Eirenikon Park Residential Home

Eirenikon Park is a care home registered to provide accommodation and nursing or personal care. Eirenikon Park accommodates up to 13 people in one adapted building. At the time of the inspection there were 12 people living at the residential service. The provider also operates a domiciliary care service, which provides personal care to people in their own homes. We did not look at the domiciliary care service during this inspection.

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

People were relaxed and comfortable with staff and had no hesitation in asking for help and support from them. Staff were caring and spent time chatting with people as they moved around the service. People said; “Lovely Place to live” and ‘I like living here.”

The service had suitable safeguarding systems in place, and staff knew how to recognise and what to do if they suspected abuse was occurring.

Food offered and provided at lunchtime was piping hot, a good choice and appetizing. People spoken with said the food was; “Food is gorgeous!” and “lovely!” People said they had a choice of meals and snacks.

There were sufficient trained and qualified staff on duty to meet people’s needs. The registered manager informed us they were in the process of recruiting additional staff to support people.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised. All equipment was checked and serviced regularly.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Suitable visiting arrangements were in place for families to visit as per current government guidance.

Care plans included risk assessments and guidance for staff on how to meet people’s support needs. Risk assessment procedures were satisfactory so any risks to people were minimised. People received their medicines safely and on time.

The service was managed effectively. Staff were working well together, and one staff said; “They (the registered manager and provider) are both supportive and have been here nearly every day during the pandemic to make sure we are all ok.” There were appropriate audit and quality assurance systems in place.

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 30 December 2017).

Why we inspected

This was a planned inspection based on the previous 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.

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.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Staff were following current infection prevention and control guidance to help people to stay safe. Visitors and staff entered the premises into an area designated for hand sanitising, changing of clothes and putting on PPE. Appropriate waste bins were in place for the deposing of used PPE.

All staff had completed online infection prevention and control and covid-19 training. In addition, the infection control lead carried out individual training with staff to check they understood the online training and were putting on their PPE correctly.

Before the pandemic staff worked between the residential home and the domiciliary care service. Once the home closed to visitors, on the 13 March 2020, staff were designated to only work in one of the services to limit the risk of cross infection. The service recruited new staff and shifts were overstaffed to allow for any sickness, to ensure there was a consistent staff team. Staff had chosen to limit their own social contact, outside of work, to reduce the risk to people living at the service.

Staff have been keeping in touch with families by regular telephone and video calls. Visitors could also book times to visit people outside in the garden or under a gazebo. Most people preferred to spend their time in the communal lounge and staff supported them to this whilst maintaining physical distancing.

The premises looked clean and hygienic. Additional cleaning processes had been put in place and there was a clear audit trail to check these were being completed.

The service had reviewed their infection control policy in response to the pandemic. A specific covid-19 policy had also been developed to provide guidance for staff about how to respond to the pandemic. These policies were being updated as changes to government guidance was published.

The registered manager was communicating with people, staff and relatives regularly to ensure everyone understood the precautions being taken to keep people safe.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

We carried out this unannounced inspection on 28 and 30 November 2017. At this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 5 October 2016.

In October 2016 we found documentation relating to people’s medicines at the residential service was not always correctly completed, fridge temperatures were not always recorded and medicines were not always safely stored. Records did not indicate that people’s capacity had been assessed as required. Where people were likely to have reduced ability to make decisions, records did not indicate the type of decisions people could make or what decisions might need to be made in their best interest. There was no written evidence of best interest processes, to ensure that decisions reached were the least restrictive available.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained. Staff explained to people what their medicines were for and ensured each person had taken them before signing medicine records.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People had their capacity assessed appropriately. The service knew who had appointed lasting powers of attorney for either finances or health and these people were asked to consent on behalf of the person if they lacked the capacity to do this for themselves. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

On the day of the inspection there was a calm and relaxed at the residential service. We observed that staff interacted with people in a caring and compassionate manner. People told us they were happy with the care they received and believed it was a safe environment. Comments included, “I have been here for about a year, it's good enough for me”, “I am very happy here”, “Everything is OK” and “I feel safe knowing staff are around if I need them.”

People who received a service in their own homes said they were happy with the care provided. They also told us that they had a team of regular, reliable staff, had agreed the times of their visits and were kept informed of any changes. People commented, “All the staff are kind”, “The service always lets me know if staff are running late” and “Rarely has the rota gone wrong, my visits are when I need them.”

