We inspected Euroclydon Nursing Home on 22 November 2018. Euroclydon Nursing Home is registered to provide accommodation and nursing care to 48 older people and people living with dementia.

We carried out this inspection following concerns raised regarding the service in November 2018, these concerns were focused on the safety of people, in particular skin integrity care and the responsiveness of staff to people’s safe care and treatment. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Euroclydon Nursing Home on our website at www.cqc.org.uk.

At the time of our inspection, 30 people were living at Euroclydon, one of these people was in hospital at the time of the inspection. Euroclydon is based near Drybrook in the Forest of Dean. Eurocluydon has accommodation for people over two floors. The home had an enclosed garden which people could enjoy, as well as a lounge diner, and two other communal lounges. The home was undergoing a range of refurbishment work which had reduced the current occupancy of the home.

We previously inspected the home on 27 January 2018. The service was meeting all the legal requirements and we rated the service as “Good” overall. At this inspection in November 2018, we only looked at ‘Is the service safe?’ and ‘Is the service well led?’ questions. We found concerns that people’s medicines had not been administered as prescribed. Some of the systems operated by the management were not always formalised, meaning concerns around the management of medicines had not been identified. At this inspection the service was rated as ‘Requires Improvement’ overall.

There was no registered manager in place at Euroclydon. The manager 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.

People and their relatives told us they were safe living at Euroclydon. People’s risks had been clearly assessed and guidance was in place for nursing and care staff to follow. Where people were cared for in bed, they received effective support to maintain their skin integrity. Staff we spoke with were able to tell us how they assisted people to reduce their risks and prevent them from avoidable harm.

People did not always receive their medicines as prescribed. Nursing staff did not always maintain an accurate record of when they had assisted people with their prescribed medicines.

There were enough staff deployed to ensure people’s health needs were being met. The manager had systems to learn from incidents and accidents and reduce future incidents of preventable harm and share this information with staff. Where people had an accident, care staff followed recognised post-accident protocols.

The manager and provider had some systems to monitor the quality of care people received at Euroclydon, however these were not always robust or consistent. Audits were not always effective at identifying concerns that we found in relation to the management of medicines. There were not always structured systems in place to seek and act on the views of people and their relatives, including a log of communication.

We found one 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 this report.

The inspection site visits took place on 27, 29 and 30 January 2018. The first day of the inspection was unannounced. This was our third rated inspection of this service.

Our first rated inspection on 22, 23, 27 and 28 July 2016 found a breach in relation to the cleanliness of the environment. Improvements were also needed to the activities in the home as well as people’s care plans and mobility support. The service was rated Requires Improvement.

During our second rated inspection 7 February 2017 we found the provider had taken action and had made the required improvements. We again rated the service Requires Improvement as these improvements needed to be sustained over time in order for the home to be rated Good.

At this inspection we found all improvements had been sustained and the home’s overall rating improved to Good.

Euroclydon Nursing Home 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. Euroclydon Nursing Home provides accommodation, nursing and personal care. The home specialised in providing care to people who lived with dementia and to some with specific physical disabilities.

The care home is registered with the Care Quality Commission (CQC) to accommodate 48 people. Since 2016, the provider has accommodated no more than 27 people in one adapted part of the building. This is because alterations for the use of the rest of the building are in progress. At the time of our site visit 27 people were accommodated.

Accommodation comprised of single bedrooms with private washing facilities and sometimes toilet facilities, a window, bedroom furniture and heating. People had the use of several communal rooms. There were ample communal toilets and bathrooms. A conservatory provided access to an enclosed garden. People who lived at Euroclydon Nursing Home had access to the provider’s day centre which was on site. There was parking for eight visitors with one designated disabled parking space.

A registered manager was 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.

People were kept safe because staff assessed risks which may have an impact on people and managed these effectively. People were protected from abuse and discrimination because staff had received training on these issues and knew how to recognise them and report concerns. There were enough staff, who were safely recruited, to meet people’s needs. People received support to take their medicines as prescribed. People lived in a home which was clean and where there were infection control arrangements in place.

People’s needs were assessed prior to admission and thereafter to ensure these were identified and met. People were cared for by staff who had received appropriate training and support. People received help to eat and drink, were provided with a choice of food and their nutritional wellbeing was supported. The principles of the Mental Capacity Act were adhered to. 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 home supported this practice. Adaptations had been made to the environment to support people’s mental and physical needs.

Care was provided in a kind and compassionate way. Staff took into consideration people’s wishes and preferences and tailored their care around these. Staff were skilful in communicating with people and supporting them to live well with dementia. People’s dignity and privacy was upheld. Relatives and friends were mad

We carried out an announced comprehensive inspection of this service on 22, 23, 27 and 28 July 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements, in relation to the cleanliness and maintenance of the care home.

