This inspection took place on 25 and 31 January 2019 and was unannounced. This meant the staff and provider did not know we would be visiting.

Eboracum House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Eboracum House is registered to provide accommodation and personal care for up to 18 people. Accommodation is provided over two floors, accessed by stairs or a passenger lift. Communal lounges and dining areas are provided. The home is a detached period building with a large garden close to local amenities. The care provided is for people who have needs associated with those of older people. On the day of our inspection there were nine people living at the home, two people were living on the first floor the remainder living on the ground floor and two people were staying having respite. Respite care is a short-term stay, often around one to two weeks, in a care home.

Our last inspection at Eboracum House took place on 2 and 7 November 2017. We found the service was in breach Regulation 12, of the Health and Social Care Act 2008 (Regulated Activities) 2014; Safe care and treatment and the service was rated requires improvement overall.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key question asking if the service was safe, to at least good.

The registered provider sent us an action plan detailing how they were going to make improvements.

At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the regulations.

There was registered manager at 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 and associated Regulations about how the service is run.

People living at Eboracum House told us they felt safe and they liked the staff. Staff confirmed they had been provided with safeguarding vulnerable adults training, so they understood their responsibilities to protect people from harm.

We observed that many areas of the home required refurbishment, however the provider had a maintenance programme in place which showed clear timescales of how and when the works were to be completed.

People gave us mixed feedback in relation to staffing levels. We found there were enough staff to provide basic care, but limited time was available to engage with people.

The staff recruitment procedures and checks in operation promoted people’s safety.

We found systems were in place to make sure people received their medicines safely.

Staff were provided with relevant training and supervision to make sure they had the right skills and knowledge to support people.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had access to a range of health care professionals to help maintain their health.

People and health professionals, we spoke with made positive comments about the care provided by staff.

People were treated with dignity and respect and their privacy was protected; a range of activities were available to provide people with leisure opportunities.

People were confident in reporting concerns to the registered manager or staff and felt they would be listened to and their concerns would be addressed.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full an

This was an unannounced inspection carried out on 2 and 7 November 2017. Our last inspection took place on 14 March 2017 when we found people received care which was not safe, effective and well-led. This was due to continued breaches of regulation in relation to safe care and treatment, specifically in regard to the management of medicines and the need to gain consent. We rated the service inadequate overall and placed it into special measures. Following our inspection, we took enforcement action against the registered provider who subsequently submitted a ‘home improvement action plan’ to demonstrate areas of improvement. We carried out this inspection to check whether the necessary improvements had been made to the service and found appropriate action had taken place in most areas.

Eboracum House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Eboracum House is registered to provide residential accommodation for older people, including those with dementia, for up to 18 people.

At the time of our inspection the manager was registered 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.

Risks to people were not always effectively managed as information recorded in risk assessments was not up to date and consistent with levels of risk.

A staff handover was carried out in the presence of people who lived at the service which did not respect their privacy and dignity. Care records were not securely stored. The registered provider took immediate action to resolve these concerns.

The administration and documentation of medicines did not always follow safe practice. However, other areas of medicine management were appropriately managed.

People felt safe living at Eboracum House. Recruitment processes were robust which meant people were cared for by staff who were suitable to work with vulnerable adults. Staffing levels were appropriate to meet the needs of people who lived at the service.

The recording of people’s mental capacity was decision-specific and staff demonstrated a clear understanding around offering people choice, consent to care and people refusing care. Applications for Deprivation of Liberty Safeguards authorisations had been made where required and authorisations granted by the local authority were all in date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to receive timely access to healthcare services. People felt staff were suitably trained and training records demonstrated high levels of completion. Staff were also supported through supervision, appraisals and staff meetings.

People and relatives knew how to complain if they were dissatisfied with the service they received. Complaints were responded to and feedback from satisfaction surveys was on display in the service.

People were satisfied with their meals. Kitchen staff were aware of people’s specific dietary requirements, although records to reflect these needs required updating. The lunchtime meal experience was positive as people were well supported.

People and relatives spoke positively about the care they received from staff. Staff knew how to respect people’s privacy and dignity and we saw this happened in practice.