There were enough suitably qualified staff on duty and additional staff were allocated if peoples’ needs increased, such as when someone was unwell. Staff were supported by a system of induction training, one-to-one supervision and appraisals. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

The environment in the residential service was clean and there were no unpleasant odours. Bedrooms were personalised to reflect people’s individual tastes.

People had access to healthcare services such as occupational therapists, GPs, chiropodists, community nurses and dentists. Relatives told us staff always kept them informed if their relative was unwell or a doctor was called.

People had personalised care plans that provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. There was an effective system in place for staff to feedback any changes to people’s needs. Any risks in relation to people’s care and support were identified and appropriately managed. This included any environmental risks in the residential service and in people’s own homes.

People had a choice of meals and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told us they enjoyed their meals. One person living at the residential service told us, “The food here is fine.”

People were able to take part in activities facilitated by staff and external entertainers. These included playing cards, board games, singing sessions, music entertainers, pamper sessions and quizzes.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example. Comments from staff included, “A lovely job”, “A really good place to work”, “Management are really supportive” and “We can spend one-to-one time with people.”

People and relatives all described the management of the home as open and approachable. There were regular meetings for people and their families, which meant they could share their views about the running of the service. People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

The service had a registered manager in post. 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.

At the previous inspection on 18 January and 2 February 2016 we found issues in relation to the management of medicines at the residential service. Medicines in stock for one person were inaccurate. Records had not recorded where the medicine had been refused therefore, the level of stock was inaccurate. Some medicines which had belonged to a person who had died had not been returned to the pharmacist. The registered manager was not carrying out audits of medicines which would highlight where issues were occurring. This meant people’s medicines were not being managed in accordance with medicine regulation and good practice guidance. At this inspection, some improvements had been made including the introduction of medicines audits, but some new issues relating to medicines management were identified.

Staff from both the residential and domiciliary service had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. However we found that many of the staff had lapsed in their refresher training in a number of subjects identified by the provider as mandatory, including medicines management. Staff were supported in their role by an ongoing programme of supervision, appraisal and competency checks.

Some staff were knowledgeable about the Mental Capacity Act and how this applied to their role. However where people had been considered to lack capacity to make certain decisions this had not been assessed or documented and there was no evidence of a best interest process. This meant that less restrictive alternatives to meeting their care needs may not have been considered. This applied to people who lived at Eirenikon Park and people who were supported in the community. Where people’s liberty was restricted for those living in the residential service, applications for DoLS authorisations had been made to the Supervisory Body. People were involved in planning their care and staff sought their consent prior to providing them with assistance.

We found that morale amongst staff from both services was mixed. Staff told us that dynamics between some staff members was difficult. This meant that some members of staff were reluctant to work with each other and this caused problems for senior staff when planning rotas. The registered manager was aware of the issue and was taking action to address it. New staff were being actively recruited.

There had been a recent environmental health inspection of the kitchen which had rated it as one out of five in terms of food hygiene. A number of issues were highlighted by that inspection as requiring improvement, however the registered manager was in the process of addressing this and many of the concerns had been resolved by the time of our inspection.

We observed positive, compassionate and caring interactions between people and staff in both the residential and domiciliary service. Staff knew the people they cared for well and spoke about them with kindness, fondness and affection.

People told us they enjoyed the food. People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. We found that menu plans were not being used due to recent staff changes in the kitchen. This meant there was not a plan of what people would be having to eat and we could not see what meals choices were on offer, or had been on offer in recent weeks. The registered manager said this was going to be re-introduced.

People had their healthcare needs met. For example, people had their medicines as prescribed and on time in both the residential and domiciliary service. People were supported to see a range of health and social care professionals including social workers, district nurses and doctors. Changes to people’s healthcare needs in both the residential and domiciliary service were promptly referred to external professionals when required.

People living at Eirenikon Park were kept mentally and socially engaged through a range of activities inside and outside the home. The service employed an activities coordinator who had developed a programme of activities to suit people’s individual needs. This was regularly reviewed.

People were kept safe by suitable staffing levels. Relatives of people living at Eirenikon Park told us there were enough staff on duty and we observed unhurried interactions between people and staff. People who received care at home said the staff were on time and did not miss visits. This meant that people’s needs were met in a timely manner. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

There was a safeguarding adult’s policy in place and staff had undergone training. Staff confidently described how they would recognise and report any signs of abuse. The registered manager promoted an ethos of openness and honesty which demonstrated the requirements of the duty of candour. There was a policy in place on whistleblowing which supported staff to question and report poor practice.

