This inspection took place on 22 and 23 February 2018. Day one of the inspection was unannounced, and day two was announced.

Eversleigh Care Centre 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. This service provides nursing and personal care for up to 84 people. At the time of this inspection, there were 59 people living at 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. The registered manager was present throughout this inspection.

At the time of our last inspection undertaken on in May 2017, we rated the service as Requires Improvement and found the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not enough staff deployed to safely meet people's needs. At this inspection, we found improvements had been made and the provider was no longer in breach of this regulation. The service is now rated Good.

Staff had time to attend to people's physical and emotional needs. People did not have to wait for help from staff when this was needed. The provider followed safe recruitment processes.

The risks associated with people's individual care and support needs had been assessed and were reviewed as people's needs changed. People received their medicines safely and these were stored in accordance with the prescriber's directions.

People were protected from the risk of infection, and there was an understanding by staff of the importance of infection control and prevention. Where there were concerns about people being at risk of harm or abuse, action was taken to safeguard the individuals concerned.

Staff received ongoing support, training and guidance in their roles. The provider kept staff's training needs under review and arranged additional training in line with the health and emotional needs of people living at the home.

People's rights were upheld in accordance with the Mental Capacity Act. People had access to a range of healthcare professionals, as required.

People enjoyed a variety and choice of foods. People were encouraged to eat and drink, and there were initiatives within the home to raise the awareness of hydration and nutrition, as well as the importance of people's dining experience.

People were supported to express themselves and communicate through a range of different methods. People had individual communication support plans in place, which were followed by staff.

People enjoyed respectful and positive interactions with staff. People were involved in decisions about how they wanted to be cared for. People's independence was promoted, whilst maintaining their safety.

People's changing health and wellbeing needs were responded to. People enjoyed their individual hobbies and interests, as well as having the opportunity to experience new social and leisure opportunities.

There was system in place for responding to and acting on complaints, comments, feedback and suggestions.

The atmosphere and culture of the home was upbeat and relaxed, which helped people to feel calm and happy. Staff, the registered manager and the provider were all striving to achieve the highest possible CQC rating and to provide the best possible service to people living at the home. The registered manager and the service had won local and national awards in recognition of what they had achieved.

The provider had quality assurance measures in place to routinely monitor the quality and safety of care provided.

This inspection was unannounced and took place on 6 February 2017. At the last inspection in February 2016, we found the provider was not meeting the regulations in relation to the safe management of medicines, the overall rating was ‘requires improvement.’ Following the inspection the provider sent us an action plan of what they would do to meet legal requirements of regulation 12, of the Health and Social Care Act (Regulated Activities) Regulations 2014. At this inspection we found the provider was no longer in breach of this regulation. However, we identified a new breach of the regulations and improvements to governance, staffing arrangements and how people received care that was personalised to their needs were required.

Eversleigh Care Centre is registered to provide accommodation with nursing and personal care for up to 84 people including older people, people living with dementia and people with physical disabilities. The home caters for people who require, residential, nursing and respite care. The home is divided into three units, Garden’s House, West Park and Robinswood. On the day of the inspection there were 68 people living at the home.

Although there was no registered manager in post a new manager had been recruited in October 2016 and they advised us they planned to submit an application to become the registered manager once they had completed their probationary employment period. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found there were not always sufficient numbers of staff available to respond to people’s care and support needs in a timely way. People told us they felt safe, but staff were not always able to respond promptly to requests for support. People received their medicines as prescribed and systems used to manage and monitor the administration of medicines were safe. Risks were assessed and managed and any changes to people’s risks were shared with the staff team. The provider carried out pre-employment checks to ensure staff were safe to work with people.

People did not always receive the required support at meal times to enable them to make choices or enjoy their food. People felt that staff had the skills and knowledge to meet their care and support needs. Staff received induction and training which was relevant to their role. People were asked for their consent before care was provided and where people’s rights were restricted this had been done lawfully within the boundaries of the Mental Capacity Act (MCA). People were supported to access healthcare professionals when required.

People told us they received support from staff who were kind, but who did not always take time to engage with them. Some staff were focused on support tasks rather than people. Most people we spoke with felt they were involved in day to day decisions about their care and people and relatives told us staff provided dignified support which protected people’s privacy.

People told us there were not enough leisure opportunities and activities which supported people’s hobbies and interests were not widely available. People and relatives felt they had been involved in the assessment and planning of their care and knew how to complain if they were unhappy about any aspect of their care and support.

