Ersham House Nursing Home

Updated 28 June 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 two inspectors.

Service and service type

Ersham House Nursing Home 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. Ersham House Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

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

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service and the service provider. We looked at notifications and any safeguarding alerts we had received for this service. Notifications are information about important events the service is required to send us by law. 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 used all this information to plan our inspection.

During the inspection

We looked around the service and met with the people who lived there. We used the Short Observational Framework for Inspection (SOFI) during the morning of the first day of our inspection. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 10 people to understand their views and experiences of the service and we observed how staff supported people. We spoke with the registered manager, area manager and 7 staff members. We were able to speak with three visitors during the inspection.

We reviewed the care records of six people and a range of other documents. For example, medicine records, four staff recruitment files; staff training records and records relating to the management of the service.

Following the site visits, we continued to seek clarification from the provider to validate evidence found during the inspection process. We were sent, staff rotas, training and supervision data and immediate actions taken by the management team following the site visit. We also spoke with three professionals who visit the service and two family members.

Updated 28 June 2023

About the service

Ersham House Nursing Home is a care home with nursing and accommodates up to 40 people in a purpose-built building. The service supports adults whose primary needs are nursing care. Some people also live with additional mental health disorders, and dementia. At the time of our inspection there were 22 people living at the service

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

The providers’ quality assurance and governance systems had improved under the consistent leadership of the registered manager, who came into post after the last inspection in September 2022. Whilst there had been improvements, there were still areas of care delivery, and documentation that needed to be improved and embedded into everyday practice. This relates to food and fluid records, oral health, and the updating of the mental capacity assessments.

There were suitably trained staff deployed, but the numbers of staff on duty had not always ensured peoples’ needs were met consistently. Staffing levels had the potential to impact on safe outcomes for people’s health and well-being, such as remaining in bed in their bedroom as staff had not time to hoist them and being assisted with meals that were no longer hot.

During the inspection process, the provider had reviewed staffing levels and increased the number of staff deployed.

All staff had received training to recognise signs of abuse or risk and understood what to do to support people safely. “One person said, "Very safe here, staff very vigilant." Another said, "The staff make sure we are all safe." Risk of harm to people had been reviewed and risk mitigated as good practice guidelines for the management of medicines, pressure care management, and nutrition had been followed. 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.

Infection control audits and cleaning schedules were in place, and the premises were clean and hygienic. The provider ensured that when things went wrong, accidents were recorded, and lessons were learned.

The home now had an effective management team which provided good leadership for staff and communicated effectively with people, relatives, and professionals. Staff were positive about their roles and felt valued for the work they did. People told us, "The staff are very kind and respectful," and "They are all nice, I know the manager and can talk to her if I have a problem."

The views of people who lived at the home, their relatives and staff were encouraged and acted upon by the management team. People told us, "Staff are very kind, they look after me very well," and "I think the staff are lovely." Relatives said, "I have total faith my (relative) is safe. Things have improved and the staff are polite and thoughtful,"

People and their relatives felt able to raise any concerns they had and were confident these would receive an appropriate response. One visitor said, “Very much improved, I feel listened to now.”

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 29 September 2022)

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.

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At our last inspection we recommended that the provider consider current guidance regarding health and well-being decisions made on peoples’ behalf when they lack capacity to make their own decisions. At this inspection they had reviewed their mental capacity assessments and had made improvements.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service and review the rating, and to follow up on action we told the provider 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.

We conducted an unannounced focused inspection of this service on 18 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, and good governance at this inspection.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe 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 but have met the breaches of regulation. 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 Ersham House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.