Emberbrook

Emberbrook is a care home which provides nursing care and accommodation for up to 68 people, some of whom may be living with dementia. The home is divided into four units; two on each floor, each with their own lounge and dining areas. At the time of our inspection, 63 people were living at the service.

People’s experience of using this service and what we found

We were given mixed feedback about staffing levels, particularly in some parts of the service. There were similar views in relation to activities taking place in the service. The registered manager had recognised these areas required improvement; however, we have issued a recommendation in relation staff deployment to the registered provider.

People felt safe and well cared for at Emberbrook. They told us staff were kind, caring and showed them respect. People felt well known by staff and they received safe, effective and person-centred care. People told us their lives had improved through staff attention and access to health care professional input.

People received the medicines they required and they were provided with sufficient food and drink to help maintain their well-being. People lived in an environment that was checked for its safety, kept clean and one that was suitable for their needs. People were supported to personalise their rooms and there were communal areas that people could use.

People were cared for by staff who felt supported by their managers and staff who received sufficient training to help ensure they had the relevant skills for their role. Staff were recruited through a process which helped ensure they were suitable to work in this type of service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People knew how to raise any concerns or complaints and they were given the opportunity to participate in the running of the service through meetings. People said they received a good level of care and they were happy living at Emberbrook.

Relatives gave equally positive views about the care their family member received. They told us communication from management was good and relative meetings were positive.

The registered manager had a clear vision for the service and had already started to make improvements. Good governance arrangements were in place to monitor the quality of the service and the registered manager had already identified areas which required improvement. The registered manager and other staff worked well with external health and social care professionals to help improve people’s experience of living at Emberbrook.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (report published 7 October 2020). This was following a focused inspection on 27 august 2020. Prior to that we had carried out a fully comprehensive inspection on 18 June 2019 when we rated the service Requires Improvement.

At our inspection on 18 June 2019 we found the registered provider was in breach of regulations in relation to person-centred documentation, compliance with the principles of the Mental Capacity Act and insufficient staff on duty to care for people in a timely way. At this inspection, we found improvements had been made and the registered provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Emberbrook on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Emberbrook is a care home which provides nursing care and accommodation to people. The service is divided into four living areas, all with their own dining and communal space. Most people living at Emberbrook are living with dementia or have a nursing need. At the time of our inspection 59 people were living at the service.

People’s experience of using this service and what we found

We found improvements we identified at our last inspection in June 2019 had been sustained. The new manager had created a positive atmosphere within the service and had continued to drive improvement.

People said they felt safe living at Emberbrook and they did not have to wait for attention from staff. People told us they received the medicines they required and that staff knew them well.

Changes had been made to the service during the pandemic to help reduce any spread of infection. No concerns were found in relation to infection prevention and control practices of staff.

Risks to people had been identified and staff were able to describe people’s individual needs. Where people had an incident or accident these were responded to, lessons learnt and action taken to prevent further accidents.

The manager had an open-door policy and staff told us they felt supported and valued by them. They said they could approach the manager and deputy manager to raise concerns and they felt listened to.

A range of audits were completed to ensure people received a good level of care. The provider was consistently looking at ways to improve the governance of the service and as such had introduced a new auditing regime. We will check on the effectiveness of this at our next inspection.

Relatives told us they were very happy with the care their family members received. One relative told us the manager was, “Marvellous” and another said they had recommended the home to several people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (report published 16 July 2019).

At this inspection we found improvements previously made had been embedded.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 June 2019. At that inspection we awarded the service a Requires Improvement rating as although improvements were found we needed to be assured these would be embedded into practice.

We carried out this focused inspection due to the service having been rated as Requires Improvement at the last three inspections. The service had also been without a registered manager for some time. At this focused inspection we reviewed the key questions of Safe and Well-led only and this report covers our findings in relation to these key questions.

We found at this inspection improvements to the service and as such the ratings of the key questions of Safe and Well-Led have improved to Good. However, the ratings from the previous comprehensive inspection and breaches of regulation for key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Emberbrook on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.

Emberbrook is a care home providing personal and nursing care to up to 68 people in one purpose-built building which was divided into four separate units. Two of the units specialised with those living with dementia. At the time of our inspection there were 66 people living at the service. People were living with a range of complex health care needs. This included people who have had a stroke, diabetes and Parkinson's disease. This inspection took place on 17 June 2019.

People’s experience of using this service and what we found

Although people told us they were cared for by staff, they said agency staff did not always know their needs. Staff told us they too felt there was a negative impact on people and themselves when agency staff were on duty.

People lived in an environment that was cleaned to a satisfactory standard, however there was a lack of adaptations to support people living with dementia. We have made a recommendation to the registered provider in relation to ensuring the service was adapted to meet people’s needs.

The service was without a registered manager and as such the lack of consistent management meant that staff were not supported, either through supervisions or training. We have made a recommendation to the registered provider in relation to staff training, supervision and support. Although, we did find an improvement in the governance within the service which meant shortfalls were being identified, there was further quality work to be done to embed and sustain these improvements for the service to achieve a Good rating. Since the inspection, one of the regional support managers provided us with evidence they had applied to register with the service.

Although Deprivation of Liberty applications had been submitted, staff had not followed the principles of the Mental Capacity Act (2005) by considering first whether the person had capacity and having a best interests discussion to check they were using the least restrictive practices for the person.

People told us they were attended to by staff in a timely manner and they received the medicines they required. However, we found at times staff deployment was not well organised and the medicines processes were such that medicines rounds were taking up a disproportionate amount of staff time. We have made a recommendation to the registered provider in relation to deployment of staff and their medicines processes.

