Eaton Lodge Nursing Home

Eaton Lodge Nursing Home is a care home providing personal and nursing care to 21 older people some who may be living with dementia at the time of the inspection. The service can support up to 24 people in one large adapted building.

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

People told us they felt safe and the staff were kind and caring towards them. Staff knew how to protect them from discrimination and abuse.

Potential risks to people’s health and welfare had been assessed. Staff were provided with guidance to mitigate the risks. People’s care plans had improved and now contained information about people’s choices and preferences. People told us they were supported in the way they preferred. People had been asked about their end of life wishes.

There were enough staff to support people safely, regular agency staff covered any shortages and knew people well. Staff had been recruited safely and checks were completed to make sure nurses had maintained their professional registration.

Medicines were managed safely, and people received them as prescribed. Accidents and incidents had been analysed and appropriate action had been taken to stop them happening again.

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.

The service was clean and hygienic. Staff were following government guidance and wearing appropriate personal protective equipment. People and staff were being tested for Covid-19 as required by national guidance.

A new manager was in post; they had started their registration with the Care Quality Commission (CQC). Checks and audits had been completed. When shortfalls had been identified, an action plan had been put in place to make sure they were rectified.

People had been asked for their opinion about the service. Staff attended regular meetings and were asked for their opinions and suggestions. The manager had investigated complaints when they had been raised.

People were supported to maintain relationships with their friends and family. People were given information in a way they could understand.

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 19 September 2019). An IPC inspection was completed on 30 November 2020 (published 24 December 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted by our data insight that assesses potential risks at services, including the previous rating of requires improvement.

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 carried out an unannounced comprehensive inspection of this service on 5 August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

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, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Eaton Lodge Nursing 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.

We found the following examples of good practice.

People had been given information to help them understand the changes that had been made due to the pandemic. Changes included staff wearing personal protective equipment (PPE), such as masks, aprons and gloves and the importance of social distancing and isolating in their rooms when necessary.

The service was clean and extra cleaning duties were being carried out such as regular deep cleaning and cleaning of areas that were often touched. Such as door handles, stair rails and light switches.

We observed staff using PPE appropriately. Fully equipped PPE ‘stations’ had been distributed around the service to ensure PPE was available to staff when needed.

The provider and registered manager were following advice and guidance from other agencies about infection control and prevention and had updated staff training and practice accordingly.

Further information is in the detailed findings below.

Eaton Lodge Nursing Home is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 24 people in one adapted building.

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

People told us they felt safe living at the service. Relatives told us they thought their loved ones were supported to remain as safe as possible.

Each person had a care plan, these did not consistently contain detailed information about people’s choices and preferences. However, people and relatives told us that staff knew them well and they were supported in the way they preferred.

Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place for staff to mitigate the risks.

The provider and registered manager had improved the oversight, checks and audits completed on the quality of the service. Some recording of the outcome of audits needed further improvement but action had been taken to rectify shortfalls.

Accidents and incidents had been recorded and analysed to identify patterns and trends to reduce the risk of them happening again. The registered manager and staff understood their responsibility to keep people safe from abuse and discrimination.

There were enough staff, who had been recruited safely to meet people’s needs. Staff received training, supervision and appraisal to develop their skills.

Medicines were managed safely. Staff monitored people’s health and referred people to relevant healthcare professionals when required. Staff followed health professional advice to keep people as healthy as possible.

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.

People met with the registered manager before they moved into the service to check that staff would be able to meet their needs. People were supported to eat a balanced diet, people had a choice of meals, people’s preferences and dietary needs were catered for.

People’s end of life wishes were recorded. Staff worked with the GP to support people at the end of their lives. People were treated with dignity and respect and supported to be as independent as possible.

There was an open and transparent culture within the service, people and staff were asked for their views and opinions about the service and these were acted on. Complaints had investigated following the provider’s policy. People received information in a way they could understand.

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 August 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of one regulation. The service has been rated Requires Improvement for the last three inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eaton Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and care provided, and both were looked at during the inspection. Eaton Lodge accommodates up to 24 people in one adapted building. At this inspection, 23 people were living at the service.

There was no registered manager in post. The previous registered manager had left the service in May 2018. There was a manager in post, who had started the registration process. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We inspected Eaton Lodge in February 2018 when three continued breaches and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, person centred care, safe recruitment of staff. We imposed a condition in relation to good governance, the provider was required to send CQC a monthly report with details of the audits completed on the service and the action taken. These had been submitted as required to meet the condition.

