Euroclydon Nursing Home

Euroclydon Nursing Home is a care home providing accommodation to persons who require nursing or personal care, for up to 48 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 36 people using the service. People are accommodated in one adapted building.

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

People and their relatives told us they felt Euroclydon Nursing Home was safe and that staff responded to their needs. Staff had received training in recognising safeguarding concerns and knew the actions to take to protect people from harm. Nursing staff engaged with external healthcare professionals to ensure people received timely care and support that was appropriate to their needs.

People’s needs were known by staff. Staff spoke positively about people and the support they required. People’s care plans were reflective of their needs and the support they received.

People and their relatives spoke positively about the registered manager and clinical lead and the caring culture of the staff. Staff spoke positively about the support they received from the management team.

Safe recruitment practices were in place. The registered manager and provider ensured appropriate checks were being carried out to ensure staff were of good character.

There were enough staff deployed to meet people’s needs. Staff, people and relatives spoke positively about the staffing at Euroclydon Nursing Home.

The provider had infection control procedures in place to protect people and prevent the spread of infection.

We observed positive interactions between people and staff throughout our inspection. People living in the home clearly enjoyed the time they spent with staff and others. People enjoyed the engagement and activities provided by staff and others.

Incidents and accidents were reviewed to reduce the risk of a reoccurrence. Complaints were responded to appropriately and opportunity was made to identify and make improvements.

The manager and deputy manager ensured appropriate action was taken when people lacked capacity in accordance with the Mental Capacity Act. Staff supported people in the least restrictive way possible and in their best interests.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 20 December 2022).

Why we inspected

We carried out an unannounced inspection of this service on 7 and 8 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve people’s person-centred care and their good governance systems.

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.

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 Requires Improvement to Good. This is based on the findings at this inspection.

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.

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

Euroclydon Nursing Home is a residential care home providing accommodation to persons who require nursing or personal care, to up to 48 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 30 people using the service. People are accommodated in one adapted building.

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

The manager and provider had implemented new quality assurance and monitoring systems to improve the outcomes for people at Euroclydon Nursing Home. However, these systems were not fully embedded and were therefore not fully effective at addressing the shortfalls we identified on inspection. More time was needed to allow whole service improvement and sustained good outcomes for people.

People’s care records were not always current and reflective of their needs. The manager was aware of this shortfall and taking action to improve people’s care records and outcomes.

People did not always receive care which was personalised to their needs and promoted their wellbeing.

Measures were in place to make improvements and ensure people received person-centred care. More time was needed to allow the improvements to be implemented and maintained.

Risks relating to the environment were now assessed. However, the manager was further developing a system to oversee recruitment and legionella risk management, where shortfalls were found. We have made recommendations about the management of both recruitment and legionella.

Staff supported people in the least restrictive way possible and in their best interests. Where people were living under Deprivation of Liberty Safeguards; staff understood the support they required.

Since our last inspection, the registered manager and provider had ensured records in relation to people’s mental capacity had been reviewed.

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.

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 22 August 2022).

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, however the provider was still in breach of the regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 17, and a requirement notice in relation to Regulation 12 and Regulation 18 Care Quality Commission (Registration) Regulations 2009, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also received information of concern in relation to people’s personal care since our last inspection.

This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings of this inspection.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to person centred care and records in responsive, and a continued breach in relation to good governance, at this inspection.

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.

Euroclydon Nursing Home is a residential care home providing accommodation to persons who require nursing or personal care, to up to 48 people. The service provides support to older people; some whom live with dementia. At the time of our inspection there were 32 people using the service. People are accommodated in one adapted building split over two floors.

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

People were placed at risk of not receiving their medicines as prescribed. Staff had not always ensured people had access to their prescribed medicines.

Infection prevention and control was not always effective. Staff were not always wearing PPE in line with government guidance. This placed, people, visitors and staff at risks of infection. The manager had taken immediate action during our inspection to address these concerns.

People were not always protected from the risks of their environment. The provider had not undertaken effective measures to ensure that service users would be protected from risks associated with fire safety.

There were limited monitoring systems in place, and systems operated by the service had not identified or addressed concerns found during our inspection. This included concerns in relation to infection control, medicine management, fire safety and people’s person-centred care.

A new manager was in place, who staff and relatives spoke positively about. The manager had made some positive changes to the service, however the provider had limited oversight to ensure the service was meeting the required regulations.