People, staff and relatives were encouraged to give feedback through staff meetings and residents’ meetings. This feedback was used to drive improvements within the service. There was a system in place for receiving and managing complaints. The registered manager operated an annual cycle of quality assurance to monitor the quality of both parts of the service. The registered manager undertook audits in areas such as medicines management and accidents and incidents to provide an overview of the quality of service.

The registered manager had arrangements in place for the disposal of domestic waste and a contract in place for the removal of clinical waste. The provider had systems in place to monitor the safety of the premises, some of which included fire checks, water temperatures, legionnaire’s checks and PAT (portable appliance) testing.

We identified breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in post. 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.

There were suitable facilities available to store medication safely in the residential service. However, medicines in stock for one person were inaccurate. Records had not recorded where the medicine had been refused and therefore the level of stock was inaccurate. Some medicines which had belonged to a person who had died had not been returned to the pharmacist. The registered manager was not carrying out audits of medicines which would highlight where issues were occurring. This meant peoples medicines were not being managed in accordance with medicine regulation and good practice guidance. There were safe systems to manage people's medicines in their own homes. Records showed medicines were being administered at the prescribed times.

Records for people using the domiciliary care agency included evidence of people being involved in their care planning and reviews. In addition, people s consent was sought in respect of the care and treatment they were receiving. However, some records in the residential service required updating to show where involvement was taking place and consent had been sought. People told us they had been involved in their care planning and asked for their consent before any support was provided.

There were a variety of methods in place to assess and monitor the quality of the service. Meetings and surveys had taken place and showed people were engaged with and listened to. However, medicine audits had not taken place resulting in discrepancies in administration not being identified and acted upon.

Staff recruitment files contained the relevant recruitment checks, to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. However, whilst DBS confirmation numbers were recorded there were no dates included to show when the check had been received. It was therefore not possible to identify if the member of staff had commenced employment at the service after the DBS had been received. There were no commencement dates in place to confirm when staff had commenced working in the service. Pre-employment checks had been completed to help ensure staff had the appropriate skills and knowledge required, to provide care to meet people’s needs.

We have made a recommendation for the provider to address this.

There were sufficient numbers of care staff to support the needs of the people living at the service and using the domiciliary care service. People were being cared for by competent and experienced staff. People had choices in their daily lives and their mobility was supported appropriately.

Staff understood the needs of people being supported, so they could respond to them effectively. We observed care being provided and spoke with people who used the residential services and domiciliary care service, their families and healthcare professionals who visited the service regularly. All spoke positively about the staff and the registered manager. One person told us, “I love living here. The staff are all wonderful and caring”. A family member told us, “(Persons name) has settled here very well. I can walk always knowing (persons name) is safe and well cared for”. People using the DCA service told us, “Excellent service, always here on time and stay longer many at time” and “Can’t fault any of the staff. They know just what I need and get on with the job”.

Staff supported people to be involved in and make decisions about their daily lives. If people did not have the capacity to make certain decisions the service had systems in place to act in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This was to protect people and uphold their rights.

People were protected from the risk of abuse because staff had a good understanding of what might constitute abuse and how to report it. All were confident that any allegations would be fully investigated and action would be taken to make sure people were safe.

People told us they knew how to complain and would be happy to speak with the registered manager if they had any concerns.

Equipment and supply services including electricity, fire systems and gas were being maintained.

We identified a breach of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.

People who live in the home told us they were happy, the food was okay and staff were okay and usually listened.

Relatives told us, "I am extremely pleased with the care X receives. I never announce when I am going and X is always clean and cared for. Overall I am very pleased". Other relatives told us, "Staff are friendly, X is looked after. There is always someone around. They get X ready on time for us to take out they are always appropriately dressed and presentable". Other relatives told us, "Excellent care, really good, helpful staff". A district nurse told us, "Brilliant, staff are very caring, they contact us if there are any worries".

We found care and treatment was planned and delivered in line with people's individual care and support plans. One person who used the service told us "I like living here, they look after me very well".

We found suitable safeguarding policies and procedures were in place. Access to information about local reporting procedures and contact telephone numbers was not readily available to all staff. All staff had received safeguarding, first aid, medicines management and infection control training. We were told staff were supported with supervision and there was always access to training.

We saw that the home was clean and tidy and that there were good infection control practices within the home. There were robust systems in place for ordering, storing, administering and disposing of medication. All staff had undertaken management of medicines training to ensure to ensure they were up to date with current good practice recommendations.