Ermington House

Ermington House is a residential care home providing personal care to up to 34 people. The service provides support to people aged 65 and over. At the time of our inspection there were 24 people using the service.

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

Risks to people's health and safety were assessed and guidance was in place to manage risk. However, monitoring records did not always show that people were receiving care according to their assessed needs.

Whilst quality assurance and governance systems were in place to monitor the quality-of-care people received, the providers audits and checks had not identified the shortfalls we found regarding people’s monitoring records.

During the inspection we observed people were supported by enough staff to meet their needs safely. However, we received mixed feedback from people and staff about staffing levels and some people told us they had to wait for their needs to be met. We made a recommendation to the provider about this.

People spoke positively about the service and told us they were happy with the support they received. People were complimentary about the staff and told us they felt safe living at Ermington House.

Systems and processes were in place to protect people from the risk of infections. People were supported to receive visitors at the service when they wanted.

Medicines were managed safely, and people received their medicines from trained and competent staff. Staff were recruited safely.

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.

Systems were in place to review and analyse accident and incident records to identify any trends so action could be taken to reduce the risk of avoidable harm.

People and their relatives had opportunities to provide feedback in the form of questionnaires, feedback forms and regular meetings.

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 6 January 2021).

Why we inspected

The inspection was prompted in part due to concerns received about poor care, staffing levels, infection control and medicines management. A decision was made for us to inspect and examine those risks. 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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ermington House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to managing risk and the providers governance systems at this inspection.

We also made a recommendation in relation to staffing levels.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Ermington House is a residential care home providing personal and nursing care to 28 people aged 65 and over at the time of the inspection. The service can support up to 34 people and supports older people, some of whom may be living with a dementia. Ermington House also supports people for a short time whilst they rehabilitate or rest before going back to their homes in the community.

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

People told us they were happy with the service and felt safe, relatives said the same. Safeguarding concerns and incidents were investigated and learned from. Risk assessments were in place and staff knew people’s needs well and how they liked to be supported. The service was clean and staff were wearing masks and other Personal Protective Equipment (PPE) appropriately.

There were enough staff to meet the needs of people. Environmental improvements were still ongoing but environmental safety was checked regularly. Staff recruitment processes were robust. We saw evidence that people were supported to feel safe, have their needs met and achieve positive health outcomes.

A new registered manager had been recruited and was due to start soon after the inspection. The nominated individual had been running the service since our last inspection to ensure consistency in management approach, and develop systems and processes to ensure auditing and governance were robust. Staff said they felt supported and relatives said they knew who to contact if they had any concerns and communication was good with the service.

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.

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 (report published 24 December 2019).

Why we inspected

We received concerns in relation to staffing and the management of safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

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

We found improvements in every area during this inspection. People, staff, relatives and professionals told us they had seen a positive change in the service.

People felt safe and were supported by adequate numbers of staff. Staff knew how to identify, and report abuse and were recruited safely. New staff had been guided through an induction.

Staff were supported with training and supervision and felt they could approach the management team with any concerns. Health professionals said the service had improved in identifying issues with people’s health and had seen improvements in infection control and wound care practises.

People told us they enjoyed the food. There had been substantial changes in the environment. Several bedrooms had been renovated, new carpets and décor had been arranged and the service was now wheelchair accessible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were caring and took their time to support people.

People felt listened to, comfortable to make a complaint and more involved in the running of the service than at our last inspection. The activities programme was being improved and we saw the care was more person centred and responsive.

The quality assurance system was more robust and was saw how effective auditing had ensured actions to make improvements were being made. Staff felt supported by a compassionate, visible and dedicated management team.

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 (report published on 1 August 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People told us that despite staff being kind and caring they weren’t always treated with dignity and respect. This was due to the layout of the building and some toilets with doors that led straight out onto the lounge and were not lockable. People told us they were not given a choice of which toilet they were supported to use. We have asked the provider again to remedy this.

The premises were undergoing lots of improvement work, but we had concerns that it was not safely accessible by wheelchair or by people requiring a walking frame to walk safely. There were large amounts of old equipment continuing to clutter up communal areas. Since this inspection this has been removed.

People weren’t always supported to move as often as their skin integrity plan suggested they should. Staff required further instruction on how to support people in bed, so they didn’t slip down the bed. We saw the manager supporting staff with this after we had identified it.

There were improvements in medicines management since our last inspection, but we found some areas that still needed addressing to ensure medicines were administered safely.

Staff were not receiving any formal supervision in line with the provider’s policy. We had feedback the manager was supportive and had informal catch ups with staff.

Quality audits were completed and where issues were identified these were followed up. However, the manager and provider were not aware of all the concerns we picked up during inspection. This showed oversight of the day to day care provision was lacking. The lack of robust systems and processes in this area had a negative effect on people’s quality of life. There were no provider quality checks currently in place.

Activity provision did not meet people’s needs; people were unhappy with the current provision. A new activities co-ordinator was employed to start shortly following the inspection.

Care staff knew people well. People told us they liked the care staff.

People enjoyed the food and had drinks within reach.

Risks that people faced relating to individual health concerns were assessed. Communication had improved between staff and health professionals visiting the service.

Staff knew how and where to report safeguarding concerns. Recruitment practises were robust.

