to us and improve things if necessary� and �They look after us great, you can�t find anywhere any better� .