Eversleigh Care Centre

Eversleigh Care Centre is a residential care home providing personal and nursing care to up to 84 people. The service provides support to older people, some of whom are living with dementia, or have a physical disability. At the time of our inspection there were 49 people using the service.

Eversleigh Care Centre accommodates people in 3 separate units, each of which has separate adapted facilities. Only 2 units were in use at the time of the inspection.

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

Systems and processes in place to monitor people’s care delivery were not effective in ensuring actions were taken when there were gaps in records.

People did not always have their medicines administration documented. People’s care records did not always show how and when their planned care had been delivered.

Staff understood how to support people to manage risks to their safety and could recognise any signs of abuse and taken action to protect people.

Staff were recruited safely and there were enough staff to meet people’s needs. The service was clean, hygienic and infection prevention control procedures were followed. When incidents occurred, these were reviewed, and actions taken to prevent them from happening again.

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.

People were supported to be engaged in the home. There was support for staff in their role and regular updates about learning when things went wrong. There were relationships with other health professionals where required to support people with their care needs. The provider had systems in place to ensure they met their responsibilities for duty of candour.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (6 April 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of some regulations, but others remained in breach.

Why we inspected

We carried out an unannounced focussed inspection of this service on 7 February 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to governance arrangements at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eversleigh Care Centre is a residential care home providing personal and nursing care to up to 84 people. The service provides support to older people, some of who are living with dementia, or have a physical disability. At the time of our inspection there were 49 people using the service.

Eversleigh Care Centre accommodates people in three separate units, each of which has separate adapted facilities.

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

Risks to people’s health and wellbeing were not always managed safely. People experienced delays in support to protect their skin integrity and assist with their food and fluid intake. This placed people at risk of harm.

There were not always enough staff to meet people's care needs or respond to people when required. Staff had not always been safely recruited.

Actions taken following incidents and events did not always consider what staff should do to reduce the risk of avoidable harm. Systems used to ensure the safe management and administration of medicines were not always effective.

Governance and audit systems designed to monitor the quality of care people received were not always effective. The provider’s systems for assessing staffing levels had not always considered people’s individual needs.

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.

People were supported by staff who knew how to identify signs of potential harm and abuse and who were following infection control guidance. There was some evidence of learning from incidents and events.

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 10 August 2022).

Why we inspected

We received concerns in relation to people’s care needs not being met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

Enforcement

We have identified breaches in relation to risk management, staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

Eversleigh Care Centre is a nursing home providing personal and nursing care to 49 people aged 65 and over at the time of the inspection. The service can support up to 84 people. The home is divided into three units split over two floors. They are Robinswood, Garden House and West Park which is for people living with dementia.

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

Risks to people were assessed and there were plans in place to mitigate risks. The provider followed best practice in relation to infection control and prevention and management of risks relating to COVID-19. People received their medicines when they needed them from staff who were trained and competent to carry out the role. People felt safe living at the home and with the staff who supported them. The provider’s staff recruitment procedures helped to protect people from harm.

People told us staff knew them well and what was important to them. People were supported to maintain contact with those who were important to them and were provided with opportunities for social stimulation. People’s communication needs were assessed and responded to. People did not raise any concerns about the care they received but felt confident action would be taken to address any concerns they may have. There were systems in place to ensure people’s needs and preferences would be understood and met during their final days.

Systems to monitor and improve the quality of the service provided had improved. The manager had implemented systems to improve staff morale and to ensure they received the support and supervision they needed. The views of people were sought and valued. The manger worked in partnership with other professionals to ensure good outcomes for people. The manager was aware of their legal responsibilities and of their responsibility to be open an honest when things go wrong.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was requires improvement (published 13 December 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the environment, infection, prevention and control, staffing and moving and handling. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eversleigh Care Centre is a nursing home providing personal and nursing care to 58 people aged 65 and over at the time of the inspection. The service can support up to 84 people. The home is divided into three units split over two floors. They are Robinswood, Garden House and West Park which is for people living with dementia.

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

People on the discharge from hospital to assessment pathway did not always have their risks suitably assessed and managed. This would enable staff to be aware of increased risks such as falls or for evacuation from the building in the case of fire. Medicines were not always safely managed. Systems were in place but the checking of these was not robust so errors could not be identified.

