Archived: The Liberty of Earley House

At the previous inspection in January 2017 we found breaches of Regulation 12 regarding medicines management, Regulation17 regarding governance and oversight and Regulation 18 regarding staff support.

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 key questions, Safe, Effective and Well-led, to at least good. The service submitted an action plan which detailed the steps proposed to address the breaches identified.

At this inspection we found the majority of these actions had been carried out or were in process, although the service had not recruited a deputy manager as stated in the action plan. This placed additional burdens on the registered manager to maintain effective overview of the service. The trustees had provided some additional support through a series of six-weekly meetings with the manager to provide an opportunity for issues to be brought to their attention and discussed.

Improvements had been made to medicines recording and administration practice to significantly reduce the number of reported errors and omissions. Identified health and safety-related environmental works had been completed. Staff had been provided with regular support through supervision and the majority had now had a performance appraisal to explore their progress and learning needs. Sufficient improvements had been made that there were no longer breaches of these regulations. However, the provider needed to evidence their ability to sustain the improvements.

Some issues identified during this inspection were dealt with immediately following the inspection. The trustees and registered manager should identify ways to ensure they do not recur. These issues are referred to within the body of the report.

The Liberty of Earley House is a ‘care home’. 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. The service provides support for up to 35 people with needs associated with old age. People each have their own bedsit or flat with kitchenette and en-suite toilet/shower. Facilities are arranged over two floors served by a passenger lift. At the time of this inspection there were 19 people receiving support.

A registered manager was in post as required. 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 were generally safe in the service. Appropriate risk assessments had been carried out, with one exception, to identify potential risks and action had been taken to mitigate them. Better oversight of health and safety matters had been exercised since the previous inspection, as evidenced by the prompt response to the Legionella risk assessment, received during the inspection.

People felt safe and said staff treated them with kindness. No one raised any concerns about staff approach or attitude as had been the case at the previous inspection.

People and staff regularly commented that at times they felt staffing levels were not sufficient to meet people’s needs. People noted that at times they had to wait too long for a response to their call bell.

The service had a robust staff recruitment process which included all required actions. However, we identified some gaps in required records which could have put people at risk. These were addressed following the inspection.

People felt the service met their needs and provided them with effective care. They gave us positive feedback about the approach of staff, who they said supported them to do as much as possible for themselves. 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’s rights, privacy and dignity were respected by staff. Their spiritual and other diverse needs were provided for.

People were provided with effective support to meet their dietary and healthcare needs and were consulted when planning menus.

People’s views about the service were sought and acted upon. People felt they had opportunities to raise any concerns and that they would be listened to.

A range of suitable activities and events were provided which people could chose to take part in if they wished. People’s views and suggestions about activities were sought during regular residents' meetings.

The registered manager failed to notify the Care quality Commission as required by law, of one incident, although it was investigated at the time. The notification was provided retrospectively after the inspection. Other matters requiring notification had been reported.

The registered manager had a range of systems in place to monitor the day to day operation of the service and reported on a six-weekly basis to the trustees. This helped ensure improved governance over the service’s operation.

Staff understood the ethos of the service as it had been established. However, the increased dependency of more recent admissions put additional pressures on aspects of their work such as monitoring of people’s well-being in their flats.

This is the second consecutive time the service has been rated 'Requires Improvement'.

This was a comprehensive inspection to follow up all of the previous areas of concern and review the overall compliance of the service. We found the service had made improvements in some areas but identified three breaches of the regulations which are detailed below.

The Liberty of Earley House is a care home without nursing that provides care for up to 35 people with needs relating to old age. Twenty four hour support is provided by a team of staff. At the time of this inspection, 22 people were receiving support. The service is operated by The Trustees of The Earley Charity.

A registered manager was in place as required in 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.

We found that despite the range of steps taken by management, the previously identified issue of significant medicines errors had re-emerged, which placed people at potential risk of harm. This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2014.

The trustees (the registered provider), carried out monthly monitoring visits to the service. However, these had not always identified key issues requiring action in a timely way. Health and safety issues had not always been effectively managed proactively to ensure action was taken promptly to address concerns. This was a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2014.

Further improvement was necessary in some aspects of management overview and proactive action, by both the registered manager and the trustees. We recommend that the registered manager and provider seek recognised guidance regarding their responsibilities for health and safety matters.

Staff had not received a consistent level of support through supervision and performance appraisal in accordance with the provider’s own expectations or the requirements of legislation. This was a breach of Regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

Feedback from people and relatives about the care and support provided by staff was positive although some people recognised staff were under a lot of pressure to meet people's needs due to recent staff shortfalls. People felt safe and well cared for and said they were treated with dignity and their privacy was respected by staff.