During the inspection the manager took immediate action in relation to PPE. Following the inspection, the manager provided the inspection team with a service improvement plan. They told us they were committed to improving the service.

The service had not always sent required notifications to the Care Quality Commission (CQC) without delay.

People’s care plans detailed their individual risk and the support they required. Staff understood people’s needs and how to protect them from the risks associated with their care.

The manager had increased staffing levels prior to our inspection. Staff and people told us there were enough staff to meet their needs. The manager was ensuring all staff had access to training to meet people’s needs.

People told us they felt safe and well looked after. They told us the staff were tolerant, patient and friendly.

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 29 July 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included information about the people’s assessed care needs, associated risks and falls management.

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.

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.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, good governance and reporting incidents at this inspection.

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

Follow up

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

Euroclydon Nursing Home is a residential care home providing personal and nursing care to 32 people aged 65 and over at the time of the inspection. The service can support up to 48 people.

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

At the time of our inspection the service had several staff and housekeeping vacancies and relied on agency staff. Staff told us this placed them under increased pressure and meant that it was more difficult to provide person centred care. The provider and registered manger had already identified staffing as a high priority and were putting measures in place to reduce the risk whilst they developed a more consistent staffing team.

The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff accessed personal protective equipment (PPE) and staff followed the providers guidance and expectation. The provider was developing their paperwork to evidence that visits for people were in accordance with current guidance.

The provider was developing clearer documentation to evidence that risks to people had been identified and managed in areas such as moving and handling, and recruitment.

People had access to a balanced diet and were supported to eat nutritious meals.

At our last inspection we recommended the provider review published guidance about best practice in relation to the provision of access to, and assessment of, oral healthcare in care settings. The provider had made improvements.

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 (published 31 December 2019)

Why we inspected

The inspection was prompted in part due to concerns received about food choices, infection control, staffing and moving and handling.

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.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

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.

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

Euroclydon Nursing Home is registered to provide accommodation and nursing care to 48 older people and people living with dementia. 29 people were living at the home at the time of our inspection.

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

The provider had made improvements to their medicine management systems since our last inspection. Quality monitoring systems were being embedded and were ensuring appropriate action was taken when shortfalls had been identified.

People received care and support that was safe. People were protected from avoidable harm and abuse. There were enough staff deployed to support people safely. The provider met good practice standards with respect to managing medicines and preventing the spread of infection.

People's oral healthcare needs had been assessed and their day to day oral health needs were met. However, people were not always supported to access dental check-ups in line with published guidance about best practice.

Relationships and interactions between staff and people living in the home were positive and relaxed. People were clearly at ease in the company of staff and with each other.

People told us they were supported by staff who were kind and caring. We observed many kind and caring interactions between people and staff. Considerations were given to people's equality characteristics. Staff practice ensured people's dignity and privacy was respected.

The service had received compliments from the relatives of people who had passed away about the care people received during the end of their life.

People's care and support met their needs and reflected their preferences. People had access to a range of relevant activities designed to avoid social isolation. Visitors were welcomed at the home at any time.

The provider and registered manager ensured people were well-cared for and was making ongoing improvements to the home to enhance the surroundings for the people who lived and worked there.

People were happy with the way the home was managed. There was a positive and inclusive culture within the service and the registered manager supported staff and sought to improve the quality of care and support for people.

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.

We have made one recommendation about oral healthcare assessment and support.

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 requires improvement (published 10 January 2019) and there was one breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of the 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.

We carried out this inspection following concerns raised regarding the service in November 2018, these concerns were focused on the safety of people, in particular skin integrity care and the responsiveness of staff to people’s safe care and treatment. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Euroclydon Nursing Home on our website at www.cqc.org.uk.

At the time of our inspection, 30 people were living at Euroclydon, one of these people was in hospital at the time of the inspection. Euroclydon is based near Drybrook in the Forest of Dean. Eurocluydon has accommodation for people over two floors. The home had an enclosed garden which people could enjoy, as well as a lounge diner, and two other communal lounges. The home was undergoing a range of refurbishment work which had reduced the current occupancy of the home.

We previously inspected the home on 27 January 2018. The service was meeting all the legal requirements and we rated the service as “Good” overall. At this inspection in November 2018, we only looked at ‘Is the service safe?’ and ‘Is the service well led?’ questions. We found concerns that people’s medicines had not been administered as prescribed. Some of the systems operated by the management were not always formalised, meaning concerns around the management of medicines had not been identified. At this inspection the service was rated as ‘Requires Improvement’ overall.

