Ernelesthorp Manor & Lodge

Ernelesthorp Manor and Lodge is a care home providing accommodation and personal care. It can accommodate up to 65 people in 2 units, at the time of our inspection 1 unit was closed. Some people using the service were living with dementia. There were 33 people using the service at the time of the inspection.

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

People told us they felt safe living at the service. Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Relatives we spoke with told us their family members were kept safe. There were enough staff to support people safely. People received medicines safely and as prescribed. Staff administering medicines had received training which was regularly refreshed. Staff were aware if people were at risk due to their health condition. Risk assessments contained guidance on how to minimise risks. Incidents and accidents were reviewed to ensure lessons were learnt. 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 followed infection prevention and control procedures. The registered manager and staff understood the importance of infection control. However, we identified some minor issues at site visit, which were addressed by the registered manager immediately, systems were also improved to ensure issues were identified promptly.

The management team were visible in the service and worked alongside staff as needed. This meant they were aware of the culture of the service and able to check staff reflected their values. People felt listened to and their views were obtained. Feedback we received from people and their relatives was positive.

There was a quality monitoring system in place covering all aspects of the management of the service. Action plans were then developed to help drive improvement. We identified some documentation that could be improved to ensure standards were maintained. The registered manager addressed this following our site visit and sent us the actions taken to improve these areas.

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 20 November 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook this focused inspection and this report only covers our findings in relation to the Key Questions safe and well led. 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 Ernelesthorp Manor and Lodge 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.

Ernelesthorp Manor and Lodge is a residential care home providing nursing and personal care for up to 65 people. At the time of the inspection 22 people were using the service. The provider had closed part of the service known as the Lodge and had refurbishment plans for the future of the Lodge.

People’s experience of using this service:

After the last inspection of February 2019 the provider had sent us an action plan to tell us how they would address the areas we raised on inspection. At this inspection we found the provider had effectively addressed concerns regarding safe care and treatment, person-centred care, dignity and respect and governance and there were improvements in the quality of the service.

The effectiveness of the governance and audit processes in the home had been improved. Although, there were areas that required further embedding into practice to ensure improvements were sustained. There was evidence of people being asked about their satisfaction with the service, however, there was room to improve the consultation and involvement of people who used the service.

Improvement had also been made to ensure risks associated with people's care and treatment were identified and managed safely. This meant people received the right support to meet their needs and safe care and treatment. Although, there were some areas of minor risk still to be addressed. Additionally, there remained brief periods, during staff handovers, when staff could have been better deployed to ensure a timely response to people’s needs. The provider had made improvement to ensure safe arrangements were in place for managing people's medicines. Although, there remained room to improve the consistency of some records. The provider had a system in place to safeguard people from the risk of abuse.

Improvements had been made in the way people's needs and choices were assessed and care and treatment were delivered in line with current legislation and standards. Care records had been improved and showed people's needs were being met. There were noticeable improvements in the environment, with the home looking and feeling much lighter and brighter.

The provider supported people to live healthy lives. We spoke with other professionals who felt confident that people received appropriate care and support. The provider ensured that staff received training and support to carry out their role. Staff told us they felt supported by the registered manager.

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. The provider was adhering to the principles of the Mental Capacity Act (MCA). People who lacked capacity had decisions made in their best interests.

Staff we saw were kind and caring in their approach. Staff recognised when people needed support and engaged appropriately with people to ensure their needs were met. People were treated with dignity and respect. We looked at whether the service complied with the Equality Act 2010, in particular, how the service ensured people were not treated unfairly because of any characteristics that are protected under this legislation. Our review of records and discussion with staff and the registered manager showed the service did promote people’s rights.

There were considerable improvements in the opportunities provided for meaningful activity. There were also improvements in the way the provider ensured people received care that was responsive to their needs. People’s care plans we looked at contained accurate and up to date information. People's choices for their end of life care had been considered and were recorded and reviewed. All the people we spoke with knew how to raise a complaint and said they felt comfortable speaking with any of the staff team.

Rating at last inspection and update

The last rating for this service was inadequate (Report published May 2019) 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 we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Ernelesthorp Manor and Lodge is a residential care home providing nursing and personal care for up to 65 people. At the time of the inspection 32 people were using the service. The provider had closed part of the service known as the Lodge. The provider had discussed refurbishment plans for the future of the Lodge.

People’s experience of using this service:

After the last inspection of July 2018 the provider had sent us an action plan to tell us how they would address the areas we raised on inspection. At this inspection we found concerns regarding safe care and treatment, person-centred care, dignity and respect and governance. Whilst the action plan had addressed some of our immediate concerns, it had not been effective in improving the service. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We completed a tour of the home with the registered manager and found some environmental risks which had not been identified by the provider’s audit system.

