Eshcol House Nursing Home

Eshcol House Nursing Home provides personal care for up to 31 predominantly older people. At the time of our inspection the service was supporting 25 people.

The service is a detached three-story building set into a hillside, with ground level access to each floor and sea views.

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

The service was following current infection control guidance and there were appropriate procedures in place to ensure people were protected from infection control risks. High contact areas were cleaned regularly and the roles and responsibilities of staff in relation to infection control were well understood.

People were protected form all forms of abuse and discrimination. Staff understood how to report safeguarding concerns and health professionals told us they were confident people were safe.

All accident and incidents had been appropriately investigated to prevent similar events from reoccurring.

Risks had been identified and effectively mitigated. Firefighting and lifting equipment had been regularly serviced and tested.

Staff had been recruited safely and there were enough staff on duty to meet people’s needs. Care was provided at a relaxed pace and with compassion by the dedicated staff team. People had received their medicines as prescribed and were well supported during mealtimes.

People, relatives and professionals were complimentary of the quality of care and support provided by the service.

There had been some management turnover since that last inspection as the previously registered manager had taken on a different role within the provider organisation. This manager had now returned to the service. The staff team were complimentary of the support provided both by the manager and the providers director.

Quality assurance systems were robust and an additional staff member had been recruited with specific quality assurance and auditing responsibilities since our last inspection.

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 overall rating for this service was requires improvement (Report published 11 March 2021) and there was a breach of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made. The provider was no longer in breach of regulations and has been rated as Good.

Why we inspected

We undertook this focused inspection to check that action had been taken to address and resolve the issues identified during our previous inspection.

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, which will help inform when we next inspect.

Eshcol House Nursing Home provides personal care for up to 31 predominantly older people. At the time of our inspection the service was supporting 28 people.

The service is a detached three-story building set into a hillside, with ground level access to each floor and sea views.

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

Prior to our inspection we received information of concern that staff were not using surgical face masks while supporting people during the Covid-19 pandemic. We gave notice of our intention to inspect the service from the car park. On entry to the building, we found that current infection control guidance was not being consistently followed. One staff member providing care was wearing a cloth face covering, administrative staff were not wearing face masks and social distancing measures were not respected during staff breaks.

These issues were reported to the registered manager. The registered manager subsequently informed staff that they had to wear surgical face masks, and subsequently we observed staff doing this. In addition, two staff were subsequently appointed as PPE champions with specific responsibilities for challenging staff practices in relation to the use of face masks.

The service was clean and there were additional cleaning procedures in place to limit infection control risks within the service. Additional hand washing facilities had been provided at the service’s entrance and arrangements had been made to enable relatives to visit people safely.

Staff understood their role in protecting people from harm or possible abuse. Accidents had been investigated to identify areas of learning and similar incidents from being repeated. Medicines were managed safely and records regularly audited.

At our previous inspection we made a recommendation in relation to systems for the updating of people’s care plans. At this inspection, we found people’s care plans were accurate and up to date. People were supported to engage with a variety of activities they enjoyed. Complaints received had been addressed and resolved.

The staff team were well motivated and relatives were complimentary of the quality of care provided at Eshcol House. The roles and responsibilities of the staff team, registered manager and provider were clearly defined and well understood. Audits had been completed and quality assurance systems were in the process of being updated.

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

Rating at the last inspection

The last overall rating for this service was good. (Report published 5 October 2018)

Why we inspected

We undertook this focused inspection in response to information of concern that we had received. This information indicated staff were not following current government infection control guidance.

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.

We have found evidence that the provider needs to make improvements. Please see the; Safe, and Well led sections of this full report.

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

There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 4 July 2017. In July 2017 we found systems for the management of medicines, the checking of pressure relieving mattresses and the management of risks in relation to people who had lost weight were not robust. There were gaps in charts to monitor the care provided for people and some information about people’s care needs were omitted from shift handover records.

Records of a Deprivation of Liberty Safeguards (DoLS) authorisation were not available at the service. The system for staff appraisals had not provided staff with an appropriate reflective two-way process with a line manager who knew how they worked. There were no pictorial signs for people who might need support to orientate around the premises. The dining room was not used by people, which meant there was no opportunity for meals to be a shared social occasion for people who might like to interact with others. The rating at the last inspection was Requires Improvement.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good overall.