There was no registered manager in place at Euroclydon. The manager was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us they were safe living at Euroclydon. People’s risks had been clearly assessed and guidance was in place for nursing and care staff to follow. Where people were cared for in bed, they received effective support to maintain their skin integrity. Staff we spoke with were able to tell us how they assisted people to reduce their risks and prevent them from avoidable harm.

People did not always receive their medicines as prescribed. Nursing staff did not always maintain an accurate record of when they had assisted people with their prescribed medicines.

There were enough staff deployed to ensure people’s health needs were being met. The manager had systems to learn from incidents and accidents and reduce future incidents of preventable harm and share this information with staff. Where people had an accident, care staff followed recognised post-accident protocols.

The manager and provider had some systems to monitor the quality of care people received at Euroclydon, however these were not always robust or consistent. Audits were not always effective at identifying concerns that we found in relation to the management of medicines. There were not always structured systems in place to seek and act on the views of people and their relatives, including a log of communication.

We found one breach 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.

Our first rated inspection on 22, 23, 27 and 28 July 2016 found a breach in relation to the cleanliness of the environment. Improvements were also needed to the activities in the home as well as people’s care plans and mobility support. The service was rated Requires Improvement.

During our second rated inspection 7 February 2017 we found the provider had taken action and had made the required improvements. We again rated the service Requires Improvement as these improvements needed to be sustained over time in order for the home to be rated Good.

At this inspection we found all improvements had been sustained and the home’s overall rating improved to Good.

Euroclydon Nursing Home 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. Euroclydon Nursing Home provides accommodation, nursing and personal care. The home specialised in providing care to people who lived with dementia and to some with specific physical disabilities.

The care home is registered with the Care Quality Commission (CQC) to accommodate 48 people. Since 2016, the provider has accommodated no more than 27 people in one adapted part of the building. This is because alterations for the use of the rest of the building are in progress. At the time of our site visit 27 people were accommodated.

Accommodation comprised of single bedrooms with private washing facilities and sometimes toilet facilities, a window, bedroom furniture and heating. People had the use of several communal rooms. There were ample communal toilets and bathrooms. A conservatory provided access to an enclosed garden. People who lived at Euroclydon Nursing Home had access to the provider’s day centre which was on site. There was parking for eight visitors with one designated disabled parking space.

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

People were kept safe because staff assessed risks which may have an impact on people and managed these effectively. People were protected from abuse and discrimination because staff had received training on these issues and knew how to recognise them and report concerns. There were enough staff, who were safely recruited, to meet people’s needs. People received support to take their medicines as prescribed. People lived in a home which was clean and where there were infection control arrangements in place.

People’s needs were assessed prior to admission and thereafter to ensure these were identified and met. People were cared for by staff who had received appropriate training and support. People received help to eat and drink, were provided with a choice of food and their nutritional wellbeing was supported. The principles of the Mental Capacity Act were adhered to. 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 home supported this practice. Adaptations had been made to the environment to support people’s mental and physical needs.

Care was provided in a kind and compassionate way. Staff took into consideration people’s wishes and preferences and tailored their care around these. Staff were skilful in communicating with people and supporting them to live well with dementia. People’s dignity and privacy was upheld. Relatives and friends were made to feel welcomed.

People and where appropriate their relatives were involved in making choices about their care and treatment. Care plans gave staff guidance on how people wished their needs to be met and how these should be met safely. People were supported to take part in activities which they enjoyed and which enabled them to be socially included. Arrangements were in place for complaints and areas of dissatisfaction to be raised, listened to and resolved, where possible. People were supported to have a dignified and comfortable death. End of life care was discussed and prepared for so people’s wishes and preferences were met.

The service was well managed by a registered manager whose values and visions promoted and achieved good outcomes for people. They had supported a period of change in 2016-2017, where people, relatives and staff had needed additional support to get used to a new environment. They kept their personal skills and knowledge up to date in order to promote and support best practice. There were arrangements in place to monitor the services provided and to drive improvement. Links with the community were made which benefited the people who lived in the home and those in the wider community.

We undertook this focused inspection on 7 February 2017 to check that they had followed their plan and to confirm that they now met legal requirements. We found legal requirements had been met and work was in progress to achieve other improvements which were not a breach of legal requirements. This report only covers our findings in relation to these legal requirements and progress on other improvements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Euroclydon Nursing Home on our website at www.cqc.org.uk.