At our last inspection, the service was rated ‘Requires Improvement’ overall with well led being Inadequate. At this inspection, improvements had been made but there continued to be breaches of regulation. Therefore, this is the third consecutive time the service has been rated Requires Improvement.

At our last inspection, there continued to be shortfalls in the service that were identified in the previous two inspections. At this inspection, improvements had been made but there were three continued breaches of Regulation.

Potential risks to people’s health and welfare had not been consistently assessed and there was not always detailed guidance for staff. Improvements had been made in providing guidance for staff around diabetes and epilepsy but there continued to be shortfalls around how to move people safely. The manager had started to write new care plans for each person, however, these did not always contain detailed information about people’s choices and preferences. Care plans did not always reflect the care being given. Staff knew people well and could describe how they supported people and moved them safely. During the inspection we observed people being moved safely.

There were sufficient staff on duty to meet people’s needs; however, staff continued not to be recruited safely and the provider’s policy had not been followed. Staff told us they felt supported by the manager and had discussed any concerns they had. The manager had not recorded these conversations and did not have a structure in place to formalise staff supervision. This is an area for improvement.

The manager had completed audits on all areas of the service and these had been recorded on the reports sent to CQC. However, the manager did not have a system in place to ensure that they continued regular audits. The manager showed us the documentation they planned to use which included an action plan, who was responsible for the action and when it was completed. The provider now recorded their visits to the service, the areas they had looked at and who they had spoken to. However, they had not recorded if they found any shortfalls and what action they had taken.

Previously, medicines had not been managed safely. At this inspection, the manager had taken action when shortfalls were identified. Medicines were now managed safely, there had been no errors in administration and people received their medicines when they needed them. Staff competency had been checked.

Accidents and incidents had previously not been analysed to identify patterns and trends. The manager had analysed behaviour charts for people and identified trends. Measures had been put in place to reduce the incidents of behaviour that challenged and these had been successful. The manager had not formally recorded the process they had completed and this was an area for improvement.

The manager met with people before they moved into the service to make sure that staff could meet their needs. The pre-admission assessment covered all areas of people’s lives including their physical, mental, social and cultural needs, this assessment was used to develop the person’s care plan. People’s needs were assessed using recognised tools in line with current guidance, however, previously these had not been person centred. At this inspection, the manager had ensured that all assessments reflected the person’s needs.

People told us they knew how to complain. There had been one complaint since the last inspection, this had been investigated in line with the provider’s policy and resolved.

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 worked with healthcare professionals to keep people as healthy as possible and receive effective care. Staff monitored people’s health and referred people to healthcare professionals when changes were identified such the dietician. Staff recorded and followed the advice given. People had access to the dentist and chiropodist when required. People were supported to stay as healthier as possible, people were encouraged to take part in exercise.

People were offered a choice of meals and snacks, when people required a special diet and assistance to eat their meals this was provided.

People were supported to express their end of life wishes. Staff received training to support people at the end of their life and keep them comfortable. People told us that staff were kind and caring. People were encouraged to be as independent as possible and involved in their care.

There continued to be an open and transparent culture within the service. The provider had held resident and staff meetings to discuss the previous inspection rating. The responses from the meetings were positive. At staff meetings, their practice was discussed and how staff could work towards improvements within the service.

The manager recognised they needed to update their skills and knowledge to meet the Regulations, they had attended training and local forums. The manager worked with the local commissioning group and the safeguarding authority to ensure people received joined up care.

Staff knew the signs of abuse and were confident to raise concerns with the manager and that they would be dealt with appropriately. People were protected from the risk of infection. The service was clean and odour free.

The building had been adapted to meet people’s needs, there continued to be improvements to decoration. Staff had completed checks on the environment and equipment people used to make sure people were safe.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner and had done so.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the services can be informed of our judgements. We found the provider had conspicuously displayed the rating in the reception area of the service. The provider did not have a website to display the rating.

At this inspection three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

Eaton Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Eaton Lodge accommodates 24 people in one adapted building. There were 24 people living at the service at the time of the inspection.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We last inspected Eaton Lodge in December 2016 when three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, person centred care and good governance.

