Eventide Residential Home Limited

Eventide Residential Home (Eventide) is a residential care home providing personal care to up to 18 older people. At the time of our inspection there were 17 people using the service.

Eventide Residential Home Limited is a charitable organisation which is overseen by a voluntary committee. Eventide is an older style property close to the centre of Bude and local beaches. The

accommodation is spread over three floors and there was a working lift.

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

People received their medicines as prescribed and in line with their personal preferences. When people preferred to administer their own medicines there were robust systems in place to support this. Records to show when people had received medicines for use as required did not contain the necessary detail to minimise any risk. The registered manager addressed this at the inspection.

The service was clean and people’s rooms reflected their personal taste. Any necessary repairs were completed quickly. Shared bathrooms were functional but did not provide a relaxing environment.

There were enough staff to support people and ensure they were safe and occupied. Staff had received relevant training and told us they were well supported and enjoyed working at Eventide. Pre-employment checks were in place to ensure new staff were suitable to work in the sector.

People and their relatives said Eventide provided a safe and caring service. One relative commented; “[Family member] feels safe there. They make sure she is okay. They give her full attention.” Staff had access to safeguarding information and were confident about systems for raising concerns.

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 worked in line with the principles of the MCA and sought people’s consent before providing personal care. People were fully involved in decisions about how their care was provided. Staff supported people to maintain their independence.

The registered manager was supported by the organisations trustees who made monthly quality assurance visits. These were also used as an opportunity to gain feedback from residents. This was underpinned by regular meetings for residents, families and staff.

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 30 August 2018).

Why we inspected

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

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.

Recommendations

We have made recommendations about the management of medicines for use when required and supporting people’s sensory needs in the environment.

Follow up

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

We found the following examples of good practice.

Staffing absences, due to COVID-19 infections and other issues had not impacted on staffing levels or the quality of support people received. Staff had worked hard to contain this outbreak within the service. The registered manager and staff team had completed additional shifts as necessary and the service had not needed to request support from agency staff or the wider system.

Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised. Changes had been made to the service’s routines to limit infection risks during the current outbreak.

The service was following current guidance in relation to visiting care homes during outbreaks of COVID-19. Essential care givers and visits to people in receipt of end of life care were possible. However, the service was currently closed to other visitors. People understood the need for these restrictions and were confident staff were taking appropriate steps to manage the outbreak of the infection. All five people we spoke with were happy with the care they received. Their comments included, “They are looking after me”, “[The staff] all wear masks” and “[The staff] stick to the rules”.

The service had invested in a “visitor pod” which enabled relatives to visit, see and talk to their relative’s while ensuring social distancing measures were respected. Prior to the current outbreak and subject to negative lateral flow tests, relatives had been able to visit people in their own rooms.

People’s relatives understood why visiting restrictions were currently in place and had confidence the service was meeting people’s needs. There comments included, “[My relative] is very happy with the quality of care and their approach” and “When we visit, we wear PPE and do a test before we go. They are all following the rules”.

Eventide is a ‘care home’ that provides care for up to 18 adults. At the time of the inspection 17 people were living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Eventide Residential Home Limited is a charitable organisation which is overseen by a voluntary committee. The accommodation was in an older style property close to the centre of Bude and local beaches. The accommodation was spread over three floors and there was a working lift. There was a lounge and a conservatory where people could choose to spend their time.

There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run.

People told us they felt safe living at Eventide. Comments included; “I feel safe, I just press the call bell and they come quite quickly” and “I had a fall in my room and the staff heard me fall and came straight away so I feel safe.” The atmosphere was relaxed and friendly. Staff supported people to move around and encouraged people to be independent.

People received their medicines as prescribed and their health was well maintained. We identified some concerns in how medicines were administered and medicine recording systems and we have made a recommendation about this in the report.

There was a stable staff team in place who knew people well. New staff were required to complete and induction and some initial training. Training was regularly refreshed. Supervisions, annual appraisals and staff meetings enabled staff to raise any issues or suggestions.

People were supported to have maximum choice and control of their lives. There were no restrictive practices in place and people were able to make day to day choices about where and how they spent their time. They were asked for their views of the service regularly and told us they would not hesitate to raise any concerns. members of the management committee visited the service regularly to talk with people and staff about their experiences.

Care plans outlined people's needs in terms of care and support. There was also information about their personal histories and life experiences. This enabled staff to identify what mattered to people and helped facilitate meaningful conversations. The care plans were reviewed regularly to help ensure they gave an accurate picture of people's needs. Staff told us they worked well as a team and were kept up to date with any changes in needs.

People had access to a range of activities both inside and outside of the service. Staff told us this was an area of the service that had improved since our last inspection. The activities provided were in line with people's interests and preferences.

The registered manager was supported by a deputy manager and senior care workers. Key workers had oversight of individuals care plans and arranged appointments for people. Regular audits were carried out to identify any areas for improvement. The registered manager informed CQC of any significant events in line with their legal obligations.

After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their plan and to confirm that the legal requirements were now met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eventide on our website at www.cqc.org.uk.