People said staff were kind and caring and they had good relationships with the permanent staff. There were times however during our inspection we felt staff did not engage with people as much as they could have. We also found that people’s care records were not always comprehensive, especially in relation to their end of life wishes. We have issued a recommendation to the registered provider.

Activities were available to people and we saw people participating in them during the day. Work was being undertaken to improve socialisation for people who remained in their room.

People said they were happy with the food provided to them and that they had choice. They also told us they could access healthcare professional input when needed. People were helped to stay safe as any risks identified for them were assessed and monitored. Where people had accidents, staff took appropriate action to help reduce reoccurrence.

People, relatives and staff said they had started to see some improvement within the service but felt that a clinical lead and registered manager would enable them to improve the service further.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 26 March 2019) and there were multiple breaches. We also took enforcement action against the registered provider for a lack of management oversight of the service. The registered provider completed an action plan after that inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made as we found the registered provider was no longer in breach of some regulations. However, we found three breaches of regulation and we have made two recommendations to the registered provider.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection through our enforcement action. The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection.

Follow up

We will meet with the registered provider following this report being published to hear what changes they plan to make to ensure they improve the service to at least Good, as this is the fourth time we have rated this service as Requires Improvement. We will also work with the local authority to monitor progress.

At the time of our unannounced inspection on 24 October 2018 there were 60 older people living at the home, many of whom were living with dementia.

There was not a registered manager 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. The service had been without a registered manager since December 2017. A new manager had commenced in post in August 2018 and was applying to become registered.

We last inspected Emberbook in July 2017 when we rated the service as Requires Improvement. This was because we found shortfalls in staff deployment, following the principals of the Mental Capacity Act, records and governance. There was a breach of Regulation 11 in relation to obtaining people’s consent. Following that inspection, the provider sent us an action plan telling us how and when they planned to meet the regulations. We checked at this inspection whether or not they had followed their action plan and we found they had improved in some areas, but there were shortfalls in others.

The service had been without a registered manager since December 2017. A new manager had commenced in post, but resigned after four months. During the time without a registered manager the registered provider had failed to ensure there was robust management oversight of the service. This has resulted in a people receiving a level of service less than they should expect.

People were living in a service that had insufficient staff to care for them and risks to people were not always addressed or recorded in a way that gave guidance to staff. We also observed poor moving and handling practices. Medicines management processes did not follow good practice. Where people lived with dementia the environment was not adapted for their needs. There was a lack of signposting or aids to orientate people. The service was clean.

Although people’s needs were assessed before moving into the service. People had care plans in place which gave detailed guidance in many areas of their care needs, but writing was very difficult to read and people’s background histories had not been obtained to help staff get to know people.

People were cared for by staff who did not always show them respect or respond to them in a caring way. People were not always given a choice of the meal they would like to eat, although we did see people were provided with sufficient food and drink.

Accidents and incidents were recorded but not routinely analysed and although staff knew what to do in the event of a concern of abuse, paperwork in relation to reporting concerns could not be found. People’s consent was sought before care commenced. Although we found an improvement in ensure the principals of the MCA were followed, there was further work to be done.

People were cared for by staff who had been recruited through a robust process. Staff had received induction and training for their role, however regular supervision, including clinical supervision, did not always happen.

Records relating to the service prior to the manager’s appointment were difficult to find. There was a lack of complaints and audit information. However, the manager could access information we requested of them on the day.

People had access to activities both within and external to the service. However, there was a lack of equal access to activities across the service.

People and staff were enabled to participate in the running of the service. Audits had commenced under the leadership of the manager. The manager had an evident desire to improve the service, the culture within the staff team and the approach of staff to help ensure people had good quality care. The manager worked in conjunction with external agencies in order to help them achieve this. In the event of an emergency people’s care would continue uninterrupted.

During our inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made five recommendations to the registered provider. You can read what action we have asked the registered provider to take in the main body of the report.

Emberbrook Care Home is a nursing home that is registered to provide accommodation for up to 68 people who may require nursing or personal care. Some people who reside in the home may be living with dementia. The service has four units arranged over two floors and each person has their own bathroom. On the day of our inspection there were 61 people living in the service.

This is the first inspection of the service since it was newly registered with CQC in August 2016 under a different provider. We had previously inspected the service under the old provider and identified that some improvements were needed. We checked to make sure that action had been taken and improvements had been made.

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.

People’s human rights were not always protected as the provider had not ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, some mental capacity assessments and best interests decisions had not been completed. The registered manager had not always ensured that relatives making decisions on people’s behalf had the legal authority to do so. Staff were heard to ask peoples consent before they provided care

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Applications had been made to the local authority.

There were sufficient staff to keep people safe. However, we have made a recommendation to review staffing levels at break times. There were recruitment practices in place to ensure that staff were safe to work with people. There were plans in place to ensure people received care should there be an emergency.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of areas such as falls and moving and handling. The registered manager ensured that actions had been taken after incidents and accidents occurred to reduce the likelihood of them happening again.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. Staff received regular supervision and an annual appraisal.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives, people and health professionals were involved in planning people’s care. People’s choices and views were respected by staff. Staff and the management knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care plans contained information for staff to support people effectively, however they needed to be more personalised. The registered manager had identified this and work was progressing to improve this. People told us that there were enough activities and there was a good choice.

The home listened to staff, people and relative’s views. There was a complaints procedure in place. Complaints had been responded to in line with the provider’s complaints procedure.

The management promoted an open and person-centred culture. Staff told us they felt supported by the management. Relatives told us the management was approachable and responsive.

There were procedures in place to monitor and improve the quality of care provided. However, they did not identify areas of improvement that we had picked up. We have made a recommendation. Record keeping was also an area that required improvement.

The management understood the requirements of CQC and sent in appropriate notifications.

During our inspection 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 the report.