Recent management changes meant the home had been without a registered manager since April 2015. Although systems were in place to monitor the quality of the service provided some areas requiring improvement identified at our last inspection had not been addressed. In particular the deployment of staffing at mealtimes. People expressed mixed views about the care they received at the home. People and their relatives had been i

We carried out an unannounced comprehensive inspection of this service on 7 and 15 January 2015. 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 safe care and treatment, regulation 12 of the Health and Social Care Act (RA) Regulations 2014.

During our inspection on the 9 and 10 February 2016, we found that the provider had not fully followed their plan which they had told us would be completed by the 31 July 2015 and legal requirements had not been met.

Since the last inspection the registered manager had left the service and a new manager has been appointed. The manager advised that following our visit they would be applying to CQC to become the 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 on time because medication rounds took longer than required. People’s medical conditions were not always treated appropriately by the use of their medicines because given in the prescribed dosage and some medicines were not being stored correctly.

People were cared for by staff who had a good understanding of protecting people from the risk of abuse and harm. Staff knew their responsibility to report any concerns and were confident that action would be taken.

Staffing arrangements need to ensure there were enough staff who were organised in the right way to meet people’s needs effectively.

Staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were supported.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). However records were not detailed to show which decisions the person would require help to make. People told us that staff sought their consent before providing care and they could choose the support they received.

People’s nutritional needs were met. People were given a choice of meals, however they felt the quality of the food they received could be improved. People were supported with a choice of drinks throughout the day. The manager was working with the chef to improve people’s dining experience.

People were supported to access health care professionals and staff were responsive to the advice received in providing care to people.

Relatives were positive in their feedback about the service and confirmed they were involved in making decisions about care and treatment. Relatives told us people’s privacy and dignity was maintained by staff and we made observations that supported this.

People received care that met their individual needs. Relatives and staff said managers listened to them and they felt confident they could raise any issues should the need arise.

The management team had systems in place to check and improve the quality of the service provided and take actions where required. Some improvements had been implemented but further action was required to ensure that changes were embedded and also further improvements made in a timely way. Staff felt the new management team had made positive improvements to care provided.

We used a number of different methods to help us understand the experiences of people who used the service because the people who used the service had complex needs, which meant they were not able to tell us their experiences.

We found the service had improved in the way they managed medicines. As a consequence we found the service managed medicines safely for the people who used the service.

We carried out an inspection on 20 August 2013 and found that the provider was not meeting the regulations for the management of medicines and records. The provider wrote to us and told us what action they were going to take to put this right. During this, our latest inspection, we looked to see what actions had been taken.

We carried out this inspection so that we could answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with nine people who lived at the home, five relatives, two members of staff who supported people, the registered manager and the area manager. We looked at five people's care records.

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

Is the service safe?

We found that systems were in place to support learning from events like accidents, incidents and complaints. People we spoke with told us they were able to raise concerns they had about the service. One person said, "I give my opinions to any member of staff".

We found that systems had improved since our last visit. Care records were up to date with information that reflected people's current needs and changes. People and relatives we spoke with felt the service was safe.

We found that people were still at risk of poor medicines management. We found there was no proper process put in place to give staff consistent guidance in how to administer medicines through a Percutaneous Endoscopic Gastrostomy (PEG) tube. A PEG tube is used where someone is unable to maintain adequate nutrition by consuming food through through their mouth. 24 hours after our inspection the provider had put a system in place so staff had clear guidance as to how to administer people's medicines through a PEG tube.

We found that one person who was having their medicines administered covertly did not have in place the appropriate documentation to evidence this process was being done within acceptable guidelines. We found that systems were not in place to ensure the safe administering of insulin or to ensure that the storage of medicines were being stored safely.

No applications for the Deprivation of Liberty Safeguards had been submitted by the service. Staff were able to access training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards(DoLS) and the service had an understanding of the process.

Overall we found that the provider did not have adequate processes and systems in place to ensure people were cared for and supported in a way that kept them safe during the administering of their medicines. We have asked the provider to tell us what they were going to do to meet the requirements of the law.

Is the service effective?

We found that people's needs were assessed and there was a support plan in place to meet people's needs. People we spoke with told us they were happy with the support and treatment they got from staff. One person said, "Staff encourage me to get up".

