This inspection site visit took place on 18 January 2019 and was unannounced.

Evedale 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.

The home accommodates 64 people in one adapted building across two floors. On the day of our visit 53 people lived at the home. The home is located in Coventry in the West Midlands.

We last inspected Evedale Care Home in November 2017 and gave the home an overall rating of 'Requires Improvement'. The inspection identified continued breaches of Regulation 14 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not always receive adequate support with eating and drinking to maintain their health. The provider’s quality monitoring systems had not been embedded and therefore, were not effective.

We asked the provider to send us a report, to tell us how improvements were going to be made to the service. At this inspection on 18 January 2019 we checked to see if the actions taken by the provider were effective. A range of improvements had been made and sufficient action had been taken in response to the breaches of Regulations. However, previously demonstrated standards of some aspects of medicine management and administration had not been maintained.

This is the third consecutive time the home has been rated as requires improvement.

The service had 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 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 did not always receive their medicines as prescribed because some medicines had not been in stock. Improvements had been made to the level of detail and accuracy of completed daily records. However, further improvement was needed and action was planned to address this.

People felt safe living at the home. Staff were recruited safely and enough staff were available to respond to people’s requests for assistance. The use of agency staff had reduced which meant people were supported by staff they knew.

Risks to people’s safety and the environment were identified. Staff knew how to manage risks and risk management recommendations made by a health care professional were followed. The home was clean and well maintained. Staff followed good infection control practice.

Care records supported staff to provide personalised care. People and relatives, were involved in planning and reviewing people’s care. Staff were caring and kind. Staff respected people’s rights to privacy, dignity and independence and supported people to maintain important relationships and make new friendships.

Staff received the support they need to be effective in their roles through an induction, regular meetings and on-going training. People and relatives knew how to make a complaint. Complaints were managed in line with the provider’s procedure.

People and relatives shared their views about the home and feedback was used to support continuous improvement. Quality monitoring had improved but further improvement was needed to ensure checks and audits were effective.

The registered manager was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff gained people’s consent before they supported people and respected people’s decisions and choices.

This inspection took place on 29 November 2017 and was unannounced. At our previous inspection in May 2017 we found three breaches of the Regulations. At this inspection we found improvements had been made but there continued to be a breach of two of the Regulations.

During this visit we saw improvements in providing people with support to eat and drink had been made on the first floor of the home; however the improvements for people on the ground floor were only recent and had not yet fully embedded. Therefore the service remains in breach of Regulation 14 (Nutrition).

At our last inspection visit the provider was in breach of Regulation 17 (Governance); and well-led was rated as inadequate. During this visit improvements had been made, but they had not been made for a long period of time for us to be confident they would be sustained, and further improvements were still required. Therefore the service remains in breach of Regulation 17.

At our last inspection visit the provider was in breach of Regulation 18 Registration Regulations 2009 (Notifications of other incidents). During this visit we found one incident which had not been notified to us, but this had occurred before the current manager started to work at the home. They have since sent a formal notification.

Following the last inspection we have met with the provider twice to discuss on-going concerns at the home and actions taken by the provider to improve the service. We have been in regular contact with the provider’s senior management team in relation to issues which have arisen.

Evedale Care Home is a care and nursing 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.

Evedale Care Home accommodates up to 64 people in one adapted building. The ground floor of the building provides accommodation to older people and people with general nursing needs. The first floor provides accommodation to older people with dementia who have nursing needs. The home also provides short term stays of up to six weeks for people who have been discharged from hospital but who require further assessment to determine their future needs.

At the time of our visit there were 47 people who either lived at Evedale or who were on a short term stay at the home. This was because the provider had decided to stop admitting people for longer term care until they were satisfied the home was providing better quality care.

The home did not have a registered manager; however the new manager was in the process of applying to the Care Quality Commission to be registered. 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.

Since our last visit in May, the manager at the time of our inspection visit left the service, and two further managers have worked at the home. The most recent manager is applying to be registered with the CQC. They had been in post for five weeks at the time of our inspection visit. They had worked extremely hard in a short period of time to start improving the quality of care provided.

At our last visit there was a high number of agency staff working at the service to cover the staff absences resulting from staff leaving the service, sickness and planned leave. There continued to be high levels of agency workers but these had been booked over longer periods of time to provide continuity of care; and new staff were being recruited and inducted. Some staff who previously left the service had returned. There were enough staff on duty to meet people’s needs.

There have been safeguarding concerns raised since the la

This inspection was carried out on 25 & 30 May 2017 and was unannounced.

At our last comprehensive inspection of this service on 21 June 2016, we found the provider had not met all of their legal requirements and were in breach of the regulations. This was because people did not always adequately receive support with food and fluids to maintain their health and well-being. After the inspection, the provider wrote to us to say what they would do to meet their legal requirements in relation to the breach. During this inspection visit we found the provider had not made the improvements required, people were not always given the support they required to eat and drink. We found there continued to be a breach of the regulation in relation to this.

