About the service: Ennis House accommodates up to 40 people in one adapted building. This is three houses that have been joined together over the years. One of the houses was not in use at this time, people lived in the main house or ‘Oakleigh’. At the time of the inspection there were 35 people living there.

People at the home were living with a range of complex mental health care needs and dementia. Most people were independent and needed minimal assistance while others required some assistance related to their personal care and day to day support.

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

People’s experience of using this service:

The provider lacked effective quality assurance systems to identify concerns in the service and drive necessary improvement. Where the need for improvement was identified these were not always addressed in a timely way. Improvements were needed to the recruitment of new staff.

There was a reliance on the care manager for oversight of the service. In their absence staff did not have access to all the information they may need.

The home was in need of general maintenance throughout. Infection control procedures were not always being followed to prevent spread of infection. A fire risk assessment had been completed however, we found an area of the home that had not been included in this risk assessment.

People were not consistently protected against the risk of abuse. There was a lack of oversight of incidents. This had resulted in reoccurring incidents not being recognised and therefore had not been reported as a safeguarding concern. There was no overview or monitoring of incidents, accidents and safeguarding to identify any trends or themes for individuals or the home in general.

Mental capacity assessments had not been completed in relation to key decisions which had been made regarding people’s care. There was no information about whether people had capacity or whether decisions had been made in their best interests. Staff were unable to tell us whether people had Deprivation of Liberties Safeguards (DoLS) authorisations in place or if applications had been made.

Some people were able to independently engage in activities of their choice. However, improvements were needed to ensure people, who were less able, were able to access a variety of meaningful activities. There was no guidance for staff about how people could be supported to maintain their interests.

The provider had identified staff had not all received the training updates they needed and not all staff had received supervision. This was being addressed at the time of the inspection and a plan was in place to ensure this was completed. Staff told us they felt well supported.

Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff about individual and environmental risks.

People were supported by staff who treated them with kindness, respect and compassion. Staff understood people’s needs, choices and histories and knew what was important to each person. People were enabled to maintain their independence and make their own decisions and choices about what they did each day.

People were supported to receive their medicines safely and when they needed them.

People's health and well-being needs were met. They were supported to have access to healthcare services when they needed them. People's dietary needs were assessed, and people were provided with a choice of freshly cooked meals each day.

Rating at last inspection:

Requires Improvement. (Report published 18 April 2018.)

The provider sent us an action plan and told us how they would address these issues.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found that whilst some improvements had been made to the environment further improvements were needed. We also foun

We inspected Ennis House on 19 and 20 February 2018, we returned on 21 February to give feedback to the provider and manager. On 2 March we went back again to check some improvements to the environment had been made.

At our previous inspection in March 2015 the service was rated ‘good’ in all areas.

Ennis House 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. Ennis House provides personal care and accommodates up to 40 people in one adapted building. At the time of the inspection there were 33 people living at the home. People at the home were living with a range of complex mental health illnesses. Most people were independent and needed minimal assistance and others required some assistance related to their personal care and day to day support at the home.

The home is managed by a registered provider who was supported by a care manager. 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 were required to ensure the provider is meeting all of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home was in need of maintenance and general redecoration throughout. The provider and staff were aware of what was required, however no or limited action had been taken. There was a lot of ‘clutter’ at the home. This had not been taken into account when assessing risks to people. Risks in relation to infection control and fire had not been safely managed.

Although there was a training programme in place not all staff had received the training in line with the provider’s policy. Quality assurance systems were not always effective at identifying and addressing areas that needed to be improved in a timely way.

Care documentation did not always support individual and person centred care. It did not reflect the support people received and required. Improvements were needed to ensure people were able to access a variety of meaningful activities.

Despite these concerns there were also positive aspects of the service. People were supported by staff who knew them well. They understood people’s individual needs and preferences. Staff were committed to ensuring people lived happy lives.

Medicines were managed appropriately and people received the medicines they had been prescribed. People’s nutritional needs were assessed and met and they were supported to enjoy a variety of food and drink of their choice.

There were enough staff on duty, who had been appropriately recruited, to meet the needs of people. Staff had a clear understanding of the procedures and their responsibilities to safeguard people from abuse.

Staff had an understanding of the Mental Capacity Act 2005 and DoLS assessments had been made to determine peoples’ capacity. Appropriate referrals were made to the local authority if people needed to be deprived of their liberty to ensure their safety and well-being.

There was a positive culture at the service. People spoke highly of the staff team. They told us staff were kind and caring. People were supported to maintain and develop relationships and friendships that were important to them. People’s dignity and privacy was respected.

People were supported to attend healthcare services and maintain good health. A complaints procedure was in place and complaints were responded to appropriately.

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 this report.

Ennis House provides personal care and accommodation for up to 40 people with mental health problems. There were 39 people living at the home during the inspection, most people were independent and needed minimal assistance and others required some assistance, including personal care and moving around the home.

We inspected the home on 14 August 2014 and found some improvements were required to the internal and external environment. At this inspection we found these concerns had been addressed.

The home is managed by a registered provider who was supported by a care manager. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how a service is run.