Risks associated with people's care and treatment were not always identified or managed safely.

This put people at risk of not receiving the right support to meet their needs and showed the provider was not doing all that was reasonably practicable to mitigate risks associated with people's care and treatment.

The provider did not always ensure that safe arrangements were in place for managing people's medicines. We found one person was prescribed medication to be taken as and when required known as PRN (as required) medicine. However, whilst some people had protocols in place to guide staff on how these should be administered, one person did not have a protocol for a pain relieving medicine.

The provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in safeguarding and confirmed that they would take appropriate action if they suspected abuse. During this inspection we identified safeguarding concerns which we asked the provider to report to the safeguarding authority.

There was not enough staff available to meet people needs and we found staff to be task orientated. Staff and relatives told us that there were times during when staff were in short supply.

People's needs and choices were assessed but care and treatment was not always delivered in line with current legislation and standards. Care records did not clearly evidence if people's needs were being met.

Where people were at risk of weight loss, food and fluid charts did not always provide an accurate account of diet taken.

We spent time observing staff interacting with people and found they were not always kind and caring in nature. Staff did not always recognise when people needed support and did not always engage appropriately with people, to ensure their needs were met.

Dignity and respect was not always maintained.

We found people did not always receive care that was responsive to their needs. Care plans we looked at did not always contain the most up to date information or contained information that was contradictory. People were not always provided with opportunity for meaningful activity.

The provider supported people to live healthy lives. We spoke with some healthcare professionals who felt confident that people received appropriate care and support.

The provider ensured that staff received training and support to carry out their role. Staff told us they felt supported by the registered manager.

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. The provider was adhering to the principles of the Mental Capacity Act (MCA). People who lacked capacity had decisions made in their best interests.

People's choices for their end of life care had been considered and were recorded and reviewed.

All the people we spoke with knew how to raise a complaint and said they felt comfortable speaking with any of the staff team. However, we saw one person had raised a complaint as part of the provider’s quality questionnaire. This concern had not been recorded and we could not evidence if the person’s concerns had been fully addressed.

Accident and incident analysis was taking place effectively and there was evidence that trends or patterns were being identified.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; person-centred care, Regulation 10; dignity and respect, Regulation 12; safe care and treatment, Regulation 17; good governance.

Rating at last inspection:

At the last inspection the service was rated Inadequate (report published 14 August 2018).

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

Enforcement:

There are four breaches in regulatory requirements. You can see what action we asked the provider to take at the end of the report. Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

After this inspection we requested an action plan and evidence of improvements made in relation to person centred care, safe care and treatment, dignity and respect and governance.

The overall rating for the service is inadequate and the service will be placed 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.

Ernelesthorp Manor and Lodge is a care home. People living 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.

Ernelesthorp Manor and Lodge can accommodate up to 65 people. At the time of our inspection 36 people were using the service. The registered provider had closed part of the service known and the Lodge and people had moved from the Lodge to vacancies available at the Manor. There was no refurbishment or other plans in place for the future of the Lodge.

At the time of our inspection the service had a registered manager. 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.

Risks associated with people’s care and treatment were not always identified or managed safely. This put people at risk of not receiving the right support to meet their needs and showed the registered provider was not doing all that was reasonably practicable to mitigate risks associated with people's care and treatment.

We completed a tour of the home with the registered manager and found that some environmental risks which had not been identified prior to our inspection.

Accident and incident analysis was not taking place effectively and there was no evidence that trends or patterns were being identified, or that actions had been taken to reduce hazards in relation to people's care.

The registered provider did not always ensure that safe arrangements were in place for managing people’s medicines. We found some people were prescribed medication to be taken as and when required known as PRN (as required) medicine. However, whilst some people had protocols in place to guide staff in how these should be administered, some people did not have these. The protocols that were completed had not been reviewed. We also saw that eye creams and ointments were not always dated when opened. Medicines in stock did not tally with the amount recorded on the MAR sheets. Therefore, we could not evidence that people had received their medicines as prescribed.

The registered provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in this subject and confirmed that they would take appropriate action is they suspected abuse. During this inspection we identified two safeguarding concerns which were reported to the safeguarding authority.

The registered provider ensured that there were enough numbers of suitably qualified staff to support people to meet their needs. However, staff told us that there were times during staff breaks, when staff were short supply.

The registered provider ensured that staff received training and support to carry out their role. Staff told us they felt supported by the registered manager.

