Archived: Eckington Court Nursing Home

At the last inspection on 18 November and 8 December 2015, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following our inspection in April 2015 the service was rated as ‘Inadequate’ due to serious concerns about the safety and well-being of the people who lived there. The commission placed the service in special measures. At the time of this inspection we found that although there were areas where further improvement was needed that significant progress had been made in the way that the home operated and in relation to the way in which care was being provided. Enough improvements had been made to take the provider out of special measures.

Eckington Court Nursing Home is required to have a registered manager. At the time of our inspection there was a new manager in place and their application to become a registered manager was being processed. 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 is registered to provide residential care for up to 50 older people. At this inspection 29 people were using the service.

At our last inspection on 18 and 8 December 2015 we asked the provider to take action as risks to people were not well-managed. At this inspection we found improvements in how some risks to people were managed, such as risks of weight loss, pressure area care and fluid intake. However, we found improvements were still required to how the service managed risks to people who experienced, or were at risk of experiencing falls. Whilst medicines administration practices had also improved, some improvements were still required.

We had asked the provider to make improvements to the planning and deployment of staff to meet people’s needs. On this inspection we found the staffing group had stabilised, however we still found occasions when staff had not been deployed to meet people’s needs safely. In addition, we were not assured that the number of staff planned to meet people’s needs was based on the current needs of people using the service. We were concerned that there were not sufficient staff deployed to meet people’s needs. Staff were recruited safely because checks to help confirm their suitability to work with people using the service had been completed prior to them starting work. We had asked the provider to make improvements to the supervision, support and training of staff. At this inspection we found training had either been completed or had been arranged and that staff had started to have supervision and further support had been planned. In addition, we found staff meetings had been held.

At our last inspection we asked the provider to take action to ensure the principles of the Mental Capacity Act (MCA) 2005 were followed and any applications for people to receive assessment for a Deprivation of Liberty Safeguard (DoLS) were made appropriately. At this inspection we found applications had been made where people required them.

At our last inspection we had asked the provider to take action to ensure people received personalised and responsive care and support. We found some improvements on this inspection, however, staff were not always aware of people’s food preferences. We saw staff understood the needs of people using the service and demonstrated their knowledge of how to work with people in a personalised and responsive way.

At our last inspection we asked the provider to take action as the service did not have a registered manager and was managed by an interim management team. Systems and checks were also not in place or operated effectively to asses, monitor, reduce risks to people and improve the quality and safety of services provided. This included systems to check on the control and prevention of infections. We also found that records of people’s care and treatment were not accurate nor made contemporaneously. This included information on people’s dietary needs, risk assessments, quality satisfaction survey results and daily records. The provider had also not sent in notifications of changes, events or incidents that they must tell us about.

At this inspection we found some improvements had been made and some improvements were still required. Systems and processes to check on the quality and safety of services were in place, however these were not always effective. We found further improvements were required as actions identified by the new audits had not always been carried out. In addition audits were not always based on accurate information as care plans were not always accurate. This meant that improvements to the quality and safety of services people received were not always implemented or effective. We were concerned that this may put the health and safety of people using the service at risk.

At this inspection we found some improvements to record keeping and saw that records were being transitioned across to a new system used by the new provider. We found improvements were required as some handwritten care plans and staff rotas were illegible.

We found people benefited from seeing other external health professionals involved in their care and treatment, such as GP’s, opticians and continence professionals. However we could not be assured that people at risk of falls were appropriately referred for further assessment s to help identify how any further risks from falls could be reduced.

People told us they were happy with most, but not all of the staff who worked at the service and we discussed this with the manager. Staff respected people’s privacy and promoted people’s dignity when they provided care and support. People’s views and opinions were respected and included in the planning of their care and support.

We saw people enjoyed a variety of pastimes and activities and families were free to visit people when they wanted. People also had opportunities to comment or complain or offer feedback on the service. Where people had raised any issues with the manager we saw that they had been recorded and resolved in an open style. People were provided with sufficient and nutritious food and drink to meet their needs.

We found that the manager and the senior staff team were open and approachable and were supported by a motivated and committed staff team. The manager had also applied to become the registered manager and understood their responsibilities and had submitted notifications to inform us of any changes, events and incidents that they have to tell us about.

We found two breaches continuing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found that a new acting manager had been appointed and had subsequently left after four weeks and the permanent nursing staff had left in June 2013. We found that Eckington Court had a high percentage of agency staff covering the vacant nursing hours.

People using the service and their relatives we spoke with told us they were happy with the care provided. One person said, 'it is a pleasure to sit in the lounge now everything had been done." Others told us and the care staff at Eckington Court were good to them." We were told they liked their room and the meals were nice and appetising.

We found that where someone was unable to make decisions for themselves, for example due to dementia, the appropriate procedures were not always being used to obtain and record consent.

Although some work has been undertaken to update care plans we found that the level of recording was poor. Evaluations of care plans were out of date and where changes had been identified these were not recorded.

We found unpleasant odours from carpets in the communal areas and fire regulations from April 2013 had not been met.

We found that alhough the correct protocols for medicines were in place., there were gaps in the recording of when people people were administered there medication.

People using the service and their relatives we spoke with told us they were now happy with the care provided. They said 'they do anything I ask them to, nothing is too much trouble,' and ' the care staff are very caring and know the residents well.'

We saw care staff showing respect for people's wishes to remain in their bedrooms or to use the lounge areas. We saw people were in engaged in activities such as dominos, reading the paper over a leisurely breakfast and chair based games.

We found that where someone was unable to make decisions for themselves, for example due to dementia, the appropriate procedures were not always being used to obtain and record consent for their care.

We found that people's care needs had been assessed, the care plans we saw were not up to date and did not provide sufficient information to show the care support and treatment needed to ensure that people received safe and appropriate care.

We saw that although the provider had systems in place regarding medicines, medication was not always administered safely.