Archived: Euxton Park Care Home

Euxton Park Care Home is a residential care home providing nursing and personal care to up to 63 people. At the time of the inspection, the provider was supporting 22 people on the residential unit and 20 people on the nursing unit. The home has two floors with each having its own dining room and lounge area. The kitchen and laundry facilities are on the ground floor. Each floor is accessible by both stairs and a lift.

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

We found some concerns with how medicines were administered but note as soon as we discussed these with the management team both a flash meeting and individual supervisions were completed to address the issues. Risk assessments were not routinely updated following incidents, but we were assured changes in need were recorded and given to staff at handover meetings to ensure people’s changing needs were met. Staff were using Personal Protective Equipment (PPE) effectively to keep both themselves and people in the home safe during the pandemic. There were enough safely recruited staff to meet people’s needs and the provider continued to recruit additional staff as needed. People we spoke with told us they were happy in the home and their needs were met.

The provider had a comprehensive suite of audits which were overseen by the regional team. However, due to the size of the home the current system risks some aspects of service delivery not being monitored for some time. We discussed this with the area manager who was going to review this. We saw staff worked well together and engaged well with the people they supported. They were well trained and supported by the management team. The provider submitted notifications of incidents to the commission as required and had the ratings of their previous inspection available.

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 comprehensive rating for this service was requires improvement (published 12 March 2020).

At our last comprehensive inspection, we recommended that the provider consulted people to ensure there were enough available staff. At this inspection we found staff were readily available to support people in a timely way and people told us this was the case.

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.

The inspection was prompted in part due to concerns received about the care provided to people including a lack of support with people’s risks to their skin integrity and hydration needs. A decision was made for us to inspect and examine those risks to the people supported by the home. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

We received concerns in relation to risk and as a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. spacing

Therefore the overall rating for the service remains the same at requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 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.

Euxton Park Care Home is a residential care home and at the time of the inspection was providing personal and nursing care to 51 people aged 60 and over. The service can support up to 63 people. There are two units within the home, one for people who require residential care and another for nursing care.

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. These were commonly known as the 'New National Restrictions'. This meant the Covid-19 alert level was very high and there were tighter restrictions in place affecting the whole community.

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

The service had robust measures in place around the use of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly.

The provider and manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Some areas around the disposal of PPE required attention and we have signposted the registered manager and provider to latest guidance so their approach is strengthened.

People received their medicines as prescribed and all aspects of medicines administration and storage were safe. A person said they were happy they received their medicines as prescribed by their doctor.

Details of this can be seen in the 'Safe' section of this report.

Rating at last inspection

The last rating for this service was Requires Improvement (published 12 March 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about whether medicines were being administered correctly and whether appropriate infection prevention measures were in place. The overall rating for the service has not changed following this targeted inspection and remains 'Requires Improvement'.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Euxton Park Care Home on our website at www.cqc.org.uk.

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.

Euxton Park is a residential care home providing nursing or personal care for 57 people aged 65 and over at the time of the inspection. The service can support up to 63 people. There are two units within the home, one for people who require residential care and one for nursing care.

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

Most people told us they felt safe and were supported by staff who knew them well. Recruitment was managed safely. There was mixed feedback about staffing levels. One person told us, "There are not always enough staff; you’re looking for somebody [to support you] sometimes, and they’re all busy." We discussed this with the area manager and made a recommendation around staffing. People were not overly complimentary about the food. Although a new chef had started at the service, there were still areas for improvement.

People told us there wasn’t much to do at the service. One person said, "We don’t have a lot to do; we keep saying we’ve nothing to do and it’s awful being bored. The school children come in sometimes to entertain us and that’s very nice, when it happens." However, a new activity coordinator had just started at the service and had met with people to discuss what they would like to do.

Staff treated people with respect and maintained their dignity when supporting them. Care plans were detailed and medicines were managed safely.

People told us they were happy living at the service. One person said that they "wanted to stay here forever and would only leave if they won the lottery." 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.

Staff and people told us they liked the new registered manager and she was approachable. Staff told us morale was starting to improve and the registered manager had implemented various initiatives to recognise staff achievements.

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 28 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Euxton Park is registered to provide accommodation and nursing or personal care for up to 63 people. The home provides care for older people and people who have a physical disability. There are two units within the home: one for people who require personal care and one for people who required nursing care. Care is provided on a 24 hour basis, including waking watch care throughout the night. All bedrooms at the home are single and some include en-suite facilities. There are a variety of communal areas, including well maintained grounds for the use of people who use the service.

