Archived: Eldonian House

This inspection was also to follow up on the concerns which were identified in a previous inspection on 18 and 19 August 2015. The home was rated as ‘requires improvement’ overall and was rated ‘inadequate’ for the well-led domain Following the inspection we issued a notice to stop any further admissions to the home. The statutory notice we issued remains in place at this inspection.

Eldonian House is a purpose built care home for 30 older people 22 people were living at the home at the time of our inspection. . It is part of the Eldonian Village community in the Vauxhall area of North Liverpool, close to the city centre. Accommodation includes all single bedrooms with en-suite facilities, two main lounges and a dining room. The home was built by the Eldonian Community but is now operated by Raydonborne Ltd who operates the home on a leasehold basis.

There was not a registered manager they had left two weeks prior to our inspection. However the deputy manager had applied to the Commission to become 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.

During our last inspection in August 2015, the home was in breach of one regulation regarding the safe management of people’s risks. Some people did not have risks appropriately assessed. We also found that people had not been referred to dieticians when there were concerns around their food/fluid intake, and we did not find a nutrition risk assessment/care plan to manage these concerns or improve people’s health. During this inspection, we could see that improvement had been made and risk assessments were in place and had been reviewed in relation to nutrition and pressure care. People had care plans in place which contained personalised information. The home was no longer in breach of this regulation.

We saw that staff were not always supervised or appraised. Staff told us they had not had a regular supervision and records confirmed this.

We saw the home did not have a thorough complaints procedure in place, the procedure was not displayed in a place readily accessible for people and complaints were not managed well. The complaints policy had not been reviewed since 2012.

We saw that the home was not always operating in accordance with the Mental Capacity Act 2005 (MCA). Applications to deprive people of their liberty were not always submitted and one application had expired without the home realising.

During our last inspection in August 2015 we found the home in breach of regulations relating to the quality assurance of the home. This was because medication audits and audits on peoples care plans and risk assessments were not always effective and did not pick up any errors or omissions. We found during this inspection that most of this had been addressed and quality assurance procedures were regularly being checked and audited. However, even though these systems were much improved they had not highlighted that people’s liberties were being unlawfully restricted or their DoLS had expired. We could see that the deputy manager, having only been in post two weeks, had not audited the DoLS applications yet. They had highlighted that staff supervisions were overdue, and the deputy manager had devised an action to address these. The home was no longer in breach of this regulation.

People told us they felt safe living at the home. Relatives of people living at the home told us they felt their loved ones were safe.

Staff were recruited safely and the relevant checks had been carried out on staff before they started work.

Staff we spoke with understood what constituted as abuse and knew what actions to take if they felt someone at the home was being abused. There was a safeguarding adults policy in place for the staff to refer to.

People living at the home were protected with the risks associated with the safe administration of medications.

The home was clean and tidy, there was an issue with regards to the central heating at the time of inspection, however we received information that this has now been addressed.

We observed warm and caring interactions between staff and people who lived at the home. Staff we spoke with clearly demonstrated knowledge of the people they supported, and could explain how they maintained peoples dignity and respect.

We saw that people were supported to access other medical professionals, such as the GP, if they felt unwell.

The food was plentiful and flavoursome, and we saw if someone did not want what was offered they were given something else to eat.

Staff told us the deputy manager of the home was approachable and was working hard to ensure staff felt supported.

The concerns we identified are being followed up and we will report on any action when it is complete.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager. People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were managed. Staff had been provided with up to date training in a range of topics including safeguarding people from abuse the Mental Health Act (2005) and Deprivation of Liberty Safeguards (DoLS) .

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. People who lived at the home felt included in making decisions about how the service was run. We found that improvements had been made to how people were involved in decisions about their care and support. People's care and support had been reviewed and care plans updated. Staff had been provided with up to date training in a range of topics including safeguarding people from abuse.

Is the service caring?

People who lived at the home and their relatives told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity. People were supported by attentive staff who were readily available to support them. We saw that staff showed warmth and familiarity when supporting people.

Is the service responsive?

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. People's feedback was then used to make improvements to the service.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on practice and seeking the views of people who lived at the home. Staff felt well supported and records we reviewed confirmed that staff were appropriately skilled and experienced to carry out their role. During and after our inspection visit we discussed the lack of a registered manager with the current service manager. During our discussions it was stressed to management that the processes for formal registration of a registered manager should be undertaken immediately.

We found appropriate care plans and risk assessments in place. These were sufficiently detailed, individualised to each person and reviewed regularly. However, we saw limited evidence of involving people in planning their care and establishing consent. We observed staff providing care and found they were warm, polite and respectful in their interactions. Staff had a good understanding of the needs of the people that used the service. This view was shared by the relatives we consulted.

We looked at the policies and procedures in place for the management of medicines. We found a number of inaccuracies in medication stock when compared with the records. This demonstrated that the service was not effectively protecting people against the risks associated with the unsafe use of medicines.

We found evidence of the service cooperating with other providers in order to ensure people's health and social care needs were met. The service had an appropriate complaints policy and procedure in place.

Everyone we spoke with told us that staff had provided people with the support they had needed and were always polite and respectful. Comments included, 'Oh they are good, I tell them what I want and they do it', 'The carers are very nice. I would sooner be at home but prefer this care home to any others' and, 'Excellent, I have no complaints. They listen to what I want'. Relatives told us that they were satisfied with the support provided to people.

People told us that they had always had enough to eat and drink and alternative meals had always been available. Their comments regarding the quality of the meals provided included, 'we eat it' 'edible' and could be better'.

People told us they had been consulted about their care and that staff listened to them. Relatives had mixed views, some said that they had been fully involved and others said they would like more involvement. The manager was aware of this and was taking action to included relatives, where appropriate, in care reviews.

Throughout our visit we observed that there were sufficient staff to meet people's needs. This was confirmed during our discussions with people who told us support had always been available.