Care plans were more person-centred at this inspection and included detailed life histories. We recommended the registered provider update some

The inspection took place on 14 March 2017 and was unannounced. This meant the people who lived at Eboracum House and the staff who worked there did not know we were coming. The home was last inspected on 10 August 2016, at which time we found the service was not meeting the requirements of four regulations of the Health and Social Care Act 2008 (regulated Activities) Regulations. The regulations in breach at the last inspection were safe care and treatment in regard to people’s medicines, premises and equipment in regard to the safety of the building, the need to gain consent from people to receive care and support and good governance. We found at this inspection that whilst the required improvements had been made to the safety of the building the registered provider had not made sufficient improvements in relation to the other breaches of regulation and there were continued breaches of regulation in relation to the safe care and treatment in regard to the management of medicines and the need to gain consent.

Eboracum House provides accommodation for up to 18 older people who have personal care needs, some of whom are living with dementia. At the time of this inspection there were 12 people who used the service and one person who was staying at the home for a short period of respite care. Respite care is where a person uses the service for a short period of time.

There was a registered manager in post. They had registered with us in January 2017 and had been in post since November 2016.

Staff had undertaken training in safeguarding vulnerable adults; however safeguarding concerns were not always recognised or appropriate action taken to protect people from harm.

Risk assessments were not risk specific and did not explain the measures which needed to be in place to minimise risks to people.

Medicines were not always managed safely as the medication administration records were not completed correctly or clearly and there was inconsistent monitoring of the temperatures at which medicines were stored.

There were sufficient staff on duty and there was a recruitment policy which was robust but we found one instance where this had not been followed to ensure the member of staff was of good character and suitable to work with vulnerable adults.

All staff had not undertaken all the training they required to ensure they were suitably skilled and knowledgeable to carry out their roles effectively and training was not always refreshed in line with the organisation’s policy. Staff had received some supervision sessions however there had not been any appraisals carried out recently.

The home was not always working in line Mental Capacity Act 2005 and we could not evidence that consent to care had been sought or gained appropriately from people who use the service.

People told us the food was good and we saw people had access to drinks and snacks throughout the day.

Staff were kind, caring and sympathetic; however they did not always protect the dignity of the people they cared for.

Care plans were not person centred and did not contain sufficient detail about people in relation to their preferences, likes, dislikes and needs. Whilst care plans were reviewed each month care plans were not re-written to reflect changes to people’s needs.

The home had an activities coordinator and we saw there were planned activities which people engaged in and enjoyed. However, the activities coordinator only worked part time which meant there were prolonged periods of time where people did not have meaningful activities to occupy them.

Complaints had been recorded, investigated and responded to appropriately.

There was visible leadership within the home as the registered manager was accessible to people and staff during the day. People and staff spoke positively of the registered manager, who they told us was approachable.

Processes to monitor the quality and safety of the service were not effective or consistent and had not addressed the b

The inspection took place on 10 August 2016 and was unannounced which meant that people did not know we would be carrying out an inspection on this day. We last inspected the service in May 2015 and found the service was not meeting the requirements of the regulations we inspected at that time. This was in relation to the safe management of medicines and the need to gain consent.

Eboracum House provides accommodation for up to 18 older people who have personal care needs and some of who are living with dementia. There were 16 people living at the home at the time of our inspection.

There was no registered manager at the home. However there was a manager who was in the process of registering with the Care Quality Commission. 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.

We found the management of medicines was not safe. We found multiple and serious concerns about the storage of medicines and concerns about the records which were kept to show what medicines had been administered to people who lived at the home.

Recruitment processes were reviewed and we found the provider was carrying out appropriate checks which allowed them to make safer recruitment decisions.

The home appeared to be generally clean; however there were areas where malodours were present. There was work in progress to eliminate these odours and the hours for domestic staff had been increased to include weekends to improve the general cleanliness in the home.

We found concerns in relation to the safety of the building with regard to an electrical installations report which had been carried out in June 2015. There were areas of serious concern identified which had not been actioned. The operations manager took immediate action on the day of inspection to ensure this work was carried out.

We saw staff had undertaken a range of training to ensure they had the required skills and knowledge to carry out their roles. Staff received supervision and appraisals and told us they felt supported by the management team.

We found consent to care was not always clearly sought or gained, as care plans were not signed by people to show their agreement to the support they received. We saw no evidence that people or their relatives were involved in their care planning.

The provider had made applications for Deprivation of Liberty Safeguards to be authorised for people who had been assessed as not having the mental capacity to make decisions about where they lived. We were however concerned other people were being deprived of their liberty which had not been recognised as there was a door from the main area of the service to the entrance which some people would not be able to open as there was confusion handles fitted and the top handle was very high up.

