We inspected Engleburn Care Home on 28 and 29 April 2016 and 6 May 2016. Engleburn Care Home is registered to provide nursing care for up to 76 older people, some of whom live with dementia. There were 68 people living at the home at the time of our inspection. The home is separated in to two units. Engleburn provided support for people who were more independent. Foxholes provided care and support for people with more advanced dementia.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager currently managed the home with the support of two deputy managers. They also managed a second home belonging to the provider and had identified that it was difficult covering two large homes. New management arrangements had been put in place to take effect from June 2016 which included the appointment of a new manager to take full time responsibility for Engleburn Care Home.
We received mixed feedback from people and relatives during the inspection, with some saying they had a positive experience of receiving care whilst others less so. We also identified inconsistent quality in the delivery of care, safeguarding, record keeping and monitoring systems within the home.
People were not always protected from possible abuse. Staff were able to identify some signs of abuse and understood who to report concerns to within the home. However, staff had not identified that unexplained bruising could be a sign of abuse and a number of such incidents had not been investigated and had gone unreported to the local authority and to CQC.
We received mixed feedback about the level of staffing and whether it was sufficient to meet people’s needs. Staff told us they thought there were enough staff most of the time but some staff said there could sometimes be pressure points in the day, such as early mornings. People and relatives said they thought there were times when there were not enough staff and gave examples of times when care had been delayed.
Staff interacted positively with people when they delivered care. We observed staff showing kindness and re-assurance to people when they became upset or worried and people’s dignity was respected by most staff. However, we observed other care practices and written notices around the home which did not always refer to people with dignity and respect.
Staff regularly involved people or their relatives in reviewing their care plans. Reviews took place on a regular basis or when someone’s needs changed. However, we found some examples of care plans which were out of date and did not reflect people’s most current circumstances or support needs. Health professionals visited the home regularly to provide advice and treatment when necessary. However, it was noted that not all staff were able to identify when people needed medical advice or treatment in a timely way.
Staff received induction and training in a range of areas to support them to meet people’s needs. However, there were some key areas of training which had not been kept up to date by all staff, such as safeguarding people from abuse.
The home worked with health and social care professionals and family members to ensure decisions made in people’s best interests were reached and appropriately documented. However, some staff were not sufficiently knowledgeable about the requirements of the Mental Capacity Act 2005 (MCA) to be able to explain how to safeguard people’s best interests and the MCA was not always implemented correctly.
The management team understood about the deprivation of liberty safeguards (DoLS) and submitted applications to the local authority for DoLS where appropriate. Some applications were still waiting to be processed by the local authority.
People received a choice of food and drink to meet their specific choices and dietary needs and where required, were assisted by staff to eat their food. However, some people told us their food was often cold.
The home employed activities co-ordinators to provide opportunities and help encourage people to participate in activities. Most people’s records documented their hobbies, interests and described what they enjoyed doing in their spare time. However, arrangements were not always in place to ensure people who preferred to stay in their rooms or who were unable to join activities in the lounge had regular opportunities for activities or social interaction.
People and relatives were given opportunities to provide feedback, compliments and comments. Some people and their relatives told us they knew who the registered manager was and felt able to raise concerns with them or the deputy managers. Others told us they did not know who the registered manager was and never saw them. We observed during the inspection that the registered manager spent most of their time in their office whilst the deputy managers provided supervision and guidance to staff.
The home had a range of audits in place to help monitor the quality of the service. However, not all of these were effective as we identified a number of areas of concern which their audits had not picked up, such as inaccuracies and discrepancies in record keeping. When we raised this with the registered manager and deputy managers they put systems in place to address this in future, but it was too soon to assess these for effectiveness.
Medicines were managed, stored and administered safely. People were asked for consent before receiving their medicines and accurate records were maintained.
We found 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and 1 breach of the Care Quality Commission (Registration) Regulations 2009.. You can see what action we have told the provider to take in the main report.