Archived: Epworth House Care Centre

The service had a history of breaches of regulation. We checked to see if any improvements had been made with the breaches identified at the last inspection, which included, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 17 Good governance. We checked and found improvements had been made, sufficient to meet regulations.

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

The registered provider was placed into special measures in December 2015 by CQC. The service has been in administration since November 2016 and was being run by Care Regeneration Services a company appointed by the administrators.

There was no registered manager in post; however there was a temporary manager 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.

At this inspection we found improvements had been made sufficient to meet regulations. However, the registered provider must evidence to the commission that they can sustain the improvements made so that the service remains compliant with all regulations.

Epworth House Care Centre is a care home registered to provide personal care and accommodation for up to 67 older people. The home is separated into two units. One unit is for people living with dementia and is sited on the first floor. The second unit is for people who have personal care needs with the main living accommodation sited downstairs. At the time of our inspection 29 people were living at the home.

People who used the service told us they felt safe living in the home. Their relatives spoke positively about the standard of care and support their family member received.

Systems for the safe administration of medicines were in place. The manager must continue to closely monitor and audit medicines so that mistakes or omissions are dealt with promptly.

Staff were knowledgeable about safeguarding people from abuse, and were able to explain the procedures to follow should there be any concerns of this kind.

Procedures in relation to recruitment and retention of staff had improved and were robust which ensured only suitable people were employed in the service. We found staff were skilled and experienced and there was a programme of training. Supervisions and appraisals were scheduled to take place throughout the year and staff told us they felt supported by the manager and deputy manager.

Staffing levels were appropriate to meet the needs of people who used the service. We saw staff engaging with people in an inclusive manner by encouraging them to join in conversations and activities.

The manager was aware her legal responsibilities with regard to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them. The service had made improvements to the way they obtained consent to people’s care and treatments and we saw evidence of authorised DoLS in place for some individuals.

People’s health was monitored and reviewed as required. This included appropriate referrals to health professionals. Individual risks had also been assessed and identified as part of the support and care planning process.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

Staff and people who used the service were mutually respectful. People were seen enjoying the company of staff and staff spoke with people in a polite and caring way.

A varied activity programme was on offer to people. We saw people thoroughly enjoying the activities available on the day of the inspection.

Staff told us they felt supported and they could raise any concerns with the manager and felt that they were listened to. Relatives told us they were happy to raise any concerns directly with the manager.

There was a new manager in place who was working in partnership with other professionals to improve the quality of the service.

We found minor shortfalls in some areas and were provided with evidence that confirmed improvements to these were on going. Further improvements were required to make sure the service continued to improve. Systems in place to assess and monitor the quality of the service needed to be maintained and fully embedded into practice so that improvements were sustained.

The service had a history of breaches of regulation. We checked to see if any improvements had been made with the breaches identified at the last inspection, which included, regulation 12 safe care and treatment, regulation 16 receiving and acting on complaints and regulation 17 good governance. The registered provider was placed into special measures in December 2015 by CQC. This inspection found there had still not been enough improvement to take the registered provider out of special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Epworth House Care Centre is a care home registered to provide personal care and accommodation for up to 67 older people. The home is separated into two units. One unit is for people living with dementia and is sited on the first floor. The second unit is for people who have personal care needs with the main living accommodation sited downstairs. At the time of our inspection 38 people were living at the home.

There was no registered manager in post; however there was a manager who was responsible for the day to day running of the service, who told us it was their intention to register with CQC. 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 and their relatives told us they felt safe at the home, and they were satisfied with the care and support which was being given by the staff team.

Staff had received training and were able to demonstrate their knowledge and understanding of how to safeguard vulnerable adults. However, we found there had been a serious incident which had not been investigated thoroughly or in a timely manner.

We found there were updated personal emergency evacuation plans in place in all the care files we reviewed, which had been a concern at the previous inspection.

There were risk assessments in place for particular risks, however, we found these were not always correctly completed and information contained within them did not always match other records in the care file.

We looked at the management of medicines. We found there were still concerns with record keeping for medicines, which were being administered within the service and the temperature at which medicines were stored was not always within the recommended range.