People and their relatives spoke very positively about the quality of the food which was served and the variety of meals, drinks and snacks which were available to people throughout the day.

There had been little thought given to the suitability of the environment for people living with dementia, as the bedrooms were not easily distinguishable from each other and corridors were hung with mirrors which people may find confusing and disorientating.

Staff were kind, caring and compassionate when supporting people. We heard friendly chatter throughout the day and staff made every effort to include people in conversations. Staff respected the privacy and dignity of the people who lived at the home and maintained their confidences.

Care plans had recently been re-written and there was some evidence that they were more person-centred, however there were sections which were still missing, these included ‘about me’ and end of life care pl

The inspection took place on 6 May 2015 and was unannounced which meant that people did not know we would be inspecting the service before we visited. We last inspected this service in July 2014 and found that the service was not meeting the requirements of four of the regulations we inspected at that time. These were in relation to safeguarding procedures not being followed, people’s needs not being effectively responded to, staffing levels and ineffective quality assurance. An action plan was subsequently received from the provider setting out how the service intended to address these issues.

Eboracum House provides accommodation for up to 18 older people who have personal care needs and may be living with dementia. There were 15 people living at the home at the time of our inspection.

There was a registered manager employed at 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.

We saw that medicines were not managed in a safe way. Some information in people’s medication administration records was incomplete. We saw dates of birth and room numbers missing on some medication administration records and contradictory information recorded about allergies. We observed that medicines were not administered in line with good practice. This meant there was a risk that people did not receive safe care and treatment in respect of medicines.

The registered manager had applied for deprivation of liberty safeguard authorisations for some people at the home and was aware of the requirement for these. However we saw that a decision where a person had medicines administered covertly had not been made in accordance with the Mental Capacity Act 2005.

People and relatives we spoke with were positive about the care they received and about staff who supported them. We witnessed positive and caring interactions between staff and people. People were treated with respect and dignity. Staff demonstrated familiarity with people’s preferences and wishes. Care records were in place for people and these were reviewed at regular intervals. However we saw that two people had a lack of information in place to inform how they needed to be supported.

Staff demonstrated knowledge of safeguarding procedures and received training in safeguarding. Incidents were monitored for referral on to other agencies where required to prevent and reduce potential reoccurrence.

Since our last inspection, a part time activities co-ordinator role had been introduced. Activities were available to provide and encourage stimulation for people. Relatives said they had seen an improvement in activities and one told us they would still like to see more activities. Peoples’ nutritional needs were accommodated and people were supported to access healthcare professionals and maintain good health.

Recruitment processes ensured new staff were assessed as suitable to work at the service. Staff received supervisions although all appraisals had not yet been completed. Staff told us they felt supported by the registered manager.

People who used the service and relatives we spoke with felt there were enough staff available The registered manager felt current staffing levels were appropriate and said a new call bell system had improved efficiency. Staff we spoke with told us they felt staffing levels were suitable for the needs of the people there.

Feedback was sought by the registered manager by way of relatives and residents meetings which were incorporated into social events. There was a complaints procedure in place and people and relatives told us they would feel comfortable to address any concerns with the registered manager. Quality assurance systems were in place which identified areas for improvement but these required more detail in some areas to be suitably effective.

We found two 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 this report.

We talked with five people who used the service and two visiting relatives. The people who used the service told us they were happy living at the home, liked the staff that looked after them, and enjoyed their food. Some comments made by the relatives included “very good care”, “very friendly [staff]”, “they do a good job here”, “staff really look after her (mother)”, “really can’t praise them highly enough” and “all care staff are lovely.”

People were supported to have adequate nutrition and hydration.

During our inspection we conducted a tour of the premises and found it was clean, tidy and free of any unpleasant odours. There were systems in place to reduce the risk and spread of infection.

We found people’s needs had been met by sufficient numbers of appropriate staff.

We found accurate and appropriate records had been maintained.

We used periods of observation to see how members of staff interacted with people who use services. We saw staff treated people with dignity and respect by using a positive, friendly and kind approach. We found people looked clean, tidy and had their personal care and welfare needs met.

We talked to four people who used the service. People told us they liked the staff that looked after them, thought their bedroom was kept clean and received support with hygiene care from staff. Some comments captured included, “I get on very well with them all (staff)”, “all the staff are good to me” and “people who look after me are lovely”.

