Eversfield House

Eversfield House is a residential care home providing personal care to up to 24 people. The service provides support to older adults. At the time of our inspection there were 24 people using the service.

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

People were at risk of receiving unsafe care and support. There were insufficient care records that did not detail specific information about risks to people’s safety and how they were to be supported. We observed staff supporting people safely and they had good knowledge of people’s needs, but this information was not recorded.

The provider did not ensure the environment was always safe and people were protected from the risk of falling from height. Windows were not appropriately restricted and there were no barriers from the fire escape to prevent people from going onto part of the building with a flat roof.

Medicines were not managed safely. Staff did not maintain accurate records of administered medicines and staff were not observing people taking their medicines to ensure they were taken as prescribed. Medicines were dispensed into staff’s hands prior to being given to people, increasing the risk of contamination.

There were insufficient systems in place to provide adequate oversight of the quality of the service. Audits and checks on the quality of care had not been completed in the months before our inspection. There were no clear improvements plans in place to ensure timely action was taken to address any concerns identified.

Despite the concerns raised about the systems and processes in place, staff were knowledgeable about people’s needs and we observed them providing people with the level of support they required to ensure they had a good quality life, and they were supported in a safe way. Staff worked closely with the GP and staff from the local authority’s care home support team to ensure any concerns about people’s health or welfare was reviewed.

People enjoyed living at Eversfield House and told us they felt comfortable speaking with staff, and expressing their views and opinions. 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.

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

Rating at last inspection

The last rating for this service was good (published 16 June 2021).

Why we inspected

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

We undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement based on the findings of this inspection.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Eversfield House is a residential care home providing personal care for up to 24 older adults. There were 22 people using the service at the time of our inspection.

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

The provider had responded positively to a recent infection prevention and control audit by the Clinical Commissioning Group (CCG). We found they had improved since this audit and the CCG confirmed all the concerns they raised had been resolved after our inspection.

Staff supported people to keep in regular contact with loved ones through regular phone and video calls and visits in line with guidance. The provider had recently installed a pod in the garden to accommodate visits which relatives could access without entering the home. Visitors were asked COVID-19 screening questions on arrival and had their temperature checked. A COVID-19 lateral flow test was carried out on visitors who were not on the national testing programme as part of keeping people safe.

The provider trained staff and people using the service in relation to COVID-19, infection control and safe use of PPE. The service had sufficient levels of PPE which staff used in accordance with current guidance. The home had an area for staff to don and doff (put on and take off) personal protective equipment (PPE). Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The registered manager was experienced and understood their role and responsibilities, as did staff. People and staff were very positive about the registered manager and told us they communicated well with them about any changes to the service. People felt listened to.

There was a comprehensive programme in place to review the quality and safety of the service. Where improvements were identified as being required, these were addressed promptly.

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

Rating at last inspection

The last rating for this service was good (published February 2018).

Why we inspected

The inspection was prompted in due to concerns received from the CCG relating to infection prevention and control practices and their oversight at the home. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found staff had been recruited safely, continued to receive on-going training relevant to their role and felt supported by the registered manager.

Staff knew how to keep people safe and the staff members we spoke with demonstrated a good knowledge on how to recognise abuse and how to report any concerns.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care while still encouraging people to be independent.

There were appropriate arrangements in place for the storage, administering, recording and disposal of medicines. Staff administered medicines safely. All areas of the service were clean and well maintained. Cleaning schedules were in place and staff had access to personal protective equipment when required.

People were supported to keep healthy and well. They were supported to attend appointments with GP’s and other healthcare professionals when they needed to. People were supported to have sufficient amounts to eat and drink. Risks associated to people’s diet were identified and staff knew what to do to manage this risk.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were relaxed and comfortable in the company of staff. Staff supported people in a way which was kind, caring, and respectful. People were encouraged to participate in a wide range of activities.

There were a number of audits and quality assurance systems to help the provider understand the quality of the care and support people received and look at ways to continually improve the service.

Further information is in the detailed findings below.

The home had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that the office door was open and people could speak to the registered manager or deputy at any time.

Care plans showed that staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person’s daily life. Where risks were identified, management plans were in place. Records showed that incidents or accidents were thoroughly investigated and actions put in place to help avoid further occurrences. We saw that regular checks of maintenance and service records were conducted.

We observed that there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people’s rooms and we observed that staff knocked on people’s door and waited to be invited in. People were supported at the end of their lives and had their wishes respected.

People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. People told us they felt happy to speak up when necessary. From our discussions with the registered manager and deputy, it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. The provider had systems in place to assess and monitor the quality of the service. Weekly, monthly and annual health and safety and quality assurance audits were conducted by the home.

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe and that they were cared for individually. Assessments carried out by the staff ensured that people's needs were identified and met. Risks were assessed and reviewed regularly to ensure people's individual needs were being met safely. People were involved in making decisions about their care and how they wanted to be cared for. Staff had undertaken training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and understood how this could impact on the people they cared for. People were supported to take their medicines in a safe way. Staff knew and understood the policies and procedures that were in place, to assess and monitor the service to prioritise people's safety.

Is the service effective?

People received effective care from staff that were trained and supported by the manager. People told us they were happy, well cared for and treated with respect. People we spoke with told us that they were provided with clear information which helped them understand the care and treatment choices available to them. People were involved in assessments of their health and care needs and in writing their plan of care.

Is the service caring?

The service was good and caring. This was confirmed by all the people we spoke with. Staff respected peoples' privacy, dignity and their right to be involved in decisions and make choices about their care and treatment. Care plans we viewed detailed people's individual preferences, so that staff knew people's individual wishes. People told us that staff were caring and friendly. Comments we received from people included, 'better than some places, the staff are helpful, they put themselves out for you' and 'it's a very nice place, I would recommend it, staff are very caring' and 'you can't fault the staff' and 'the manager and deputy are fantastic'. 'staff are perfect'.

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs. For example, we saw the local GP practice visited almost daily for booked appointments but would see anyone who needed assessing. People told us they enjoyed the activities on offer and the home catered for their individual preferences.

Is the service well-led?

Eversfield House is a registered charity with a Board of Trustees who were involved in the running of the home. Governance arrangements were in place and staff were clear about the values of the organisation. The home had a registered manager who was experienced and knew the service well. People using the service and staff we spoke with said the leadership of the service was excellent and it was a good place to work. Staff felt well supported to raise any concerns and said they were always acted on.

In this report the name of a registered manager Mrs Carole Harradence appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We were able to speak to eight people who used the service, all of whom were very positive about living at Eversfield House. One person told us, 'I give it 97 out of a 100, if there is anything that worries me I just tell Teresa (the manager) and she will try and do her upmost to sort it out'. Someone else told us, 'you can't please everyone, but I think that if you complain about this place you're mad'.

Eversfield House had a warm, relaxed atmosphere. There was a lot of humour and banter between people who used the service and with the staff team. Care was provided with time and reassurance so that people who used the service felt unhurried.

People that we spoke with wanted to particularly highlight the quality of the food and the activities that were available and organised by the home.

There were some minor areas for improvement, and these are highlighted in the main body of the report.