At our last inspection, the service was rated ‘Requires Improvement’. We asked the provider to complete an action plan to show what they would do and by when to improve all five key questions to at least Good. The provider had not provided an action plan and there had been minimal improvement. At this inspection there were three continued breaches of regulation. This is therefore the second consecutive time the service has been rated Requires Improvement.

There continued to be shortfalls in the service that were identified at the previous two inspections. The oversight of the service by the provider had not improved. The provider’s representative told us that one of them visited the service regularly and this was confirmed by the registered manager and staff. However, these visits were not recorded and there was no information about what the provider checked at each visit. The provider had not identified that improvements had not been made and that regulations had not been met. The provider did not have oversight of the quality of the service being provided to people.

The registered manager told us that they completed audits on all areas of the service, including care plans, medicines and infection control. These audits were not recorded to show what had been reviewed and if any shortfalls had been found. The registered manager had not identified the continued shortfalls found at this inspection.

Risks to people continued not to be consistently assessed and there was no detailed guidance for staff to mitigate the risks. There were no environmental risk assessments available and the provider did not have a contingency plan in place to keep people safe in the event of an emergency. Following the inspection, the registered manager sent us environmental risk assessments for the service.

Each person had a care plan that included information about their families, their lives before moving to the service. Nurses reviewed the care plans regularly and had recorded changes to people’s care needs briefly in the evaluation documentation. They had not changed or updated the care plans when needed so staff had up to date information and guidance. Care plans did not always include details about how staff should support people according to their preferences. Care plans did not reflect the care being given to people so were not accurate or up to date.

There was a stable staff group, who knew people well. Staff knew people’s preferences and described how people were different and if they were independent in any aspects of their care. Staff attended a handover when they arrived for their shift, staff discussed the care that people had received and if there were any changes to people’s care. People and relatives told us that staff supported them in the way they preferred.

People were not protected from the unsafe management of medicines. There had been three medicine errors, appropriate action had been taken at the time and no harm had come to people. However, these errors had not been fully investigated and analysed and there was no action plan in place to stop them from happening again. Nurses had not had their competency to give medicines checked by a qualified person to ensure that all staff including the registered manager were competent.

Accident and incidents were recorded, but these were not analysed to identify any patterns or trends. Action had not been consistently planned or taken to reduce the risk of these happening again.

The registered manager met with people and their relatives before they moved into the service to ensure that the service was able to meet the person’s needs. The pre-admission assessment covered all areas of people’s physical, medical, social and cultural needs. The person or their relative signed to say they agreed with the care plan when it had been written.

The registered manager assessed people’s health care needs, using recommended tools following guidance from the National Institute of Clinical Excellence. However, assessments were not always person centred and assessment documentation was not accurately completed.

There were sufficient staff to meet people’s needs; however, staff had not always been recruited safely and the provider’s recruitment policy had not been followed. Staff told us they felt supported by the registered manager and received regular supervision including clinical supervision and appraisal to discuss their training and development needs. Staff received training appropriate to their role.

People told us they knew how to complain. There had been two complaints since the last inspection. The registered manager had acted immediately to address the issues, however, the actions taken were not clearly recorded and the provider’s complaints policy had not been followed.

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 supported to eat and drink enough to maintain a balanced diet. People were assisted to eat when needed and received special diet and fluids as recommended by healthcare professionals.

Staff worked with other healthcare professionals to ensure people received effective care. People had access to opticians, dentists and chiropodists. Staff supported people to lead as healthier life as possible. People were encouraged to change their positions as much as possible in their chairs or if able walking as much as possible to help keep their skin healthy and intact. Staff offered people the opportunity to have preventative treatment such as the flu vaccination. People were protected from the risks of infection. The service was clean and there were no offensive odours.

People told us that staff were kind and treated them with respect. People were encouraged to be involved in their care as much as possible. People’s privacy and dignity was maintained by staff. Confidential information was kept securely and staff understood their responsibility to keep information confidential.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager. The registered manager understood their responsibility to report any concerns to the local safeguarding authority.

There was an open and transparent culture within the service. People and their relatives were encouraged to be involved in the service. Quality assurance surveys were sent to people, staff and healthcare professionals. Feedback from the surveys had been positive; however, some people felt that there was not enough choice at meal times. The registered manager held staff and resident meetings to discuss more choices at meal times. A later survey showed that people were now happy with the choice of meals.