Recruitment records we looked at showed that there were some staff who had not had a recent disclosure and barring service check (DBS). We also found that previous employers had not always been contacted to gain references to ensure the good character of staff.

There was sufficient staff on duty to meet the needs of the people who used the service.

There had been a significant improvement in the training of staff, however we found there was an concern with how this had been recorded which meant it was not possible to identify whether training had been face to face or a booklet.

We found that whilst there had been applications made for Deprivation of Liberty Safeguards (DoLS) to be authorised, the records were disorganised and there was no clear record of who required a DoLS, when the application had been made, if the DoLS had been authorised or when the provider needed to apply to renew the DoLS.

We found there was very little evidence of the provider seeking consent to care from people who used the service. We found clear evidence that consent was being signed for by staff and relatives who did not have any legal authorisation to do so. This meant the provider was not working within the Mental Capacity Act 2005, and best interest decisions were not being made where people did not have capacity to consent to their own care.

People told us they enjoyed the meals and had access to a good range of snacks and drinks throughout the day.

Care staff treated people with dignity and respect. We observed staff interacting with people kindly and considerately, kneeling by their sides to address them at their own level and being patient when assisting people.

We found there had been some improvement to care plans, however, there was still further work to be done to ensure personal information was included and care plans were written in a person centred way with the person’s involvement.

The processes which were in place to monitor the quality and safety of the service were not effective and were not bringing about change. There was evidence that concerns were being identified during audits which were carried out, however there was no action taken to ensure concerns identified were resolved.

Monthly audits were completed and supplied to senior management and the registered provider; however, there was no oversight resulting from this information, as no feedback was given to the manager and no action plans were created.

We found the breach of regulation 16 receiving and acting on complaints had been resolved as the complaints process had sufficiently improved. We found continued breaches of regulation 12 safe care and treatment and regulation 17 good governance. We found additional breaches of regulation 13 safeguarding service users from abuse and improper treatment and regulation 11 need for consent 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.

On this visit we found the delivery of care did respect people and maintain their dignity. This was because when we checked people's bedding on the dementia unit we found bedding was clean and ready to use when people wanted to use their bed.

People had call alarms to use or pressure mats in place, so they could summon assistance when required to maintain their dignity.

We had also received some information of concern about how the service were respecting and maintaining the dignity of people who used the service and this information was also checked on this visit.

People we spoke with told us that staff respected them and maintained their dignity. People told us they always had bedding for their bed and staff made sure their call alarm was to hand. One person said, 'I've always had a clean bed. Sometimes you get 'sticky' when it's hot with having plastic covers over the mattress.'

We found the delivery of care did not always respect people and maintain their dignity. This was because on the dementia unit we found bedding was not always clean when beds had been made for people to use. People did not have call alarms to use and there had been no assessment of their capacity to make decisions in regard to their ability to use a call alarm.

We found in the sample of bathrooms, shower rooms and toilets we looked at that the areas were clean, tidy and hygienic.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Discussions with people confirmed they made their own choices in their day to day care, for example, rising and retiring when they wished.

People experienced care, treatment and support that met their needs and protected their rights.

An effective operation of systems to maintain appropriate standards of cleanliness and hygiene to prevent and control the spread of health care associated infection had not been maintained in all areas of the home.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received, for example, audits, staff and resident/relative meetings.

People were protected from the risks of unsafe or inappropriate care and treatment. This was because the service had accurate and up to date information about people using the service.

One person using the service said, 'It's alright living here.' Another person said 'They're (staff) not too bad if you need help. Night staff are brilliant. They get me dressed. They do anything I need and come straight away. I'm one of the first up.'

We found there was a lack of assessment of people's needs and care delivered, did not correspond with the care documented in care plans. This meant people were not protected against the risks of receiving unsafe or inappropriate care.

Sufficient numbers of staff were provided to care for people. People said, 'Biggest part of them (staff) are brilliant. They're not too bad if you need help. They do anything I need and come straight away.' and 'Staff are very nice. Sometimes when you use the buzzer they can be a bit late, but you don't have to wait long. They're polite. They come quickly.'