The provider had systems in place that gave oversight of the service, but these were not always used to identify errors or areas for improvement. People did not feel staff always responded quickly to their requests for support in relation to their personal care

People enjoyed the activities provided but wanted more social interaction with other people in the home.

The home had enough staff to meet the needs of people living there. Staff received training on how to keep people safe from harm and abuse. They were trained in the use on infection prevention and control and had a dedicated member of staff to ensure guidance was followed by staff and visitors to the home.

The provider ensured information was in an accessible format although the activity boards did not display information in line with the policy.

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 20 June 2019).

Why we inspected

The inspection was prompted in part due to concerns about the management of medicines and people’s nursing care needs. A decision was made for us to inspect and examine those risks.

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 received concerns in relation to medicines management, recording of people’s needs, access to activities and risk management. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines management, fire safety and general management of risks for individuals and the lack of oversight of how this is audited and managed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Eversleigh Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service provides nursing and personal care for up to 84 people. At the time of this inspection, there were 59 people living at the home.

There was 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. The registered manager was present throughout this inspection.

At the time of our last inspection undertaken on in May 2017, we rated the service as Requires Improvement and found the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not enough staff deployed to safely meet people's needs. At this inspection, we found improvements had been made and the provider was no longer in breach of this regulation. The service is now rated Good.

Staff had time to attend to people's physical and emotional needs. People did not have to wait for help from staff when this was needed. The provider followed safe recruitment processes.

The risks associated with people's individual care and support needs had been assessed and were reviewed as people's needs changed. People received their medicines safely and these were stored in accordance with the prescriber's directions.

People were protected from the risk of infection, and there was an understanding by staff of the importance of infection control and prevention. Where there were concerns about people being at risk of harm or abuse, action was taken to safeguard the individuals concerned.

Staff received ongoing support, training and guidance in their roles. The provider kept staff's training needs under review and arranged additional training in line with the health and emotional needs of people living at the home.

People's rights were upheld in accordance with the Mental Capacity Act. People had access to a range of healthcare professionals, as required.

People enjoyed a variety and choice of foods. People were encouraged to eat and drink, and there were initiatives within the home to raise the awareness of hydration and nutrition, as well as the importance of people's dining experience.

People were supported to express themselves and communicate through a range of different methods. People had individual communication support plans in place, which were followed by staff.

People enjoyed respectful and positive interactions with staff. People were involved in decisions about how they wanted to be cared for. People's independence was promoted, whilst maintaining their safety.

People's changing health and wellbeing needs were responded to. People enjoyed their individual hobbies and interests, as well as having the opportunity to experience new social and leisure opportunities.

There was system in place for responding to and acting on complaints, comments, feedback and suggestions.

The atmosphere and culture of the home was upbeat and relaxed, which helped people to feel calm and happy. Staff, the registered manager and the provider were all striving to achieve the highest possible CQC rating and to provide the best possible service to people living at the home. The registered manager and the service had won local and national awards in recognition of what they had achieved.

The provider had quality assurance measures in place to routinely monitor the quality and safety of care provided.

Eversleigh Care Centre is registered to provide accommodation with nursing and personal care for up to 84 people including older people, people living with dementia and people with physical disabilities. The home caters for people who require, residential, nursing and respite care. The home is divided into three units, Garden’s House, West Park and Robinswood. On the day of the inspection there were 68 people living at the home.

Although there was no registered manager in post a new manager had been recruited in October 2016 and they advised us they planned to submit an application to become the registered manager once they had completed their probationary employment period. 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.

We found there were not always sufficient numbers of staff available to respond to people’s care and support needs in a timely way. People told us they felt safe, but staff were not always able to respond promptly to requests for support. People received their medicines as prescribed and systems used to manage and monitor the administration of medicines were safe. Risks were assessed and managed and any changes to people’s risks were shared with the staff team. The provider carried out pre-employment checks to ensure staff were safe to work with people.

People did not always receive the required support at meal times to enable them to make choices or enjoy their food. People felt that staff had the skills and knowledge to meet their care and support needs. Staff received induction and training which was relevant to their role. People were asked for their consent before care was provided and where people’s rights were restricted this had been done lawfully within the boundaries of the Mental Capacity Act (MCA). People were supported to access healthcare professionals when required.