We undertook this focused inspection on 7 February 2017 to check that they had followed their plan and to confirm that they now met legal requirements. We found legal requirements had been met and work was in progress to achieve other improvements which were not a breach of legal requirements. This report only covers our findings in relation to these legal requirements and progress on other improvements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Euroclydon Nursing Home on our website at www.cqc.org.uk.

Euroclydon Nursing Home is registered with the Care Quality Commission to provide care and accommodation to up to 48 people. At the time of our visit 27 people with varied physical needs were receiving care, including some people who lived with dementia.

The registered manager was present during the inspection. 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.

The care home was clean and maintained. Work still needed to be completed to secure the garden but people were not using this at the time of our visit and this was due to be completed soon. Refurbishment of the area where people lived had been completed. This had included redecoration and replacement of floor coverings. Improvements had been made to fire safety, security and window safety. Changes had been made to how cleaning and maintenance tasks were carried out so that the improvements so far could be sustained. Additional staff had been recruited since the last inspection which had enabled these improvements to be achieved.

Some improvements had been made to how activities were being provided for people to enjoy. Staff were receiving additional support sessions in relation to moving people safely. Work was in progress on improving people’s care plans.

The inspection took place on 22, 23, 27 and 28 July 2016 and was unannounced.

Our last inspection was in August 2015 when we followed up a breach in regulation related to medicines. We found the provider had met this fully.

The care home's environment was being reconfigured and the provider's business restructured. In the care home, what used to be a separate dementia care unit called Bluebell had been opened up and incorporated into a new 28 bedded unit which was now housed in the extension end of the main building. The main building was to be entirely closed off from this unit once the last people had moved into newly allocated bedrooms. Relatives in particular had found this change difficult as had the staff. The people had needed to adapt to bedroom moves and, for those originally in the small dementia care unit, having more people around them. Modifications and refurbishment were also still taking place in the extension area. This was an unsettling time but the registered manager told us the changes were necessary and were sensible business decisions.These changes would enable the provider to carry on providing a nursing home service to the local community. Plans for the older main part of the building were not yet finalised.

The registered manage had been registered with the Care Quality Commission since July 2012. 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.

Despite the changes taking place in the environment the service was not as safe as it could be. Areas used by people were not kept clean or maintained well enough. You can see what action we told the provider to take at the back of the full version of the report. We also made three recommendations; that the service seek advice from a suitable source regarding the numbers of staff that need to be recruited and the numbers of staff required to be on duty to meet people’s individual needs. Also, on what kind of window restrictor would be most appropriate to keep people safe and to review staffs’ training in moving and handling to ensure it gave them the skills they required. There were other good arrangements in place in relation to people’s safety.

People were cared for by kind and compassionate staff who understood them as individuals and their specific needs. Home cooked food was provided which looked appetising and smelt inviting. People who were at nutritional risk were monitored and action was taken to help the, for example, gain weight or swallow their food more easily. People who lacked mental capacity were protected under relevant legislation because the staff followed its principles. This meant staff were supported to make as many decisions as they could independently but when they were unable to decisions were made on their behalf and in their best interests. Staff actively involved other health care professionals and relatives in the planning of people’s care and when best interests decisions needed to be made. People’s health was reviewed regularly by their GP and the care home had a good working relationship with the local GP practices. Staff were always able to get advice when needed from other health care professionals.

There were opportunities for social activity although these needed to become more personalised. Information had been gathered about people’s life histories, their hobbies and interests before they had become ill so the staff had the information they needed. This now needed to be used in a more meaningful way. There were arrangements in place for people to raise a complaint and have this investigated and resolved where possible. The registered manager provided strong leadership. They communicated with relatives and staff through meetings and on

We carried out an unannounced comprehensive inspection of this service on 25 February 2015. A breach of legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to medicines.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Euroclydon Nursing Home on our website at www.cqc.org.uk.

This inspection took place on 10 August 2015 and was unannounced. The service cares for people who have physical needs and for those who live with dementia. It can accommodate up to 42 people and at the time of this inspection there were 41 people receiving care.

A registered manager was employed. 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 the last inspection on 25 February 2015, we asked the provider to take action to make improvements in how medicines were administered. This was to ensure people received their prescribed medicines safely. This action had been completed.

We found all staff who administered medicines had discussed the process of safe medicine administration with the registered manager. Their awareness had been raised in relation to ensuring people had taken their medicines after they had been given them. Various arrangements had been made to ensure people were not prescribed medicines they no longer required and to ensure the staff who administered medicines were able to do this in an unrushed and undisturbed way.

