Emsworth House Care Home with Nursing

Updated 20 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by four inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Emsworth Care Home with Nursing is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Emsworth Care Home with Nursing is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed notifications the provider had sent us. Notifications are sent when a significant event has happened in the service. We used all this information to plan our inspection. We used all this information to plan our inspection. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed

During the inspection

We spoke with 22 people who used the service and 17 relatives about their experience of the care provided. We spoke with 21 members of staff including the registered manager, assistant unit managers, nurses, care workers, an assistant practitioner, cook, housekeeper, maintenance person and administrator. We received emailed feedback from 2 external health and social care professionals. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included 7 people's care records in full and sections of other people’s care records. We reviewed 7 people's medication records in detail. We looked at 5 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 20 April 2023

About the service

Emsworth House Care Home with Nursing is a care home. The home is registered to provide accommodation and nursing care for up to 79 people. At the time of the inspection, 66 people were living at the home. The home comprises single room accommodation arranged in two separate sections; the residential unit provides accommodation with personal care and the nursing unit provides accommodation with nursing care. Each unit also has a wide range of communal areas where people can spend time and socialise.

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

Quality assurance systems had not been effective in identifying the concerns we found at inspection or driving the necessary improvement. When the registered manager was made aware of any issues, they acted to address them and told us of their plans to further improve.

There were not enough staff deployed to safely support people throughout the day and ensure their needs were always met. Risks to people were not always assessed, monitored or mitigated effectively. Medicines were not always managed safely.

The provider had effective safeguarding procedures in place and people were protected from the risk of abuse. Recruitment practices were safe. The home was clean overall, and the provider had effective processes in place to prevent the spread of infection.

Not all staff had received appropriate training to ensure they had the skills and knowledge to effectively support people.

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. However, improvements were needed with The Mental Capacity Act 2005 (MCA) records, and we have made a recommendation about this.

People received enough to eat and drink and told us the food was satisfactory. Improvements were needed to ensure people had the right support at mealtimes to make it a more enjoyable experience. The service had good relationships with external professionals to ensure joined up care and good health outcomes for people.

People and their relatives provided positive feedback about the caring nature of the permanent staff, and we saw kind and caring interactions during our observations. The registered manager was working on developing a more person-centred culture in the service.

The registered manager was open, honest and told us they were committed to make the necessary improvements to ensure the service provided safe, compassionate and well-led care.

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 (report published 5 September 2019). This service has been rated requires improvement for the last three consecutive inspections. We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

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

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 have found evidence that the provider needs to make improvements. Please see the full details of the report which is on the CQC website at www.cqc.org.uk

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to staffing, risk management, medicines management, training and governance at this inspection. We have also made a recommendation in relation to MCA records.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.