People had been involved in reviews of their care and felt they had a say in the support they received. They felt the service responded to their changing care and health needs. They knew how to make a complaint if necessary and felt involved and consulted through the residents meetings. Although people’s views were sought through survey forms as part of trustee visits it was not clear how this information was collated and used to develop the service.

People’s rights and freedom were protected by staff who sought their consent before providing support or accessing their flats. People were provided with a varied menu with daily options and the range of activities and entertainment was being developed in response to people’s requests.

The service had a robust staff recruitment system to help ensure staff were suitable to work with vulnerable people. New staff received a thorough induction to the service and premises. However, progress on the national ‘Care Certificate’ induction training process (or equivalent), had been slow. The service had yet to establish a comprehensive system of competency assessment to ensure all staff had up to date knowledge of their role and responsibilities. Good progress had been made with staff training and courses had been booked to address remaining shortfalls, although a need for additional training in some areas was identified.

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.

If you wish to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the service had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of people and a member of the management team was available on call in the case of emergencies.

Staff records demonstrated that care workers had the required training to perform their roles and appropriate employment checks were completed prior to commencing in post.

We reviewed the safe keeping and administrations of medicines during our visit and saw inaccuracies when recording stock levels of controlled drugs. There were a high number of incidences relating to medication errors and omissions and we saw no evidence of investigations and outcomes that addressed these concerns. We have set a compliance action against the provider in respect of this.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Although no recent applications had been submitted we were informed during our visit about one application that had been submitted. This involved a person who became increasingly confused and the service had been unable to manage their care. We noted policies and procedures were followed which had resulted in that person being moved to a service that could care for their needs. The manager had been in the process of updating procedures . Relevant staff had been trained to understand when an application should be made in order to ensure people's rights were being protected.

Is the service effective?

People told us they were happy with the care they received and that the care workers were "first class" and "absolutely excellent". They told us the care workers "involved" them with their care and "helped keep them independent". Care workers we spoke with had a good knowledge of the people they cared for and told us they gave people choice about the care they received. One person told us how care workers managed their medicines as they had struggled with taking them correctly. They told us they had Parkinsons' disease, which is a neurological condition that requires medicines to be taken at the same time each day to ensure its efficacy. They told us care workers ensured their medicine's were "always on time". This meant care workers had ensured medical conditions were managed appropriately.

New care plans were being put in place during our visit which had a wider variety of assessments. Previous assessments did not include: falls risks, nutritional status, skin integrity and end of life care. This meant that the service would improve the effectiveness of the care people received because they were considering people's needs in a wider variety of contexts. Care records we reviewed that had been written using the old documents were inaccurate and not fit for purpose. We have set the provider a compliance action due to inaccurate records.

Is the service caring?

We observed care workers interacting with people and saw they were supported by caring and attentive staff. We heard them say "no problem" in response to calls for assistance and ask people "how are you today". Care workers we spoke to told us they encouraged people to "do their own care" and give them choice about their daily routine. People told us the care workers were patient and encouraged them to do things at their own pace.

Is the service responsive?

People's needs had been assessed prior to moving to the service. People met with their key worker every month and they told us they discussed their care during this time and were able to implement any changes they wanted. Records confirmed these discussions had taken place and people had signed their care plans to indicate agreement with the contents. People had access to a wide variety of activities and were encouraged to access activities outside of the service. Monthly resident committee meetings were held and families and care workers were encouraged to attend these. People told us they were able to "all make suggestions" and they were "listened to".

Is the service well-led?

Care workers had a good understanding of procedures within the service and their roles and responsibilities which meant consistent care was given. Quality assurance processes were in place. People told us they were asked for their opinions and had completed a satisfaction survey. The survey we saw for 2013 had mainly positive comments, people stated they were "happy" with the care and the food was "okay". One person commented that care workers did not always answer the call bells quickly enough. People told us this had been discussed at the residents committee meeting and care workers tried to answer them quickly. Care workers told us there were regular staff meetings and they felt their ideas and opinions were valued. They told us any concerns about people at the home were addressed quickly and the manager "moves very fast with these things". Care workers told us the training "was excellent" and the manager was "very open". A care worker told us about a person who they felt needed more help with their mobility and the manager responded quickly which ensured a risk assessment was completed and mobility aids provided.

Care was planned with the involvement of the people who use the service and their relatives, and reflected their individual needs.

During our inspection we observed a clean environment throughout the home. People living in the home and relatives we spoke with told us the home was always kept clean and tidy. People were protected from the risk of infection because protocols based on current Department of Health guidelines had been followed. We found there were systems in place to manage and monitor the prevention and control of infection.

All the required information and checks were in place prior to the employment of staff. This meant the provider had an effective recruitment process which ensured that people who use the service, were not placed at risk of being cared for by staff who were not suitable to provide their care and treatment.