We carried out this visit to check if shortfalls found at our inspection in November 2013 had been met. Our inspection of 7 November 2013 found when a person's capacity to consent was unclear, due to their having an illness such as dementia, legal requirements had not always been met. The provider wrote to us and told us mental capacity assessments would be completed for people where they may lack capacity and these would be kept under regular review. Where people were assessed as lacking mental capacity for specific decisions consent would be sought from appropriate relatives and professionals. The provider told us these changes would be implemented by 30 January 2014.

At this visit we found the compliance action set in November 2013 had been met. We looked at the care records for five people and found assessments of individual’s overall mental capacity and their ability to make specific day-to-day decisions had been completed. We saw where significant decisions needed to be made for people best interest meetings had taken place, involving other professionals as well as family members and advocates.

We also checked how the home was staffed because we had received information raising concerns about inadequate staffing levels. We looked at staff rotas, spoke with staff and observed people during a lunchtime period. We found there were enough qualified, skilled and experienced staff to meet people’s needs.

When people had capacity to consent they were asked for consent before care was provided and staff acted in accordance with their wishes. When a person's capacity to consent was unclear, due to their having an illness such as dementia, legal requirements had not always been met.

One person said, “They knock on the door gently in the morning and if you want to spend the day in bed, that’s fine. If you want to see a doctor, one comes. If you don’t want a male carer, they get you a female…They are very, very, very good”. We saw several examples of excellent care, in particular in supporting people with dementia. The way staff interacted with people in the dementia care unit created a calm and reassuring atmosphere where people were enabled to engage with the activities taking place and the people around them.

Arrangements to safeguard people were clearly embedded, no safeguarding incidents had occurred at the home since our previous inspection. Staff felt well supported and told us they received appropriate training to enable them to meet people’s needs. One said, “We have a lot of training courses. We are trained brilliantly”. Another said, “The training is really really good”.

Systems were in place to monitor the quality of the service and people were able to make complaints and suggestions. Staff demonstrated commitment to their roles. One person said, "I have never needed to complain. If they asked me to leave this place, I would weep. I love this place".

This inspection took place on 25 and 26 February 2015 and was unannounced.

At the last inspection on 25 June 2014 we asked the provider to take action to make improvements to how the home was kept clean and in how it was maintained. The registered provider told us they would meet these legal requirements by 1 November 2014. We found these actions had been met.

The service predominantly cared for older people and could accommodate up to 49 people. At the time of the inspection 39 in total were cared for. A separate unit provided support to people who lived with dementia.

There was a registered manager. 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 person’s have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Arrangements for the management of medicines were generally good but some people had not had their medicines administered correctly and this had resulted in them not taking their medicines as prescribed. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The evidence was gathered prior to 1 April 2015 when the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 came into force. You can see what action we told the provider to take at the back of the full version of the report.

People were safe because the environment was cleaner and better maintained. People were protected from abuse because staff knew how to recognise this and report any allegations of abuse. Staff knew how to raise their own concerns, if they had any, and were aware of how to contact relevant external agencies if they needed to. People’s human rights were upheld and people were not discriminated against. Robust staff recruitment practices ensured people were protected from those who may not be suitable to look after them. Accidents and incidents were responded to quickly and monitored.

People’s needs were met and their risks managed. This was despite, at times, the staffing numbers falling below what the management staff ideally wanted to provide. This subsequently had meant that some people had not received their support at a time that they would have preferred to have received it. People received the care and support they needed from staff who had the skills and knowledge to provide this. Staff received training and support and were actively encouraged to improve their practice and knowledge.

People’s consent was sought before they received care and treatment and people who were assessed as lacking mental capacity, were protected under the appropriate legislation. People received support to eat and drink and any related risks were managed.

The people staff supported mattered to them and they provided their care with compassion and understanding. People’s dignity and privacy was maintained. People were recognised as individuals and the people who mattered to them were included and communicated with where possible. People who lived with dementia were looked after by staff who had a real passion for this area of care and who delivered very person centred care. People’s care was planned with them or their representatives if more appropriate. People’s views and preferences were sought and included in the planning of their care. People had opportunities to take part in a large selection of activities, if they wished to. Activities were designed to be meaningful to the person taking part. People generally told us their concerns and complaints were listened to and responded to, although because of the way these were recorded, it was not possible for us to ascertain if this was always the case.

The service had a strong leader who ensured all staff knew what her expectations were and that these were met. Staff worked well together and were predominantly driven to ensure people were cared for well. Staff and people were actively encouraged to be involved in contributing to decisions made about the service. Monitoring arrangements ensured the services were provided safely and consistently.