This inspection was carried out on 6 October 2015 and was unannounced.
Essendene care home is a small service providing personal care and accommodation to older people and people who are living with dementia. The service supports 13 people. There are nine single rooms and two double rooms within the service. At the time of our inspection there were seven people living at Essendene.
There was a registered manager that has oversight of the whole 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.
At the last inspection on 11 May 2015 we found that there were a number of improvements needed. These were people being at risk of receiving care and treatment that did not meet their needs or reflect their preferences. Care and treatment was provided to people without appropriate consent being sought and did not take regard of the Mental Capacity Act 2005 (MCA). Also the provider failed to have proper and safe systems for management of medicines and there was no system or process in place to identify, manage and assess risks to health, safety and welfare. We asked the registered provider to take action to make a number of improvements. After the inspection, the registered provider informed us they would meet all the relevant legal requirements by the end of July 2015. We found on this inspection that the provider had made improvements in these areas.
Staff were caring and they always treated people with kindness and respect. People were happy with the care that they had received. Relatives and visitors told us that they had no concerns about the care that they observed. They said they had always been made to feel welcome when visiting.
Staff were respectful of people’s personal choice and provided care and support in a dignified way.
Care plans and risk assessments accurately recorded people’s individual care and support needs. Records were personalised and contained information about how a person wanted to be supported.
The automatic lift doors were broken and the appropriate safety check (LOLER) had not been completed. Staff and people living at the service had to manually open the doors of the lift. The registered provider contacted engineers during our visit to arrange for the appropriate checks to be undertaken.
The registered provider had undertaken some checks in relation to the safe management of Legionella. However there was insufficient records to determine whether these met Health and Safety requirements. We contacted the Health and Safety Executive following the inspection who confirmed they would provide advice to the registered provider.
Staff had completed safeguarding adults training and were able to describe the different types of abuse and knew how to report concerns they had about people’s safety. Records showed that safeguarding concerns had been addressed in partnership with the local authority.
There were safe systems in place for the management of medicines. This included the completion of a robust monthly audit which identified any areas of concern. Medicines were administered safely and administration records were up to date.
People received their care from people who were of suitable character and the registered provider had a good understanding of safe systems for recruitment of staff. Staff attended regular training sessions in areas such as moving and handling, first aid and safeguarding adults to update their knowledge and skills. Staff had regular team meetings and supervisions to discuss areas of improvement in their work.
Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had a good knowledge and understanding of the Mental Capacity Act 2005 and their role and responsibility regarding this. Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and were able to show an understanding of the key principles. Staff practice showed that people’s consent was considered before any daily care or support was provided.
Where a person’s liberty was being restricted or they were under continuous supervision, we found that the registered manager had made the appropriate application to the supervisory body under Deprivation of Liberty Safeguards.
People were supported to have a healthy balanced diet. A good choice of food was available and we observed people being offered alternative choices to the main meal provided. Care plans detailed people’s likes and dislikes and specialist dietary requirements.
The registered provider had introduced quality assurance systems in place to audit the service. Records showed that checks were regularly carried out in a number of different areas including medication, equipment and the environment. The audit system in place was effective and well managed and ensured people were protected from unsafe or inappropriate care and support.