OSJCT Eresby Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation and nursing care for up to 42 people, including older people and people living with dementia.We carried out this inspection on 15 December 2017. The inspection was unannounced. There were 40 people living in the home at the time of our inspection.
The service was run by a company who was the registered provider. At the time of this inspection the home did not have a registered manager in post. The registered persons had notified us about the reason for the change in manager and had kept us updated regarding the leadership arrangements in place at the home. As part of this inspection the registered persons had confirmed they had appointed a new manager and an application for the new ‘acting manager’ to register with the Care Quality Commission (CQC) was in the process of being submitted. After we completed our inspection the manager completed their registration and was formally registered to manage the home.
A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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. In this report when we speak both about the company the area manager and the registered manager we refer to them as being, ‘The registered persons’.
At the last inspection on 30 October 2015 the service was rated, ‘Good’.
At this inspection the service was rated, ‘Requires Improvement’. We found there was a breach of regulations. This was because the registered persons had failed to assess risks to people’s health and safety and had not done all that is practical to keep people safe. We also found some of the arrangements used to ensure that all parts of the environment were safe were not sufficiently robust. You can see what action we told the registered persons to take at the back of the full version of the report.
In addition we found that improvements were needed to ensure that people reliably benefited from receiving well-led care. This was because the registered persons had not always ensured action was taken quickly enough when things had gone wrong. In addition, quality and environmental safety checks had had not always resulted in identified shortfalls being put right.
Our other findings at the present inspection were as follows:
People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.
We found there were sufficient care and nursing staff available to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively, internally and externally.
Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff provided end of life care in a sensitive and person-centred way.
Staff were kind and attentive in their approach and there was a friendly, relaxed atmosphere around the home and. People were provided with food and drink that met their individual needs and preferences. The overall physical environment and facilities in the home generally reflected people’s requirements.
People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.
The registered persons had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests. 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.
CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Through our discussions with staff it was clear they understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, four people who lived at the home were subject to a DoLS authorisation and the registered persons informed us they were awaiting the outcome of a further four applications which had been submitted to the local authority.
People were involved in giving their views on how the service was run and there was a range of audit and review systems in place to help monitor and keep improving the quality of the services provided.