There was a registered manager in place at the time of the inspection. 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 our previous inspection on 19 and 27 January 2016, we made recommendations that if implemented, could bring about improvements to the way services were delivered. These included further development in the way health care assistants were supervised, enhancement to the system of infection control audit, individual activities, and the development of one page profiles within people's care plans. At this inspection we found that improvements had taken place across all areas.

People felt safe living in the home and said they had no concerns about their safety. Staffing numbers were reviewed and assessed to make sure sufficient numbers of staff were available to provide quality care and support to people.

Medicines were managed safely. Staff were trained in medicines administration and had their competency checked annually which helped to prevent mistakes being made.

Staff were required to complete an induction and programme of learning so they had the knowledge and skills required to carry out their role.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who lacked capacity to make important decisions themselves.

Healthcare professionals were actively involved and included in making best interest decisions for people who used the service.

People who used the service and their relatives spoke highly of the staff. They told us staff were kind and caring and treated them with dignity.

A programme of activities was available to people. People could choose if they wanted to be involved in activities. If people didn't want to be involved then staff respected this.

The mealtime experience was pleasant. People were seen being offered choices and being supported to eat their meal in a dignified way. Food, snacks and drinks were readily available throughout the day and night.

There were systems in place to assess and monitor the quality of service provided and to make improvements to the service.

Euxton Park is registered to provide accommodation and nursing or personal care for up to 63 people. The home provides care for older people and people who have a physical disability. There are two units within the home - one for people who require personal care and a nursing unit.

Care is provided on a 24 hour basis, including waking watch care throughout the night. All bedrooms at the home are single and some include en-suite facilities.

There are a variety of communal areas, including well maintained grounds for the use of people who use the service.

There was a registered manager in place at the time of the inspection. 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 last inspection of the service took place on 4 and 5 August 2015. During that inspection we found the provider was in breach of a number of regulations. The breaches were in relation to safe care and treatment, medicines management, safeguarding people from abuse, arrangements for the safe maintenance of equipment, infection control, nutritional care, person centred care, dignity and respect, staffing and good governance.

We found significant improvements across all areas of the service during this inspection. We have judged the service is no longer rated as inadequate for any of the five key questions. Therefore, Euxton Park will no longer be in special measures and we have stopped taking enforcement action against the provider. We found the provider to be meeting all the regulations we assessed. However, we identified some areas where further improvements should be made, which are detailed below.

During the last inspection of the service we had concerns about the way risks to the health, safety and wellbeing of people were managed. During this inspection we found the registered manager had implemented a robust risk assessment and care planning process. We found that risks to people’s safety or wellbeing were clearly identified and there was clear guidance in place for staff about how to maintain people’s safety. We found staff had a good understanding of people’s needs and took appropriate measures to support them safely.

Concerns identified about the management of people’s health care needs at the last inspection in August 2015 had been addressed and we found good improvements in this area. People’s health care needs were carefully assessed and planned for. There were processes in place to ensure that staff had the skills to care for people effectively. Where care workers undertook health care tasks, clear procedures were in place to ensure they received the necessary training and support to do so safely. We identified further possible improvements in relation to the support of health care assistants. We made a recommendation about this.

Arrangements for the safe maintenance of equipment and infection control were improved. There were designated staff members responsible for the auditing of these areas to help ensure that equipment was maintained to a safe standard and that all areas of the service were clean and hygienic. However, we found that some areas and equipment had not been included on the audits. We made a recommendation about this.

Significant improvements were found in relation to the management of people’s medicines. We found there were safe systems in place, which helped to ensure people received the correct medicines at the correct times.

Feedback regarding staffing levels at the home was significantly improved. In discussion, people who used the service, their relatives and staff all confirmed that staffing levels were much better. People told us they were no longer having to wait for assistance for undue amounts of time. Most people also felt there was an improvement in consistency across the staff team with the use of agency staff having been reduced.

We saw the registered manager and provider had taken a number of measures to reduce agency staff use, including a determined recruitment drive of permanent staff. We also noted that staffing levels had been increased due to more effective use of the staffing dependency tool, used to calculate staffing levels.