At the last inspection we found the provider had not met the regulations with regard to the suitability of the premises.

Risk assessments had been completed as part of the care planning process; these identified people’s support needs, and had been reviewed with people’s involvement.

There were systems in place to manage medicines, including risk assessments for people to manage their own medicines. Medicines were administered safely and administration records were up to date.

Staff had attended safeguarding training and a safeguarding policy was in place. They had an understanding of recognising abuse and how to raise concerns if they had any.

People were supported by a sufficient number of staff and appropriate recruitment procedures were in place to ensure only people suitable to work at the home were employed. Staff told us they felt supported to deliver safe and effective care. Staff demonstrated they knew people well and felt they supported people to maintain their independence.

The provider and care manager had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

People told us the food was very good. Staff spoke with people daily and changes were made to the menu if needed. People said there were always at least two choices, and were seen to enjoy lunch. People told us they decided what they wanted to do and some preferred to remain in their rooms.

People had access to health care professionals as and when they required it, and visits were recorded in the care plans with details of any changes to support provided.

People said they were involved in decisions about the support provided. Staff made suggestions, but did not make decisions for them, and people told us they had been involved in writing their own care plans.

Complaints procedures were in place and they were displayed in the entrance hall. People said they knew about the complaints procedure, but had not needed to use it. The care manager told us the home operated an open door policy and people were able to talk to staff at any time.

People told us the provider, care manager and staff were approachable and supportive and they could talk to them at any time. The provision of residents meetings had been discussed with people and they had decided they did not need them.

The provider had quality assurance systems in place to audit the support provided at the home. These included audits of medicines, care plans, laundry and menus.

We carried out this inspection to assess the safety and suitability of the premises at Ennis House, following receipt of two anonymous concerns with regard to poor maintenance of the home.

We spoke with eight people who lived at the home. People told us they were comfortable and did not have any concerns about the home.

We spoke with one visitor, three members of staff and the provider during the inspection. We looked at the garden areas, the internal environment of the home including bedrooms, and the cleaning schedule.

We found that since the last inspection carried out on 28 May 2014 some improvements had been made. However, we identified at this inspection that further improvements were required to ensure that the premises were suitable and safe for people who lived at, were employed at or visited Ennis House.

We carried out this inspection to look at the care and treatment that people living at the home received. At the last inspection on 28 August 2013 we found that there were concerns with regard to people’s care and welfare, safeguarding, the suitability of the premises and the homes response to complaints. We found at this inspection that these issues had been addressed.

We spoke with ten of the people who lived at the home. People told us that they were very happy living at Ennis House. One person said, “The staff are excellent, they know how to look after us”. Another person told us, “I feel safe here, the staff know what I need”.

We spoke with five care staff, the administrator and the provider. We reviewed four care plans and associated documentation; we looked at the complaints book and the complaints procedure, safeguarding policies and staff training records, and we looked at the premises.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found during our inspection that people were safe, their rights and dignity had been respected; staff had attended training and knew how and when to report safeguarding concerns. There were policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, although no applications were in place at the time of the inspection.

Is the service effective?

We found during our inspection that the service was effective. Staff we spoke with demonstrated an understanding of people’s specific needs, and we observed staff supported people to maintain their independence and make choices.

Is the service caring?

We found during our inspection that the service was caring. We observed that people were supported by respectful and kind staff.

People's preferences, interests, and diverse needs were supported. We saw how some people chose to go into the town centre; one person preferred to watch television and people chose to spend time in their rooms and in the lounge areas of the home.

Is the service responsive?

We found the service to be responsive during our inspection. Staff were available to support people when needed, whilst allowing people to decide how they spent their time.

Is the service well led?

We found during our inspection the service was well led. Staff we spoke with said management was very supportive, and were available at any time if they had any concerns.

People that we spent time with during the visit told us that they were happy living in the home and comments included. “Generally it’s very good here, the food is good and I can go out when I like."

There were processes in place to ensure that people, wherever possible, were supported to give informed consent about the care they were receiving.

People had their individual needs and wishes recorded in a plan of care. Improvements were needed to ensure that care was clearly recorded and carried out to a consistent standard.

The home’s staff worked with a variety of healthcare professionals including local doctors and mental health teams.

In order to ensure that people were being kept safe from risk of abuse. Improvements were needed to the way identified concerns are responded to and managed.

In order to ensure that people are living in a safe and hygienic environment, improvements were needed to the repair, decoration and furnishings in the home.

Staff were only employed following a structured recruitment and interview process and relevant checks were carried out prior to them starting work.

There was a complaints policy in place. In order to ensure that people's concerns were fully addressed, improvements were needed to the way complaints are recorded and acted upon.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant that they were not able to tell us their experiences. However those who could told us that their home was lovely, they were very happy living at Ennis House and that the staff looked after them very well.

People who spoke with us said they were very comfortable, the food was very good with lots of choices and they could decide what they wanted to do.

We spoke with eight people who told us that they were happy living in Ennis House.

Two people said that they had freedom to come and go from the home as they wished.

All people said the food was good and that they were given a choice of food.

People told us that staff were kind to them and nothing was too much trouble for the staff.