Estherene House

Estherene House is a care home providing personal and nursing care to 29 older people at the time of inspection. The service can support up to 36 people.

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

At the last inspection the service needed to make improvements to comply with recommendations made following a fire risk assessment and water quality risk assessment. This work had been completed at this inspection. This assured us that people were safe from the risk of Legionella and of harm in the event of a fire.

At the last inspection the service needed to make some improvements to care planning. At this inspection we found that the information in care planning and risk assessments had improved.

People’s medicines were managed, monitored and administered safely and there were enough staff to provide care to people at the time they required it.

The service was clean and there were appropriate procedures in place to minimise the risk of the transmission of COVID19. At the last inspection some staff were not wearing PPE (Personal Protective Equipment) properly, but this had improved at this inspection.

The provider had made improvements to the quality assurance system in place and had employed a new member of staff to complete quality assurance audits on their behalf. These had already resulted in positive development of the service.

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 (21 July 2021).

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 and the provider was no longer in breach of regulations.

This service has been in Special Measures since 21 July 2021. During this inspection the provider 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 was a planned inspection based on the previous rating.

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.

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.

Estherene House is a care home providing personal care to a maximum of 36 older people. At the time of inspection there were 34 people using the service.

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

Whilst people using the service told us they felt safe, we found that the provider did not always have clear and robust measures in place to reduce the risks to people. Where risks had been identified, there was not always appropriate care planning in place to guide staff on how those risks should be reduced.

The environment was not consistently safe because environmental risks identified to the service, such as fire risks had not been acted upon in a timely way.

Staff were observed to not always be following infection, prevention and control procedures and government guidance regarding preventing the spread of COVID-19

The provider had not always taken appropriate actions in line with their duty of care to protect people from harm. For example, ensuring actions of fire and legionella risk assessments were completed. Requests made by the registered manager had not always been acted upon by the provider.

The registered manager had an appropriate system in place to monitor the quality of the service and identified area’s for improvement. They had identified the action required by the provider to address safety concerns and added this to their improvement plan.

Medicines were managed and administered safely, and in line with the instructions of the prescriber.

Sufficient numbers of staff were deployed to ensure people were provided with support when they needed it.

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’ (Report published 21 February 2019)

Why we inspected

We received concerns from whistleblowers about staffing and the safety of the service. As a result, 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.

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

Enforcement

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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.

Estherene House provides accommodation and personal care for up to 36 people who require 24 hour support and care. Some people were living with dementia. At the time of our visit 35 people were using the service.

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

We received information raising concerns about how risks to people were managed. We contacted the registered manager and received reassurances regarding the concerns. We also liaised with Suffolk County Council contracts team to obtain their feedback about the service.

We inspected the service to check the feedback we had received was correct. We found that risks to people from receiving care and support were mostly effectively assessed and managed. However, there was no risk assessment regarding access to the two stair cases. We brought this to the attention of the registered manager during the inspection visit and they have confirmed this is now in place.

We found people were protected mostly from the risk of acquiring infections and the service was clean. Personal protective equipment was available to staff and all staff were following the latest guidance.

The registered manager was working with the local authority contracts team to improve practice within the service and make improvements where needed.

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 21 February 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns received about the management of risks within the service. 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 coronavirus and other infection outbreaks effectively.

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.

• People who live at Estherene House are supported by sufficient numbers of staff who are appropriately trained. We observed people’s requests for assistance being answered promptly. The quality of interaction between staff and people was good and staff were kind and caring towards people.

• The environment was comfortable and safe. The décor was stimulating and there was dementia friendly signage making it easier for people to find toilets, dining room and lounges.

• People were supported to remain engaged and had appropriate access to meaningful activity. There was a range of activities on offer to suit people’s preferences.

• People were provided with a choice of good quality nutritional meals which met their individual needs. People were provided with appropriate support to reduce the risk of malnutrition or dehydration. Improvements had been made to the dining experience but further improvement was required to ensure meals were served promptly. The manager was taking action to address this.

• People received the support they required at the end of their life. However, improvements were required with end of life care planning.

• People were supported to have contact with other healthcare professionals and the service worked well with external organisations to ensure people’s complete needs were met.

• People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

See more information in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 09 January 2018)

About the service: Estherene House provides accommodation and personal care for up to 36 people who require 24 hour support and care. Some people were living with dementia. At the time of our visit 34 people were using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service has made sufficient improvements to be rated Good.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

There were 33 people living in the service when we undertook this comprehensive unannounced inspection on 7 and 8 November 2017.