People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "The staff always call in at least twice a night to make sure I'm alright", "My relative feels safe because she tells me the staff can always spare a few minutes to make sure she is ok" and "There's always somebody around to help if you need it." Staff knew how to recognise and report the signs of abuse.

Care records were personalised to the individual. Risks were identified and included guidance for staff on the actions they should take to minimise any risk of harm. Where some people had been identified as being at risk of losing weight this was being well managed. Care plans and risk assessments were kept under regular review. Staff were provided with information about people’s changing needs through effective shift handovers and electronic daily records. However, care plans were not always updated in a timely manner when people’s needs changed. We have made a recommendation about this.

Records to evidence when people were re-positioned, their skin was checked or their food and fluid intake was measured were accurately completed by staff. Where people had pressure relieving mattresses in place, to help prevent skin damage due to pressure, we found mattresses were set to the correct level.

Staff had developed good working relationships with healthcare professionals to help ensure people had timely access to services to meet their health care needs. These services included tissue viability nurses, community nurses, GPs and speech and language therapists (SALT).

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately and records of these were held at the service.

Staff were supported in their roles by a system of induction, training, one-to-one supervision and appraisals. Staff all told us they were well supported and were positive about the new appraisal system. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people's changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge.

There were safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained. Medicine Administration Records (MARS) were completed appropriately and there were no gaps in the records.

The design, layout and decoration of the service mostly met people’s individual needs. Since the last inspection changes had been made to how the shared living areas were used. On the day of our inspection both the shared lounge and dining room were used by people living at the service. Work to upgrade assisted bath and shower rooms was in progress and until completed people had limited access to suitable bathing facilities. There was pictorial signage to help support people who might need help to orientate around the premises.

People were able to take part in a range of group and individual activities. A full-time activity coordinator was in post who arranged regular events for people. These included, bingo, film afternoons, arts and crafts and board games. In addition, people went out on trips and external entertainers visited regularly. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

People were supported to eat a healthy and varied diet. Comments from people about their meals included, "The cottage pie today was very pleasant”, "The food is very good, bordering on excellent" and "You always have a good choice of food."

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong and supportive leadership.

People, their families and healthcare professionals were all positive about the management of the service and told us they thought the service was well run. Comments included, "There's nothing to complain about being here", "You wouldn't want to live anywhere else", “Eshcol House is open to ideas and suggestions”, “The general opinion locally is that people feel safe when their relatives go into Eshcol House” and “No concerns, have always found them to be helpful and cooperative.”

Details of the complaints procedure were displayed in the service and people and their families were given information about how to complain. Where complaints had been received these had been well managed and effectively resolved. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

Eshcol House is a care home which offers nursing care and support for up to 31 predominantly older people. At the time of the inspection there were 29 people living at the service. Some of these people were living with dementia. The service occupies a detached house over three floors. There was a passenger lift to support people to access the upper floors, however, this lift was out of order on the day of inspection visit.

Systems for the management and administration of medicines were not entirely robust. The service had reported a medicine error to CQC in April 2017. The wrong medicine was given to a person. The investigation in to this incident was robust and led to recommendations that specific actions be taken to help reduce the risk of future events. The recommendations seen at the inspection were not in place. Following the inspection the provider sent CQC information that stated it was "Written in retrospect." A meeting was held with the nurses to discuss the implementation of the recommendations. It had been decided not to implement the wearing of a red tabard during medicine rounds as it "Did not mitigate disruptions." The nurse was seen being disturbed during medicine rounds at this inspection. This meant the risk of a further error had not been reduced.

It was not always possible to establish if people had received their medicine as prescribed. There were some gaps in the medicine administration records (MAR). Handwritten entries on to this MAR had not always been signed by two staff to help reduce the risk of errors. Prescribed creams and liquids were not always dated when opened. There was one expired cream stored in the medicine fridge. Regular medicines audits were not being carried out. This meant any errors were not being identified in a timely manner.

Staff were not provided with formal supervision in line with the policy held by the service. Most staff had been provided with annual appraisals. However, many appraisals had been provided by an external consultant bought in by the provider. This did not provide staff with a reflective two way process with their line manager who knew of their practice. Whilst staffing rotas showed there were sufficient numbers of staff on shift and the registered manager monitored dependency scores in order to meet people’s needs, staff reported being ‘under pressure’ and ‘quite stressed’. Throughout the day of this inspection call bells rang constantly. Some people reported having to wait for staff to respond to them at times.