We talked to two family members of one couple who came to live at the home around one month ago. Comments captured from family members included, “[In the] short time coming here I can see our [relative’s] needs are being met and the staff are very caring” and “the staff appear very concerned with knowing exactly what needed to ensure [people’s] needs are being met”.

People using the service told us they were happy with the care provided and were involved in decisions about their care and welfare needs. We spoke with two relatives who told us their relative’s dignity was respected and confidentiality was always maintained.

People using the service told us they were happy living at the home and they were well looked after. One person told us “I am very well looked after”, and “It feels like a family and I have friends here”. Another person told us “it was lovely living here”. Staff were described as marvellous, nice and helpful.

We spoke with two relative’s who told us that staff were very good, nice, approachable and caring. One relative we spoke with told us they were happy with the care and their family member was well looked after.

We spoke with two relatives who confirmed they would talk to the manager if they had any concerns. People told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?

The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

This was an unannounced inspection. During the visit, we spoke with eight people living at the home, four relatives, the provider, the manager, the deputy manager, two care workers, the cook and a domestic worker. We also spoke with two healthcare professionals who attended the home on the day of our inspection. Until May 2014 there had been a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. On the date of our inspection a new manager had been recruited and was due to commence employment later that week. We returned to the home on 17 July 2014 to review further information and speak with the new manager.

Our last inspection at Eboracum house was 6 August 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.

Eboracum House provides accommodation for up to 18 older people who have personal care needs and may be living with dementia related conditions. There were 14 people living at the home at the time of our inspection.

People were positive about the care they received although from speaking with people and our observations, we found that sometimes people did not have their preferences met. One person was not offered a choice of where they wanted to eat. We saw two people did not have access to call bells so were unable to call for assistance via this method. We heard these people having to shout for staff attention. This demonstrated that the home was not meeting all requirements for care and welfare of people who use services, as people’s safety and welfare was not always ensured.

Due to the layout of the home, and the number of staff on duty, there were long periods where people did not have supervision. We found that appropriate steps had not been taken to ensure there were sufficient numbers of suitably qualified, skilled and experienced staff employed to carry on the regulated activity. As there were only two care staff working, with several people requiring assistance from two staff members for their care needs, this meant there were times where people risked receiving a lack of timely support. It also created a risk of not being able to safely evacuate people in case of an emergency.

Staff received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) however they did not express a clear understanding of the legislation and how it applied to their role. We asked about safeguarding and care staff said they would report any abuse to the management. However we were aware of some prior physical incidents had not been referred by the home to the local authority in line with safeguarding procedures. This demonstrated that the requirements relating to safeguarding people were not being met as appropriate referrals were not being made to protect people using the service.

No activities took place on the day of our inspection which meant people did not always have sufficient opportunity for stimulation as staff did not have time to facilitate this or to sit and chat with people.

Everyone we spoke with gave positive comments about the staff.  We undertook observations to help us understand the experience of people who could not talk with us due to their health condition. We saw that staff were kind and caring in their interactions with people who in turn responded positively. People told us staff treated them with respect and maintained their privacy.  However, the majority of interactions between staff and people at the home were task based and when a specific need was being met.

People were positive about the food and the cook had detailed knowledge of people’s likes and dislikes as well as any specific dietary requirements people had. There were measures in place to ensure that people’s nutritional needs were monitored and actions taken where required. We saw that people were referred on to other professionals where needed to ensure that a holistic approach was taken in relation to their care provision.

Staff received training necessary for their roles as well as additional relevant training to improve their knowledge and skill set. Staff told us they could undertake further training if they required. This showed that staff had opportunities to improve and develop within their roles.  However, staff did not have regular supervisions and appraisals which meant their practice was not formally monitored and areas for improvement may not be identified.Relatives told us that if they had any concerns they would tell the staff or manager and said they felt their issues would be dealt with. Feedback from people at the home was sought by way of discussions and resident meetings. Satisfaction surveys were provided to people, relatives, staff and stakeholders so that people’s views could be obtained  but the findings of these was not fed back to people.

The provider, manager and staff told us they felt they had a good team. Staff said the provider was approachable and communication was good within the home. Team meetings took place where staff could discuss various topics and share good practice. However, the audit system was not clear to follow and ensure actions were completed where identified. A number of policies and procedures had not been reviewed for a significant time which meant there was a risk current practices were not implemented. This meant there was a breach of the requirements to protect people from risk and unsafe care by effectively assessing and monitoring the service being provided.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.