Eventide Residential Home is a care home that provides care and support for up to 18 older people; at the time of the inspection 18 people were living at the service. Eventide Residential Home Limited is a charitable organisation which is overseen by a committee who give their time voluntarily. The accommodation was in an older style property close to the centre of Bude. The accommodation was spread over three floors and there was a lift available. There was a lounge and a conservatory where people could choose to spend their time. At the front of the building there was seating on a pleasant patio which was protected from the sun by an electric awning.

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.

At this inspection we found action had been taken to address most of the concerns raised in the warning notices. Valves to control the water temperature from taps had been fitted. New fire alarms had also been fitted to ensure the alarms could be heard throughout the building. The fire alarms were switched on and in working order.

Systems for the management of medicines had improved. Medicine Administration Records (MAR) where appropriately completed. One person self-administered their medicines and this was documented and reviewed regularly.

Some people had health conditions which meant they needed regular monitoring so staff would be aware of any decline in their well-being. This was documented in care plans and monitoring records were completed appropriately.

Staff had received safeguarding training and there was an updated policy in place to guide them on the action to take if they suspected abuse was taking place.

Auditing and quality assurance systems had been developed to help the management team have an oversight of the service. This included training and supervision matrixes, a robust process for auditing care plans and the introduction of surveys to gather the views of people living at Eventide and their relatives. The registered manager was working in the office four days a week to enable them to complete management tasks effectively. They were supported by a deputy manager and administrative assistant.

Some areas of concern remained in respect of the management of potentially hazardous cleaning products and protecting people from cross contamination. Cleaning products were left unattended in an unlocked bathroom. There were items left in bathrooms such as unnamed flannels and mesh shower puffs. These pose a risk of cross contamination if shared between people. We have made a recommendation about this in the report.

At this inspection we also reviewed the action taken to address the breach of regulations in other areas. We found staff starting work at the service now received a comprehensive induction including completion of the care certificate for those staff new to care. Recruitment processes were robust and staff files showed references were followed up. The principles laid down by the Mental Capacity Act (2005) were adhered to. The recording of consent had improved and people were supported to make day to day decisions. The service ratings were clearly displayed both on the premises and on the provider’s website.

There were enough staff on duty to help ensure people’s needs were met. People and relatives told us staff were always available when needed. The registered manager used a dependency tool to assist in assessing staffing levels when people’s needs changed.

People had access to a range of external healthcare professionals as necessary. Records showed GP’s, community nurses and chiropodists visited regularly. People told us the food was good and staff were aware of their preferences.

Eventide Residential Home is a care home offering care and support for up to 18 older people; at the time of the inspection 18 people were living at the service. Some of these people were living with dementia. Eventide Residential Home Limited is a charitable organisation which is overseen by a committee who give their time voluntarily. The accommodation was in an older style property close to the centre of Bude and local beaches. It was based in a residential street overlooking the golf course. The accommodation was spread over three floors and there was a lift available. There was a lounge and a conservatory where people could choose to spend their time. At the front of the building there was seating on a pleasant patio which was protected from the sun by an electric awning.

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. On the day of the inspection neither the registered manager or deputy manager were on duty. The deputy manager came into the service to support the inspection. Following the inspection the registered manager contacted us to discuss the inspection findings.

We identified some areas of concern associated with the premises. Water from hot taps in hand basins became extremely hot very quickly which meant there was a risk from scalding. Fire door alarms were not activated and potentially hazardous cleaning products were not stored safely.

Medicines were stored appropriately and people received their medicines as prescribed. Some handwritten entries on Medicine Administration Records (MARs) had not been checked or counter signed. Arrangements in place for safeguarding people who chose to self-administer medicines were not robust.

Staff starting work at the service did not receive a comprehensive induction to include training in relation to the fundamental standards of care. Not all staff had two references on file which was contrary to the service policy.

The principles laid down by the Mental Capacity Act (2005) were not consistently adhered to. Mental capacity assessments were not carried out to establish if people were able to consent to their delivery of care. Best interest processes were not followed.

Care plans were well organised and contained information regarding people's day to day personal care needs. However, we did identify some gaps in the care records. Staff told us the systems for ensuring they were up to date with people’s needs were effective.

Limited activities were provided at the service. Staff and committee members were proactive in taking people on trips into the local town. There were plans to introduce more activities such as bingo sessions.

People were encouraged to remain independent. They were able to maintain control over day to day decisions such as where they spent their time and when they went to bed and got up. Some people chose to spend most of their time in their rooms and staff checked on these people regularly to ensure they had all they needed. People told us they were supported safely and they had no concerns regarding staff approach to care.

There were systems in place to audit various aspects of the service including the environment and care plans. However, these audits had failed to identify the concerns highlighted within this report. Concerns raised at previous inspections had not been addressed. We identified several areas where concerns had reoccurred since 2012. For example a lack of supervision for staff, a weak induction process and a failure to properly implement the MCA.