Evedale Care Home provides accommodation for up to 64 older people and people with dementia who require support with their nursing and personal care. There were 58 people living at the home at the time of our inspection. The home consists of two floors, the ground floor supports people with general nursing needs and the first floor is the Dementia Unit.

The home did not have 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 persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Since our last inspection the registered manager and deputy manager had left their employment at the service. There had also been three different regional managers appointed by the provider during this time. This meant the home had not had consistent managerial oversight. Continued changes in management had affected staff confidence and staff morale. People and relatives also told us they found this unsettling. At the time of this inspection a temporary manager from the provider’s resident experience team (RET) was overseeing the day to day running of the home whilst a new manager was recruited.

Staff felt unsupported by the provider and did not feel valued or listened to. Constant managerial changes had affected the organisation and smooth running of the home and the provider was working hard to address this.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home; however the provider acknowledged that these had not been maintained. The accuracy of some audits carried out since our last inspection visit in June 2016 could not be assured and the provider was taking robust action to ensure systems and processes were used effectively to assess the quality of the service people received.

The provider’s managing director and management team acknowledged the challenges the home had been through and that improvements were still required. They were taking positive steps to address the issues we identified and to provide support to staff to ensure stability for the home.

The provider had relied on high levels of agency (temporary) staff to support staffing numbers as several permanent staff had also left their employment at the service. This meant people did not receive consistent support from staff who they were familiar with, and who knew how people liked to receive their care. Some people and their relatives told us at times staff were not always available when people needed them.

The provider had also increased the number of staff on duty to support people’s needs; however this created pressure on permanent staff to support agency workers who were not familiar with the home and people’s needs.

At our last inspection in June 2016 the provider told us they were making improvements to the environment on the Dementia Unit to make it more ‘dementia friendly’ and additional training was being provided to staff on the unit. We saw refurbishment was taking place, however staff had no

This inspection was carried out on 21 June 2016 and was unannounced.

At our last comprehensive inspection of this service on 21 October 2014, we found the provider had not met all of their legal requirements and were in breach of the regulations. This was because there were not enough staff to meet people’s care needs safely, and there continued to be an over reliance on bank and agency staff. Risks relating to people’s care had not been fully assessed and call bells were not available to people when they needed them.

After this comprehensive inspection, the provider wrote to us to say what they would do to meet their legal requirements in relation to the breaches. We undertook a focused inspection on the 23 April 2015 to check that they had followed their plan and found they met legal requirements.

Evedale Care Home provides accommodation for up to 64 older people and people with dementia who require support with their personal care. There were 58 people living at the home at the time of our inspection. The home consists of two floors and the first floor is the Dementia Unit.

A new manager had been working at the home since December 2015 and was applying to be registered with us. 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.

We found there was a clear divide between the two floors of the home and the care and support provided. We found improvements had been made on the ground floor since our last inspection; however we still found areas where improvements were required on the Dementia Unit. Some staff spoke of feeling happier and more valued on the ground floor. However some relatives felt there were not enough staff to support their relations on the Dementia Unit.

The manager had already identified this and was working hard to make improvements to bring both floors into alignment with each other. The provider was also investing in making improvements to the environment on the Dementia Unit to make it more ‘dementia friendly’ and additional training was being provided to staff on the unit.

People and their relatives told us most staff were kind and considerate, and they felt people who lived at the home were safe. We observed, and people told us, staff members were caring but did not have time to interact with people unless they were providing personal care and we saw some people on the Dementia Unit left for periods with little interaction.

Staff treated people with kindness. Staff had a good understanding of people’s needs and most supported people with respect, most people told us staff ensured their dignity was maintained at all times.

Most staff told us they were happier working at Evedale because the number of staff on duty to support people’s needs had increased and they felt the new manager was supportive and making improvements to the home.

Most people and relatives were happy with the care provided and staff were committed to providing a good standard of care, however we observed there were delays in attending to the personal care needs of some people on the Dementia Unit.

There were systems and processes in place to protect people from the risk of harm. Most staff understood their responsibility to safeguard people from harm but we saw one incident that should have been referred to the local safeguarding team had not been. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks.

Most people were involved in decisions about their care and told us they received support in the ways they preferred. People were supported to maintain relationships with people important to them and visitors were welcomed at the home

Staff received support from the provider and

We carried out an unannounced comprehensive inspection of this service on 21 October 2014, at which breaches of legal requirements were found. This was because there were not enough staff to meet people’s care needs safely, and there was an over reliance on bank and agency staff. This meant there was a lack of continuity of care. Risks relating to people’s care had not been fully assessed and call bells were not available to people when they needed them.