We walked around the service which was comfortable and warm. There was no pictorial signage for people who required additional support to orientate them around the building. Some of the communal areas were in need of redecoration and the carpets were worn and marked in places. Two of the bathrooms were not being used by people and where full of equipment. We were told there was a plan to change the use of these rooms in to a storage room and a wet room. The provider had commissioned a project manager. They were in the process of addressing required actions identified at a fire assessment of the premises. There was a dining area. However, we were told this was not used by people living at the service. The dining table and chairs were used by staff during this inspection. People ate their meals in their bedrooms or at their chairs in the lounge.

The service had applied for appropriate Deprivation of Liberty Safeguards authorisations. We were told one authorisation was in place at the time of this inspection but the documentation relating to this was not available for review. The service did not have a copy of the authorisation. We contacted the Cornwall DoLS team who told us there was no authorisation in place. The registered manager was asked to contact the funding authority for the person to obtain the authorisation which was not present in the records for reference.

Care plans provided information related to people’s care needs. Shift handover records also contained specific information about people living at the service such as if they were diabetic and their resuscitation status. Some information was not always accurate. For example, when people’s needs had changed this was not reflected in their care plan. One person was diabetic and this was not indicated on the handover sheet. Some monitoring charts were not completed by staff as directed in people’s care plans. There were gaps in these charts. Some people had lost weight recently. This had been recorded but no subsequent action was taken to review the person’s risks or their care needs. Some people had been assessed as needing pressure relieving equipment on their beds and this had been provided. However, the correct settings for each mattress related to their weight was not recorded or monitored to help ensure people were protected from the risks associated with pressure damage to their skin.

The service had invited people and their families to attend meetings held at the service in order to seek their views and experiences of the service provided. Two meetings had been held, at one no people or families attended and at the second only two residents and one relative attended. Eshcol had received mostly positive responses to a survey carried out in November 2016.

Care plans were well organised and were reviewed regularly. However, people’s changing needs were not always recorded such as when they lost weight. Where appropriate, relatives were included in care plan reviews. Some consent to care forms were not signed appropriately by the person, where they had capacity, or indicated when they were not able to do this. Where people did not have capacity to do this, only people with a lasting power of attorney for care and welfare are legally able to do this on behalf of the person. The service held records of any lasting powers of attorney held by people living at Eshcol.

Recruitment processes were safe. New staff were supported by a period of induction. Staff were provided with appropriate training to carry out their roles. Training was monitored and updates were provided as needed.

There were some activities provided for people. Some people were taken out in to the local area. A Head of Well being had been recently appointed to increase the amount of meaningful activity provided for people, particularly people cared for in bed.

People were treated with kindness, compassion and respect. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff meetings were held and provided staff with an opportunity to air any concerns or suggestions they had regarding the running of the service.

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 able to get up and go to bed as they chose.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. All meals were cooked from scratch on the premises.

The registered manager was supported by two administrators and the provider. Staff told us they felt supported by the manager and were happy working at the service.

We carried out an unannounced comprehensive inspection of this service on 17 December 2015. A breach of legal requirements was found. Processes and procedures in place to help ensure the smooth running of the service were not robust. For example, handwritten entries in Medicine Administration Records (MAR) had not been double signed, accidents and incidents were not routinely analysed to identify trends, training records were inaccurate and there were not systems in place to gather people’s views of the service. The auditing systems in place had not enabled the registered manager to identify these issues. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eshcol House on our website at www.cqc.org.uk.

The service is required to have a registered manager and at the time of our inspection a registered manager was 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.

Audits took place regularly to enable the registered manager to identify any trends. Where patterns had been highlighted these were further investigated to establish if any action could be taken to minimise risk.

There were systems in place to help ensure staff received regular supervisions and appraisals. Training needs were closely monitored to enable staff to keep up to date with good working practices. Staff meetings took place regularly and staff told us these were an opportunity for them to raise any suggestions or concerns.

The registered manager actively sought out people’s views and those of other stakeholders. Quality assurance questionnaires had been circulated at the end of 2016 and the results were positive. Where people had expressed dissatisfaction with any aspect of the service this had been acted on.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff told us they felt well supported and had confidence in the management team.

Eshcol House is a care home which offers nursing care and support for up to 29 predominantly older people. At the time of the inspection there were 27 people living at the service. Some of these people were living with dementia. The service comprises of a detached house providing accommodation over three levels.

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.