We identified breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Eventide Residential Home is a care home offering care and support for up to 18 older people; at the time of the inspection 17 people were living at the service. Some of these people were living with dementia. Eventide Residential Home Limited is a charitable organisation which is overseen by a committee who give their time voluntarily. The accommodation was in an older style property close to the centre of Bude and local beaches. It was based in a residential street overlooking the golf course. The accommodation was spread over three floors and there was a lift available. There was a lounge and a conservatory where people could choose to spend their time. At the front of the building there was seating available on a pleasant patio which was protected from the sun by an electric awning.

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.

People told us they felt safe and were treated with respect and dignity. Relatives and external healthcare professionals were also positive about the service provided at Eventide. Comments included; "I have been fortunate to work with the care home and care team for a number of years. At all times the care staff present as caring, open and approachable. They are able to offer an in depth knowledge of their residents needs and requirements" and "The care is excellent."

Risk assessments were in place for a range of circumstances such as using a wheelchair and bathing and showering. One person had suffered a series of falls in recent weeks. There was no risk assessment in place for this person to guide staff on the action they could take to minimise the identified risk.

A member of staff had taken a decision to stop one person’s medicine because they were concerned it was making them unwell. They had not consulted with any medical professionals before taking this decision. There was no effective system in place to ensure staff recorded when they had applied creams to people in line with their care plan.

We identified some areas of concern associated with the premises. A bath hoist was not securely attached to the floor and was unstable. A fire alarm connected to fire exits had been turned off and so staff would not have been aware had a resident left the building via this route. Water from hot taps in hand basins became extremely hot very quickly which meant there was a risk from scalding.

Staff had not received training in the Mental Capacity Act and associated Deprivation of Liberty Safeguards. The service policy in this area did not contain the most up to date information. Some people were under constant supervision and were not free to leave the service unsupervised due to risks to their well-being. No applications to authorise these restrictions had been made to the local authority as is required by law.

Staff starting work at the service received an induction and training was refreshed periodically. The induction process was not planned in line with current best practice and we have made a recommendation about this in the report.

Staff were empathetic in their approach to people and offered reassurance and support to people when they became anxious or upset. Staff had no concerns about people’s safety and told us if they had they would report them immediately to the management team. They were confident any concerns would be listened to and acted on.

There was a stable staff team in place many of whom had worked at the service for a number of years. Staff told us they enjoyed their work and were well supported. Before they started work unsupervised they were required to complete an induction process including shadowing more experienced staff and some basic training.

Care plans were well organised and contained information regarding people's day to day personal care needs. Staff told us the systems for ensuring they were up to date with people’s needs were effective.

Some activities were provided at the service. However, the programme of scheduled activities was limited with only occasional visits from entertainers. Staff and committee members were proactive in taking people on trips into the local town. There were plans to introduce more activities such as bingo sessions.

People were encouraged to remain independent. They were able to maintain control over day to day decisions such as where they spent their time, when they went to bed and got up and who administered their medicines. Some people chose to spend most of their time in their rooms and staff checked on these people regularly to ensure they had all they needed.

There were systems in place to audit various aspects of the service including the environment and care plans. However, these audits had failed to identify the concerns highlighted within this report.

We identified two breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

During this visit we met with seven of the people who were living in the home, the registered manager and two staff on duty, and spoke with two health care professionals. We looked at policies and procedures, care plans, staff records and other records.

People said they liked living at Eventide because it was 'homely' and because the staff were friendly. One person who had recently moved in said 'One look and I knew this was the place for me'. Another person said, 'The staff are all very good to me. They treat me with respect.'

We found that people, sometimes with the support of their family, had been involved in the decision about moving into the home and had agreed with staff how their care was to be provided. We saw that care plans had been reviewed and updated regularly to make sure that staff knew about changes in people's care needs.

We saw that training had been provided to enable staff to work in a safe way and staff performance had been evaluated. Systems were in place to monitor the quality and safety of the service.

The home was managed by a committee of volunteers. They had arranged for improvements to be made to the safety of fire doors throughout the home and for suitable locks for bathroom doors to be provided.

People living at Eventide told us this was a friendly home, where people were cared for by staff who knew them well. 'They have looked after me very well,' one person told us. Another person said, 'Everyone's nice. They know what I like.' One person told us that they were happy that they were allowed to remain as independent as possible.

However, we found that good care practice that we saw was not supported by guidance for staff. Policies and procedures and care planning were neither helpful nor adequate. This meant that people would be at risk of not receiving appropriate care if the regular staff were unavailable.

Quality monitoring was not good enough to pick up on gaps in provision. This included gaps in record keeping and failure to implement regulations including the Mental Capacity Act 2005.

Care plans did not not record how people would like their care to be provided which is important for people who cannot speak for themselves or who might lose this ability.

Staff said that all the people living in the home were able to call for help when they needed it. We saw that call bells had been placed so that people sitting in easy chairs could reach their bell. This was important because the home is on three floors and staff were not available to supervise people at all times.

We found that some people living in the home had health conditions that made them vulnerable and in need of consistent care. While we found that people were well cared for at the time of this visit, the training and record keeping systems in place were not sufficiently robust to ensure that this level of care could be maintained and choices and preferences may not be met for people not able to speak for themselves.

The house was pleasant and comfortable but issues with some fittings and equipment in the home posed a risk of harm to people using the service and staff.