As a result of the breaches of the legal requirements and the impact these had on people who lived at Evedale Care Home we rated the key question of 'Safe' as 'Inadequate'.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on the 23 April 2015 to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Evedale Care Home’ on our website at www.cqc.org.uk’.

Evedale Care Home provides accommodation for up to 64 older people and people with dementia who require support with their personal care. There were 49 people living at the home at the time of the focused inspection.

A new manager had been working at the home for three weeks. She was applying to be registered with us. 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.

At this inspection on the 23 April 2015, we found that the provider had followed their plan which they had told us would be completed by the end of March 2015 and legal requirements had been met.

People and their relatives told us staff were kind and considerate, and they felt people who lived at the home were safe. Staff told us they were much happier working at Evedale Care Home, because the number of staff on duty to support people’s needs had increased. There was now minimal use of agency and bank staff and people were now being supported by a consistent staff group who understood the risks of the people they provided care for.

Risks to people were being documented more effectively, and people had access to call bells, or were being more closely monitored to ensure the risks to them were minimised.

Two inspectors carried out this inspection on Thursday 24 April 2014, one inspector returned the following morning to complete the inspection. We visited the service from 11.30am to 8pm on the first day and from 9.30am to 12.30pm the second day. We spoke with the registered manager, the regional manager, three visiting relatives, a visiting healthcare professional, two people who used the service and nine nursing and care staff. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We inspected staff rotas and talked with staff. We were made aware the service had been experiencing difficulties in retaining and recruiting staff because of a local hospital’s recent recruitment campaign. We saw sufficient staff had been rota’d to meet the assessed needs of people living at the home. We found there was a high level of bank staff being used and the service had to use agency staff to cover some of the shifts. Staff told us they felt there was not enough staff to meet people’s needs and staff were phoning in sick.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was nobody living at Evedale who had a current DoLs in place.

Is the service effective?

People all had an individual care plan which set out their care needs. These provided staff with the information they needed to support people with their care. Assessments included people’s needs for equipment, skin integrity and specialist dietary requirements. We saw some inconsistencies and insufficient information in some care records which could impact on the care provided.

Is the service caring?

People were supported by staff who were kind, caring and patient. We saw staff were very busy throughout the time we were inspecting the service. They did not have time to sit and talk to people unless they were supporting them to eat. However, when staff were undertaking care tasks or talking with people, they treated people with dignity and respect.

We spoke with three relatives and two people who used the service. One person told us, “Staff are busy but they will do things if you ask them.” A relative told us, “We can’t speak highly enough of the staff, the care is so much better here than the previous home.”

Is the service responsive?

People had access to a range of health care professionals, some of which visited the home. During our inspection we observed a GP visiting a person, and a speech and language therapist visiting another. They told us, “They (staff) seem to be quite proactive in phoning us when things change.” We also saw a person being taken to hospital accompanied by one of the care workers. This meant the service responded to the changing health needs of people living at Evedale.

The service was less responsive to people’s social needs. There was little time available for staff to sit and talk with, or undertake social activities with people. The service employed one activity co-ordinator who worked each week day. They were responsible for providing activities and social stimulation for the 55 people living at the service. One person living at the home told us, “It’s boring here.”

Is the service well-led?

The regional manager and manager told us the service had been going through a challenging period since our last visit. We saw the regional manager was supporting the manager to ensure systems designed to assure the quality of service were fully implemented. They were also supporting the manager in dealing with the challenges in recruiting and retaining staff.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People’s personal care records, medication records and other records kept in the home, had been identified by the organisation as requiring improvement. The service was working to the company’s action plan in addressing the areas of concern.

Our visit at Evedale started at 9.30am and finished at 6.15pm. During this time we observed the support staff gave to people living at the home. We spoke with people, their relatives, staff, and management. We also looked at a sample of care and staff records.

We observed staff to be kind and considerate to people living at Evedale. We saw people being treated with respect and their dignity was being maintained. Care records showed that people with high dependency needs were being well cared for.

The majority of the relatives we spoke with were pleased with the care received by people living in the home. One relative told us, “The care is marvellous…the carers are warm towards X.”

We looked at the equipment used in the home. We saw sufficient equipment to meet the needs of people living at Evedale. Equipment was satisfactorily maintained.

We looked at staff recruitment. We noted the recruitment procedure ensured all the appropriate pre-employment checks were carried out to support the safety of people living in the home.

We looked at the complaints procedure. We saw the small number of complaints received by the service had been thoroughly investigated and action taken when necessary.

We checked whether the service had good systems in place to safeguard people from abuse. We were satisfied that staff understood how to safeguard people in their care.

We looked at nutrition. We saw people were given good support to meet their nutritional needs.

We visited Evedale Care Home to follow up concerns raised at our last inspection on 2 August 2012.