Euroclydon Nursing Home is registered with the Care Quality Commission to provide care and accommodation to up to 48 people. At the time of our visit 27 people with varied physical needs were receiving care, including some people who lived with dementia.

The registered manager was present during 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 care home was clean and maintained. Work still needed to be completed to secure the garden but people were not using this at the time of our visit and this was due to be completed soon. Refurbishment of the area where people lived had been completed. This had included redecoration and replacement of floor coverings. Improvements had been made to fire safety, security and window safety. Changes had been made to how cleaning and maintenance tasks were carried out so that the improvements so far could be sustained. Additional staff had been recruited since the last inspection which had enabled these improvements to be achieved.

Some improvements had been made to how activities were being provided for people to enjoy. Staff were receiving additional support sessions in relation to moving people safely. Work was in progress on improving people’s care plans.

Our last inspection was in August 2015 when we followed up a breach in regulation related to medicines. We found the provider had met this fully.

The care home's environment was being reconfigured and the provider's business restructured. In the care home, what used to be a separate dementia care unit called Bluebell had been opened up and incorporated into a new 28 bedded unit which was now housed in the extension end of the main building. The main building was to be entirely closed off from this unit once the last people had moved into newly allocated bedrooms. Relatives in particular had found this change difficult as had the staff. The people had needed to adapt to bedroom moves and, for those originally in the small dementia care unit, having more people around them. Modifications and refurbishment were also still taking place in the extension area. This was an unsettling time but the registered manager told us the changes were necessary and were sensible business decisions.These changes would enable the provider to carry on providing a nursing home service to the local community. Plans for the older main part of the building were not yet finalised.

The registered manage had been registered with the Care Quality Commission since July 2012. 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.

Despite the changes taking place in the environment the service was not as safe as it could be. Areas used by people were not kept clean or maintained well enough. You can see what action we told the provider to take at the back of the full version of the report. We also made three recommendations; that the service seek advice from a suitable source regarding the numbers of staff that need to be recruited and the numbers of staff required to be on duty to meet people’s individual needs. Also, on what kind of window restrictor would be most appropriate to keep people safe and to review staffs’ training in moving and handling to ensure it gave them the skills they required. There were other good arrangements in place in relation to people’s safety.

People were cared for by kind and compassionate staff who understood them as individuals and their specific needs. Home cooked food was provided which looked appetising and smelt inviting. People who were at nutritional risk were monitored and action was taken to help the, for example, gain weight or swallow their food more easily. People who lacked mental capacity were protected under relevant legislation because the staff followed its principles. This meant staff were supported to make as many decisions as they could independently but when they were unable to decisions were made on their behalf and in their best interests. Staff actively involved other health care professionals and relatives in the planning of people’s care and when best interests decisions needed to be made. People’s health was reviewed regularly by their GP and the care home had a good working relationship with the local GP practices. Staff were always able to get advice when needed from other health care professionals.

There were opportunities for social activity although these needed to become more personalised. Information had been gathered about people’s life histories, their hobbies and interests before they had become ill so the staff had the information they needed. This now needed to be used in a more meaningful way. There were arrangements in place for people to raise a complaint and have this investigated and resolved where possible. The registered manager provided strong leadership. They communicated with relatives and staff through meetings and on a day to day, informal basis offering explanations and reassurance during a period of unsettling change. There were monitoring arrangements in place which helped the management staff and the provider identify areas of improvement. There was evidence to show that actions had been completed following completion of various audits which were on-going throughout a year’s time frame. The provider’s representative was a regular visitor to the care home and was fully involved in the changes taking place.

The views of people, their relatives, staff and professionals had been sought and listened to. Staff were asked for their ideas on how the service could be improved and some of their suggestions were implemented. It was planned that people’s views would be sought again once the changes had been fully completed.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed 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?

The service was safe because people's rights and dignity were upheld. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Two applications had been appropriately made. Proper policies and procedures were in place. Consideration of deprivation of liberty principles was reflected in people's care plans. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service was safe because managers ensured learning took place following accidents and incidents. Arrangements for listening to people's concerns and complaints were in place, although, because of the way these were categorised, there was a risk that some may not be managed appropriately. We made the provider's representative aware of this during the inspection process. The service was safe because people's risks were assessed and managed. When people exhibited behaviour that could be perceived as challenging this was safely managed by the staff.