People told us they received support from staff who were kind, but who did not always take time to engage with them. Some staff were focused on support tasks rather than people. Most people we spoke with felt they were involved in day to day decisions about their care and people and relatives told us staff provided dignified support which protected people’s privacy.

People told us there were not enough leisure opportunities and activities which supported people’s hobbies and interests were not widely available. People and relatives felt they had been involved in the assessment and planning of their care and knew how to complain if they were unhappy about any aspect of their care and support.

Recent management changes meant the home had been without a registered manager since April 2015. Although systems were in place to monitor the quality of the service provided some areas requiring improvement identified at our last inspection had not been addressed. In particular the deployment of staffing at mealtimes. People expressed mixed views about the care they received at the home. People and their relatives had been invited to give feedback about the home. People, staff and relatives felt the new manager was approachable and supportive. The provider had notified us of events and incidents as required by law.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection on the 9 and 10 February 2016, we found that the provider had not fully followed their plan which they had told us would be completed by the 31 July 2015 and legal requirements had not been met.

Since the last inspection the registered manager had left the service and a new manager has been appointed. The manager advised that following our visit they would be applying to CQC to become the registered manager. 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.

People did not always receive their medicines on time because medication rounds took longer than required. People’s medical conditions were not always treated appropriately by the use of their medicines because given in the prescribed dosage and some medicines were not being stored correctly.

People were cared for by staff who had a good understanding of protecting people from the risk of abuse and harm. Staff knew their responsibility to report any concerns and were confident that action would be taken.

Staffing arrangements need to ensure there were enough staff who were organised in the right way to meet people’s needs effectively.

Staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were supported.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). However records were not detailed to show which decisions the person would require help to make. People told us that staff sought their consent before providing care and they could choose the support they received.

People’s nutritional needs were met. People were given a choice of meals, however they felt the quality of the food they received could be improved. People were supported with a choice of drinks throughout the day. The manager was working with the chef to improve people’s dining experience.

People were supported to access health care professionals and staff were responsive to the advice received in providing care to people.

Relatives were positive in their feedback about the service and confirmed they were involved in making decisions about care and treatment. Relatives told us people’s privacy and dignity was maintained by staff and we made observations that supported this.

People received care that met their individual needs. Relatives and staff said managers listened to them and they felt confident they could raise any issues should the need arise.

The management team had systems in place to check and improve the quality of the service provided and take actions where required. Some improvements had been implemented but further action was required to ensure that changes were embedded and also further improvements made in a timely way. Staff felt the new management team had made positive improvements to care provided.

We found the service had improved in the way they managed medicines. As a consequence we found the service managed medicines safely for the people who used the service.

We carried out this inspection so that we could answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with nine people who lived at the home, five relatives, two members of staff who supported people, the registered manager and the area manager. We looked at five people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that systems were in place to support learning from events like accidents, incidents and complaints. People we spoke with told us they were able to raise concerns they had about the service. One person said, "I give my opinions to any member of staff".

We found that systems had improved since our last visit. Care records were up to date with information that reflected people's current needs and changes. People and relatives we spoke with felt the service was safe.

We found that people were still at risk of poor medicines management. We found there was no proper process put in place to give staff consistent guidance in how to administer medicines through a Percutaneous Endoscopic Gastrostomy (PEG) tube. A PEG tube is used where someone is unable to maintain adequate nutrition by consuming food through through their mouth. 24 hours after our inspection the provider had put a system in place so staff had clear guidance as to how to administer people's medicines through a PEG tube.

We found that one person who was having their medicines administered covertly did not have in place the appropriate documentation to evidence this process was being done within acceptable guidelines. We found that systems were not in place to ensure the safe administering of insulin or to ensure that the storage of medicines were being stored safely.

No applications for the Deprivation of Liberty Safeguards had been submitted by the service. Staff were able to access training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards(DoLS) and the service had an understanding of the process.

Overall we found that the provider did not have adequate processes and systems in place to ensure people were cared for and supported in a way that kept them safe during the administering of their medicines. We have asked the provider to tell us what they were going to do to meet the requirements of the law.

Is the service effective?