During the last inspection, which took place in August 2015, we found the arrangements to protect people against abuse or improper treatment were inadequate and that allegations of abuse were not always reported or managed in line with safeguarding procedures. During this inspection, we found the registered manager had taken a number of measures to ensure all staff were fully aware of their responsibilities to report safeguarding concerns and were able to recognise them.

We found the feedback from people who used the service about the care they received was much improved and during this inspection, very positive. People spoke highly of staff and expressed satisfaction with the way care workers treated them. People felt they were involved in their care and able to make choices and decisions about their daily lives.

We found that the rights of people who did not have capacity to consent to all aspects of their care were protected because the service were working in accordance with the Mental Capacity Act 2005.

We found people’s care was planned in line with their individual needs and wishes. We saw some very good examples of care that was tailored to meet people’s preferences and took into account the things that were important to them. Care plans were very detailed and contained a lot of information. We noted that some information was difficult to find quickly. We made a recommendation that one page profiles and clinical alert sheets be put in place for each person who used the service so staff could quickly find pertinent information.

During the last inspection carried out in August 2015, we identified some concerns about the leadership of the service. Some staff felt they were not able to raise concerns and were not confident they would be supported if they did so. We saw during this inspection that a number of measures had been taken to address these concerns. Staff had been provided with additional whistle blowing helplines and contacts. Open surgeries were now held during which staff could speak directly with senior managers and members of the organisation’s Human Resources Team.

We saw that supervision of staff had improved and measures had been taken to ensure that all those providing it, had received the appropriate training to do so.

The governance of the service had improved. During the inspection carried out in August 2015, we found the registered manager was not always aware of significant incidents that had occurred and the service didn’t always learn from adverse incidents. During this inspection we found the provider had made changes to the reporting system which meant registered managers were required to clearly record any lessons learned from adverse incidents and what measures could be taken to prevent a reoccurrence. These incidents were now more closely monitored by senior managers to ensure this work was followed through.

Significant improvements to the home’s internal quality assurance processes were noted. These included the implementation of a much improved medicines auditing system, which helped to ensure that any areas for improvement could be identified and addressed in a prompt manner.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with eight people who used the service, two relatives, staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report

Is the service safe?

We received mixed feedback from people who used the service about staffing levels. Some felt they were not always adequate and gave us examples of when they felt they had to wait too long for their call bells to be answered.

The registered manager acknowledged there had been some difficulties due to a high staff turnover and was able to tell us a number of measures she had taken to improve the situation.

This was supported by information from some people who felt the staffing levels at the home had improved and were continuing to do so.

Is the service effective?

Staff were aware of people's health care needs and the support they required. The provider had arranged for regular, additional support from a clinical specialist employed within the organisation to support effective health care.

People felt that in general, care workers were skilled and competent to provide support although two people commented that agency workers were not as knowledgeable about their particular needs.

We spoke with a care worker who was in the process of induction. She told us the induction had been very thorough and that she was receiving a good level of support.

We observed a lunch time service and saw that people were provided with adequate support in a timely manner. We saw a pureed diet being served to one person in the dining room. This looked well presented with the different tastes being served separately.

Is the service caring?

People told us the majority of care workers treated them with kindness and patience, describing them in ways such as 'lovely', 'brilliant' and 'very good'. However, some people told us they felt the approach of a small number of care workers was not kind. Three people told us they had been made to feel rushed by some care workers and described them as impatient.

We carried out a SOFI (Short Observational Framework for Inspection). This is a specific way we observe the care and interaction of people who are unable to tell us their views. On this occasion we noted very positive interaction between care workers and people they supported.

Is the service responsive?

Generally people felt their needs were met by care workers. A relative told us the needs of her loved one had changed. She was very impressed by the way the registered manager and care workers had responded to her loved one's changing needs.

Some people we spoke with were not satisfied by the response of care workers when they required assistance. Some people felt they had to wait too long for their call bells to be answered, which they felt was because of inadequate staffing levels.

Is the service well led?

The new registered manager showed a clear understanding of the concerns we had previously identified and was able to describe in detail, her clear plans for improvement. It was evident that the registered manager had a good understanding of her role and the responsibilities of a registered manager.

Senior managers from the organisation demonstrated a positive and proactive approach in ensuring the registered manager received sufficient support.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Most residents we spoke with told us they felt safe and well cared for. People said that staff understood their needs and were able to meet them. A relative described the service as 'a good, solid home' and another person commented, 'This is a good place. I have no worries and if I did have any, I would soon let them know.'