The registered manager’s vision for the service was for it to be a centre of excellence for end of life care. Staff were trained to support people and ensure their end of life wishes and preferences were met. The registered manager completed regular training in end of life care to keep up to date with current practice.

The registered manager worked with other agencies to improve their knowledge and to share information to the benefit of people using the service.

The building had been adapted to meet people’s needs. The building was being decorated to improve people’s surroundings.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The registered manager was aware that they needed to inform CQC of important events in a timely manner and had done so.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed the rating in the reception area of the service. The provider did not have a website to display the rating.

At this inspection three continued breaches and a new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

Eaton Lodge Nursing Home provides accommodation, personal and nursing care for up to 24 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to access the upper floors. The service has 14 single bedrooms and five double bedrooms that people could choose to share. There were 19 people living at the service at the time of our inspection.

We last inspected this service in May 2016. We found significant shortfalls and the service was rated inadequate and placed into special measures. We took enforcement action and served warning notices. We required the provider and registered manager to make improvements. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us information about actions taken to make improvements following our inspection. At this inspection we found that improvements had been made in many areas. However, there were still areas where improvements were required.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Possible risks to people had been identified, however people had not always been involved in the assessments so they could share their experience and views and care could be planned to keep them safe in the way they preferred. People who were at risk of choking were not always monitored while they were eating to make sure action could be taken quickly if they choked. People's pressure relieving equipment was used correctly to reduce the risk of people sustaining skin damage.

Assessments of people's needs had not been completed with them before they began to use the service to make sure staff knew about their needs and preferences. Further assessments were not completed to gain more detail after people had moved in.

Care had not consistently been planned to support people to manage their catheters. People were supported to have health checks such as eye tests and blood tests.

People were not consistently supported to tell staff how they preferred their care provided. Guidance had not always been provided to staff about how to meet people's needs. Some people's care plans contained details of their care preferences but other people’s care plans did not. Care plans had been reviewed each month and any changes noted had been used to plan the care people received.

People received the medicines they needed to keep them well. Action had been taken to make sure medicines were ordered, stored, recorded or disposed of to keep people as safe as possible. However, further improvements were required to make sure people were always protected from the risks of unsafe medicines management.

Plans to evacuate people from the building in an emergency had not been amended to include all the information staff or the emergency services needed to evacuate people safely. Action had been taken to make sure fire escape routes were safe. Following the inspection we raised our concerns about fire safety with the local Fire and Rescue Service.

Since our last inspection checks the registered manager completed on the quality of the service had increased. However, they had not identified the shortfalls we found during our inspection. The provider and registered manager had improved their oversight of the service. Staff had been supported to provide a good level of care and were aware of their roles and responsibilities. Staff were motivated and felt supported by the registered manager.

People and their relatives were asked for their views of the service. Staff had been asked to complete quality surveys but most had chosen not to respond. The registered manager had not been given staff other opportunities to share their experiences of the service anonymously.

People and their relatives told us that staff were kind and caring. The registered manager had taken action to ensure staff treated people with dignity and respect at all times.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Arrangements were in place to apply to the supervisory body for a DoLS authorisation when people who lacked capacity to consent were restricted.

Staff did not consistently follow the principles of the Mental Capacity Act 2005 (MCA). People's capacity to make some decisions had been assessed. Guidance had been provided for staff about the day to day decisions people were able to make and how people might tell staff about their decisions. People with capacity were not always involved in making complex decisions and decisions had been made in their best interests but without their involvement. This was an area for improvement.

The accuracy of records about the care and support people received and about the day to day running of the service had improved. However, further improvements were needed.

People and their representatives were confident to raise concerns and complaints they had about the service. They told us complaints had been resolved to their satisfaction. Action had not been taken to check complaints and use them to continually improve the service.

The registered manager was now informing CQC of important events that happened at the service, without delay. Arrangements had been put in place for the safe management of the service when the registered manager was absent or on leave. There were enough staff to meet their needs.

The provider's recruitment procedures had been followed consistently.

Staff had completed the training they needed to provide safe and effective care to people. The provider's process of regular meetings between staff and a manager to discuss their role and practice had been followed. Staff told us they felt supported and were confident to raise any concerns they had.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team.

People told us they liked the food and were involved in planning the menu and choosing their meals each day. The dining room had been changed and people were offered the opportunity to eat in the dining room as well as in their bedrooms or in the lounge.

