What life is like for people using this service:

• People who live at Estherene House are supported by sufficient numbers of staff who are appropriately trained. We observed people’s requests for assistance being answered promptly. The quality of interaction between staff and people was good and staff were kind and caring towards people.

• The environment was comfortable and safe. The décor was stimulating and there was dementia friendly signage making it easier for people to find toilets, dining room and lounges.

• People were supported to remain engaged and had appropriate access to meaningful activity. There was a range of activities on offer to suit people’s preferences.

• People were provided with a choice of good quality nutritional meals which met their individual needs. People were provided with appropriate support to reduce the risk of malnutrition or dehydration. Improvements had been made to the dining experience but further improvement was required to ensure meals were served promptly. The manager was taking action to address this.

• People received the support they required at the end of their life. However, improvements were required with end of life care planning.

• People were supported to have contact with other healthcare professionals and the service worked well with external organisations to ensure people’s complete needs were met.

• People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

See more information in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published 09 January 2018)

About the service: Estherene House provides accommodation and personal care for up to 36 people who require 24 hour support and care. Some people were living with dementia. At the time of our visit 34 people were using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service has made sufficient improvements to be rated Good.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

Estherene 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. Estherene House provides accommodation and personal care for up to 36 older people, some living with dementia. The service is divided into two units, Estherene and Barton units, each of which has bedrooms, and communal dining and lounge areas. There is a main kitchen where meals are prepared.

There were 33 people living in the service when we undertook this comprehensive unannounced inspection on 7 and 8 November 2017.

There was a registered manager in place. 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.

This overall rating of this service was Requires Improvement at our last inspection of 26 and 29 September 2016. The key questions Safe, Effective and Caring were rated as Requires Improvement. Responsive and Well-led were rated as Good. In Safe we found breaches of Regulations 12 Safe care and treatment and 18 Staffing of the Health and Social Care Act (Regulated Activities) Regulations 2014. 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 breaches of Regulation.

During this inspection, the overall rating remained Requires improvement. There had been some improvements made in the service such as staffing levels and systems for reducing risks to people. The breaches of Regulations 12 and 18 had been addressed. However, we found shortfalls relating to how the service recorded people’s care and how staff interacted with people. The key question Safe had improved to Good. Effective and Caring remained Requires Improvement. Responsive had deteriorated from Good to Requires Improvement. As a result Well-led had also deteriorated from Good to Requires Improvement. This was because the service had not made the improvements required to provide people with good quality care at all times.

There were quality assurance systems in place which assisted the provider and the registered manager to identify shortfalls and address them. Where shortfalls were identified there were plans in place to address them to improve the service people received. However, these were not yet fully implemented and embedded in practice to ensure that people were provided with good quality care at all times.

Improvements were needed in people’s care plans to identify how they were provided with person centred care which was tailored to meet their specific needs. There were some inconsistencies in care records which needed attention to ensure that staff were provided with the most up to date guidance on how people’s needs were met.

Improvements had been made in the staffing levels in the service and these were ongoing. However, improvements were needed in how staff interacted with people. There were missed opportunities for staff to include people in how the daily records of people were completed.

Interactions which people received from staff varied in quality. Some were very caring and positive and some did not demonstrate compassion for people’s condition and how they expressed themselves. The service’s management team were taking action by a programme of training which had been delivered and was booked to address this. This had not yet been fully implemented at the time of our inspection.

People’s nutritional needs were assessed and met. However an incident, which occurred during the first day of our inspection, had affected people’s dining experience in one unit.

The environment was clean and hygienic and there were

Estherene House provides accommodation and personal care for up to 36 older people who may also be living with dementia. There were 35 people in the service when we inspected on 26 and 29 September 2016. This was an unannounced inspection.

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.

There was a positive, open and inclusive culture in the service. The providers had acquired the service in October 2015 and were committed in their approach to drive forward improvement to ensure all people’s care and support needs were being met. They were working with the staff team to help them to understand and share the culture, vision and values of the service in its main objective to provide high quality care and continued positive life experiences to those who used it.

However, there were times of the day when more staff were needed to ensure all people’s needs were being met in an appropriate and timely manner. Risks to people injuring themselves or others were not always appropriately assessed and managed.

Staff had a good knowledge and understanding of each person, about their life and what mattered to them. People were mostly complimentary about the way staff interacted with them. Independence, privacy and dignity was promoted and respected by most staff but there was still work to be done to ensure these were core values in the service upheld by all staff.

Care plans reflected the care and support that each person required and preferred to meet their assessed needs and promote their health and wellbeing. Further work was needed to ensure care plans were consistent and demonstrated individual’s differing care needs in terms of interests, social activities, types and stages of dementia.

People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. They were supported to maintain good health and had access to appropriate services which ensured they received ongoing healthcare support.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Staff knew how to minimise risks and provide people with safe care. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. People knew how to raise concerns and were confident that any concerns would be listened and responded to.

People were provided with their medicines in a safe manner but there were times when these had not been provided at the times prescribed. People were prompted, encouraged and reassured as they took their medicines and given the time they needed.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Some work was needed to ensure all staff understood the importance of gaining people’s consent to the support they were providing.

The service had a quality assurance system in place which was used to identify shortfalls and to drive continuous improvement. The provider was working through a comprehensive improvement plan which was regularly updated as changes were being made within the service and as other areas requiring improvement were identified. The directors and management team were open and responsive to concerns we raised and immediately began work on making changes as a result.