We found that records had improved since the last inspection and changes were being recorded so staff were able to follow people's changing needs. Where people had a particular wish this was being recorded appropriately and where other professionals needed to be involved this was taking place.

Overall we found that the provider had systems in place to ensure people's needs were being assessed and any changes to people’s needs could be identified and actioned appropriately.

Is the service caring?

Records showed that satisfaction surveys were being used to help the provider make improvements to the service. The provider also held relatives meetings to enable people and their relatives to share any concerns they had on a regular basis. Relatives we spoke with told us they were able to attend these meetings.

We observed staff interacting with people. People were being supported by staff in a caring manner. We saw staff supporting people in a patient and caring way allowing people who lacked capacity the opportunity to communicate at their own pace.

Records showed that people's preferences, likes, dislikes and interests were being recorded to support how people's needs were met. Where people had cultural needs these were also recorded on people's care records. Records showed that people were able to practice their religion. One person's file showed that they were able to see their priest regularly. This meant that were supported to practice their religion.

Is the service responsive?

Records showed that people were able to share any concerns they had and the provider had a process in place to investigate their concerns and take appropriate action.

We observed people having access to regular fluids throughout our inspection. Staff proactively asked people if they wanted a drink in some instances. People told us they were able to access a range of activities as part of social interaction. One person said, "Activities are organised, bands, singers, games, jigsaws and the like, but I prefer to read my bible"

Overall we found that the provider had systems in place to meet the requirements of the law in relations to ensuring that the service was responsive.

Is the service well-led?

We found that improvements had been made since our last inspection. Audits were being carried out to ensure the service was meeting people's needs appropriately. We saw evidence of regular audits being carried out by the provider to check on the quality of the service. Where action was required as part of service improvement this was taking place.

We saw improvements in how people's needs were being met. Staff we spoke with were able to explain people's support needs. Staff told us that competency assessments were being carried out to ensure they were able to meet people's needs safely.

Overall we found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensuring that the service was well led.

On the day of the inspection, there were 61 people living at the home. We spoke with six people, two relatives, four staff, the home manager and a senior manager.

People received appropriate care that met their needs. One person said, “They are caring.”

Sufficient arrangements were not in place for the safe handling of medicines to ensure that people received their medicines as prescribed.

Records showed that staff received supervision and training. One person told us, “Staff are good, they help me.”

Improvements had been made to the suitability of premises and risks were being managed appropriately.

Systems were in place to monitor the quality of the service. People’s comments were appropriately recorded and addressed.

Records continued to be insufficiently maintained and failed to ensure that they were fit for purpose, accurate and updated on a regular basis.

We carried out this inspection to check whether improvements had been made in the way people’s care was delivered. There were 49 people living at the home on the day of the inspection. We spoke with three people, two relatives, seven staff, the newly appointed home manager, and the operations manager.

We found that improvements had been made and people received care that met their needs. We saw staff deliver care in a timely manner. One relative said, “Our relative’s care has improved, and we have noticed the change.”

There were enough staff to look after people at the home. Training records showed that staff had access to different training to improve their skills and knowledge. One relative said, “There never used to be enough staff, but now things are different. There is always at least one staff in the lounge.”

We received some information of concern about the environment as there was planned refurbishment work taking place at the home. We inspected the home to follow-up on these concerns.

We spoke with three people, two staff, the operations manager, and another operations manager who was acting as the home manager.

We found that risks related to the planned work had not been identified, assessed, and managed appropriately to ensure the wellbeing of people who lived at the home.

We carried out this inspection to follow-up concerns identified at previous inspections on 28 May 2012 and 2 June 2012.

On the day of the inspection there were 54 people living at the home. We spoke with four people, two relatives, two staff, the proprietor, two senior managers, the home manager, and the deputy manager. There had been some changes in the manager since our previous inspections. A new home manager had recently been appointed and had been at the home for three days when we carried out the inspection.

We found that improvements had been made in the way that people were offered choices and relatives had opportunities to be involved in making care and treatment decisions. One person said, "It's fine here."

We saw that people continued not to receive the care they needed or preferred in a timely manner. We found that opportunities for activities had not improved. We saw that there were limited interactions between staff and people. This meant that people did not always receive care that met their needs.

We found that improvements had been made to ensure that people were safeguarded from abuse.

We found that improvements had been made in assessing and monitoring the quality of the service.

