Endeavour Residential Home

We found the following examples of good practice.

Although Endeavour is a small home, people were able to use various areas which meant they could be spread out using the television room, activity/dining room and lounge. There was a sense of space due to the large windows out to the courtyard. People were able to maintain their friendship groups and one group showed us how they had made knitted mobility frame bags for other people at the home during the pandemic. Activities had continued to take place throughout the pandemic and the spacious dining room had socially distanced dining tables. This arrangement allowed people to maintain their friendships and contacts within the home, while minimising the spread of infection. There was a Covid 19 contingency plan which supported effective 'zoning' and alternative use of the activity/dining room in the event of a person showing symptoms of Covid 19 or testing positive.

The service ensured people could continue to receive visitors in line with government guidance. There was a clear process, including a health questionnaire and testing regime in place for visitors, with personal protective equipment (PPE) provided. A dedicated visiting pod had been purchased accessed from outside with a dividing perspex screen and microphone system. People were also starting to book visits in peoples’ rooms with visitors accessing rooms through entrances nearest the room. External visiting took place in the garden if required.

Visits were supported for people at the end of their lives. People were able to become essential care givers if they wished, who followed the same testing regime as staff. There had been good communication between the home and families to ensure they knew what was happening throughout the pandemic and to offer reassurance. People and families had been consulted about moving rooms to ensure visitors to those at the end of their lives were able to visit without entering the main communal spaces.

Staff received ongoing training in infection control and staff had received training regularly from various sources to ensure they were up to date.

Staff were seen to wear PPE throughout the inspection. They frequently used hand sanitiser, available vis wall dispensers throughout the home. Five people told us how safe and happy they felt living at Endeavour Residential Home. They said they were all looking forward to seeing staff without masks one day and they felt staff had been ‘wonderful’ in keeping them safe. People spoke highly of the effectiveness and professionalism of the staff team with one person asking for their positive praise to be noted in the residents’ meeting minutes.

There was an extensive cleaning schedule, with regular spot checks and audits. This ensured cleaning was completed to a high standard.

The registered manager reported good support from the provider who had visited and praised the staff. Staff felt well supported with their wellbeing, for example the registered manager had ensured their shift pattern was kept shorter and that they received treats and praise. There were regular staff meetings and a secure web communication page. The staff team had remained stable and worked very well together.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the service. There were sufficient staff available to meet people's needs. Risk assessments had been completed and actions taken to minimise harm. People received their medicines safely. A relative told us “It absolutely is the best place for [person’s name]. It couldn’t be more homely. It’s wonderful. She’s happy. We don’t have to worry anymore.”

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. Comments from people living in the home and their relatives included, “The one in charge is lovely!” and “They always seem well organised.” A visitor told us “In my experience of homes in Exeter, this one is excellent! It is an absolutely lovely place to live. I’ve been very impressed.”

People continued to receive care from a stable and consistent staff team who had the skills and knowledge required to effectively support them. Staff were competent and well trained. People's healthcare needs were monitored by the staff and people had access to healthcare professionals according to their individual needs. Staff were well supervised and supported.

People received a varied and balanced diet to meet their individual nutritional needs and preferences. Each person’s dietary needs were known and understood by all of the staff team, clearly documented in care plans. Staff made sure people were eating and drinking enough throughout the day, and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff were caring and people had built good relationships with the staff. We observed staff being

patient and kind, and they clearly understood how people liked to be cared for. People's privacy was respected. People and their families were involved in decisions about the care and support people needed. There was a strong emphasis on equality and diversity, and treating people as unique and much loved and cared-for individuals. A relative told us, “The staff are so wonderful. The most lovely care. They make it seem every person is so special. They seem to have so much time for everyone.”

The service remained responsive to people's individual needs and provided personalised care and support. People were able to make choices as far as possible in their day to day lives. There had been no formal complaints since the last inspection and the complaint process ensured any complaints would be fully investigated and responded to. Each person’s social needs, interests and preferences had been carefully assessed. Staff provided each person with the support they needed to enable them to lead interesting and fulfilling lives. People were offered a wide range of activities, outings and opportunities to participate in daily routines in the home. .