People’s needs and choices were assessed but care and treatment was not always delivered in line with current legislation and standards. Care records did not clearly evidence if people’s needs were being met. People mainly had access to healthcare professionals, however there were occasions where this was delayed or did not happen.

People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible; the policies and systems in the service were designed to offer people maximum choice. Some people, who lacked capacity, did not have best interest decisions in place for the use of bed rails and specialist chairs which posed a restriction. However, we saw some people had clear documentation regarding other decisions such as personal care. We have made a recommendation that the registered provider ensures that all aspects of the MCA are being adhered to.

People received support to maintain a balanced diet. Meals provided were nutritious and looked appetising. However, where people were at risk of weight loss, food and fluid charts did not always provide an accurate account of diet taken.

We spent time observing staff interacting with people and found they were kind and caring in nature. However, staff did not always recognise when people needed support and did not always engage appropriately with family members to ensure their needs were met. Information about people was not always kept confidential. The duty office was very open and documents could be easily accessed.

We found people did not always receive care that was responsive to their needs. Care plans we looked at were not always followed in line with people's current needs. People’s choices for their end of life care had not always been considered and were not clearly recorded, communicated or kept under review.

All the people we spoke with knew how to raise a complaint and said they felt comfortable speaking with any of the staff team. People felt that any concerns they had would be addressed quickly and effectively.

Audits were in place to ensure the service was working to the registered providers expected standards. However, audits were not always effective and did not identify the concerns we had raised as part of this inspection. Some concerns were highlighted as part of the audit process but there was no evidence that sufficient action had taken place to correct them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; person-centred care, Regulation 12; safe care and treatment, Regulation 17; good governance. We have also made a recommendation regarding Regulation 11; consent to care and treatment. 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 the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.

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.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ernelesthorp Manor & Lodge’ on our website at ‘www.cqc.org.uk’.

The service had a registered manager who had been registered with the Care Quality Commission since January 2011. 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.

Ernelesthorp Manor & Lodge is registered to provide nursing and residential care for up to 65 people. It is a purpose built care home situated in the village of Armthorpe, near to Doncaster. The home is in two units, the Manor and the Lodge. The Lodge is more geared to supporting people who are living with dementia. At the time of our inspection 43 people were living at the home. There were 27 people living in the Manor and 16 people were living in the Lodge.

We found improvements were needed to the way medication was stored to prevent over stocking. The store room needed painting and the room was cluttered and untidy. We found medication was administered safely and key staff had received training and had their competencies checked periodically. Following the first day of our inspection, the registered provider and registered manager acted swiftly to make improvements. This included a full stock check of medication and the return of some items that were no longer required.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

The support plans we looked at included risk assessments, which identified any risks associated with people’s care and had been devised to help minimise and monitor the risks without placing undue restrictions on people.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so that appropriate referrals to health professionals could be made.

There were sufficient staff with the right skills and competencies employed and on duty to meet the assessed needs of people living in the home. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

We found improvements were needed to make the environment more dementia friendly. The registered provider told us they had identified this and they sent us a refurbishment programme which confirmed improvements were due to be completed within the next six months.

We identified the kitchenette on the Lodge required deep cleaning to prevent the risk of cross infection. On the second day of the inspection we saw this had been actioned and a new fridge had been ordered to replace the broken fridge seen on the first day of the inspection.

On the first day of the inspection we did not see any activities taking place. We were told the activity co-ordinator was unavailable to facilitate activities. On the second day of the inspection we observed the activity co-ordinator organising games of bingo. The atmosphere was much improved and people were more stimulated.

Overall, we found the service had a friendly, relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt staff knew them well, and their likes and dislikes.

Formal supervision’s took place at the frequency required by the provider. Staff we spoke with told us they had recently received supervision and they told us that they felt supported by the registered manager.

The complaints process was clear and people’s comments and complaints were taken very seriously, investigated and responded to in a timely way. People didn’t have any complaints to tell us about and indicated they were happy living at the home. Relatives we spoke with raised no concerns about the care provided at the service.

There were systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager and the provider. The reports included any actions required and these were checked each month to determine progress. However, actions identified were not always given a date for when they needed to be completed by and, at times, lacked in detail. We told the registered manager and regional manager about this, who told us they would ensure more detail and a completion date were added in future.

People experienced care, treatment and support that met their needs and protected their rights. Relatives we spoke with said they were happy with the care provided.

We saw that staff treated people with dignity and kindness. We observed that a friendly and positive approach was used, to ensure that the wishes and needs of people using the service were respected.

We found that systems were in place that protected people who used the service against the risks associated with the unsafe use and management of medication.

Appropriate checks had been undertaken on staff when they were recruited to work in the home and complaints were investigated and responded to in a timely manner.