Enbridge House Care Home

Enbridge House Care Home is a residential care home providing personal care for up to 17 people aged 65 and over. The service was supporting 12 people at the time of the inspection. The care home accommodates people in one adapted building, across three floors. People were accommodated in single rooms, most of which have an en-suite. People have access to a communal lounge, dining room and garden area.

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

We received positive feedback from people and their relatives that they were happy with the care provided at Enbridge House Care Home. People told us they were treated with kindness and respect and that they had good relationships with the staff. Relatives told us they felt their loved ones received personalised care and the service was homely and welcoming.

Medicines management had improved since the last inspection. However, further improvements are needed to ensure medicines are always managed safely at the home. We have made two recommendations to improve records relating to people’s medicines administration records and their prescribed as required medicines. We identified areas of improvement were still required to ensure safety checks and actions taken to reduce risk were consistently managed in line with current guidance. We found the provider was continuing to embed good practice to meet people’s needs and continued to build on communication with external professionals to ensure people’s health care needs were met and timely referrals were sought when changes were identified. There were clear systems in place to safeguard people from abuse and there were enough staff available to meet people’s needs.

We reviewed the providers infection, prevention and control measures and how the provider protected people from the risks of infection outbreaks, including COVID19. We observed staff consistently wore appropriate PPE, regular cleaning schedules were in place and the home operated safe visiting arrangements to enable people to maintain relationships with their loved ones. However, the frequency of staff completing lateral flow testing was not in line with national guidance and written protocols were not always fully up to date with current national guidance.

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.

We found some systems and processes in place to monitor and improve service delivery were not always effective. The provider used a range of tools and audits to monitor the care people received, however they had not identified the issues we found at this inspection. We have recommended the provider reviews the scope of their audits to address this. There was a clear leadership team in place and people, their relatives and staff knew where they could access advice and support. The providers were open and responsive to our feedback and we received positive feedback from professionals that the service had made improvements in areas identified in our last report.

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 requires improvement (published 16 February 2022).

Why we inspected

We inspected Enbridge House Care Home to review our findings from the last report and identify if further improvements had been made. We found the provider continued to embed improvements from our last report, however we identified at this inspection areas where further improvement was required. We undertook a focused inspection to review the key questions of safe and well-led only.

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.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full 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.

Enbridge House Care Home is a residential care home providing personal care for up to 17 people aged 65 and over. The service was supporting ten people at the time of the inspection. The care home accommodates people in one adapted building, across three floors. People are accommodated in single rooms, most of which have an en-suite. People have access to a communal lounge and dining room.

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

People and their relatives were happy with the service they received. Their comments included, “It is very clean and has a happy atmosphere and is friendly” and “I can’t speak highly enough about them, they are all there to help.”

The providers needed to demonstrate a consistent approach to the management of health and safety issues, to ensure they could be proactively identified and managed. Not all of the required health and safety checks for the service had been completed, until after we brought them to their attention. People had not experienced harm but the required checks had not been completed. The providers had not ensured staff had access to an up to date safeguarding policy, until we brought this to their attention. We identified some issues in relation to medicines and the providers’ took the relevant action. Since the inspection, the providers have submitted notifications relating to the authorisation of applications for people made under the Deprivation of Liberty Safeguards.

The providers had made the required improvements since the last inspection, with oversight and support from external agencies. It will take further time for them to be able to demonstrate they can sustain the new processes for themselves.

Processes were in place to identify, assess and address potential risks to people. Staff had undertaken relevant training to safeguard people and understood their role. The providers had improved medicines safety overall. There were sufficient numbers of suitable staff to support people safely and to meet their needs. Staff understood their responsibility to raise any concerns and processes were in place to record and review any incidents.

People’s needs had been assessed and their care was planned and delivered in accordance with legislation and guidance. The providers had ensured staff had the skills and knowledge to deliver effective care. Staff supported people to eat and drink sufficient for their needs. Staff worked both within and across organisations to ensure people’s healthcare needs were met and they received effective care and support. We have made a recommendation for the providers to review current guidance on dementia friendly design for the communal areas 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 treated people with kindness and compassion. They demonstrated a good knowledge of the people whom they cared for, they knew their personal histories, backgrounds and preferences. People were supported to express their views about their care. Staff upheld people’s privacy and dignity during the provision of their care.

People received personalised care which was responsive to their needs. Staff were still getting used to the new electronic planning system and were working on improving their recording of how people spent their time. People were supported appropriately at the end of their lives.

