About the service:

•Evergreen Care Home is a care home providing personal care and accommodation for up to 24 people. At this inspection 16 people lived within the service.

People’s experience of using this service:

• People were not always protected from the risk of harm. New staff did not receive any formal training or competency checks. Staff had limited awareness of how safeguarding issues could be escalated to other agencies. We observed some poor infection control practices as staff did not have easy access to personal protective equipment and there was insufficient sanitary waste bins. The provider had a recruitment process to ensure the appropriate checks were carried out when recruiting staff. People received their medicines as prescribed although the procedures for administering homely remedies were not robust

• There were mixed views about the quality and quantity of the food provided, some people told us the food was good whilst other people’s views were not so positive. Staff supported people to access health care when needed.

• People did not always receive care and support that respected their dignity and privacy. People’s views on the staff that supported them were mixed. Some people thought staff were kind and caring whilst other people’s views were not so positive. People’s equlity and diversity was respected.

• Care plans in place for people were limited in detail about how people would like their care to be provided although staff knew how to care for people in practice. People were not always involved in reviews about the support they received. People told us they felt bored and there were not enough activities. The provider was in the process of recruiting an activities co-ordinator in order to provide more activities for people. People’s views on how complaints were handled varied.

• The registered manager and provider did not understand the legal requirements within the law to notify us of Deprivation of Liberty Safeguards (DOLS). Risk assessments contained conflicting information and though updated did not not give clear information of peoples’ needs. There was a lack of robust oversight of accidents and incidents. Staff consistently reported feeling undervalued and not listened to. Leadership arrangements were unclear. The environment was clean and comfortable. The registered manager and provider did understand the legal requirements within the law to notify us of other incidents of concern, deaths and safeguarding alerts.

Rating at last inspection:

•Rated Good (Report published 17/11/2015).

Why we inspected:

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

Enforcement

•Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

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

The inspection took place on 17 November 2015 this was an unannounced inspection. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using, or caring for someone who uses this type of service. Our expert by experience had experience of using this type of service.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People felt safe with the staff that supported them because staff knew how to protect people from harm. Procedures were in place that ensured the service was safe and that people’s rights were protected.

People were supported with their medication and staff had been trained.

There were sufficient numbers of suitably recruited staff available to support people and keep them safe. Relatives and people that lived there felt that the staff were good. Staff had received training that ensured they had the skills and knowledge to care for people.

People were consulted about their care so their wishes, choices and preferences were known so they could receive care on an individualised basis.

People were supported with their nutritional and health care needs, and referrals were made when needed so people’s health care needs were met.

People were supported to undertake activities of their choice in the home and out in the community.

Systems were in place to monitor and check the quality of care provided and where changes for improvement were required we saw that action was taken.

During our inspection we spoke with four relatives, two staff, the manager, one visiting professional and six people who lived there. We did this to give us an overview of the experiences that people had, to determine the standard of care provided and the satisfaction of the people who used the service. All the people we spoke with gave positive comment about the service provided. Our conversations with people and their relatives helped us to answer our five questions we always ask.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All relative spoken with told us that they felt reassured that their relatives were safe with the staff that supported them. One relative told us, “No concerns about the care or the staff.” All the people we spoke with who lived there told us they felt safe. One person told us, “I think staff are very willing to help no matter what you ask for.’’ Another relative told us, “The staff are polite and helpful nothing is too much trouble.”

All the staff that we spoke with confirmed that they had received training on how to protect people and understood what safeguarding people meant. They told us that the training was updated when required.

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes. This is a domiciliary service. No one using this service was subjected to an application to deprive them of their liberty. The manager was aware of what procedures to follow in the event that an application was made.

Records sampled showed that the provider had systems in place to establish whether people had capacity to give consent to care and were able to make informed decisions. Staff spoken with understood about people making decisions and how to respect their rights.

All of the staff spoken with were able to tell us about the needs of the people they were supporting. This meant staff were knowledgeable about how people wanted to be supported.

Is the care effective?

Records sampled showed that people who used the service and their relatives, where possible, had been involved in an assessment of their needs. This meant that people were able to influence the care they received.

Care plans and risk assessments were in place to ensure that people received safe and appropriate care.

Is the service caring?

We saw from daily records sampled that where staff had concerns about people’s health, additional support was provided or other health care professionals were made aware and advice sought. We saw that reviews of people’s care needs were completed. This ensured that the service provided met people’s changing needs. All the people we spoke with told us that they were happy with their care and one person told us, “ We could not ask for better staff than we have here’’.

We saw staff responded to people’s requests by speaking to them using their preferred name. For example, their chosen name or if they liked to be called a shortened version of their name. We saw that staff interacted well with the people who lived there in a respectful and caring way. This meant people were addressed as they preferred and with respect and kindness

Is the service responsive?

Records sampled showed that there were systems in place to gather the views of people so that the service was developed taking into consideration the views of staff and people who received a service.

Is the service well led?

We saw that there had been a staff team for a number of years so people had continuity of care. There was a manager that had been registered with us and was responsible for the day to day running of the service. This meant that people knew the people that supported them.

Staff told us they were clear about their roles and responsibilities and had regular staff meetings. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This ensured that people received a good quality service at all times.

On the day of the inspection, there were eighteen people living at the home. We spoke with seven people who used the service, four relatives, three staff members and the home manager.

People were asked about the care they wanted. All the people spoken with told us staff ask them before they do anything. One person told us, “They ask me what I want, the staff are good like that.” This meant people were consulted about their care.

People received care that met their needs. One person told us, “This place is smashing, you cannot fault a thing.” People had access to other healthcare professionals when needed. This meant people’s health and welfare was monitored.

We saw that systems were in place to keep people safe from harm. Staff received a range of training to support the people who used the service. One person told, “There's no safer place I think, we are all looked after here’’.

The arrangements in place for the safe handling and storage of medicines were not robust and did not ensure people received their medicines as prescribed.

All staff spoken with told us they were supported and received the training they needed to care for people.

There were systems in place to monitor how the service was run to ensure people received a quality service however some audits completed were not robust to ensure all aspect of the service provided was monitored.

Records were stored securely to ensure people’s personal information was protected.

People told us what it was like to live at Evergreen Rest Home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a second inspector and an Expert by Experience that is a person who has experience of using services and who can provide that perspective. We were also joined by a practising professional, a person currently working the medical field.

Seventeen people were living in the home at the time of our visit. We spoke with the majority of people sitting in the lounge in general and three people in depth about their experience of living at the home. We also spoke with three relatives, three staff, the owner of the home and two healthcare professionals visiting the home. To help us understand people's experiences we observed care and their interactions with staff.

We saw that staff treated people with warmth and respect most of the time. We saw staff giving sufficient time for people to respond to questions, listening to and acting on their responses and assisting them discreetly when providing personal care. One person told us, “Staff are great – friendly and nothing’s too much bother.” A family member told us, “The staff are really nice, I feel like they understand (my relative) and try to do their best by her.” This showed that people were treated with dignity and their privacy respected.

People told us that they were happy with the food and were given choices at meal times. The meals served looked appetising and portion sizes varied according to people’s needs. We saw that staff provided people with the support they needed to eat their meals and encouraged people to eat independently where possible. People’s food and drinks were monitored to ensure that their dietary needs were met.

Records were stored securely and were easily accessible. However the detail in care plans did not ensure that new staff would have sufficient information to meet people’s needs.