We found that people's needs were assessed and there was a support plan in place to meet people's needs. People we spoke with told us they were happy with the support and treatment they got from staff. One person said, "Staff encourage me to get up".

We found that records had improved since the last inspection and changes were being recorded so staff were able to follow people's changing needs. Where people had a particular wish this was being recorded appropriately and where other professionals needed to be involved this was taking place.

Overall we found that the provider had systems in place to ensure people's needs were being assessed and any changes to people’s needs could be identified and actioned appropriately.

Is the service caring?

Records showed that satisfaction surveys were being used to help the provider make improvements to the service. The provider also held relatives meetings to enable people and their relatives to share any concerns they had on a regular basis. Relatives we spoke with told us they were able to attend these meetings.

We observed staff interacting with people. People were being supported by staff in a caring manner. We saw staff supporting people in a patient and caring way allowing people who lacked capacity the opportunity to communicate at their own pace.

Records showed that people's preferences, likes, dislikes and interests were being recorded to support how people's needs were met. Where people had cultural needs these were also recorded on people's care records. Records showed that people were able to practice their religion. One person's file showed that they were able to see their priest regularly. This meant that were supported to practice their religion.

Is the service responsive?

Records showed that people were able to share any concerns they had and the provider had a process in place to investigate their concerns and take appropriate action.

We observed people having access to regular fluids throughout our inspection. Staff proactively asked people if they wanted a drink in some instances. People told us they were able to access a range of activities as part of social interaction. One person said, "Activities are organised, bands, singers, games, jigsaws and the like, but I prefer to read my bible"

Overall we found that the provider had systems in place to meet the requirements of the law in relations to ensuring that the service was responsive.

Is the service well-led?

We found that improvements had been made since our last inspection. Audits were being carried out to ensure the service was meeting people's needs appropriately. We saw evidence of regular audits being carried out by the provider to check on the quality of the service. Where action was required as part of service improvement this was taking place.

We saw improvements in how people's needs were being met. Staff we spoke with were able to explain people's support needs. Staff told us that competency assessments were being carried out to ensure they were able to meet people's needs safely.

Overall we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensuring that the service was well led.

We found that some improvements had been made to the management of medicines. However, further improvements were required in the way medicines were stored, administered and audited.

We found that records continued to lack sufficient information and were not fit for purpose, accurate or up to date.

People received appropriate care that met their needs. One person said, 'They are caring.'

Sufficient arrangements were not in place for the safe handling of medicines to ensure that people received their medicines as prescribed.

Records showed that staff received supervision and training. One person told us, 'Staff are good, they help me.'

Improvements had been made to the suitability of premises and risks were being managed appropriately.

Systems were in place to monitor the quality of the service. People's comments were appropriately recorded and addressed.

Records continued to be insufficiently maintained and failed to ensure that they were fit for purpose, accurate and updated on a regular basis.

We found that improvements had been made and people received care that met their needs. We saw staff deliver care in a timely manner. One relative said, 'Our relative's care has improved, and we have noticed the change.'

There were enough staff to look after people at the home. Training records showed that staff had access to different training to improve their skills and knowledge. One relative said, 'There never used to be enough staff, but now things are different. There is always at least one staff in the lounge.'

We spoke with three people, two staff, the operations manager, and another operations manager who was acting as the home manager.

We found that risks related to the planned work had not been identified, assessed, and managed appropriately to ensure the wellbeing of people who lived at the home.

On the day of the inspection there were 54 people living at the home. We spoke with four people, two relatives, two staff, the proprietor, two senior managers, the home manager, and the deputy manager. There had been some changes in the manager since our previous inspections. A new home manager had recently been appointed and had been at the home for three days when we carried out the inspection.

We found that improvements had been made in the way that people were offered choices and relatives had opportunities to be involved in making care and treatment decisions. One person said, "It's fine here."

We saw that people continued not to receive the care they needed or preferred in a timely manner. We found that opportunities for activities had not improved. We saw that there were limited interactions between staff and people. This meant that people did not always receive care that met their needs.

We found that improvements had been made to ensure that people were safeguarded from abuse.

We found that improvements had been made in assessing and monitoring the quality of the service.

We found some improvements in the daily recording of information. However, further improvements are required to minimise the risk of inconsistent care being delivered.