The providers had ensured since the last inspection, they had only provided their registered regulated activity of personal care and not nursing care, which they had been found to have provided at the previous inspection. Processes were in place to assess, monitor and improve the service. The culture of the service had improved and has become more open. The providers had processes in place to enable people to raise any issues or concerns and they felt able to do so. The providers have worked openly and transparently with external agencies.

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 inadequate (published 19 August 2021) and there were breaches of regulation. The providers 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 and the providers were no longer in breach of regulations.

This service has been in Special Measures since 19 August 2021. During this inspection the providers demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the providers to take at the last 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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Follow up

We will meet with the providers 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.

Enbridge House Care Home is a residential care home providing personal care for up to 17 people aged 65 and over. The service was supporting 14 people at the time of the inspection. The care home accommodates people in one adapted building, across three floors.

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

People were not safe in the service. There were serious concerns about the care of people’s skin in the service. The provider had not involved external healthcare professionals appropriately to support people safely. There were health and safety risks in the service. The provider lacked understanding of safeguarding processes. Medicines were poorly managed, and the service did not learn from incidents.

There were serious failings to assess and meet people’s health needs, including where people had lost weight. The service was not up to date with best practice.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider had not sought appropriate authorisation to restrict people’s freedom.

The provider told us they tried to protect people from COVID-19 by keeping professionals out of the service. This had created a closed culture where people were put at risk and people’s health needs were not met. The provider had failed to maintain oversight of the service and had not identified the concerns identified in the inspection. They were providing treatment that had not been agreed with healthcare professionals and were making decisions without appropriate consultation with the GP or community nurses.

Though we observed some caring interactions from staff, the closed culture within the home and lack of support for people’s health needs did not demonstrate a caring culture. People were not appropriately involved in decisions about their care.

Care records were not person-centred or appropriately detailed and sometimes were out of date. There was a lack of meaningful activities taking place in the service. Decisions around end of life care planning were not appropriately documented.

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 13 April 2019).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Enbridge House on our website at www.cqc.org.uk.

Why we inspected

The inspection was prompted due to concerns received about wounds, moving and handling, the management of the service and that people’s needs were not being met. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements.

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

The provider was working with external agencies to make improvements and reduce the risks identified in the inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding service users from risk of abuse, meeting nutritional needs, good governance, staff training, recruitment, notification of incidents and display of the Commission's rating at this inspection.

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

Follow up

We requested and received an action plan from the provider following the inspection to understand what they will do to improve the quality and safety of the service. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Enbridge House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.

The service supported older people, some of whom were living with dementia. At the time of our inspection there were 14 people living in the service and one person attending the home for daily respite care.

People’s experience of using this service:

¿ We received positive feedback about the service and the care people received. The service met the characteristics of good in four areas but was requires improvement in well-led.

¿ Medicines were stored and dispensed safely. However, audits of medicines records (MARs) were not completed. There were some unexplained gaps in people's medicines administration records and no record of actions taken by staff to address this.

¿ Systems and processes were in place for monitoring quality and safety in the service. However, these were not always effective, as they failed to identify errors and omissions, such as the gaps in MARs, lack of medicines audits and the lack of records of actions taken following accidents. We recommended that the service seek advice and guidance from a reputable source about auditing MARs and making records of actions taken to prevent accidents.

¿ There were enough staff to support people and keep them safe. People were supported by skilled staff with the right knowledge and training.

¿ Staff had respectful caring relationships with people they supported. They upheld people’s dignity and privacy, and promoted their independence.

¿ People’s care and support met their needs and reflected their preferences. The provider upheld people’s human rights.

¿ There was a positive, open and empowering culture. Staff roles and responsibilities were clear. Staff worked in partnership with professionals to deliver care and support and maintained links with the local community.

Rating at last inspection:

¿ At the last inspection the service was rated good overall with a rating of requires improvement in safe. At this inspection the service was rated good overall with a rating of requires improvement in well-led.

Why we inspected:

¿ This was a planned, comprehensive inspection of the service.

Follow up:

¿ We did not identify any breaches at this inspection. We will therefore re-inspect this service within the published timeframe for services rated Good. We will continue to monitor the service through the information we receive.

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

Enbridge House Care Home is registered to provide care (without nursing) for up to 17 older people. There were 14 people resident on the day of the visit. The building offers accommodation over two floors in 14 single and two double rooms. The double rooms are generally used as singles, unless shared by a married couple. One room is currently used to provide short term care. This meant that the service had one vacancy on the day of the inspection. The second floor is accessed via a staircase or lift. There is a small flight of stairs on the second floor leading to the lift from two bedrooms. Only people who are fully mobile are allocated these bedrooms. The shared areas within the service are spacious and meet the needs and wishes of people who live in the home.