There was a registered manager in place. 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.

This overall rating of this service was Requires Improvement at our last inspection of 26 and 29 September 2016. The key questions Safe, Effective and Caring were rated as Requires Improvement. Responsive and Well-led were rated as Good. In Safe we found breaches of Regulations 12 Safe care and treatment and 18 Staffing of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the breaches of Regulation.

During this inspection, the overall rating remained Requires improvement. There had been some improvements made in the service such as staffing levels and systems for reducing risks to people. The breaches of Regulations 12 and 18 had been addressed. However, we found shortfalls relating to how the service recorded people’s care and how staff interacted with people. The key question Safe had improved to Good. Effective and Caring remained Requires Improvement. Responsive had deteriorated from Good to Requires Improvement. As a result Well-led had also deteriorated from Good to Requires Improvement. This was because the service had not made the improvements required to provide people with good quality care at all times.

There were quality assurance systems in place which assisted the provider and the registered manager to identify shortfalls and address them. Where shortfalls were identified there were plans in place to address them to improve the service people received. However, these were not yet fully implemented and embedded in practice to ensure that people were provided with good quality care at all times.

Improvements were needed in people’s care plans to identify how they were provided with person centred care which was tailored to meet their specific needs. There were some inconsistencies in care records which needed attention to ensure that staff were provided with the most up to date guidance on how people’s needs were met.

Improvements had been made in the staffing levels in the service and these were ongoing. However, improvements were needed in how staff interacted with people. There were missed opportunities for staff to include people in how the daily records of people were completed.

Interactions which people received from staff varied in quality. Some were very caring and positive and some did not demonstrate compassion for people’s condition and how they expressed themselves. The service’s management team were taking action by a programme of training which had been delivered and was booked to address this. This had not yet been fully implemented at the time of our inspection.

People’s nutritional needs were assessed and met. However an incident, which occurred during the first day of our inspection, had affected people’s dining experience in one unit.

The environment was clean and hygienic and there were infection control systems in place. There was a programme of refurbishment and redecoration in the service being undertaken.

Improvements had been made in how the service managed risks to people. This included how risks were assessed and systems put in place to minimise these.

There were systems in place to keep people safe; this included appropriate actions to report abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

Recruitment of staff was done safely and checks were undertaken to ensure staff appointed were fit to care for the people using 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 provided with the opportunity to participate in activities that interested them.

People were supported to see, when needed, health and social care professionals. The service worked with other professionals involved in people’s care to improve people’s lives.

There were systems in place to provide people with their medicines safely.

There was a system in place to manage complaints and these were used to improve the service.

There was 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.

There was a positive, open and inclusive culture in the service. The providers had acquired the service in October 2015 and were committed in their approach to drive forward improvement to ensure all people’s care and support needs were being met. They were working with the staff team to help them to understand and share the culture, vision and values of the service in its main objective to provide high quality care and continued positive life experiences to those who used it.

However, there were times of the day when more staff were needed to ensure all people’s needs were being met in an appropriate and timely manner. Risks to people injuring themselves or others were not always appropriately assessed and managed.

Staff had a good knowledge and understanding of each person, about their life and what mattered to them. People were mostly complimentary about the way staff interacted with them. Independence, privacy and dignity was promoted and respected by most staff but there was still work to be done to ensure these were core values in the service upheld by all staff.

Care plans reflected the care and support that each person required and preferred to meet their assessed needs and promote their health and wellbeing. Further work was needed to ensure care plans were consistent and demonstrated individual’s differing care needs in terms of interests, social activities, types and stages of dementia.

People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. They were supported to maintain good health and had access to appropriate services which ensured they received ongoing healthcare support.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Staff knew how to minimise risks and provide people with safe care. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. People knew how to raise concerns and were confident that any concerns would be listened and responded to.

People were provided with their medicines in a safe manner but there were times when these had not been provided at the times prescribed. People were prompted, encouraged and reassured as they took their medicines and given the time they needed.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Some work was needed to ensure all staff understood the importance of gaining people’s consent to the support they were providing.

The service had a quality assurance system in place which was used to identify shortfalls and to drive continuous improvement. The provider was working through a comprehensive improvement plan which was regularly updated as changes were being made within the service and as other areas requiring improvement were identified. The directors and management team were open and responsive to concerns we raised and immediately began work on making changes as a result.