We found some improvements in the daily recording of information. However, further improvements are required to minimise the risk of inconsistent care being delivered.

We spoke with some people using the service they told us that the staff help them to do the things they are now unable to do for themselves. They said the staff are kind and helpful. They said the food was “alright” and that they had enough to eat and drink. One person said that the staff take the meals to them in their room; they prefer this to sitting with the other people in the dining areas. Most people said that they were comfortable and that their accommodation was good. People told us of the recent improvements that have been already been made and those that are planned for the environment.

Some people were unable to comment about their experience of life at the home due to their very frail conditions. We had the opportunity to speak with visitors and relatives of people. They told us they were satisfied with the level of care and support that was provided; they had no complaints or concerns. One person commented how much improved their relative was since becoming resident at the home, they were very pleased with all aspects of the service. Another person spoke of the daily visits to the service to see their relative, they told us that they felt welcome to visit and had got to know the staff well. They thought that their relative was very well cared for.

During this review we saw clear evidence that there are shortfalls in the systems currently in place for planning and managing people’s care. However, most of the people we spoke to told us that they get on well with the staff that look after them, and are generally happy with the care they receive.

Our conversations with managers and people working in the service told us that there have been a number of changes to the staff team since the home’s ownership changed. Changes to some established work practices have taken place, and everyone connected with the home is adjusting to these. Senior staff at the home recognised that the way in which people’s care and support is managed needs to improve. They told us that action is being taken to address this problem. This includes recruiting staff to fill vacancies, updating statutory training for all the staff team, introducing new care plans and reviewing the ways that risks in the home are assessed.

Our inspection took place on 07 and 15 January 2015 and was unannounced. We last inspected the service on 9 July 2014 where we did not identify any areas where the provider was not meeting the law.

Eversleigh Care centre provides accommodation for up to 84 people. The service caters for older people with dementia and people who have a physical disability. The service provides nursing care with nursing staff available 24 hours a day.

The service had a registered manager at the time of our 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 registered manager was leaving but a new manager had been employed by the provider and was working with the registered manager at the time of our inspection.

We found that people had not always received their medicines as needed which meant there was a risk their healthcare conditions would not be treated as intended. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered manager and staff demonstrated awareness of what abuse was and how abuse should be reported in order to keep people safe. Staff were aware of how to report issues to the provider and to outside agencies so that any allegations of abuse would be responded to.

People told us that staff responded when they needed assistance. The views of relatives and staff varied as to whether there was sufficient staff available at the service. The provider had identified issues with staffing due to vacancies in the staff team and was recruiting new staff to address this matter. We found the provider had systems in place to ensure staff were checked before working at the service and that all staff were well trained in important areas of knowledge.

People’s right to make their own decisions was respected and encouraged by staff. Where people were not able to make decisions the provider had consulted with the appropriate people to make decisions in their best interests. Staff followed people’s care plans which informed them what support people needed to ensure their rights were protected.

People’s health and well-being was supported by external healthcare professionals, when required, such as district nurses and doctors, although one relative commented on a delayed referral to dentists. The home was improving the way it managed people’s fragile skin (with support from commissioners) and we saw there was monitoring of people’s health to ensure any risks to people’s welfare were identified.

We saw that people had access to a choice of sufficient meals and drinks. People were complimentary about the food that was provided to them. We saw that people that needed help with eating were provided with appropriate assistance by staff.

Most of the people and relatives we spoke with were complimentary about the staff, describing them as caring. We saw that the care people received showed staff considered people’s privacy and dignity.

People told us that they, or their families were involved in planning and agreeing the care provided to them, where this was their choice. We saw that people had an individual plan that was accessible to them, detailing the support they needed and how they wanted this to be provided.

The provider gathered people’s views in a number of ways, for example through the use of surveys, meetings and face to face discussion. We saw that the provider had a complaints procedure that enabled people to raise concerns, with these responded to appropriately.

People felt they were able to spend their time in the way they wanted and told us they were happy with the opportunities they had for stimulation.

Regular audits were carried out by the provider and registered manager, these used with support from other agencies to identify where the service needed improvement. These audits had not always identified areas where the service needed to improve. The provider had however made some improvements, for example in record keeping although there was still further work needed to ensure these improvements continued.

We found a breach of the law in respect of how the service managed people’s medicines. You can see what action we told the provider to take at the back of the full version of the report.