The service has a registered manager running 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 2008 and associated Regulations about how the service is run.

The management team, generally, kept people, visitors to the service and staff safe. However, there were areas of safety that required improvements. These included developing a more comprehensive emergency plan and ensuring people were protected from the risk of burning themselves on hot water tanks and pipes. Most risks were identified and managed to make sure that people and others were kept as safe as possible. Staff were provided with training in the safeguarding of vulnerable adults and health and safety. Staff were able to describe how they kept people safe from all forms of abuse.

There were enough properly trained staff who had the necessary skills to provide people with safe care. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. People were given their medicines in the right amounts at the right times by staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. People in the home had the capacity to make their own decisions and choices and no one was deprived of their liberty.

Staff were properly trained and supported to enable them to meet people’s health and well-being needs. People were supported to make sure they received health and well-being care from appropriate professionals. Staff were trained in necessary areas so they could effectively meet people’s diverse and changing needs.

Staff built relationships with people so that they were able to provide caring and compassionate support. Staff encouraged people to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times. The service had a strong culture of person centred care which recognised that people were individuals with their own needs and preferences

People benefitted from a well-managed service. The management team was described by staff as supportive and helpful. The registered manager worked directly with people and was very knowledgeable about their individual needs. The service made sure they maintained and improved the quality of care provided. Some improvements were needed with regard to sending the appropriate notifications to Care Quality Commission and additional information was needed in some plans of care.

On the day of the inspection there were 17 people using the service. As part of this inspection we spoke with three people, two people's relatives, the registered manager, the registered provider and three staff. We also reviewed records relating to the management of the home which included, five care plans and daily care records.

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

Is the service safe?

We found the service to be safe because the home had been cleaned to an adequate standard. We spoke with people and one told us 'Yes, the home is clean' and a person's relative commented 'Cleanliness is fine.' The provider had identified that two carpets required replacement and arrangements had been made for this work to be completed.

At the previous CQC inspection on 24 January 2014 issues had been identified in relation to the heating of the home and the maintenance programme. At this inspection we found that the heating had been resolved and there were processes in place to ensure that adequate maintenance of the home took place. People told us 'Yes, it is adequately decorated and maintained' and 'It is warm enough.'

There were adequate numbers of staff on each shift. The provider was recruiting extra staff but arrangements had been made to ensure that shifts were covered whilst recruitment took place.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper procedures were in place. Relevant staff understood when an application should be made, and how to submit one.

Is the service effective?

We found the service to be effective because people's care needs had been assessed. Care plans provided staff with guidance about how people's assessed needs were to be met. One person told us 'Staff did an assessment to find out about my needs.'

The service had worked with the district nurses to ensure that the risks of people developing pressure areas had been assessed. When people were identified as at risk and required specific equipment to manage this risk, it had been obtained.

Is the service caring?

People and their relatives told us 'Care is brilliant' and 'Staff are caring.' We found the service to be caring as we observed that staff understood people's care needs and were kindly and caring to people in their interactions. They did not rush people's care and they listened to their requests. One person's relative told us 'Staff respect X's wishes and work with X.'

Is the service responsive?

The service was responsive as we found that they had responded to changes in people's care needs. On the day of the inspection a person became unwell and staff responded promptly to ensure that this person received medical attention. A person's relative told us 'If X is poorly, staff respond promptly. The GP is arranged smartly.'

Is the service well-led?

We found the service to be well-led. Both the registered manager and the provider were present at the service daily. This enabled people to speak with them as they wished to. One person's relative told us 'I can raise issues as required.' Audits of the service had been completed to ensure that the quality of the service provided had been monitored.

People's care plans detailed how they wanted their needs to be met and supported choices they had made. However, full assessments of people's nutritional needs were not completed to promote their wellbeing.

Staff received support and training to be knowledgeable of people's specific health and personal care needs and how they wanted those needs to be met.

The provider had not taken appropriate measures to improve and monitor the heating system and temperatures throughout the home to maintain a safe and homely environment. Checks were not completed to promote infection control and maintenance safety of the home. Some of the fabric and furnishings of the home were in need of replacement or repair.

People had opportunities to contribute their views about the quality of the service and knew who to contact should they have a concern or complaint about the services provided.

Observation of peoples care during our inspection confirmed people were receiving effective, safe and appropriate care. One person told us that 'it's rather like a hotel here and I would recommend it to anyone'.

Staff we spoke with were able to demonstrate an understanding of abuse issues and knew what to do if they suspected that someone was being abused.

Staff we spoke with confirmed that they had regular supervision from senior staff.

People we spoke to confirmed that if they wanted to change anything in their room or in their routines the staff would act upon them.