We saw people having a relaxed breakfast time, enjoying a choice of food, and a choice of whether to eat in their bedrooms or in the dining room.

We spoke with staff who told us staffing levels had improved since our last visit. We saw staff taking their time with people to help them get up and dressed. We saw people being treated with dignity and respect.

We looked at staffing levels and noted these had increased since our last visit. We saw this having a positive impact on people living at Evedale.

We saw an activities co-ordinator on duty. They were talking to people on a one to one basis. On the day we were there they had planned a group activity called 'current affairs'. This was to help people keep up to date with information read from newspapers.

We observed and talked to people in the different lounges. Due to their conditions, it was not possible to speak with people at length. We noted from facial expressions and limited conversations that people were content.

We spoke with one visitor who told us they had been pleased with the care their loved one received.

We looked at three care records and these gave good information about the care and nursing needs of each person. These had been regularly updated, and demonstrated that changes in the person's care needs had been acted upon in a timely manner.

We visited Evedale Care Home on 2 August 2012. There were 58 people living in the home at the time of this visit. All had nursing needs. 29 people had dementia care needs, and 29 were in the home under ‘continuing health care’. This meant they had a highly complex medical condition that required a lot of care and support or needed highly specialised nursing support. No one knew we would be visiting. We spoke to people who lived at Evedale, but only one in detail about the service provided. We also spoke with eight sets of visiting relatives, five staff members, the manager and the regional manager. We spent time observing the care provided to the people who lived at Evedale.

We saw people's rights to make decisions about their care and treatment were recorded and respected. Where people could not make decisions, family members were involved on their behalf. Relatives spoke positively about staff respecting people's privacy.

The manager informed us that the position of activities co-ordinator had been vacant for three months. We saw the vacancy was having a detrimental effect on people as they were not being supported to engage in meaningful activities. The provider was recruiting to the post at the time of our visit.

Records of care were not always accurate and did not clearly record the challenging behaviours of some of the people who lived at Evedale. We also identified areas where risks were not being managed to maintain health.

Staff had received training in safeguarding vulnerable adults and understood the need to report concerns. Where issues required referral as a safeguarding concern, the relevant notification had been made.

During our visit we observed staff were completing personal care tasks but had little time to talk and communicate with people. Family members spoke highly of the staff but used phrases such as "they are very short staffed", "they haven't got enough staff" and "they are very overstretched". Staff spoken with also told of staff shortages. They said they would like people to have more choices and more care that reflected their individual personal needs.

There were processes and procedures in place to monitor the quality of the service provided.

This inspection took place on 21 October between 6.45am and 7pm. It was unannounced. We went back to the home the following week to meet with the manager and regional manager who were not available on the day of our unannounced inspection.

At our last inspection in April 2014 we identified concerns with the number of agency and bank staff used and the lack of consistency in care. We also identified concerns with medication management and record management. Following this the provider sent us an action plan which told us about the improvements they intended to make. At this inspection we found there were still improvements to be made in these areas.

Evedale Care Home provides residential and nursing care to a maximum of 64 people. It provided care to older people, people with dementia, and people with mental health conditions.

Since our last visit, the registered manager resigned but had not applied to have their registration cancelled with the Care Quality Commission. The name of the manager at the front of this report is therefore not the name of the person who is currently managing 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. The new manager had not applied to be registered with us at the time of our inspection.

There were not enough staff to meet people’s needs. The provider was trying to fill the gaps in the rota with agency and bank staff. The use of agency and bank staff to cover staff vacancies meant people were not provided with continuity of care by people who knew them well. The ‘staffing tool’ used by the provider did not provide sufficient staff to meet the needs of people or take account of the size and layout of the building.

We saw staff were kind and most of them were attentive to people when they provided personal care. However, staff interaction with people was mostly when supporting people with care tasks. We saw little involvement between staff and people at any other time of the day. There were no activities and no opportunities available for people to pursue their individual interests or hobbies.

Medicines were mostly administered safely, although some areas of administration needed improvement to ensure that people received their medicine safely.

Staff had not ensured people who could use call bells had easy access to them.

Care records were not always fully completed. We could not be sure if care had been delivered to people in accordance with the person’s care plan.

People’s nutritional needs were met but they had varied experiences at mealtimes because some people did not receive the dedicated one to one support they required to eat and drink, and the provider had not considered how best to ensure people with dementia received a choice of food.

Permanent staff had received training required to undertake their work safely. We found they had not recently received sufficient supervision or support from management to help them work effectively.

We found safe recruitment practice and staff understood how to protect people who used the service from abuse.

We found the service met the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

The home had been through a period of management change and as a consequence staff had been through an uncertain and challenging period. The provider was aware there were concerns at the service and they were working with the new manager to improve the quality of care provided to people.

You can see what action we told the provider to take at the back of the full version of the report.