People said their rights were upheld and care plans showed that any concerns in relation to a resident's capacity to consent, were followed up. One resident described being completely free to come and go with no restrictions and commented that she could have visitors at any reasonable time.

Risks to people's safety and wellbeing were identified and appropriate action was taken to promote their safety.

There were effective arrangements in place to protect people against the risks of infection.

Is the service caring?

The majority of feedback we received about staff was positive. People described most staff as caring, respectful and kind. Their comments included:

'Staff are very good, they do all they can to help you.'

'They are lovely and very helpful.'

Another person described staff as 'first class' and the Expert by Experience who accompanied us on our inspection, observed staff to be pleasant, attentive and genuinely caring.

However, some concerns were raised with us by a resident about one particular incident during which she felt she had been treated unkindly by a staff member. We raised this with the local authority under safeguarding procedures for further investigation.

Is the service effective?

The home was purpose built and well equipped. The facilities were of a good standard and people told us they were satisfied with their accommodation.

Thorough assessment processes were carried out to help ensure that people were only admitted to the home when it had been determined their care needs could be met there.

People's care was well planned and there were processes to ensure that any equipment required for their care, was obtained in a timely manner.

The home worked well with external professionals to ensure that people's care needs were met.

Is the service responsive?

There were processes in place to enable people to raise concerns and express their views.

Most people we spoke with told us that they felt they could raise concerns. The majority of people expressed confidence in the manager to address any concerns they raised in an effective manner.

We saw that the manager attempted to obtain the views of people who used the service. However, we found evidence that people's views were not always acted upon or used to shape improvements within the service.

Is the service well led?

The home has been without a registered manager for several years. Whilst the current manager did make an application to register, this has now been withdrawn due to her resignation from the home.

There were processes in place to monitor and learn from adverse incidents such as complaints and accidents.

There were systems in place to constantly monitor the quality of service provided. However, we found that despite concerns being raised about the availability of staff to provide people with assistance when they required it, the area had not been addressed effectively.

Their comments included:

'This lot are brilliant!'

'Staff are generally great!'

'Everything is OK here.'

We observed the lunch time service on both units of the home, which we noted was a relaxed and social occasion. We heard staff offering residents choices about what they had to eat and engaging in pleasant discussions.

We observed a meeting, which involved a resident, their relative, staff from the home and some external health care professionals. We saw that the resident was fully involved in making decisions about his care and supported by staff to communicate his views through a communication aid. The interaction between the staff and the resident was very positive.

During the inspection we assessed the areas of staffing and record keeping. Whilst we found that the service was compliant in the area of record keeping, we identified some ongoing concerns regarding staffing levels.

The feedback we received was on the whole, very positive. Most people we consulted spoke highly of staff and the manager. Comments included:

'We are very happy with everything here.'

'I have never left here worried or with any concerns.'

'I find the staff very helpful and always willing.'

During our SOFI observation we noted that people who used the service enjoyed positive interaction with staff and each other. We saw people engaged cheerfully with each other and there was a friendly, jovial atmosphere. Staff were observed to approach people in a kind, patient manner and people appeared comfortable and relaxed.

During the inspection, we looked at a number of areas, including how people's rights to make decisions was promoted and how people were safeguarded from abuse. We looked at how people's care and welfare was promoted. We also inspected areas including staffing levels, records and quality assurance processes.

We found that the provider was compliant with the majority of areas inspected. However, we identified concerns in relation to staffing levels and records. We have asked the provider to take action to address these concerns and will carry out further work to ensure the provider takes appropriate action.

The majority of people we talked with gave very positive feedback and expressed satisfaction with the service provided at the home.

People told us that carers understood their needs and a number of people spoke very highly of staff. Comments included;

'They are little belters!'

'I let the staff know if I think something needs doing like her hair and they write it down. They always listen to me and it is done.'

'I'm very happy with the care they give (name removed), she likes them and they like her.'

'I get up a lot in the night and what is nice is that they always bring me a lovely cup of tea whatever time it is.'

Although the vast majority of comments we received about the home were very positive, some people that we spoke with did express some concerns about staffing levels. People told us that whilst they felt their needs were well met, they felt that staff were often under a lot of pressure throughout the day. One person commented 'They are great and so obliging, but sometimes they are just so busy, I feel sorry for them.' Another relative commented 'This is a really good place, but the only thing that lets it down are the staffing levels. If they could get that sorted it would be excellent.'