People told us they enjoyed the range of activities offered at the service. The registered manager had increased the number of people who visited the service to provide activities such as keep fit.

People and their relatives had been asked about their end of life care preferences and these were used to plan people's care.

Equipment and areas of the service, including bathrooms and people's bedrooms were clean. Cleaning schedules had been put into operation for all areas of the building and equipment to make sure they were cleaned regularly.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection we found that the provider had made improvements and the service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Eaton Lodge Nursing Home provides accommodation and personal and nursing care for up to 24 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. The service has 14 single bedrooms and five double bedrooms that people could choose to share. There were 22 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although people and their relatives told us that staff were kind and caring, people were not treated with dignity and respect at all times. Staff referred to people at times as ‘the feeds’ or ‘the normals’. The registered manager had not recognised that this was not a respectful way to refer to people.

The provider and registered manager did not have oversight of the service. They had not supported staff to provide a good level of care and staff were not all aware of their roles and responsibilities. Checks on the quality of all areas of the service had not been completed to make sure they were of the required standard. The provider and registered manager were not aware of the shortfalls in the service that we found at the inspection. The registered manager had not informed us of important events that happened at the service, without a delay, as they are required to.

There were no arrangements for the safe management of the service when the registered manager was absent or on leave. There were enough care staff, who knew people, to meet their needs. People’s needs had been considered when deciding how many staff were required on each shift. Staff worked as a team to meet people’s needs.

The provider’s recruitment procedures were not followed consistently. Staff had not all completed health declarations stating they were physically and mentally fit to fulfil their role. Gaps in employment had not always been questioned. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff had not completed all the training they needed to provide safe and effective care to people. The provider’s process of regular meetings between staff and a manager to discuss their role and practice had not been followed. However, staff told us they felt supported and were confident to raise any concerns they had.

Plans were not in place to keep people safe in an emergency, including plans to evacuate people from the building. Following the inspection we raised our concerns about fire safety with the local Fire and Rescue Service. Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team.

Risks to people had not always been identified, including risks posed to people from the use of bedrails. Guidance for staff about how to manage risks had not always been provided or was not clear. Some people’s pressure relieving equipment was not used correctly and there was a risk that people would sustain skin damage because of this. Risks to people had not been reviewed regularly to identify any changes.

Assessments of people’s needs had not been consistently completed to identify any changes. Detailed guidance had not been provided to staff about how to meet people’s needs and no guidance had been provided to staff about how to provide one person’s care and treatment. People’s care plans had been reviewed but any changes noted had not been used to plan or make changes to the care people received. Staff, including registered nurses, were not always following people’s care plans and the correct guidance. For example, one person’s catheter had not been changed as often as recommended by the manufacturers, placing them at risk of developing an infection. People were supported to have health checks such as eye tests and blood tests.

People received the medicines they needed to keep them safe and well. However, medicines were not always ordered, stored, recorded or disposed of to keep people as safe as possible.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Arrangements were in place to apply to the supervisory body for a DoLS authorisation when people who lacked capacity to consent were restricted. Staff did not know that one person had a DoLS authorisation in place and had not taken action to comply with the conditions of the DoLS.

Staff were not following the principles of the Mental Capacity Act 2005 (MCA). People’s capacity to make some decisions had been assessed. When people needed to make a specific decision their capacity to do so had not always been assessed. Guidance had not been provided for staff about the day to day decisions people were able to make and how people might tell staff about their decisions. Decisions made in people’s best interests had not been reviewed to make sure they continued in the person’s best interest.

Accurate records were not maintained about the care and support people received and about the day to day running of the service. Information was not available to staff to help them provide safe and consistent care to people.

People told us they liked the food but some people who needed a special diet were not offered a choice of foods. People were not offered the opportunity to eat in the dining room so they had to eat in their bedrooms or in the lounge. Some people enjoyed having lunch at a table in the garden during our inspection.

People and their representatives were confident to raise concerns and complaints they had about the service. However, complaints had not always been resolved to people’s satisfaction. Action had not been taken to check complaints and use them to continually improve the service.

People were asked for their views of the service regularly. Some people needed to support to share their views. The registered manager had not always given people the opportunity to complete surveys and questionnaires with support from their family and friends. People and their relatives had had not been informed of the outcome of surveys or about any improvements the registered manager had made. Staff did not have regular opportunities to share their experiences of the service.