The service was not safe in relation to how some people were moved. Some poor moving and handling manoeuvres were observed and these were potentially harmful to people. We made the provider aware of this so that they could address this. A lack of cleanliness and robust infection control practices meant the home was not safe. People were not living in a clean environment and were not adequately protected from potential infection. We issued a compliance action in relation to this and the provider must tell us how they plan to address this.

Is the service effective?

The service was effective because people told us they were happy with the care they received and felt their needs had been met. People were supported to partake in various activities and one person said, "I do all sorts of things I have never done before. I like doing painting and have some up on the wall". The service was effective because the staff knew the people they were looking after well. One visitor said, "This place is as good as I have seen. They deal extremely well with the person I am visiting". The service was effective as it enabled people to have trips out and visit the local community.

Is the service caring?

The service was caring because staff interacted with people in a kind and helpful way. Staff responded to people who were exhibiting behaviour that could be perceived as challenging in a non-threatening and respectful manner. The service was caring because staff recognised people's diverse needs and abilities and supported and managed these without prejudice or judgement. All the people we spoke with spoke fondly about the staff. The service was caring because people's preferences and choices had been identified, recorded and the care and support provided took these into account. One person said "very happy to be here" and another said, "I am very content here". The service was caring because staff worked sensitively with people and with those who were less able to verbally communicate.

Is the service responsive?

The service was responsive because it worked with other services and professionals to ensure people's needs were met. People had access to appropriate services and professionals when needed. The service was responsive because staff recognised people's altering needs and abilities and adjusted their support/care accordingly. Staff responded to needs that required additional support, for example, one to one care when someone's needs were particularly complex. The service had not been responsive to the altering moving and handling needs of two people and this was rectified during the inspection.

Is the service well-led?

The service was well led because arrangements were in place for staff to meet and discuss issues with the management. Meetings were used by managers to communicate to staff specific guidance or to discuss areas they wanted addressed. Staff had opportunities to raise concerns or make suggestions. There was evidence of a good working relationship between the representative of the provider and the registered manager of the service. The service was well led because there were arrangements in place to follow up action plans and longer-term improvement plans. The service was well led because audits/checks were carried out to ensure care was provided correctly and to a good standard.

The service was not well led in respect of the management of on-going maintenance issues which were having an impact on people's safety and other arrangements such as infection control. We issued a compliance action in relation to the poor maintenance we observed and the provider must tell us how they plan to address this. During the inspection the Health and Safety Executive took regulatory action to protect people.

At this visit we found the compliance action set in November 2013 had been met. We looked at the care records for five people and found assessments of individual's overall mental capacity and their ability to make specific day-to-day decisions had been completed. We saw where significant decisions needed to be made for people best interest meetings had taken place, involving other professionals as well as family members and advocates.

We also checked how the home was staffed because we had received information raising concerns about inadequate staffing levels. We looked at staff rotas, spoke with staff and observed people during a lunchtime period. We found there were enough qualified, skilled and experienced staff to meet people's needs.

One person said, 'They knock on the door gently in the morning and if you want to spend the day in bed, that's fine. If you want to see a doctor, one comes. If you don't want a male carer, they get you a female'They are very, very, very good'. We saw several examples of excellent care, in particular in supporting people with dementia. The way staff interacted with people in the dementia care unit created a calm and reassuring atmosphere where people were enabled to engage with the activities taking place and the people around them.

Arrangements to safeguard people were clearly embedded, no safeguarding incidents had occurred at the home since our previous inspection. Staff felt well supported and told us they received appropriate training to enable them to meet people's needs. One said, 'We have a lot of training courses. We are trained brilliantly'. Another said, 'The training is really really good'.

Systems were in place to monitor the quality of the service and people were able to make complaints and suggestions. Staff demonstrated commitment to their roles. One person said, "I have never needed to complain. If they asked me to leave this place, I would weep. I love this place".

The home had reviewed the nature of the activities it provided and recruited additional staff to provide activities. People told us that:" they like the activities and had been asked what activities they enjoyed".

We looked at all of the communal and some of the individual rooms at the home. There was a programme of redecoration and refurbishment which was ongoing. The refurbishment had resulted in an improved environment for people living at Euroclydon.

Staffing levels had improved at the home. There were additional qualified and care staff on duty following a recruitment process. The appointment of additional managerial staff had improved the levels of staff supervision, audits of care, and standards of record keeping.