We walked around the service which was clean, comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Staff were aware of how to report any safeguarding concerns they may have. However, the safeguarding policy held at the service did not contain the local contact details for the local authority multi agency referral unit.

We looked at how medicines were managed and administered. People received their medicines as prescribed. Medicines that required cold storage were stored appropriately and those that required stricter controls were monitored in line with legislation. We saw staff had transcribed medicines for people, on to the Medicine Administration Record (MAR) following advice from medical staff. However, 20 handwritten entries were not signed and had not been witnessed by a second member of staff. This meant that there was a risk of potential errors and did not ensure people always received their medicines safely. The clinical lead assured us they were aware of the concern and would take action with individual staff members to address this.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Staff told us they received support from the registered manager as needed. Staff meetings were held regularly to seek the views of staff and share information. Staff undertook training, however, not all staff had completed mandatory training and this was being addressed by the registered manager through individual meetings.

People were consulted about the meals provided at the service. The cook regularly discussed meal options and choices with people at the service and responded to their requests. Drinks were available to people throughout the service.

Care plans were well organised and contained accurate and up to date information. Some of the handwritten care plans had been amended and reviewed many times and this could make it difficult to find current information.

Group and individual activities were provided to people according to their individual needs.

The registered manager did not have robust processes in place to record and monitor accidents and incidents which took place at the service, staff induction, supervision, appraisal and training.

Quality assurance surveys to seek the views and experiences of people who used the service and their families had not been carried out since 2011, although regular residents meetings took place involving people who lived at the service, who could express their views.

We found a breach of the Health and Social Care Act 2014 (Regulated Activities) 2008 and you can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, at the time of this inspection we judged the service was safe.

People we spoke with were positive about the staff who worked at Eshcol House Nursing Home. People told us staff, were professional and supportive. For example, one person said 'the staff are very nice, they are very good.'

The staff we spoke with said they had confidence in colleagues' practices. For example, we were told 'If I need any help or have any concerns I know they will help me. It's a friendly and a happy, working environment.'

The service had a well organised medication system. The system was well managed and regularly audited. Records were accurate and up to date.

Is the service effective?

Yes, at the time of this inspection we judged the service was effective.

People all had individual support plans, which set out their care and support needs. Support plans contained satisfactory information and were accessible to staff. People said staff met their relatives' needs and responded promptly when they needed assistance. People said they had access to doctors, community psychiatric nurses, psychiatrists, chiropodists and opticians.

Is the service caring?

Yes, at the time of this inspection we judged the service was caring.

Relatives and documentation by professionals of people who used the service evidenced they were happy with how the service supported people and found the staff to be professional and helpful.

From our conversations with people who had experience of the service and a review of the records we assessed, we judged that individual wishes and needs were taken into account and respected

Is the service responsive?

Yes, at the time of this inspection, we judged the service was responsive.

Everyone we spoke with said the staff treated people with respect and dignity.

The registered manager and provider had good systems in place to monitor and respond to the ongoing improvements within the home. This included systems of survey and audit. There was a system to monitor accidents and incidents. People's personal care records, and other records kept in the home, were accurate and complete.

Is the service well-led?

Yes, at the time of this inspection we judged the service was well led.

Staff, relatives and professionals were all positive about the management of the service. People told us management would listen and were 'really supportive'.

We saw people's privacy and dignity were being maintained. People we spoke with told us 'They treat me kindly and with respect' and 'I have never been spoken to in a patronising way'.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed.

The premises were well maintained. Peoples own rooms were personalised to their own taste. Ongoing renovation and redecoration was improving the environment for people who used the service.

We saw staff were able to meet people's nursing and care needs. We were told one of the care workers also acted as the activities organiser and we saw the weekly activity plan. People we spoke with told us 'Girls treat me very well; they arrive quickly when I press my call button' and 'I feel comfortable in my surroundings'.

There was a complaints procedure available to people who visited the home and to people who used the service.

Records were stored securely and well maintained. They were accessible to people who needed to use them

Care and support were good. The care home environment was pleasant although some redecoration was required. The registered provider was arranging this and some refurbishment on the ground floor had been completed. The bedrooms were decorated and furnished to a good standard. The home was clean and odour free.

Staffing levels were to a good standard. Suitable staff recruitment procedures were in place.There were some gaps in records regarding the provision of training. Staff however were observed working professionally with the people living in the home. The quality assurance system was limited although satisfaction levels from staff, people who lived in the home and their representatives was very high.