People were supported to participate in a range of activities, including bingo and art and craft sessions. The range of activities was being developed and people told us they enjoyed those they took part in. Staff were motivated and felt supported by the registered manager, who they said was ‘approachable’.

People and their relatives had been asked about their end of life care preferences and these were used to plan people’s care. People’s wishes were not always followed and one person’s relative had complained their relative’s wishes had not been respected.

Equipment and areas of the service, including bathrooms and people’s bedrooms were not kept clean. Cleaning schedules were not in place for all areas of the building and equipment to make sure they were cleaned regularly.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

Eaton Lodge Nursing home can provide accommodation for up to 24 older people. There were 23 people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the management team and the records we looked at.

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

Is the service safe?

Staff were able to identify when people may be at risk of abuse and knew how to raise their concerns inside and outside of the service. People we spoke with said they felt staff safe at the service

There were systems in place to make sure that the staff learned from accidents and incidents and kept up to date with current practice and guidance.

Assessments were undertaken and care was planned to ensure that people received safe and appropriate care. Care plans detailed each person's individual needs. When risks to a person were identified the service carried out a risk assessment. However, more information was required in some risk assessments to support staff to provide safe and consistent care.

Recruitment procedures were in place. All staff employed had been the subject of criminal records checks and potential risks had been assessed when staff had cautions or criminal convictions. The manager had a plan in place to take action where they had identified that a candidate’s full employment history or references had not been obtained.

There were effective systems to reduce the risks posed to people from the spread of infection and to ensure that the service was clean and hygienic.

Is the service effective?

People’s care and support plans were individualised and had been regularly reviewed to ensure they remained current and up to date.

Staff knew people well, they responded to people’s requests and offered them choices. Staff knew what people were able to do for themselves and supported them to remain independent.

The provider operated an effective system to regularly assess and monitor the quality of the service provided. There were systems in place to ask people using the service, their relatives and staff for their views about the service and these were acted on.

Is the service caring?

People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said that staff were polite and caring. People we spoke with said they liked the staff.

People were supported to attend health appointments, such as, chiropodists. The service worked closely with health and social care professionals to maintain and improve people's health and well-being.

We saw positive interactions from staff when supporting people throughout our inspection.

Is the service responsive?

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

Staff were attentive to people using the service and responded promptly when needed. A recent quality assurance survey showed that people using the service felt that staff were responsive and responded to their requests in a reasonable time period.

The service had a complaints process in place and information had been given to people about how to make a complaint. People told us they felt confident that the manager and staff would respond to any concerns they had.

Is the service well-led?

There was an effective system to regularly assess and monitor the quality of the service to protect people’s health, safety and welfare.

The manager had a process in place to receive and share the latest guidance and best practice in nursing home care and shared this with staff in a formal way. This was integrated into the practice of the service.

Audits of the care plans and other systems were completed to assess the quality of the care being provided. Where shortfalls had been found action had been taken to protect people using the service.

The service was led by a registered manager. Staff told us that they felt supported by the manager who was approachable. They told us that the manager was accessible at all times, through an on call system. The manager had taken action to ensure that they continued to develop their clinical and leadership skills and supported staff to do the same. Staff told us they were clear about their roles and responsibilities and that they felt supported by all the staff working at the service.

One person we spoke with said, “I do the same here as I did in my own home”.

We found that the staff knew people well. People told us that staff were kind and caring. One person said, "The staff are lovely, you couldn’t find better".

People told us that they felt safe and well looked after. They looked comfortable and at ease with staff chatted in a relaxed way.

People had been involved in planning of their care and were supported to make plans for their future care. People and their families were kept informed about their care and treatment. They were encouraged to remain independent and make decisions about their future care and treatment.

We found that the service worked closely with other providers of care and treatment to the people using the service, including their doctors and the local hospice.

People received their medicines in a safe way. The service had processes in place to ensure medicines were available when people needed them. We found that staff had received appropriate training to administer medicines.

The home was in the process of being refurbished and all areas of the home had been redecorated. We saw that the provider had plans in place to continue the improvement programme, including the fitting of new carpets and curtains.

The service had a process in place to assess and monitor the quality of the service people received. People and their relatives told us that they felt confident raise any concerns or worries they had with the manager and staff.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, “The staff are kindness itself and are always very willing to help."