Enstone House

Updated 12 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Enstone House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Enstone House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. We visited the service on 11 and 19 May 2023. Following review of the evidence we had, we opened up the inspection to include the safe domain. As such we visited the home again on 12 June 2023.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We looked at notifications received from the provider. A notification is information about important events which the provider is required to tell us about by law. This ensured we were addressing any areas of concern. We also reviewed the provider’s last inspection report. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service. Some people living in the home could not verbally give us feedback. As such we looked around the home and observed the way staff interacted with people. We further received feedback from 7 relatives. We received feedback from 3 healthcare professionals. We spoke with the provider, registered manager, deputy manager and 5 members of staff including carers, the chef, activities coordinator and maintenance person. We reviewed a range of records relating to people's care and the way the service was managed. These included 5 staff training records, quality assurance audits, incidents and accidents reports, complaints records, and records relating to the management of the service. We looked at 5 care plans and 10 MAR charts.

Updated 12 July 2023

About the service

Enstone House is residential care home providing personal and nursing care to up to 36 people in an adapted building. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 26 people using the service.

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

Medicines were not always effectively managed, and the auditing system did not always cover all areas of medicine safety such as stock control, storage and safe disposal. We found there were gaps on medicine administration records (MARs), and we were not assured people received their medicines as prescribed.

Risks to people's safety and well-being were not always managed safely and there was an inconsistent approach to the risk management process. We found 2 broken window restrictors and an electrical heater which had not been risk assessed.

The environment was not always maintained to good standards. On the first day of the inspection there were malodours in the home. There were no clear cleaning schedules and there were gaps on cleaning records. The provider’s auditing systems had identified the shortfalls but there were no actions completed in relation to this.

Some people’s records contained conflicting information. The provider’s quality assurance systems were not always effective or used to drive improvements. We also found there was no clear provider oversight 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 and in their best interests; the policies and systems in the service supported this practice. Staff had a good understanding of when the principles of the Mental Capacity Act should be applied. However, the mental capacity assessments did not cover all areas where decisions needed to be assessed.

People’s needs were assessed before they came to live at Enstone House to ensure staff could meet those needs. People were supported to have a positive dining experience in a dignified manner.

Staff completed an induction which included mandatory training and shadowing an experienced member of staff and had access to supervisions and appraisals. People and relatives told us staff were skilled and knowledgeable.

The home was well-led by a long-standing registered manager who had support from a deputy manager. There was a management structure in place and a group of staff who worked well as a team. Staff worked well with external social and health care professionals.

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 11 June 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 11 May 2021 and rated the service requires improvement. We undertook this focused inspection to check they had made improvements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Enstone House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 2 breaches in relation to risk management, records keeping and auditing systems at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.