Rating at last inspection:

We last inspected this service on 25, 26 September and 2 October 2018. It was rated requires improvement overall and the report was published on 2 November 2018.

Why we inspected:

This was a scheduled inspection based on previous rating; as the safe domain was rated inadequate we returned within six months of the date of publication of the report.

Enforcement:

We found breaches in six regulations, relating to person centred care, dignity and respect, safe care and treatment, person centred care, premises and equipment and good governance. Further information is in the detailed findings. Any enforcement action will be published at the end of this report once the provider has had adequate time according to our enforcement process to respond to our proposals.

Follow up:

We will meet with the provider to discuss how they plan to improve the service and request that they evidence to us how they will address the issues we found during this inspection.

As one domain has been rated inadequate we will return to inspect the service within six months of publication of this report, in line with our process.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Kingsacre 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 provider took over this service in June 2018, when it still provided nursing care, however since July 2018, they no longer provide nursing care on site. This is obtained from the community nurse team when needed.

Kingacre accommodates 34 people in one adapted building. The building is situated in a rural location standing in its own grounds. Communal areas are situated on the ground floor with bedrooms on the ground, lower ground and first floor, all accessed by a lift. The building is old and in need of some refurbishment.

Shortly after taking over this service the nurse team resigned, leaving the home very short staffed in terms of being able to cover nursing shifts. The provider made the decision to make the service a care home without nursing. They have worked with commissioning teams to review and move those people who required nursing care. They were in the process of changing the home’s registration so that it would no longer provide the regulated activity associated with being a nursing home.

This inspection was brought forward because of a number of safeguarding concerns which are being investigated by the local authority. This resulted in the service becoming part of a safeguarding process. This meant the local authority safeguarding team, commissioners, CQC inspectors, police and other professionals had met to discuss the safety and well-being of the people living at the service. The provider, their operations team and the registered manager had been part of these discussions. The findings of our inspection have also been shared with the local authority, so that they can form part of the safeguarding process. As part of this safeguarding process the provider had agreed not to admit any new people and the local authority have placed a hold on using this service for placements until improvements have been made. The death of one person and the circumstances surrounding that death were being looked at as part of a separate CQC process and does not form part of this inspection.

There was a registered manager in place who was also the registered manager of another service owned by the provider. 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 registered manager and provider had recognised that the current management arrangements were not working. The provider had employed another manager who would be applying to register with CQC to run Kingsacre. When this has happened the current registered manager would return to managing one service.

Some aspects of the service were not safe and placed people at potential risk. These included:

• Poor recruitment processes which meant staff were employed before all checks to ensure they were suitable had been completed.

• Fire safety information and risk assessments were not completed in a consistent way to ensure staff had reliable and correct information in the event of an emergency evacuation.

• Not all windows had restrictors fitted, and there were no regular checks to ensure restrictors were still in working order.

• Hoist slings were not used for a single person’s use- they were kept in communal areas and not named for individuals. This was an infection control risk.

• There were no risk assessments in place for bed rails, we identified one person had sustained an injury when their leg was caught in a bed rail without a protector being used.

• An oxygen cylinder had been placed next to a hot radiator in one person’s room- this was removed to a safer place when we fed this back, but the service was not even sure if the person still required oxygen.

• Some prescribed medicines were being used for people they were not prescribed for- i.e. thickener was found in one room which was prescribed for someone else. Systems for the use of topical creams needed improvement.

• Some areas of the home were not safe. The patio/balcony area had an uneven and wobbly floor. There was also an area of the home where carpet was old, worn and beginning to ruck, which was a trip hazard.

• Wheelchairs did not always have footplates. This placed people at potential risk of having their feet dragged when being transported, which could lead to injury.

• Pressure cushions had been used on top of cushioned chairs which altered the seating position of some people leaving their legs dandling and placing them at more risk of pressure damage.

• Not all pressure mattresses were set at the right setting for people’s weight.

Following the inspection, the provider wrote to us to say action had been taken to address and mitigate some of these risks. This included updating risk assessments, providing further training to staff and liaising with healthcare professionals to gain the right healthcare information for people. Detailed actions about how the service mitigated the risks can be found in the section related to safe.

Our observations of the days we inspected, as well as feedback from people’s and staff showed there were key times when there was not sufficient staff for the number and needs of people currently living at the service. Staff confirmed that most days they were still assisting people to get up right up to 12.30pm. The provider did not have a dependency tool to show how they had worked out staffing levels based on people’s individuals needs and dependency levels. During the morning people were left for long periods in the communal areas without supervision or support. Some people may have been at risk of choking and there was no staff having an oversight of people in the lounge and dining area throughout the morning.

Staff did not have the right skills and competencies to ensure people’s healthcare needs were being met. This was being addressed with some additional training and support from the community nurse team. The service had not always ensured new staff had an induction, or that there was ongoing support and supervision for staff to enable them to discuss their role and any training needs. Recruitment was not robust and placed people at potential risk.

The management arrangements were not clear to staff, staff did not feel valued or appreciated for the work they did. The provider said they would address this. They had already appointed another manager as they had recognised the current registered manager was struggling to manage two locations.

Quality audits had failed to pick up on aspects of health and safety, records and lack of meaningful engagement for people.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, recruitment, the Mental Capacity Act (2005), safe care and treatment, person centred care and good governance.

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