The service continued to be well led. People and staff told us the registered manager was approachable. The provider visited regularly and always spoke with people living in the home, visitors and staff. The registered manager/provider sought people's views to make sure people were at the heart of any changes within the home and regularly enabled them to have time to discuss any issues. The registered manager/provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Further information is in the detailed findings below.

There were 20 people living at the home with one person in hospital at the time of our inspection. We spoke with the registered manager, two staff and two people living at the home. We also did a complete tour of the premises. We looked at records relating to infection control including policies and procedures, training and quality assurance.

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The systems in place to reduce the risk and spread of infection were effective. This was because the home had appropriate arrangements for staff hand washing, for cleaning and decontamination of equipment and for laundry management. The provider had also invested in new equipment and refurbished many areas of the home. Records showed there were clear systems in place to monitor hygiene and ensure staff maintained a high standard of cleanliness and followed infection control policies to keep people safe.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

On the day we visited 19 people lived at the home. Most people at the home were living with varying levels of dementia. The inspection was in response to a number of concerns raised with the Care Quality Commission. These included concerns about moving and handling practices, standards of personal care and general cleanliness, as well as concerns about people's nutrition and hydration, pressure area care and medicines management at the home. A new provider took over running the home in March 2014 and this was the first inspection under new management.

We spoke with all 19 people who lived there and with three relatives and a visitor to seek feedback about the care provided and looked at five people's care records. We spoke with eight staff who worked at the home. On the day we visited the registered manager was on leave but we spoke with them by telephone after their return and with the provider. We also received feedback from two health professionals that regularly visited the home. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people.

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found people's day to day care was safe because staff knew people well and how to meet their needs. Where people's needs had increased a GP or other healthcare professionals were consulted. Staff supervised people closely and were available to assist, when needed

However, we identified cross infection risks at the home. This was because of the arrangements hand hygiene were inadequate, and because general standards of cleanliness and the management of laundry did not meet the standards required by the Department of Health Hygiene Code. This meant people were at increased risks of cross infection and improvements were needed. Following our visit, the provider told us they took immediate steps to seek further advice about infection control issues.

Is the service effective?

Our observations showed staff interacted well with people. Staff recognised and understood people's non- verbal signals and responded to people's needs appropriately.

We found staff worked in a very structured way with set tasks and care duties carried out at regular intervals. A bathing procedure displayed in one bathroom said, 'The duration of the bath should not exceed five to 10 minutes'. Whilst this ensured people received regular care, these practices were not very individual or person centred. The environment of the home was tired and not very 'dementia friendly' in terms of decoration, colour schemes, and floor coverings. We spoke with the provider about this who told us they planned to undertake major refurbishment at the home. They told us they would seek further advice about those plans to ensure they met the specific needs of the people who lived there.

Is the service caring?

The service was caring and people appeared clean and well cared for. Care records we looked at showed people were regularly supported with personal care. We saw staff were caring and compassionate towards people and treated them with dignity and respect, with one exception. People who were able to give their views about their experience said they were happy at the home. One person said, 'So far, it's very good, I can do what I like when I like' and a second person told us the home was 'comfortable'. Relatives we spoke to told us they were very satisfied with the care provided and how staff communicated and involved them in decisions about the person's care.

Is the service responsive?

The service responded to people care needs in a timely way and staff noticed when people needed their help. We observed people being helped to the dining room although we saw some people waited in the dining room for between 20-30 minutes for lunch to be served. During this period, one person was getting very cross and another person kept leaving the table. Staff were alert to people's mood changes and intervened to distract those people. On the day we visited, we found there wasn't much happening for people as the activities co-ordinator was off sick. One person said, 'I don't like sitting doing nothing'. 18 of the 19 people who lived there spend all day in the lounge and dining areas. In the afternoon, staff played some favourite songs and engaged some people in throwing a soft ball.

Is the service well led?

We found people, staff, relatives and stakeholders views about the service had been sought. We spoke to the provider who told us about the improvements being made in response to that feedback. For example, changes and improvements to the menu and redecoration of the home and replacement of sanitary ware. This showed the provider took account of people's views to improve the quality of the service provided.

We found day to day leadership of staff was effective with regular staff meetings, daily handover and staff supervision. Staff told us they felt well supported by their manager who supervised staff regularly. Staff told us they were able to raise concerns and were confident they would be dealt with.