About the service:

Essington Manor is a care home that accommodates 41 people in two buildings that are adjoined and support is provided on two floors. The home is registered for up to 41 people. There are various communal areas, including a lounge, dining room and conservatory that people can access. The home also has a large garden.

People’s experience of using this service:

The service met the characteristics of good in all areas.

At the last inspection in January 2018, the service was rated as Requires Improvement overall, with breaches of the regulations in relation to ineffective quality assurance systems. The provider wrote to us to tell what action they would take to comply with these regulations. At this inspection, we found that the provider had made considerable improvements and there were no longer breaches of the regulations. The home had improved and is now rated as Good.

The care people received was safe. Individual risks were considered. Safeguarding procedures were in place. Medicines were managed in a safe way. There were enough staff available for people. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The care that people received was effective. They 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. Staff received an induction and training that helped support people. People received support from health professional when needed. People enjoyed the food and were offered a choice. The environment was adapted to meet people’s needs.

People and relatives were happy with the staff and supported in a kind and caring way. People were offered choices, remained independent and their privacy and dignity was maintained.

People received care that was responsive to their needs. The care they received was individual and specific to their needs. People had the opportunity to participate in activates they enjoyed. There was a complaints procedure in place.

The registered manager was approachable and there were systems in place which encouraged people to give their feedback. There were audits in place which were effective in continually developing the quality of the care that was provided to them.

More information is in the full report.

Rating at last inspection:

Requires Improvement (Last report published 19 February 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Essington Manor 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. Essington Manor accommodates 41 people in two buildings that are adjoined and support is provided on two floors.

When we completed our previous inspection on 17 January 2017 we found concerns as medicines were not always administered as prescribed and there were no system in place identifying stock levels within the home. We also found improvements were needed as people felt there could be more to do in the home. We could not be sure the needs of people living with dementia had fully been considered. The provider was rated as requires improvement overall. At this inspection we found improvements had been made however further improvements were needed. This is the second consecutive time the service has been rated Requires Improvement.

We found that risk assessments were in place for individuals however when changes occurred these had not always been considered and reviews taken place. Correct medicines management procedures were not always followed in the home so we could not be assured that risks associated with medicines had been fully considered.

We received mixed views on staffing levels within the home and some people felt this could improve. We saw that interaction from staff were positive however this was often when they were competing a task with someone. Improvements were needed as to how agency staff were inducted to ensure they had all the relevant information. Some staff were not trained in areas they were supporting people with.

People who lacked capacity were not always supported to have maximum choice and control of their lives. The policies and systems in the service did not support this practice. We have made a recommendation about decision specific assessments to support people when they lack capacity.

Quality audits were not consistently completed and the information was not always used to drive improvements within the home. There were no current systems in place so that improvements could be made and lessons learnt when things went wrong. When people and relatives identified areas for improvement we could not see how this information had been used to make changes.

People enjoyed the food and were offered a choice and people’s individual needs and preferences were considered in this and other areas. When needed people had information available to them in different format to help them understand the choices they were making. We found people were happy with the staff and the care they received. People’s cultural needs had also been considered by the provider. People were encouraged to remain independent and make choices for themselves, including the activities they participated which people felt had improved. People’s privacy and dignity was also considered. When people needed support from health professionals this was provided for them and the registered manager worked in partnership with these agencies.

Staff understood safeguarding procedures and when to report concerns. Staff working within the home had checks to ensure their suitability. The provider had considered end of life support for people and this was individual to people’s needs and wishes.

There were infection control procedures in place and these were followed by staff. The provider had received no complaints however people knew how to complain and felt they would be listened to. Staff felt supported be the management team and were happy to raise concerns.

We found a breach 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.

This inspection took place on 17 January 2017 and was unannounced. At our previous inspection in May 2015 the provider was not meeting the legal requirements in relation to consent. We asked the provider to make improvements to ensure people were supported in line with the law; they sent us an action plan telling us how they were going to do this. At this inspection we saw the provider had made the necessary improvements however, improvements were needed in other areas. Since our last inspection the provider of this home has changed.

The service provided care and accommodation for up to 43 older people and consisted of two large detached houses on the same site. At the time of this inspection 35 people were living in 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.

People’s medicines were not always reviewed to ensure that they received them as prescribed. Stock checks were not completed within the home so we could not be sure all people had received their medicines when needed. People felt there could be more to do within the home and we could not be sure the needs of people living with dementia had been fully considered.

People felt safe and staff were able to recognise and report potential abuse. Risks to people had been identified and managed to keep them safe from harm. There were enough staff available for people and they had received an induction and training that helped them to support people. The provider had completed checks to ensure staffs suitability to work within the home.

When people were unable to consent mental capacity assessments had been completed. Decisions had been made in people’s best interests. The provider had considered when people were being restricted unlawfully and authorisations were in place. Staff understood their role in this and how to support people.

People made choices about how to spend their day and were encouraged to be independent. Privacy and dignity was maintained and people were happy with the staff and the support they received. Friends and families were free to visit the home and felt welcomed. When needed people had access to health professionals. People enjoyed the food and were offered a choice.

Quality monitoring was completed by the provider and information used to bring about improvements. The provider sought the opinions from people and relatives and used this information to make changes. People spoke positively about the home and how it was run. Staff felt supported and listed to. The registered manager understood their responsibilities around registration with us.